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No / Wellbeing is a complex construct and to date there has been great inconsistency across measures of wellbeing with respect to their theoretical foundations, dimensions, composition, and psychometric properties. The need for wellbeing measures that have robust epistemological and ontological frameworks and sound psychometric properties is evident as a basis for effective care planning, outcome evaluation and research. The following paper describes the development and psychometric evaluation of the Wellbeing Evaluation Scale (WES), long and short forms, from an analysis of data drawn from a representative population of 203 adults aged 55 years and over. Following an initial pilot study (n = 98), a repeated investigation involved a representative sample of 203 adults over the age of 55 who were recruited from the West Midlands for this study. The findings suggest that the WES is a reliable, valid, and representative measure of wellbeing in adults over 55. It is concluded that the WES can be considered as a reliable tool for the purposes of assessment, care planning and research.

The purpose of this study is to explore what knowledge dementia caregivers have about advance care planning (ACP), how they learn to execute formal advance directives (ADs) or have engaged in an informal ACP process, and how they understand their roles as decision makers for the patients. Factors that contribute to the completion of an ACP process such as demographic, psychosocial, and situational factors are identified. From the grounded theory data analysis, a theory emerged about how ACP is accomplished and used by caregivers. Findings reveal that caregivers understand ACP as having the power to shape the dying process for dementia patients. It is not just about executing formal written ADs but how caregivers exercise that power. Caregivers’ knowledge and beliefs are reflected in their behavior regarding ACP in both how they do the ACP process and how they use ACP. For the caregivers in this study, the process of ACP occurs along a trajectory from: years before dementia to dementia diagnosis to end stage and death. At each of these stages, actions taken by the caregivers and their motivation are identified. Three key features of the ACP process in all three stages are examined: conversations within the family and with trusted others, gaining knowledge of ACP, and keeping ACP documents. How caregivers use ACP is based on how they define their roles as decision makers for their patients by: accepting responsibility for making difficult decisions regarding treatment for the patients, using ACP as an effective tool to shape the dying process for their patients, and doing battle with health care professionals to honor patients’ wishes. This definition is shaped by the meaning caregivers give to ACP, how caregivers understand life sustaining measures, and caregivers’ knowledge of patients’ end-of-life wishes. This new theory, the Dementia Caregiver Advance Care Planning Theory, adds new knowledge as the first model specific to dementia caregivers and adds dimension and depth to the current existing ACP models by detailing an ACP process, demonstrating the impact of conversations on the process, and identifying both the most important influences and the primary relationship in the decision making process.

published_or_final_version / Architecture / Master / Master of Architecture

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Bakgrund: Då vårdtiderna är kortare ställs det krav på samordnad vård- och omsorgplanering (svpl) för att patient och närstående ska känna sig trygga och säkra vid utskrivning. En god planering där alla upplever sig vara delaktiga minskar patient och närståendes oro.  Syfte: Syftet med denna studie var att beskriva hur patient och närstående upplever sin delaktighet vid svpl. Metod: Studien är en litteraturöversikt som är baserad på både kvalitativa och kvantitativa artiklar. Resultat: Tre huvudtema framkom Dialog som främjar delaktighet, Förmedla hälsoproblem och delta i sin planering av fortsatt vård och Att uppleva delaktighet vid överlämnande till annan vårdgivare. Resultatet visade att kommunikation hade stor betydelse för att uppleva delaktighet, ett område där det finns utvecklingspotential och som ligger i linje med personcentrerad vård. Genom att använda andra arbetsmetoder än vad som görs idag gavs möjligheten till ökad delaktighet. Slutsats: Upplevelsen av delaktighet är starkt kopplat till att patienten upplevde sig informerad samt att hen uppfattades som expert på sitt eget tillstånd. Patient och närstående kände sig informerade och upplevde sig ha kunskap när det var ett gott samspel mellan patient och vårdpersonal. / Background: When the waiting periods in health care are shortened, there is need for a coordinated healthcare plan to make the patient and family feel safe and secure at discharge. A good plan where all concerned feel involved decreases the patient and families anxieties. Aim: The aim of this study was to describe how the patient and related experience their participation in a coordinated healthcare plan. Method: The study is a literary survey based on both qualitative and quantitative articles. Results:  Three main theme emerged, Dialogue that promotes participation, Convey health problems and participate in their planning of continuing care and Experiencing involvement in transfer to another health care provider. The result show that communication where very important to feel participation, an area where there is potential for development and is in line with person-centered care. By choosing different work methods than are used today the possibility for increased participation is given. Conclusion: The experience of participation are strongly connected with the patients feelings of being informed and that he or she is perceived as an expert of his or her own condition. The patient and family felt informed and knowledgeable when there was a good interaction between them and the health personnel.