Serving children with special health care needs (SHCN) or developmental disabilities (DD) and their families is an important public health issue (Healthy People, 2020). The prevalence of children with special health care needs or developmental disabilities is significant and increasing (Boyle et al., 2011). Caregivers of children with SHCN or DD and their families demand clinical and research attention given the potential range of health and well-being outcomes that are associated with their children’s developmental or medical complexity. The purpose of this dissertation study was to use a quantitative descriptive research design to examine the experiences of pediatric parenting stress and family support for a sample of caregivers of children representing diverse special health care needs or developmental disabilities. Data were collected at four agencies that provide a range of services to children with SHCN or DD and their families. The data for 167 caregiver participants were used for the preliminary and main statistical analyses. Statistical analyses including pearson product moment correlations, independent-samples t-tests, one-way analysis of variance (ANOVA) tests, internal consistency reliability analyses, and factor analyses. Present study findings revealed that (a) the Pediatric Inventory for Parents (PIP) and Family Support Scale (FSS) measures did not appear to be internally consistent for this study sample; (b) the existing PIP and FSS factor structures did not fit the present study data well; (c) the present study sample had higher levels of pediatric parenting stress and lower levels of family support overall as compared to previous study samples of caregivers for children with chronic conditions; (d) the current study sample’s experiences of pediatric parenting stress and family support differed significantly by several caregiver, child, and family correlates; and (e) the current study sample’s levels of pediatric parenting stress and family support had a positive, significant association. Study findings emphasized the potential roles of stress and support in the caregiving experiences for children with SHCN or DD. Recommendations for further study of this caregiving population and their families are discussed.

Johansson, J & Marklund, M. Patienters upplevelser efter stomioperation. Enlitteraturstudie. Examensarbete i omvårdnad 15/30 högskolepoäng. Malmöuniversitet: Fakulteten för hälsa och samhälle, Institutionen för vårdvetenskap,2018.Bakgrund: Kroppsuppfattning är ett komplext begrepp som omfattar upplevelser,känslor, attityder och beteenden i relation till kroppen. En stark och välfungerandekropp anses som normen medan den sjuka eller avvikande kroppen måste rättastill. Kroppslig sjukdom förändrar kroppsuppfattningen, kroppen ifrågasätts ochkan vara svår att acceptera. I sjuksköterskans kärnkompetenser ingår bland annatpersoncentrerad vård och informatik, vilka är kompetenser som vid korrekttillämpning kan hjälpa patienten att möta den förändrade kroppen som enstomioperation innebär.Syfte: Syftet var att sammanställa forskning kring patienters upplevelse avkroppsuppfattning och omvårdnadsbehov efter en stomioperation.Metod: En litteraturstudie med kvalitativ ansats genomfördes. DatabasernaPubMed och CINAHL användes, varifrån tio olika kvalitativa artiklar inhämtadesoch kvalitetsgranskades utifrån en granskningsmall. Artiklarnas resultatanalyserades sedan utifrån en analysmetod för litteraturstudier, varpå olikahuvudkategorier sammanställdes.Resultat: Dataanalysen genererades i fyra olika huvudkategorier: “Känslor tillstomin”, “Den förändrade kroppen”, “Acceptans över tid” och “Betydelsen avinformation och utbildning från vården”.Konklusion: Stomins påverkan på kroppsuppfattningen är individuell. Mångapatienter upplever någon form av förändrad kroppsuppfattning. Stomin anses varafrämmande och svår att initialt acceptera. Det finns en rädsla för vad andra skatycka och en önskan om att vilja dölja stomin, vilket även påverkar patientensrelationer. Vissa patienter upplever emellertid positiva aspekter med stomin, oftaberoende på orsaken till stomioperationen. Information och stöd från vårdpersonaluppfattas i många fall vara otillräcklig. / Johansson, J & Marklund, M. Patients’ experiences after ostomy surgery. Aliterature review. Degree project in nursing 15/30 credit points. MalmöUniversity: Faculty of health and society, Department of care science, 2018.Background: Body Image is a complex concept that involves experiences,emotions, attitudes and behaviours connected to the body. A strong and wellfunctioningbody is considered the norm while the diseased or abnormal bodyneeds to be corrected. Bodily disease changes the body image, the body isquestioned and it may be difficult to accept. As a registered nurse the corecompetencies include person-centred care and informatics, which arecompetencies that applied correctly can help the patient to handle the changingbody that a ostomy operation involves.Aim: To compile research about the patients experience of body image and careneeds after ostomy surgery.Method: A literature study with qualitative approach was conducted. Thedatabases PubMed and CINAHL were used, from which ten different qualitativearticles were extracted and quality-reviewed using a review template. The resultsof the articles were analyzed using an analytical methodology for literaturereviews, whereupon different main categories were compiled.Result: The data analysis was generated in four main categories: “Feelingstowards the ostomy”, “The altered body”, “Acceptance over time” and “Theimportance of healthcare information and education”.Conclusion: The ostomy’s influence on body image is individual. Most patientsexperience some kind of altered body image. The ostomy is considered unfamiliarand difficult to initially accept. There is a fear of what other people would thinkand a desire to hide the ostomy, which also affects the patients relations.However, some patients experience the ostomy as something positive, oftendepending on the reason for the ostomy operation. Information and support fromhealthcare professionals is in many cases considered insufficient.

京都大学 / 0048 / 新制・課程博士 / 博士(社会健康医学) / 甲第19275号 / 社医博第66号 / 新制||社医||9(附属図書館) / 32277 / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 古川 壽亮, 教授 佐藤 俊哉, 教授 髙橋 良輔 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DFAM

The adequate care of older persons is a major global concern and countries are examining ways to respond to these needs, especially the needs of frail older persons in the care environment. Important strides have been made in developed countries but progress has been slow in less developed countries in the Global South and limited information exists on the care needs of frail older persons and lived experiences of formal and informal caregivers. This thesis examines the care needs of frail older persons in Namibia. Namibia has only recently been liberated from colonial rule by Germany and apartheid South Africa. During this time black communities were disenfranchised, resource-scarce and living under poor conditions. For older persons, this meant unequal treatment, social exclusion and denial of access to decent care. The aim of this study was to provide an in-depth understanding of the needs of frail older persons in the care environment in Namibia by examining the lived experiences of caregivers and analysing policy. Using a qualitative methodology, the study collected primary data from formal and informal caregivers based on semi-structured interviews and focus groups. The data analysis relied mainly on coding strategies under Atlas-ti and qualitative content analysis. The secondary data were collected from legislation, government policy documents, journals and other public reports. The finding revealed that Namibia's history has entrenched the current situation of unmet needs of frail older persons, exacerbated by inadequate policy protection. These limitations were highlighted by the Covid-19 pandemic. The study also found that the effective care of frail older persons is only possible through stakeholder engagement and cross-sectoral collaboration. The study therefore recommends that government should undertake a process of social reforms to ensure that the needs of this group are prioritised, that a performance framework should be implemented to ensure delivery and that all stakeholders should be mobilised. The study has contributed to these outcomes by suggesting a model for needs assessment of frail older persons, especially during the Covid-19 pandemic. This model could be used to improve care practices, serve government in evidence-based policy making and provide a useful analytical tool for scholarship.

This dissertation focuses on the health, health care utilization rates, and unmet health care needs of individuals aging with work-related impairments. A life course perspective is used to understand the health experiences of these individuals, and a mixed method approach was used to study their health and health care use. Three components make up the dissertation, two quantitative projects and one qualitative project. The first article provides a broad overview of chronic health conditions reported by respondents from the Research Action Alliance on the Consequences of Work Injury (RAACWI) Health and Health Care Utilization Survey who experienced a work-related impairment. Health outcomes and access to health care for this group is compared to a similar aged sample of Ontarian respondents from the Canadian Community Health Survey. The second article uses the National Population Health Survey to examine whether rates of unmet health care needs over eight cycles varied based on disability status. Respondents are categorized as either without disability, having a work-related disability, having a disability as a result of a disease or illness, or having disability for other reasons. The reasons for unmet health care needs is examined for seven cycles to determine whether unmet health care need could be characterized as personal or structural. The third article provides a deeper understanding of how 11 individuals age with a work injury. A convenience sample of 11 participants from the RAACWI Health Survey participated in semi-structured, in-depth interviews where they discussed their work injury and how they are coping with its ongoing consequences, including subsequent health problems as they age. This article provides a richer understanding of health changes and unmet health care needs that could not be examined in the other projects due to the nature of quantitative analysis. Together these three articles enable me to showcase the lived experiences of individuals with work-related impairments and how they age with the work injury and subsequent, additional chronic health conditions. / Dissertation / Candidate in Philosophy

Background: Health care transition (HCT) for adolescents and emerging adults (AEA) with special health care needs is an emerging field of interdisciplinary field of practice and research that is based upon an intergenerational approach involving care coordination between pediatric and adult systems of health care. Informed understanding of the state of the HCT science pertaining to this group of providers is needed in order to develop and implement service programs that will meet the comprehensive needs of AEA with special health care needs. Methods: The authors conducted a systematic review of the literature on the transition from child to adult care for adolescents and emerging adults (AEA) with special health care needs from 2004 to 2013. Fifty-five articles were selected for this review. An adaptation of the PRISMA guidelines was applied because all studies in this review used descriptive designs. Results: Findings revealed lack of evidence due to the limitations of the research designs and methodology of the studies included in this systematic review. Study findings were categorized the following four types: adult provider competency, provider perspectives, provider attitudes, and HCT service models. The discipline of medicine was predominant; interdisciplinary frameworks based upon integrated care were not reported. Few studies included samples of adult providers. Conclusions: Empirical-based data are lacking pertaining to the role of providers involved in this specialty area of practice. Evidence is hampered by the limitations of the lack of rigorous research designs and methodology.

Background: A better understanding of the needs of adolescents and emerging adults with special health care needs (AEA-SHCNs) is essential to provide health care transition services that represent best practices. The purpose of this systematic review was to evaluate the research on health care transition for AEA-SHCNs from their perspectives. Methods: A comprehensive literature review of research publications since 2005 was performed using the PubMed, Cumulative Index to Nursing and Allied Health Literature, and EBSCO databases. Thirty-five studies met the final review criteria. Results: The process of transition from child to adult for AEA-SHCNs is complex. Individuals experiencing the transition desire to be a part of the process and want providers who will listen and be sensitive to their needs, which are often different from others receiving health care at the same facility. Conclusions: More research that considers the voice of the AEA-SHCNs related to transition from pediatric to adult care is needed.

Bakgrund: Hälften av alla graviditeter slutar i missfall, vilket kan upplevas som en traumatisk händelse i kvinnans liv. Ett professionellt stöd är nödvändigt för att kvinnorna ska kunna hantera sin sorgeprocess, men vårdpersonal upplever sig inte ha kunskap att möta den sorg kvinnorna går igenom. Därför är det viktigt att generera ny kunskap och beskriva kvinnors vårdbehov som uppkommer vid missfall som vårdpersonal kan bemöta Syfte: Syftet med litteraturstudien var att beskriva kvinnors erfarenheter av missfall med fokus på vårdbehov. Metod: Litteraturstudien innefattar 9 kvalitativa artiklar och sökningar gjordes i databaserna PubMed, Cinahl, PsychINFO och SveMed+. Artiklarna kvalitetsgranskades och analyserades med hjälp av Fribergs femstegsmodell.  Resultat: Analysen resulterade i tre kategorier med åtta underkategorier. Kategorierna är: Att få utförlig information, Att få emotionellt stöd och bli respektfullt bemött samt Att få ett snabbt och kompetent omhändertagande.  Konklusion: Kvinnorna önskade mer information, bättre bemötande och ett snabbt och kompetent omhändertagande. Studien visade på att vårdpersonalen hade bristande kapacitet att kunna ge emotionellt stöd. Med mer utbildning och tydligare riktlinjer för sjuksköterskor skulle vården kunna omhänderta dessa kvinnor på ett bättre sätt som hjälper dem i sin sorg och bidrar till att undvika ett försämrat psykiskt mående efter genomgånget missfall. / Background: Half of all pregnancies ends in miscarriage and can be experienced as traumatic events in women's lives. Professional support is necessary for women to manage their grieving process, but healthcare professionals experiences lack of knowledge to handle their grief. Therefore, it's important to generate new knowledge and describe women's care needs in the event of a miscarriage, that care staff can meet.  Aim: The purpose of the literature study was to describe women's experiences of miscarriage with a focus on care needs.  Methods: The literature study includes 9 qualitative articles. Searches were made in the databases PubMed, Cinahl, PsycINFO and SveMed+. The articles were quality checked and analyzed using Friberg's five-step model.  Results: The analysis resulted in three categories with eight subcategories. The categories are: To receive detailed information, To receive emotional support and be treated respectfully and To receive prompt and competent care.  Conclusion: The women wanted more information, better treatment and fast competent care. The study showed that the healthcare staff lacked the capacity to provide emotional support. With more training and clearer guidelines, the healthcare would be better equipped to treat these women and help them in their grief and to avoid impaired mental well-being, after miscarriage.

The aim of the study was to examine how social workers investigate and assess addiction cases whether gender matters or not. The following questions were asked in the study;•Does the gender of the client influence whether a case is opened after the first meeting at the Addiction Unit?•Do social workers consider there is a difference in handling an addiction treatment investigation when the client is a man or a woman? •Do divergences exist in the assessment and the final decision process when the case concerns a man or a woman?The study is based on the qualitative method. The material is gathered from semi-structured interviews with social workers. Their job tasks include assessment and evaluation of addiction cases. The empiric interview material has been analyzed from a gender perspective. The results show that the social workers unanimously agree; the gender does not affect the investigation, assessment and whether a case is opened or not when a client asks for addiction treatment. The social workers almost agree; it is primarily the client’s point of view and treatment needs that decide the focus in the investigation, assessment and decision. However, gender may influence the selection of available treatments for the individual client. According to two social workers gender may influence reception, how the social workers at the Units talk about their clients, the severity and need.

No description available.