No description available.

Background: Globally, cancers are the second leading cause of death. When the cancer can no longer be cured, the care can be re-focused to palliative care. It is then important for patients to be able to participate and influence their care, and the quality of life for patients improves. Advance care planning is a person-centered process, through for example conversations, that supports patients at different stages of health to understand and share their values, life goals and preferences about their future care. Aim: The purpose of this literature review is to describe views on advance care planning in patients with a cancer diagnosis.Method: Literature review based on 16 peer-reviewed qualitative articles that … via specific criteria, these have been quality reviewed, analyzed with thematic analysis, and compiled into a result. Searches were conducted in CINAHL, PubMed and PsycInfo. Results: Advance care planning (ACP) is associated with both positive and negative emotions linked to conducting the conversation, how the conversation is structured, and involving others in the conversation. Three main themes and 7 sub-themes emerged: (1) Views on participating in conversation - Positive to conversation; Negative to conversation. (2) Views on content and execution - The importance of information and how it is presented; The decision-making process. (3) Views on the role of others in the process - Family and other close relatives or friends; Healthcare staff; Spiritual support. Conclusion: Our conclusion is that patients believe that this is an important topic that needs to be addressed more, not only in palliative care but also before patients are in need of palliative care. It is important for the nurse to find out if the patient is ready for conversations, to contribute with the information the patient needs, to support the patient in the decisions they make, and to include relatives in the conversations if the patient so wishes.

Bakgrund: Var tredje sekund insjuknar en person i demenssjukdom i världen. Demenssjukdom är en progressiv sjukdom som medför förlust av den mentala kapaciteten och individen får svårare att vara delaktig i beslut. Att vara anhörig till en person med demenssjukdom är utmanande då ens närstående sakta försvinner. Förlusten av mental kapacitet innebär att anhöriga väljer att inte involvera PMD i beslutsfattande. Enligt patientlagen 5 kap. 1 § samt patientsäkerhetslagen 6 kap. 1 § ska vården och behandlingen utformas och genomföras i samråd med patienten i största möjliga mån. PMD lägger stor tillit till sina anhöriga att ta beslut när stunden för vård i livets slut inträffar. Regelbunden och kontinuerlig kommunikation och information från vårdpersonal till anhöriga och PMD främjar en kvalitetssäkrad vård- och omsorg.  Syfte: Syftet med uppsatsen var att beskriva anhörigas upplevelser av avancerad vårdplanering för personer med demenssjukdom med fokus på vård i livets slutskede.  Metod: Examensarbetet är en allmän litteraturöversikt. Resultatartiklar har analyserats i syfte att skapa en kvalitativ innehållsanalys enligt Harden & Thomas (2008). Kvalitativa artiklar från Pubmed och Cinahl har analyserats.  Resultat: Resultatet presenteras med tre analytiska teman för att svara på examensarbetets syfte. Anhöriga uttryckte svårigheter att finna rätt tidpunkt för avancerad vårdplanering och en önskan om att skydda PMD från sjukdomen. Avancerad vårdplanering kunde också ses som en process över tid för att skapa en relation till sjukdomen men också till vårdgivare för att finna tillit och trygghet. Slutligen sågs avancerad vårdplanering som en strategi för att minska bördan hos anhöriga att fatta beslut när de slutligen ofta blir ställföreträdande beslutsfattare.  Slutsats: Avancwerad vårdplanering är inte ett engångstillfälle utan bör följas upp regelbundet under sjukdomsförloppet. Kunskap och information om sjukdomen är viktigt och en stor del i den avancerade vårdplaneringen kan i längden minska bördan på anhöriga som ställföreträdande beslutsfattare. / Background: One person every three seconds develops dementia. Dementia is a progressive disease and entails loss of mental capacity and makes it difficult to participate in decisions. Being a relative of a person with dementia is challenging as one's loved ones slowly disappear. This loss of mental capacity means that relatives choose not to involve the PWD in decision-making. According to the Patient Act ch. 5 § 1 and the Patient Safety Act ch. 6 § 1 care and treatment must be designed and carried out in consultation with the patient as far as possible. PWD leaves it up to relatives to make decisions when the end-of-life approaches. Regular and continuous communication and information from healthcare staff to relatives and PWD promotes quality-assured healthcare. Aim: The purpose of this essay was to describe relatives' experiences of advanced care planning for people with dementia in the early stages of the disease with a focus on end-of life care. Methods: The thesis is a general literature review. Result articles have been analyzed with the aim of creating a qualitative content analysis according to Harden & Thomas (2008). Both qualitative and quantitative articles from PubMed and Cinahl have been analyzed. Results: Relatives expressed difficulty finding the right time for advanced care planning and a desire to protect PWD from the disease. Advanced care planning was seen as a process over time to create a relationship with the disease but also with caregivers to create trust. Finally, advanced care planning was seen to facilitate decision-making for relatives when they ultimately often become substitute decision-makers. Conclusion: Advanced care planning is not a one-time event but should be followed up. Knowledge and information is important and a large part of the advanced care planning can in the long run reduce the burden on relatives as substitute decision makers.

Bakgrund: Informationsöverföring från slutenvården är viktigt för att kunna säkerställa patientsäkerheten i kommunal hälso- och sjukvård. Det används olika journalsystem i regionen och i kommunerna och därför är det av stor vikt att informationsöverföringen dem emellan fungerar optimalt för att distriktssköterskan ska få fullständig rapport om patienten när denne skrivs ut från slutenvården. Syftet var att belysa distriktssköterskans erfarenhet av informationsöverföring vid utskrivning av vuxen patient från slutenvård till kommunal hälso- och sjukvård. Metod: Kvalitativ metod med induktiv ansats. 12 semistrukturerade intervjuer med distriktssköterskor i kommunal hälso- och sjukvård genomfördes. Data analyserades med kvalitativ innehållsanalys (Graneheim & Lundman). Resultat: Resultatet mynnade ut i tre kategorier; Vikten av att följa överenskomna rutiner, Samverkan och Patientsäkerhet. Det framkom att rapportering via befintliga system måste fungera och att framförhållning är viktigt. Samverkan mellan de olika verksamheterna var en nyckelfaktor och när patienter krävde mer avancerade insatser efter utskrivning var det viktigt med samordnad individuell planering. Olika modeller för utskrivning förekom, vilket upplevdes både positivt och negativt. Patientsäkerheten riskerades när kommunikationen mellan verksamheterna var bristfällig. Slutsats: Det finns flera brister i informationsöverföringen mellan verksamheter idag där patientsäkerheten äventyras. Resultatet i studien skulle kunna vara aktuell för vidare forskning inom ämnet, där förbättring kring informationsöverföringen skulle behöva ses över. Utbildning till personalen i digitala kommunikationshjälpmedel skulle gynna informationsöverföringen liksom att ge tid för patientansvarig sjuksköterska inom slutenvården att kunna ge en fullständig och patientsäker utskrivning. / Background: Information transfer from inpatient care is important to be able to ensure patient safety in municipal health care. Different record systems are used in the region and in the municipalities, therefore it is of great importance that the information transfer between them works optimally for the district nurse to receive a complete report on the patient when he is discharged from inpatient care. The purpose was to highlight the district nurse's experience of information transfer when discharging an adult patient from inpatient care to municipal health care. Method: Qualitative method with an inductive approach. 12 semi-structured interviews with district nurses in municipal health care were conducted. Data were analyzed with qualitative content analysis (Graneheim & Lundman). Results: The results resulted in three categories; The importance of following agreed procedures, Collaboration and Patient Safety. It emerged that reporting via existing systems must work and that foresight is important. Collaboration between the different operations was a key factor and when patients required more advanced interventions after discharge, coordinated individual planning was important. Different models for discharge occurred, which were perceived both positively and negatively. Patient safety was put at risk when communication between the operations was deficient. Conclusion: There are several shortcomings in the transfer of information between businesses today where patient safety is compromised. The results of the study could be relevant for further research in the subject, where improvement in the information transfer would need to be reviewed. Training the staff in digital communication aids would benefit the transfer of information as well as giving time for the inpatient nurse responsible for the patient to be able to provide a complete and patient-safe discharge.

This study is an investigation of the long-term care planning entered into by 170 adult children who had independent parents. A decision-making process with four stages was hypothesized. Sons and daughters entered into planning activities primarily at the "consideration" and "discussion" stages. This involvement proceeds along a sequence of stages with lower stage activities being completed before entering into more advanced stages. Minimal involvement from adult children in "preliminary planning" and "making final decisions" suggests the process does not continue unless independence is threatened. Age and family stressors positively influenced the likelihood that respondents gave consideration to future needs of their parents. The likelihood that discussion occurs between the generations was influenced negatively by family stressors and positively by personal authority. No variables were significant for the "preliminary planning" and "final decision" stages. Application is made to educational and clinical practice. / Ph. D.

Thesis (PhD)-- Stellenbosch University, 2013. / ENGLISH ABSTRACT: A telemedicine service is a healthcare service (-medicine) that is delivered over a distance (tele-). The interest in the potential of telemedicine to increase the quality, accessibility, utilization, e ciency and e ectiveness of healthcare services is fuelled by the rapid development of information and communication technology (ICT) and connectivity. Despite this potential, the success rate of telemedicine services disappoints. Many mistakes in the implementation of telemedicine services are repeated over and over again and best practices are not captured and replicated. This study responds to the need for reference models for the assessment and optimization of telemedicine services in a consistent, systematic and systemic way. Maturity models are reference models that describe typical patterns in the development of organizational capabilities and depict a sequence of stages towards the desired state. Many reference models exist that are applicable to telemedicine services, but none of these provide guidance for the optimization of services, like a maturity model does. Many maturity models exist within a health systems context, but none of these can be applied "as is" to telemedicine services. In this study an iterative top-down design approach is followed to develop a Telemedicine Service Maturity Model (TMSMM). This model facilitates the assessment of a telemedicine service on micro, meso, and macrolevel along all the domains that comprise the telemedicine health system. Sets of capability statements are de ned, which follow each other in a cumulative manner, hence providing a maturation path towards the desired maturity state. These sets of capability statements provide yardsticks according to which quantitative values are allocated to an intangible concept, such as maturity. Once an individual service is assessed, further actions towards the optimization of the service can be derived from these yardsticks. The multidimensional design of the TMSMM, as well as the fact that capability statements facilitate the consistent quanti cation of maturity, makes it possible to analyze the aggregated results of cohort of services. To accomplish this, principles of business intelligence and data warehouse design are applied together with online analytic processing (OLAP) procedures. The TMSMM addresses the previously unful lled need for a reference model to assess and optimize telemedicine services in a consistent, systematic and systemic way. This study spans several academic and professional domains and thereby contributes to the scienti c world of telemedicine and ehealth. / AFRIKAANSE OPSOMMING: 'n Telegeneeskunde diens is 'n gesondheidsdiens (-geneeskunde) wat oor 'n afstand gelewer word (tele-). Met die snelle ontwikkeling van inligtings-en kommunikasietegnologie hou telegeneeskunde die potensiaal in om die kwaliteit, toeganklikheid, benutting, doelmatigheid en doeltre endheid van gesondheidsdienste te verhoog. Ten spyte van hierdie potensiaal, stel die aantal onsuksesvolle telegeneeskunde dienste teleur. Heelwat foute in die implementering van telegeneeskundedienste word oor en oor gemaak, terwyl die beste praktyke nie vasgevang en herhaal word nie. Hierdie studie is onderneem in reaksie op die behoefte aan 'n verwysingsmodel vir die assessering en optimering van telegeneeskunde dienste op 'n konsekwente, sistematiese en sistemiese manier. Volwassenheidsmodelle is verwysingsmodelle wat tipiese patrone in die ontwikkeling van organisatoriese vermoeëns beskryf. Dit stip 'n aantal fases neer wat uiteindelik behoort te lei na die ideale organisatoriese toestand. Daar bestaan verskeie verwysingsmodelle wat van toepassing is op telegeneeskunde dienste, maar geeneen daarvan gee leiding met die oog op die optimering van die diens, soos in die geval van 'n volwassenheidsmodel nie. In hierdie studie word 'n iteratiewe van-bo-na-onder ontwerpsbenadering gevolg om 'n telegeneeskunde volwassenheidsmodel (TMSMM) te ontwikkel. Hierdie model fasiliteer die assessering van 'n telegeneeskunde diens op 'n mikro-, mesoen makrovlak en met betrekking to al die fasette waaruit 'n telegeneeskunde stelsel bestaan. 'n Aantal vermoeëstellings is gede nieer. Hierdie stellings volg op mekaar en akkumuleer om sodoende 'n volwassenheidspad na die verlangde toestand aan te dui. Hierdie vermoeëstellings verskaf maatstawwe waarvolgens kwantitiewe waardes toegeken kan word aan 'n ontasbare konsep, soos volwassenheid. Sodra 'n individuele diens geassesseer is, kan verdere aksies met die oog op die optimering van die diens afgelei word. Die multidimensionele ontwerp van die TMSMM, tesame met die feit dat die vermoeëstellings volwassenheid op 'n konsekwente manier kwanti seer, maak dit moontlik dat die data van 'n kohort dienste saamgevoeg kan word met die oog op analise. Beginsels van besigheidsintelligensie, datastoorontwerp asook aanlyn analitiese prosessering (OLAP) word hiervoor ingespan. Die TMSMM spreek tot die voorheen onvervulde behoefte aan 'n verwysingsmodel waarmee telegeneeskunde dienste geassesseer in geoptimeer word in 'n konsekwente, sistematiese en sistemiese manier. Hierdie studie strek oor verskeie akademiese en professionele domeine en lewer sodoende 'n bydrae tot die multidissiplinêre wetenskapswêreld van telegeeskunde en e-gesondheid.

Ethnically diverse older adults are the fastest growing population in the U.S. This population may experience transitional processes associated with immigration, acculturation, aging, and end of life (EOL). Advances in technology lead to increases in care options, which can cause uncertainty to make decisions for EOL. Unmade decisions about care prior to becoming unable to communicate are associated with burdens of last-minute decisions at EOL, unwanted intensive EOL treatments for people who may die naturally of old age, financial and emotional costs, and decreased quality of life. In the U.S., a multicultural country with a variety of care options, advance directive (AD) completion and advance care planning (ACP) may improve culturally competent and person-centered care at EOL. However, the rate of AD completion and ACP is low among Americans, especially immigrant communities. These communities, including Iranian-American older adults, have been frequently understudied, and there is a gap in studies of EOL desires, attitudes, and actions/behaviors. This inquiry focused on planning ahead for EOL care across transitional processes that older immigrants may face. The aim was to enhance culturally competent care for older adults through distinguishing significant factors, which may influence planning for EOL care. Specific purposes were: To identify relationships between attitudes toward planning for EOL care and social supports, spirituality, healthcare system distrust, and acculturation; to identify a relationship between attitudes and proactive actions toward planning ahead in Iranian-American older adults. Conceptual frameworks for this descriptive, cross-sectional study included Culture Care Diversity and Universality and Transitions theories. Findings from 135 participants revealed that they were new immigrants to the U.S. (mean year of 23 in the U.S., 97% born in Iran) and highly educated and insured with high health statuses. About 55% preferred non-intensive treatments and/or homecare at EOL, and 52.6% had not communicated their EOL wishes. Attitudes toward planning ahead for EOL were positively associated with acculturation and healthcare system distrust, and negatively associated with spirituality. No significant association was found between attitudes and social support. Furthermore, favorable attitudes predicted higher proactive actions to communicate wishes. Implications for practice, policy, education, and recommendations for further studies were discussed. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2017. / FAU Electronic Theses and Dissertations Collection

Submitted by Fabíola Silva (fabiola.silva@famerp.br) on 2017-03-10T15:24:14Z No. of bitstreams: 1 mariliasilveirafaeda_dissert.pdf: 1644595 bytes, checksum: 938a2984ef496d1821eba633bca8f0a8 (MD5) / Made available in DSpace on 2017-03-10T15:24:14Z (GMT). No. of bitstreams: 1 mariliasilveirafaeda_dissert.pdf: 1644595 bytes, checksum: 938a2984ef496d1821eba633bca8f0a8 (MD5) Previous issue date: 2016-01-15 / Objectives: Analyze the correlation between nursing prescriptions recorded in the files and patient care needs; investigate the correlation between the professional profile of nurses and agreement of requirements; and investigate the conception of nurses about the nursing prescription for hospitalized patients care needs and factors associated with this conformity. Methods: Descriptive study with quantitative and documentary approach performed in 20 inpatient units and two medical clinics, two surgical clinics and 16 specialized units of teaching hospital in a city of São Paulo State. Data collection was performed in the period from September 2013 to January 2014 and from February to June 2015. On the first stage was applied the new version of validated patient classification instrument and, investigated 380 nursing prescriptions at admission and hospital discharge. Later, the participants (N = 139) answered a semi-structured questionnaire. Results: It was found that 75% of items of nursing prescriptions were consistent with the actual care needs of patients and 35% of the needs identified at admission and 32.3% at hospital discharge were not related prescriptions. It was found a low correlation between the compatibility of the nursing prescription and professional profile. For 43 (30.9%) of nurses the nursing prescriptions are always aligned to care needs of patients. Eliminations and Body Care, Skin Care and Mucous membranes and Research and Monitoring areas were the most discussed. Conclusion: The nursing prescriptions are not being carried out, if at all, in line with the needs of patients. It is recommended the implementation of strategies aimed at improving the quality of prescriptions, among others, continued qualification programs and the systematic use of instruments for evaluating the patient's attention demand in relation to nursing. / Objetivos: Analisar a concordância entre prescrições de enfermagem registradas nos prontuários e as necessidades de cuidados dos pacientes; investigar a correlação entre o perfil profissional dos enfermeiros e a concordância das prescrições; e, investigar a concepção de enfermeiros sobre a conformidade da prescrição de enfermagem às necessidades de cuidados de pacientes hospitalizados e fatores associados a esta conformidade. Método: Estudo descritivo com abordagem quantitativa e documental realizado em 20 unidades de internação sendo duas clínicas médicas, duas clinicas cirúrgicas e 16 especializadas de um hospital de ensino no interior do Estado de São Paulo. A coleta de dados foi realizada nos períodos de setembro de 2013 a janeiro de 2014 e fevereiro a junho de 2015. Na primeira etapa foi aplicada a nova versão validada do Instrumento de Classificação de Pacientes e, investigadas 380 prescrições de enfermagem no momento da admissão e alta hospitalar. Posteriormente, os participantes (N=139) responderam a um questionário semiestruturado. Resultados: Identificou-se que 75% dos itens das prescrições de enfermagem estavam compatíveis com as reais necessidades cuidativas dos pacientes e que 35% das necessidades identificadas na admissão e 32,3% no momento da alta hospitalar não tiveram prescrições relacionadas. Encontrou-se baixa correlação entre a compatibilidade da prescrição de enfermagem e o perfil profissional. Para 43(30,9%) dos enfermeiros as prescrições de enfermagem encontram-se, sempre, alinhadas às necessidades cuidativas dos pacientes. As áreas de Cuidado Corporal e Eliminações, Cuidados com Pele e Mucosas e Investigação e Monitoramento foram as mais abordadas. Conclusão: As prescrições de enfermagem não estão sendo realizadas, em sua totalidade, em consonância com as necessidades dos pacientes. Recomenda-se a implementação de estratégias objetivando aprimorar a qualidade das prescrições, dentre outras, programas de qualificação contínua e a utilização sistemática de instrumentos para avaliação da demanda de atenção do paciente em relação a enfermagem.

Advance directives in Canada are instructions made by capable adults that pertain to future healthcare treatment choices at a time of incapacity. My experience as an ethicist working in an Ontario long-term care facility that provides medical treatment to patients with Alzheimer’s Dementia portrays a range of important ethical concerns that arise out of the use of advance directives, at least in terms of their current use. In this thesis I analyze composite case studies to identify the more prominent challenges that exist and I turn to the literature to seek ways to more clearly understand these problems and to determine if they can be overcome. What I conclude is that the use of advance directives with the Alzheimer’s Dementia population in long-term care, as it is currently used, is fraught with problems that are mainly irresolvable. I offer clinical and policy recommendations that are aligned with this view.

Advance directives in Canada are instructions made by capable adults that pertain to future healthcare treatment choices at a time of incapacity. My experience as an ethicist working in an Ontario long-term care facility that provides medical treatment to patients with Alzheimer’s Dementia portrays a range of important ethical concerns that arise out of the use of advance directives, at least in terms of their current use. In this thesis I analyze composite case studies to identify the more prominent challenges that exist and I turn to the literature to seek ways to more clearly understand these problems and to determine if they can be overcome. What I conclude is that the use of advance directives with the Alzheimer’s Dementia population in long-term care, as it is currently used, is fraught with problems that are mainly irresolvable. I offer clinical and policy recommendations that are aligned with this view.