Abstrakt: Okontrollerade symptom och upprepade sjukhusinläggningar kännetecknar den sista tiden i livet hos en del patienter med mycket svår KOL. Trots att det finns en växande insikt att tidig integration av palliativ vård förbättrar patientens symtombehandling och livskvalitet, dör majoriteten av patienter med KOL utan tillgång till palliativ vård. Sjuksköterskor i hemsjukvården har en central roll när det gäller att identifiera och hantera patienternas palliativa vårdbehov. Syfte: Syftet med denna studie är att belysa hur sjuksköterskor i hemsjukvården upplever den palliativa vården av patienter med mycket svår KOL. Metod: Kvalitativ studie där 11 semistrukturerade intervjuer bearbetats med kvalitativ innehållsanalys. Resultat: Insamlat datamaterial resulterade i tre kategorier som påvisar förutsättningar för god palliativ vård i hemmet: 1) Personella och organisatoriska resurser i hemsjuk- och primärvården där stora brister i samarbetet med primärvården samt bristande resurserna för god vård i hemmet noteras. 2) Planering och kommunikation där bristande kommunikation med patienten och mellan olika vårdinsatser samt planering kring patientens vård poängteras. 3) Kunskap där ett behov av att utöka kunskapen om KOL och palliativ vård hos alla yrkeskategorier uppmärksammas. Konklusion: Patienter med mycket svår KOL får ofta en god palliativ vård i livets absoluta slutskede. Resultatet visar dock att patientens vård under de sista månaderna i livet ofta upplevs som oklar och diffus, vilket pekar på att palliativ vård behöver integreras tidigare i vården av patienter med mycket svår KOL. I kommunikations- och planeringsprocessen med patienten har sjuksköterskor en samordnande roll som behöver specificeras och utrustas med de erforderliga personella och organisatoriska resurserna, kunskaperna och befogenheterna. / Abstract: Uncontrolled symptoms and repeated hospitalizations characterize the last period of life in some patients with very severe COPD. Although there is a growing recognition that early integration of palliative care improves the treatment of patient's symptoms and quality of life, the majority of patients with COPD dies without access to palliative care. Nurses in home care have a central role in identifying and managing patients' palliative care needs. Aim: The purpose of this study is to examine how nurses in home care and in nursing homes experience palliative care of patients with severe COPD. Method: Qualitative study in which 11 semi-structured interviews processed using qualitative content analysis. Results: Collected data resulted in three categories that indicate conditions for good palliative care in the home: 1) Human and organizational resources in home- and primary care, where serious deficits within primary care and resources for good home care is noted. 2) Planning and communication, where the lack of communication with the patient and between different health care institutions as well as care planning is emphasized. 3) Knowledge, where a need to improve knowledge of COPD and palliative care for all care professions is recognized. Conclusion: The result shows that the patient's care during the last months of life is often perceived as vague and diffuse, suggesting that palliative care needs to be integrated earlier in the care of patients with very severe COPD. In the communication process and care planning with patients, nurses have a coordinating role that needs to be specified and equipped with the requisite human and organizational resources, skills and competences.

Our modern health care system requires technology that can deal with multidisciplinary and complex processes, operations, and situations. The EHR, by far, is one of the greatest health information technology innovations that satisfy these requirements because of its efficiency and the effectiveness of its features. This study sought to develop an in-depth understanding of how underserved patients' perspectives about their health and illness, can contribute to greater use of the EHR. It also sought to improve their health outcomes and maintain sustainable change in the lives of the underserved. A quantitative non-experimental design study was conducted over a 6-week period outside of three different internal medicine clinics, one in the Northwestern and the two others in the Southeastern regions of Washington, DC. Surveys were distributed directly to patients coming out of these health clinics, and participants sent their responses via mail. Data collection included 215 surveys out of 560, but, only 155 fit the overall study categories. A strong level of significance in the relationships between clinical outcome measures and the EHR was identified at a 95% confidence interval. There were considerable health determinants that demonstrated the essence of patients' perspectives and the need for its incorporation into health outcomes measures for the underserved populations. The study also identified sets of environmental health predictors which acted as facilitators and contributors to a holistic health management model designed to contribute to the needs of the underserved communities. The holistic health model and the individual care plan model derived from the study are applicable at the level of the underserved population. It can help achieve sustainable health outcomes that will save lives and promote better health.

<p>This essay’s focus lies on the collaboration that takes place in hospitals and called a care-plan (vårdplanering) between the two organisations: Health-care (landsting) and social-care (kommun). According to the Swedish-law are these organizations responsible for the care of elderly individuals in Sweden. The aim of this essay has been to study closely this collaboration in order to see which partner has the most influencing power.</p><p>This essay is of a qualitative character, which means that the results that are presented are based on six individual interviews with employees from the two organizations. The employees chosen for this essay all have job experiences from the collaboration that takes place during care-plans in hospitals.</p><p>One of the main results of this essay has been that the two organizations are not equal collaboration-partners. All the interviewed individuals talked highly about the importance of collaboration while in reality they end up in an subliminal battle against each other. The main conclusion of this essay is that the focus of a care-plan meeting appears to be on gaining the most power, in order to influence the outcome of a care-plan, rather than giving priority to the elderly individual’s needs and concerns.</p>

<p>Standardvårdplaner är vanligt förekommande inom hälso- och sjukvård och är under ständig utveckling. Standardvårdplaner är i olika grad evidensbaserade och framtagna med skiftande kvalitet. Standardvårdplaner används som ett hjälpmedel för effektivisering och kvalitetshöjning av vården för en specifik patientgrupp och är en på förhand formulerad vårdplan. Behov av ytterligare forskning efterfrågas om standardvårdplaner faktiskt minskar mängden dubbeldokumentation, leder till ökad tidsvinst och ökad vårdkvalitet. Syftet med föreliggande litteraturstudie var att göra en beskrivning av de effekter som användande av standardvårdplaner leder till. I litteraturstudien bearbetades 10 vetenskapliga artiklar som grund för resultatredovisningen. Resultatet visar att standardvårdplaner kan höja vårdkvaliteten, minska mängden dubbeldokumentation och leda till att tid frigörs till patientnära arbete. Det finns emellertid studier som visar på det motsatta. Standardvårdplanen kan ses som ett verktyg som underlättar en jämlik, högkvalitativ vård till alla patienter oavsett vem som vårdar. Utveckling av standardvårdplaner i vården bör ske på ett strukturerat och vetenskapligt sätt och tid till detta bör prioriteras. Litteraturstudien redovisar motstridiga resultat vilket indikerar behovet av fortsatt forskning av vilka effekter standardvårdplaner har för vården, både sett ur patientperspektiv, personalperspektiv samt ur ett organisatoriskt perspektiv.</p> / <p>Standardized care plans are commonly used in health care and are under constant development. Standardized care plans are to varying degrees evidence-based and designed with varying quality. Standardized care plans are used as a tool for improving the quality of care and are seen as a pre-formulated treatment plan. Research is needed into whether standardized care plans reduce the amount of redundant documentation, save time and increase quality of care. The aim of this literature study was to describe the situation regarding effects of using standardized care plans. In this study 10 scientific articles were analyzed. Results show that standardized care plans can improve quality of care, reduce redundant documentation and decrease time spent on documentation. However, there are studies that demonstrate the opposite.<strong> </strong>Standardized care plans can be seen as a tool for providing high-quality basic care for all patients. Scientific evidence should be used for development of standardized care plans and therefore priority should be given to making resources for this work available. There is a need for further research to validate the effects of standardized care plans as the results from this literature study are ambiguous. It would also be interesting to compare the views from patients, staff and management on the effects of using standardized care plans.</p>

Standardvårdplaner är vanligt förekommande inom hälso- och sjukvård och är under ständig utveckling. Standardvårdplaner är i olika grad evidensbaserade och framtagna med skiftande kvalitet. Standardvårdplaner används som ett hjälpmedel för effektivisering och kvalitetshöjning av vården för en specifik patientgrupp och är en på förhand formulerad vårdplan. Behov av ytterligare forskning efterfrågas om standardvårdplaner faktiskt minskar mängden dubbeldokumentation, leder till ökad tidsvinst och ökad vårdkvalitet. Syftet med föreliggande litteraturstudie var att göra en beskrivning av de effekter som användande av standardvårdplaner leder till. I litteraturstudien bearbetades 10 vetenskapliga artiklar som grund för resultatredovisningen. Resultatet visar att standardvårdplaner kan höja vårdkvaliteten, minska mängden dubbeldokumentation och leda till att tid frigörs till patientnära arbete. Det finns emellertid studier som visar på det motsatta. Standardvårdplanen kan ses som ett verktyg som underlättar en jämlik, högkvalitativ vård till alla patienter oavsett vem som vårdar. Utveckling av standardvårdplaner i vården bör ske på ett strukturerat och vetenskapligt sätt och tid till detta bör prioriteras. Litteraturstudien redovisar motstridiga resultat vilket indikerar behovet av fortsatt forskning av vilka effekter standardvårdplaner har för vården, både sett ur patientperspektiv, personalperspektiv samt ur ett organisatoriskt perspektiv. / Standardized care plans are commonly used in health care and are under constant development. Standardized care plans are to varying degrees evidence-based and designed with varying quality. Standardized care plans are used as a tool for improving the quality of care and are seen as a pre-formulated treatment plan. Research is needed into whether standardized care plans reduce the amount of redundant documentation, save time and increase quality of care. The aim of this literature study was to describe the situation regarding effects of using standardized care plans. In this study 10 scientific articles were analyzed. Results show that standardized care plans can improve quality of care, reduce redundant documentation and decrease time spent on documentation. However, there are studies that demonstrate the opposite. Standardized care plans can be seen as a tool for providing high-quality basic care for all patients. Scientific evidence should be used for development of standardized care plans and therefore priority should be given to making resources for this work available. There is a need for further research to validate the effects of standardized care plans as the results from this literature study are ambiguous. It would also be interesting to compare the views from patients, staff and management on the effects of using standardized care plans.

This essay’s focus lies on the collaboration that takes place in hospitals and called a care-plan (vårdplanering) between the two organisations: Health-care (landsting) and social-care (kommun). According to the Swedish-law are these organizations responsible for the care of elderly individuals in Sweden. The aim of this essay has been to study closely this collaboration in order to see which partner has the most influencing power. This essay is of a qualitative character, which means that the results that are presented are based on six individual interviews with employees from the two organizations. The employees chosen for this essay all have job experiences from the collaboration that takes place during care-plans in hospitals. One of the main results of this essay has been that the two organizations are not equal collaboration-partners. All the interviewed individuals talked highly about the importance of collaboration while in reality they end up in an subliminal battle against each other. The main conclusion of this essay is that the focus of a care-plan meeting appears to be on gaining the most power, in order to influence the outcome of a care-plan, rather than giving priority to the elderly individual’s needs and concerns.

The first part is characterized by a pond ecosystem and National Nature Reserve Řežabinec in terms of its historical development and creation. Are mentioned methods , the method and system of protection of the site. The paper describes a method of fish farming during the period of the individual plans of care farming in the last five years and the water conditions in the area . The ecosystem is assessed on the basis of available data in the literature to me In our own work we focus on monitoring water chemistry and state recovery tank , especially in terms of development and biomass of zooplankton species representation in the course of one growing season. He also details the fishing and agricultural management and water management conditions in the locality. Marginally judging submerged and littoral vegetation and the presence of water birds. This work demonstrated the dependence of the size of the fish stock on the frequency of a generic representation of zooplankton and the positive impact of lower stocking on the development and stability of the entire ecosystem. Contributes to the stability and sensitive farming in the last period.

Submitted by Adriano Leite Soares (dr.asoares@uol.com.br) on 2012-03-27T00:28:30Z No. of bitstreams: 1 TESE REVISADA FINALCOM FICHA E CAPA.pdf: 2461287 bytes, checksum: 04852765664e2f8eeecb1e2688c53bfc (MD5) / Approved for entry into archive by Gisele Isaura Hannickel (gisele.hannickel@fgv.br) on 2012-03-27T12:37:14Z (GMT) No. of bitstreams: 1 TESE REVISADA FINALCOM FICHA E CAPA.pdf: 2461287 bytes, checksum: 04852765664e2f8eeecb1e2688c53bfc (MD5) / Made available in DSpace on 2012-03-27T13:01:21Z (GMT). No. of bitstreams: 1 TESE REVISADA FINALCOM FICHA E CAPA.pdf: 2461287 bytes, checksum: 04852765664e2f8eeecb1e2688c53bfc (MD5) Previous issue date: 2012-02-27 / Os prestadores de serviços de saúde e, para este estudo, principalmente o médico, cuja atuação interfere diretamente tanto nos resultados da terapêutica instituída, como também na determinação dos custos dos diversos sistemas de saúde, têm a remuneração profissional como prioridade na agenda dos diversos participantes do setor, quer seja no Sistema Único de Saúde, quer principalmente no setor de saúde suplementar. Devido ao ritmo inflacionário do setor e às exigências estabelecidas pela regulamentação dos planos de saúde, os valores de remuneração dos prestadores de serviços têm crescimento menor que os índices inflacionários gerais. Os modelos de remuneração existentes, de forma isolada, não suprem as expectativas de todos os recursos credenciados, e, mesmo em um único sistema de saúde, os diferentes mecanismos de pagamento podem combinar-se, não sendo obrigatória a existência de somente um método de remuneração para cada sistema, pois mesmo na remuneração do médico, por esta remuneração não atender às expectativas das diversas especialidades, poderá levar a um desequilíbrio entre oferta e demanda de profissionais de certas áreas da Medicina. O objetivo deste trabalho é elencar, dentre os diversos modelos de pagamento, os pressupostos básicos para a remuneração do médico-cirurgião, levando-se em consideração os recursos empregados no tratamento, bem como o risco inerente de cada paciente tratado, tentando traduzir tais pontos em uma fórmula de cálculo padrão e comparar este novo valor com os valores atuais de remuneração. O modelo de remuneração deve fomentar a eficiência do tratamento instituído e a equidade do pagamento, além de ser de fácil implantação e compreensão pelos players do setor, bem como ter neutralidade financeira entre o principal e o agente, mantendo a qualidade e a acessibilidade aos serviços, a fim de que os médicos sejam incentivados a promover um tratamento eficiente aos beneficiários. Deve ser baseado no tratamento de doenças em si e não na realização de procedimentos, bem como estar atrelado a índices de desempenho e ao risco assumido pelo profissional. Enfim, o trabalho médico deve ser remunerado de forma diretamente proporcional à quantidade de horas trabalhadas, por profissionais que possuam equivalente nível de graduação e qualificação, e ao risco inerente a cada paciente tratado. A fórmula encontrada leva em consideração não somente a idade do paciente a ser tratado, bem como os riscos inerentes ao tratamento deste paciente, e tem como base de remuneração a doença a ser tratada, e não os procedimentos que serão necessários, ou indicados pelos médicos para tratamento desses pacientes. Desta forma, a valorização do trabalho médico cresce com o aumento do risco de tratar o paciente, quer seja pelo risco inerente à própria idade do paciente, quer seja pelo risco inerente ao procedimento anestésico, quer seja pelo risco cardíaco, havendo, portanto, uma melhor proporcionalidade entre a remuneração hospitalar dos pacientes com mais gravidade, em que são utilizados, ou colocados à disposição, mais recursos, com a remuneração crescente, também neste caso, dos profissionais que estariam tratando tais pacientes. / Health providers services, and in this case, specially medical doctors, who's works interfere directly in outcomes and cost of the health system, has their methods of payment in the agenda of the most industry players, either in the public health system, but mainly in the supplementary health system, where because the continuous growth in cost, and the industry regulation dues, the providers gains has increments below the inflationary rates. Nowadays, the methods of payment, by itself, do not fulfill the gain goals of the health system providers, and even in a single health system, the different way of payment could be combined, and it is not obligated a unique payment method for each health system, just because the goals of remuneration moves around depending of the specialties, which contribute to keep the correct balance between demand and offer. The goals of this study is to enroll, between all of the payment methods, the basic assumptions for the surgeons payment, considering the sources applied in treatment, as well as life risk of each patient treated, trying to reproduce a standard formula to calculate the remuneration, and compare them with the present expenditure. The method of payment must encourage the treatment efficiency, and the equity of payment, and be easily understood by the industry players, and financial neutrality between principal and agency, keeping the quality and accessibility to medical services, and the doctors will be stimulate to increase the quality of the treatment to the users. Might be based on disease management, and not on procedures, and linked to performance index, and the risk owned by the patient. In conclusion, the medical labor remuneration proportionally by the total of work hours, by the same levels of the professional graduation and qualification, and the life risk of the patient treated. The new formula for calculate the medical payment consider not only the patient age, but also the risk involved on the treatment, and it is based on the disease, and not on a fee-forservice system. In this way, medical remuneration grows with the patient risk, as much as the increase of patient age, the increase of anesthetic and cardiac risks, resulting in a better correlation between hospitals costs, medical remuneration, and the resources used in the treatment.

Magister Administrationis - MAdmin / The complex and multi-facet decentralisation process of Primary Health Care services in the Cape Metro District of the Western Cape will be critically assessed in this thesis. Primary Health Care is the provision of promotive; preventative; curative and rehabilitative services within the community setting. South Africa initially adopted the Primary Health Care strategy in 1978 as a member state of the World Health Organisation but this was during the Apartheid regime which did very little about implementing the strategy. In 1994 the Government of National Unity (GNU) came into power and there was a renewed commitment to implementing Primary Health Care in order to render health care services to the previously underprivileged masses. The GNU set an eight year time frame for the full implementation of this process from the date of commitment. Now more than ten years later an assessment of the process is necessary to determine if the objectives of the process has been achieved. An independent organisation such as the Health System Trust has in 1998 and 2003 provided some form of evaluation of the process and this will also be discussed in thesis. The District Health system is part of a unitary Provincial Health System that is decentralised to enable the centre (Provincial Management) and the periphery (District and Sub-district Management) to function more effectively and cooperatively. The District Health System is the management structure for primary health care services as this system allows for interaction of all the role-players involved in delivering health care at district level as it puts in place a decentralised Health Management team who is responsible for the planning, managing, implementing and monitoring of the Primary Health Care Package of care at district level. In summary the district is the place where community needs and national priorities are reconciled. This thesis will therefore show the disjuncture that exists between the Primary Health Care policy intent, the policy implementation and the service delivery outcomes on the ground level. The general objective is to do a critical assessment of the Quality of Decentralised Primary Health Care Services in the Cape Metro District of the Western Cape. More specific objectives for the research include: Defining and discussing the Primary Health Care Approach and the District Health System using the target indicators currently used by the City of Cape Town and the Provincial government of the Western Cape Health department to assess the impact of this process. To document the implementation process of the District Health System in the Cape Town Metro District as a case study while analysing the findings in terms of successes, constraints, challenges; and make recommendations for the way forward. The methodology of the study is of a qualitative and descriptive nature. The research design is a case study of the Cape Metro District. The target population will be all those accessing primary health care services in this district. The sample technique is selected by convenience. Data will be gathered directly and indirectly by doing observation and semi – structured interviews and the administration of questionnaires. The framework criteria for assessing the quality would for example include key indicators such as for example the ratio of Professional Nurse to patient; number of health services per three kilometre radius as per the Comprehensive Service Plan 2007 goals and the availability of essential drugs as per primary health care protocol. This directly relates to the key elements that underpin the District Health System namely: equity, access, quality, effectiveness, efficiency, sustainability, overcoming fragmentation, intersectoral approach and community participation. The main findings indicate that not enough resources have been allocated to the decentralising process causing much delay in its implementation. Shortages of health professionals, infrastructure constraints and poor adherence to legislation also contribute to the delay in implementation. This is why to date the four health districts of the Cape Town Metro District is not fully functional and the quality of the service they provide do not fully adhere to the 2010 Health Care Plan Model.

The thesis focuses on the development of youth pastoral care in the diocese of Ceske Budejovice in the last 10 years. The most important part of this thesis is the description of individual activities that were held for the youth in the diocese of Ceske Budejovice in 2008 - 2018 and the folowing evalution of interviews held with staff of DCM and DCŽM.