The aim of this study was to describe peripheral vascular patients´experiences of quality of care in connection whith ambulatory care, and to identify if ambulatory treatment responded to patients´expectations. / Syftet med studien var att beskriva perifert kärlsjuka patienters erfarenheter av vårdkvalitet i samband med dagkirurgisk vård och identifiera om dagkirurgisk behandling motsvarade patienters förväntningar. Detta mättes med hjälp av frågeformuläret Kvalitet Ur Patientens Perspektiv - KUPP. Designen var en beskrivande empirisk studie med kvantitativ ansats. Patienterna valdes konsekutivt och bestod av 47 respondenter (22 män och 25 kvinnor). Samtliga patienter vårdades elektivt där intentionen varit dagsjukvård. Resultatet visade att patienterna generellt varit nöjda med vårdkvaliteten. Balans eller övergod kvalitet skattades på frågor inom dimensionen fysiskt - tekniska förutsättningar och inom dimensionen kontextspecifik där påståenden om dagsjukvård besvarats. Vårdkvaliteten bedömdes även hög vad gäller medicinsk vård och väntetid, läkarens och sjuksköterskans engagemang och visad respekt och att patienterna fått tillräcklig information om själva ingreppet före behandlingen. Brister identifierades vad gäller patienternas erfarenheter av information om resultatet efter behandling. På frågor som berörde läkares och sjukaköterskors empatieka kvaliteter bedömdes vårdkvaliteten vara hög men på andra frågor inom dimensionen identitetsorienterat förhållningssätt bedömdes vårdkvaliteten bristande. detta gällde frågor som berörde information om ansvarig person, delaktighet och information/undervisning i egenvård. Slutsatsen blev att patienterna generellt var nöjda med vårdkvaliteten men att det fanns frågor där kvalitetsförbättrande åtgärder bör ges prioritet.

Objective¡G The purpose of this research is (1) to find out the overall trends of the common avoidable hospitalization diseases in Taiwan since the implementation of the National Health Insurance (NHI), (2) to compare the different distributions of the common avoidable hospitalization diseases across age groups, genders, regions, and the hospital¡¦s characters, (3) to make the related useful information and suggestions of improving avoidable hospitalizations to the policy makers, hospitals, and the general public. Method¡G Standardized rates of avoidable hospitalization from 1997 to 2004 were derived from the National Health Insurance database and the Taiwan census data. In this research, we focus on the four main diseases¡GAsthma, Pneumonia, Diabetes, Hypertension as the avoidable hospitalization diseases. Logistic regression and chi-squire tests are used to detect and describes trends in data. Results¡G During the 8-year research period, AHCs (Avoidable Hospitalization Conditions)of Asthma and Hypertension decline overall, conversely, AHCs of Pneumonia and Diabetes show increasing trends overall¡Fin the hospital characters aspects, AHCs are mostly occurred in the local hospitals¡Ffrom the viewpoint of the patients¡¦ characters, AHCs of Asthma and Pneumonia are always occurred in children male, on the other hand, AHCs of Diabetes and Hypertension are always occurred in female and above 65 years old¡Fin the regional aspect, the AHCs of Asthma and Pneumonia are comparatively higher in east Taiwan. Conclusion¡G According to the results of this research, we can find that the avoidable hospitalizations in Taiwan still need to be improved. We suggest the policy makers and the hospitals may use the ¡uavoidable hospitalization¡vas an indicator to monitor the quality of care and the outpatient care quality in Taiwan¡¦s healthcare system. Thus can not only reduce the unnecessary expenditure, but also can offer the general public better quality of healthcare and improve their quality of life.

Bakgrund: Dagkirurgi, att opereras och gå hem samma dag, är en vårdform som har ökat markant i Sverige senaste åren. Tidigare studier har visat att många patienter som genomgår dagkirurgi upplever oro inför operation, vilket orsakar lidande för individen men också ökat behov av sömnmedel och ökad risk för postoperativ smärta och oro. För att kunna genomföra omvårdnadsåtgärder för att minska oro måste den först identifieras, vilket framförallt är anestesisjuksköterskans uppgift i mötet med patienten. Syfte: Att undersöka patienters skattning av sin oro vid ankomst till operationsavdelningen vid dagkirurgi samt hur väl anestesisjuksköterskans skattning av patientens oro överensstämmer med patientens egen skattning. Metod: En kvantitativ enkätstudie som genomfördes på två operationsavdelningar i Uppsala län under en veckas tid, totalt inkluderades 88 patienter och 60 anestesisjuksköterskebedömningar. Enkäten bestod av en skattningsskala för oro enligt NRS samt grundläggande demografisk information. Resultat: En stor andel patienter skattade ingen eller mild oro (n=52, 59 %) vid ankomst till operationsavdelningen. Hos 70 % av de parvisa jämförelserna bedömdes anestesisjuksköterskans förmåga att bedöma patientens oro som god. Slutsats: Anestesisjuksköterskorna var generellt bra på att bedöma patientens oro, men vid några fall missbedömdes patienter som skattade hög oro. Denna studie visar att det finns ett behov av mer studier för framtagande av rutiner och vetenskapligt beprövade och användbara instrument för att kunna identifiera dessa patienter. / Background: Ambulatory surgery, to receive surgery and go home the same day, is a form of care which has increased markedly in Sweden in recent years. Previous studies have showed that many patients undergoing ambulatory surgery experience anxiety before surgery, which causes suffering for the individual but also increases the need for hypnotics and increases risk of postoperative pain and anxiety. To be able to carry out nursing interventions aimed at reducing anxiety,  it must first be identified, which is mainly the  nurse anesthetist’s role in the encounter with the patient. Objective: To investigate patients' estimation of their anxiety upon arrival at the ambulatory surgery department, and how well the anesthesia nurses' estimation of the patients' anxiety are consistent with the patients' own estimation. Method: A quantitative survey conducted in two ambulatory surgery departments in Uppsala County during one week, a total of 88 patients were enrolled, and a total of 60 anesthesia nurses' assessments. The survey consisted of a scale for estimating anxiety using NRS and basic demographic information. Results: A large proportion of patients estimated no or mild anxiety (n=52, 59 %) on arrival at the surgical department. In 70 % of the pairwise comparisons the anesthesia nurses' ability to assess the patients' anxiety were good. Conclusion: Anesthesia nurses were generally good at assessing the patients’ anxiety, however it was showed that in some cases patients that reported high levels of anxiety were not identified. There is a need for more studies about routines and  useful and scientifically tested instruments for the identification of patients’ anxiety.

published_or_final_version / Nursing Studies / Master / Master of Nursing in Advanced Practice

published_or_final_version / Community Medicine / Master / Master of Philosophy

Objectives: To assess the role of ambulatory blood pressure monitoring in the diagnosis of hypertension in general practice. Background: Hypertension is usually diagnosed by casual office blood pressure readings. However, ambulatory blood pressure monitoring has shown that a significant proportion of patients diagnosed as hypertension in fact do not have hypertension. Method: Sixty four Indian patients diagnosed as having mild to moderate hypertension by casual measurements were subjected to a twenty four hour ambulatory blood pressure monitoring. A blood pressure load of >35% was classified as true hypertension and < 35% as white coat hypertension. White coat hypertensives were compared to the hypertensive group with respect to various demographic characteristics, and to correlate ambulatory blood pressure monitoring and casual blood pressure readings. Results: A prevalence of 23.44% white coat hypertension was found. In addition, the demographic profile of such patients show a preponderance of non-obese females (73.33%), the majority of whom are on concomitant medication (60%). A poor correlation was found between the casual office blood pressure readings and the twenty four hour ambulatory blood pressure readings in the white coat hypertensives as compared to the hypertensive group. Conclusion: White coat hypertension is common in patients diagnosed as having mild to moderate hypertension by casual blood pressure readings. There are no reliable clinical indicators to identify patients with white coat hypertension. Ambulatory blood pressure monitoring has been shown to be a useful method for differentiating white coat hypertensives from true hypertensives. / Thesis (M.Med)-University of Natal, 1997.

Young children who experience high levels preoperative anxiety often exhibit distress behaviors, experience more surgical complications, and are at a higher risk for developing a variety of negative postoperative consequences. A significant factor in pediatric preoperative anxiety is the level of anxiety present in their caregivers. Music therapy interventions addressing a variety of procedural outcomes have been met with success. The purpose of this study was to investigate the comparative effectiveness of two music therapy interventions on reducing preoperative anxiety in young pediatric surgical patients and their caregivers. A total of 40 pediatric patient and caregiver dyads were included in this study on various days that they were present for ambulatory surgery. Pediatric preoperative anxiety was measured pre- and post-intervention using the modified Yale Pediatric Anxiety Scale, while caregiver anxiety was measured through self-report using the short form Strait-Trait Anxiety Inventory-Y6. Participants received a randomized active or passive preoperative music therapy session. Results indicate a significant reduction in preoperative anxiety for both patients and their caregivers. Neither active, nor passive music therapy interventions were significantly more effective than the other. Future studies should increase sample size and control for various factors such as sedative premedication use.

Background: Patients’ recovery from surgery differs when they are in a hospital setting or at home. However, an often forgotten aspect of post-operative ambulatory care is the patients' recovery at home following ambulatory surgery.Aim: To explore and describe the patients’ experiences of recovery at home following the ambulatory surgery procedure.Method: A systematic review of 7 qualitative studies in English with pre-specified criteria was conducted. An overview of qualitative evidence derived from the 17 identified main themes across the 7 primary studies was analyzed.Result: Seven thematic analysis themes were identified as being core to the patients’ experience during recovery process at home: physical symptoms, a period of regaining pre-operative functions, psychological effects, the surgical wound, delayed recovery process, social support, and the sick-role condition.. These seven themes were described patient's experiences at home following ambulatory surgery from early stage of recovery to the time of getting back to normal life.Conclusion: Recovery at home following ambulatory surgery seemed to be challenging, a quality self-care at home was lacking in the form having full control and knowledge about symptoms; adequate information, education and medication during self-care management; sufficient support by carer and nurses; and enough time-off for recovery.

At the Primary Health Care Centre in Vännäs (VPHCC), northern Sweden, a development work was implemented in 1976-1980. The overall purpose was to enhance primary health care planning. In trying to improve health care delivery cooperation with community members was initiated and some organizational changes like a new appointment system, a new medical record and local care programs for some common diseases were introduced. Official statistics were also used for comparative purposes. The aims of the work were postulated (increased accessibility, higher continuity, more equitable distribution and enhanced cooperation) and suitable methods were designed. From postal surveys, chartreviews and administrative data (from hospitals, out-patient clinics and health centres) figures and information were collected. Accessibility was studied by waiting room time which was reduced and continuity, analyzed with a new concept - visit based provider continuity - was improved. The question of equitable distribution was studied by the consultation rates at different out-patient clinics. It seemed as if the local development work changed the patterns of utilization but some important issues were not decisively answered. Repeated postal surveys reflected the question of equitable distribution and the cooperation between the VPHCC and the community members. Positive responses were recorded in aspects like telephone accessibility and health care information. In a tracer study of diabetes the quality of care was studied. The local care program was actually implemented in the daily practice but the question of care quality needs further penetration. Within the frames of the development work new methods in the health care planning were introduced. Our work started from the prerequisits of the VPHCC and other health centres might find other ways of planning for care provision. On a general level, however, the structure of our work - defining aims, means and evaluation methods - can be used by others. / <p>Diss. (sammanfattning) Umeå : Umeå universitet, 1986, härtill 6 uppsatser.</p> / digitalisering@umu

Ambulatory surgery is common and develops alongside surgery and anesthetic methods. Time admitted is short and aftercare takes place in the home environment. Objective: The aim of the study was to investigate which symptoms patients experience after ambulatory surgery related to anesthesia. Furthermore how strongly symptoms affect the patient. Symptoms appear as a result of anesthesia and surgery and can therefore be interpreted as nursing induced suffering. Method: Participants were recruited at ambulatory clinics at a Swedish university hospital spring, 2015.  Prior to the study permission was granted from the clinic managers. The study is a quantitative descriptive longitudinal study.  Data collection forms were administered and data collection was performed by phone. Incisional pain, headache, neck pain, hoarseness, postoperative sore throat, nausea, drowsiness, post-discharge urine retention and numbness were requested parameters. Answers were evaluated as; none-existing, mild, moderate and severe. Data was measured at 48 hours and postoperative day seven. Result: The study included 67 participants. The various symptoms were all apparent to some extent by some of the participants at 48 hours. Concerning headache, neck pain, hoarseness, sore throat, nausea, urine retention and numbness most were symptom free. Incisional pain and drowsiness however affected the participants noticeably. Seven days after surgery there was an overall improvement throughout the parameters. Although incisional pain and drowsiness also lessened some participants still evaluated their experience moderate to severe. Conclusion: The majority of the day surgery patients were content with their care, in our study 97% were satisfied. There was an improvement within the experienced symptoms after seven days compared to after 48 hours. There is room for improvement concerning pain management and time for recovery in the home environment as drowsiness was still an evident issue. / Dagkirurgi är vanligt och drivs framåt av utvecklingen inom kirurgi och anestesi. Vårdtiden är kort och mycket av eftervården sker i hemmet. Syfte: Syftet var att undersöka vilka symptom patienter upplever efter genomgången dagkirurgi relaterat till anestesi. Vidare undersöks hur starkt olika symptom påverkar patienten. Symptom efter anestesi och kirurgi uppkommer till följd av omvårdnaden och kan därför tolkas som ett vårdlidande. Metod: Deltagare har rekryterats från dagkirurgiska avdelningar vid ett mellansvenskt universitetssjukhus våren 2015. Tillstånd inhämtades före studien från verksamhetschefer. Studien är en beskrivande kvantitativ longitudinell studie och data har samlats in med frågeformulär där svaren delgivits via telefon. Parametrarna smärta i operationsområde, huvudvärk, smärta i nacke, heshet, smärta i svalg, illamående, trötthet, urinretention samt känselbortfall har efterfrågats. Svaren har delgivits på en skala som graderats i nivåer från; inte alls, mild, måttlig och svår.  Mättillfällen var efter 48 timmar samt sju dagar postoperativt. Resultat: Studien har 67 deltagare. Efter 48 timmar upplevdes de olika symptomen alltid av någon deltagare, men vid huvudvärk, smärta i nacke, heshet, smärta i svalg, illamående, urinretention samt känselbortfall var de flesta symptomfria. Smärta i operationsområdet och trötthet påverkade dock patienterna påtagligt. Efter sju dagar upplevdes förbättring i alla parametrar. Smärta i operationsområdet samt trötthet minskade, men upplevdes fortfarande av vissa som måttlig och svår. Slutsats: De flesta dagkirurgiska patienterna är nöjda med sin vård, 97% i vår studie. En förbättring i upplevda symptom finns efter sju dagar jämfört med efter 48 timmar. Förbättringspotential finns inom smärtlindring och vidare bör utrymme för återhämtning finnas då trötthet visat sig vara förekommande