Begreppet brukarsamverkan lyftes fram i Sverige i samband med WHO ́s Sundsvalls-konferens 1991 som ”essensen i det demokratiska folkhälsoarbetet”. Samverkan, där handikapp- och patientorganisationer är delaktiga i planering av hälso- och sjukvård har varit aktuellt i mer än 35 år, man utvecklade former för handikappråd redan 1970. Ändå finns det mycket lite empirisk forskning på området. Syftet med uppsatsen är att få en fördjupad kunskap om brukarsamverkan samt att erhålla ett vidare perspektiv genom att jämföra utvecklingen i Sverige med Storbritannien utifrån frågeställningarna: Vilka motiv finns för samverkan, vilka faktorer påverkar och vilka former finns för samverkan och hur stämmer dessa med existerande teorier? Arbetet är upplagt i tre delar, en litteraturstudie med material från Storbritannien, en dokumentanalys av material från Stockholms läns landsting och en intervjuundersökning som gjordes 1999 med representanter för förvaltning, sjukhus och handikapporganisationer inom SLL. Resultatet visar att brukarsamverkan anses som något önskvärt i bägge länderna. Motiven beskrivs som fördjupad demokrati, en förbättring av vårdkvalité genom överföring av kunskap och erfarenhet från brukare till de som planerar och beslutar om vård. Ett tredje motiv skulle kunna vara att ”förankra” neddragningar och ge underlag till prioriteringar, något organisationerna inte vill delta i. Trots att samverkan i Sverige underlättas av folkrörelsetraditionen med många erkända organisationer, hindras effektiv samverkan av oklara definitioner, diffusa mål och orealistiska krav på organisationernas representanter. Aktiviteten stannar på en nivå som stämmer med begreppen ”konsultation” eller ”samråd / The concept of “user involvement”/collaboration in Sweden was described at WHO:s conference in Sundsvall 1991 as “the essense of a democratic health promotion approach”. User involvement in the form of handicap or patients ́ organizations participating in the planning of health care has been of interest for more than 35 years. Work had begun with user groups in Sweden as early as 1970, but there is very little empirical research in the area.The purpose of this dissertation is to further knowledge in the area of user involvement/ patient collaboration and to gain a wider perspective by comparing developments in Sweden with the United Kingdom. What are the motives behind user involvement? What factors influence user involvement? What forms exist and how do they compare with existing theory on collaboration? The dissertation is in 3 parts: A literature study based on material from the United Kingdom, an analysis of official documents from the Stockholm County Council and an interview study from 1999 with representatives from health care administration and patient organizations. Motives for user involvement/collaboration are improved democracy as well as improved quality by making use of the knowledge and experience of health care users. User involvement may also be a method for legitimizing reductions of resources and prioritizations, a practice which the handicap movement doesn ́t wish to be part of. Despite the extensive Swedish tradition of participation in organizations and interest groups, effective collaboration is hindered by unclear definitions, diffuse goals and unrealistic demands on the organizations ́ representatives. The resulting activity can most often be characterized as “consultation” rather than “collaboration / <p>ISBN 91-7997-130-X</p>

Recent decades have seen increasing recognition of the importance of patient involvement during patient-professional interactions and promotion of preventative and long term approaches to healthcare for those with long-term conditions. The concepts of 'shared decision making' and 'personalised care planning' have both been advocated by patient groups, policy-makers, professional bodies and academia as best practice. During shared decision making, patients and healthcare professionals work in equal partnership to decide the best course of action. Shared decision making is a central tenet of personalised care planning, as it aims to foster partnerships between patients and healthcare professionals when making decisions, but personalised care planning also describes an overall approach to healthcare that is forward-planning and preventative, rather than episodic and reactive. Despite the breadth of support for such approaches, in reality they are not routinely adopted. Multiple Sclerosis (MS) is a heterogeneous neurodegenerative long term condition, which is unpredictable with limited treatments available. Such uncertainty and complexity position MS as an interesting long term condition to explore decisional and information needs. This doctoral research comprises of three methods stages. Firstly, two systematic reviews assessing the effectiveness of personalised care planning for people with long-term conditions and people with MS were carried out. Secondly, 22 in-depth semi-structured qualitative interviews were carried out with people with MS across the UK to explore experiences of decision making and interactions with healthcare professionals. Purposive sampling was carried out and data saturation determined sample size. A modified grounded theory approach was used and thematic analysis of interview data was carried out. Lastly, a series of structured qualitative interviews were carried out with 6 consultant neurologists. This stage was iterative in that problematic areas identified during analysis of interview data from stage 2 were presented to neurologists in infographic form to further examine issues raised. Framework analysis was carried out on neurologist interview data to examine their interpretations and potential solutions. Although there appears to be some evidence demonstrating that personalised care planning is effective for people with long term conditions, such favourable effects were not demonstrated in the context of MS. Based on the findings from the systematic reviews it is unclear whether personalised care planning is effective for people with MS and there is a clear gap in the literature examining this. Findings from the interview stages suggest there are key areas which are lacking in terms of information and decisional support. Such areas included the type and amount of information around the time of diagnosis, support when choosing disease modifying drugs and discussions about approaches outside mainstream medicine. Findings from neurologist interview data corroborated those from MS interview data, but through examination of issues raised it also highlighted some of the complexities and challenges of involving patients and enacting shared decision making in reality. This research identified key areas that require improvement for people with MS in terms of provision of the information and decisional support. Although in theory personalised care planning and shared decision making are positioned as best practice, in reality it is unclear whether they are effective or appropriate for people with MS. The way in which such approaches are enacted are complex and require careful consideration. Potential barriers and pitfalls identified within this study suggest a lack of clarity in how to respond to challenges and further investigation into how patient involvement is enacted is needed.

Bakgrund: Vi blir allt äldre och fler bor kvar i hemmet med behov av vård- och omsorgsinsatser. Då dessa personer av någon anledning vårdats på sjukhus och skall återgå till hemmet görs en vård- och omsorgsplanering för att patienten ska kunna lämna slutenvården på ett tryggt sätt. Med ett växande antal äldre med behov av insatser i hemmet kommer även behovet av samordnad vård- och omsorgsplanering på sjukhus att öka. En sådan planering görs allt mer via videokonferens idag. Denna form av digitala möten innebär nya utmaningar för sjuksköterskan i att skapa och upprätthålla en ömsesidighet. Syfte: Syftet med studien var att undersöka förutsättningar för vård- och omsorgsplanering via videokonferens och hur detta påverkar möjligheten för vårdpersonalen att kunna förstå och tolka patientens situation utifrån ett helhetsperspektiv och således utföra ett personcentrerat möte på distans. Metod: En kvalitativ forskningsansats användes för att erhålla en förståelse av sjuksköterskors erfarenhet av vård- och omsorgsplanering via videokonferens. Metoden bestod av en inledande explorativ litteraturstudie samt enskilda personliga semistrukturerade intervjuer. Urvalet bestod av totalt sju sjuksköterskor inom slutenvård, primärvård och kommunal hemsjukvård. Analysen av intervjumaterialet utfördes med en induktiv ansats inspirerad av fenomenologi. Resultat: Resultatet visar att kommunikationen påverkas och att möten via videoteknik förlorar närhet och således en del av den mänskliga kontakten. Detta kan bidra till sämre möjlighet att se varandra som personer men kan kompenseras av ett personcentrerat förhållningssätt. Tekniken kan fungera som ett medel för mänsklig interaktion dock ej ersättning för det. Huvudtemana som framkommer i resultatet är förlust av närhet kompenseras av flera vinster med tillhörande teman skärmen som barriär och vinster för vårdpersonal, patient och anhöriga samt teknik som medel för mänsklig interaktion med tillhörande teman ytterst beroende av personerna i mötet och hög kvalitet på utrustning och prestanda. Slutsats: Samordnad vård- och omsorgsplanering via videokonferens innebär utmaningar i att skapa närvaro och ett genuint intresse som kompenserar för den fysiska närhet som förloras. Denna mötesform kan göra det svårare se varandra som personer men detta hinder kan kompenseras av ett personcentrerat förhållningssätt. Sjuksköterskan behöver vara väl förtrogen med personcentrerad vård för att kunna möta patienten trots den barriär som skärmen kan utgöra. Teknik är ett medel, inte ett självändamål i sig. Rätt nyttjad kan informations- och kommunikationsteknologi användas med stora tidsvinster för att få tillgång till varandra oavsett geografisk plats och kan bidra till en mänsklig interaktion men inte ersätta den. / Background: We are becoming older and more people remain in their home with the need for care. When these persons for some reason have been hospitalized and are to return to their homes, care planning is performed in order for the person to be able to leave the ward in a safe manner. With an increasing number of elderly persons in need of care interventions in their home, the need for coordinated care planning in hospitals will also increase. Such planning is today being performed increasingly often via video conferencing. This form of digital encounters poses new challenges for the nurse in creating and maintaining a mutuality. Aim: The aim of the study was to investigate the conditions for coordinated care planning via video conferencing and how this affects the ability of health care professionals to understand and interpret the patient’s situation from a holistic perspective, thus performing a person-centered meeting at a distance. Method: A qualitative research approach was used to gain an understanding of nurses' experience of coordinated care planning via video conferencing. The method consisted of an initial exploratory literature study and individual personal semistructured interviews. The sample consisted of a total of seven nurses in primary care, primary care and municipal home nursing. The analysis of the interview material was conducted with an inductive approach inspired by phenomenology. Result: The result shows that the communication is affected and that meetings via video technology lose proximity and thus a part of the human contact. This can disrupt the possibility of seeing each other as persons but can be compensated by a person-centered approach. The technology can act as a means of human interaction, but not as a compensation for it. The main themes found in the result are loss of proximity compensated by multiple gains with associated themes screen as a barrier and benefits for healthcare professionals, patients and relatives as well as technology as means of human interaction with associated themes decidedly dependent on the people in the meeting and high quality in equipment and performance. Conclusion: Coordinated care planning via video conferencing involves challenges in conveying presence and genuine interest that compensates for the loss of physical presence. This form of meeting can make it more difficult to see each other as persons, however this obstacle can be compensated by a person-centered approach. The nurse needs to be well acquainted with person-centered care in order to meet the patient despite the barrier that the screen may create. Technology is a means, not an end in itself. Proper use of information and communication technology can be used with great time gains to access each other regardless of geographical location and can contribute to human interaction but not replace it.

Social care services in a certain region are highly affected by the demographic development. To evaluate the demand for social care services, the population, age structure, life expectancy, natality and mortality should be considered. There are 1691 inhabitants living in Vlachovo Březí as at 31 December 2008. Most social care services for the town residents are provided by other municipalities of the Prachatice district. The thesis was aimed at document analysis and a subsequent statistical procedure which, together with future demographic development, formed a basis for the prognosis of the demand for social care services in Vlachovo Březí at the age groups 0-7, 15-18 and 65+ years during the 2010-2020 period. The other goal was to find out the use of social care allowances by beneficiaries and financial costs of the allowances for 65+ age group in Vlachovo Březí. Based on the prognosis for single age groups and the evaluation of the current social services, the findings are as follows: As an early years child care service (0-7 years) does not exist in the district, a necessity of setting up such a facility, which will serve this age group in the district centre (Prachatice), can be expected. Social care services for the age group between 15-18 years are currently insufficient so to build a low-treshold facility should become a priority. The age group 65+ is supposed to grow. A senior home has not been established in Vlachovo Březí and the surroundings. There is a possible way in setting up a nursing home with a simultaneous enhancement of community care services. In addition, the research helped us discover the fact that expenses on the social care allowances are not spent effectively and financial costs of them will increase 1.5 times in the next 10 years. The future revaluation of a current system of the allowance payment or a dependancy rate of the beneficiaries seems to be necessary. There are 1184 beneficiaries in the Prachatice municipality with extended competence as at 31 December 2009. This thesis can serve as a draft plan of social care services in the region. It can also be helpful in further research into this topic and the dissemination of the research findings.

Förväntad effekt av vårdens elektroniska IT-system är ökad patientsäkerhet, vårdkvalitet och tillgänglighet. Ett första villkor för att kunna uppnå detta är att IT-systemet används. I denna studie granskas ett underutnyttjat IT-system, använt för informationsöverföring mellan olika huvudmän vid samordnad vård- och omsorgsplanering. Granskningen baseras på teorier om hur individers intention och vilja till att använda ett IT-system initieras eller upprätthålls genom omgivningens påverkan. Resultatet visar att IT-användare i den patientnära vården (mikrosystemet) saknar adekvat tekniskt, organisatoriskt (mesosystemet) och ledningsstöd (makrosystemet), vilket kan förklara underutnyttjandet. / Expected impact of electronic healthcare systems is increasing patient safety, care quality and availability. Using the system is essential to achieve this. This study explain the assimilation gap in an electronic healthcare system used in coordinated care planning by theories how individuals’ intentions and willingness to use electronic systems is affected by environmental influences. The result shows that the end users lack technical, organizational, and management support, which can explains the assimilation gap.

Bakgrund: Vi blir idag allt äldre. Ett ökande antal äldre med komplexa vårdbehov kräver en samordnad vård utifrån ett helhetsperspektiv med patienten som person i centrum. En samordnad vårdplanering genomförs på sjukhuset före utskrivning för att samordna hälso- och sjukvård från sjukhus, primärvård och kommunal vård. Dessa vårdplaneringar utförs idag ofta via videomöte. För att upprätthålla en personcentrerad vård och främja en trygg och säker hemgång, behöver vårdplaneringen genomföras på ett sådant sätt att den äldre upplever delaktighet och därmed kan påverka beslut kring sin egen vård och hälsa. Syfte: Syftet med studien var att beskriva samordnad vårdplanering via videomöte ur den äldre personens och närståendes perspektiv. Metod: En induktiv kvalitativ forskningsansats användes genom åtta personliga ostrukturerade intervjuer. Ett strategiskt urval gjordes som resulterade i fyra äldre personer, Md=79 år, (70-83), samt fyra närstående, Md=54 år, (45-58). Inklusionskriterier var erfarenhet av vårdplanering via videomöte och för de äldre en ålder på minst 70 år. Materialet analyserades med kvalitativ innehållsanalys. Resultat: Den äldre personens och närståendes upplevelse av vårdplanering via videomöte kan beskrivas av temat att befinna sig i ett utanförskap. Detta baseras på tre kategorier utifrån upplevelse av opersonlighet, meningslöshet samt bristande delaktighet. Otillräcklig förberedelse eller information kan skapa en känsla av utanförskap som riskerar hindra möjligheten till delaktighet, inflytande och medbestämmande i vården. Slutsats: Samordnad vårdplanering via videomöte kan möjligen bli en tillfredsställande mötesform även för äldre. Flera utmaningar och svårigheter måste dock hanteras när det gäller möjlighet till delaktighet och medbestämmande för den äldre personen och närstående i vårdplanering via videomöte. Utan tidigare erfarenhet av videomöten kan kommunikation via en skärm vara en obekant upplevelse. Ett välplanerat videomöte med förberedd och insatt vårdpersonal samt en informerad och trygg patient och närstående är förutsättningar som behöver uppfyllas. / Background: We are becoming older than ever before. A growing number of elderly patients with complex caring needs require coordinated care from a holistic perspective with the patient as a person at the center. A coordinated care planning is conducted in the hospital before discharge in order to coordinate the health care needed from hospital, primary care services and municipal care. Today, these care planning's are often performed via video conference. In order to maintain a person-centered care and provide a safe and secure return to home, care planning need to be carried out in such a way that the elderly person may experience patient participation and thus can influence decisions on their own care and health. Aim: The aim of the study was to describe coordinated care planning via video conference from the elderly person's and next of kin's perspective. Method: An inductive qualitative research approach was used through eight personal unstructured interviews. A purposive sampling was conducted which resulted in a sample of four elderly persons, Md=79 years, (70-83) and four next of kin, Md=54 years, (45-58). Inclusion criteria were experience of care planning via video conference and for the elderly an age of at least 70 years. The data was analyzed with qualitative content analysis. Result: The older person's and the next of kin's experience of care planning via video conference can be described by the theme of being in an alienation. This is derived from three categories based on experience of impersonality, futility and a lack of participation. Insufficient preparation or information may create a feeling of alienation that can hinder the possibility of patient participation, influence and codetermination in the care. Conclusion: Coordinated care planning via video conference may become an adequate meeting form even for the elderly. However, several challenges and difficulties need to be addressed concerning patient participation and codetermination in care planning via video conference. Without previous experience of video conferencing, communicating via a screen can be a strange experience for the elderly person. A well-planned video conference with prepared and trained healthcare personnel as well as an informed and safe patient and next of kin are prerequisites that need to be fulfilled.

The purpose of this article is to synthesize the evidence on advance care planning (ACP), determine what is applicable to the home health (HH) setting, and find where gaps in knowledge may exist. An integrative review methodology was chosen. Although there is ample literature on the topic of ACP, most research has been conducted in the acute care, outpatient, and general community settings. There is limited literature regarding ACP with patients living with chronic cardiovascular and pulmonary illnesses, who comprise the majority of the HH population. Some literature has been published regarding the interprofessional team's role in ACP in the HH setting. A gap in knowledge exists regarding ACP in HH, and recommendations for future research are provided.

Bakgrund: Det finns en lagstadgad skyldighet att en samordnad individuell plan, SIP, ska upprättas när en person har ett behov av insatser som ryms inom hälso- och sjukvården eller inom socialtjänsten. En SIP kan ses som ett samverkansverktyg, vilket ger en koordinerad vård som leder till trygghet och ökad patientsäkerhet. En patients SIP är således ett mycket viktigt dokument som vägleder hälso- och sjukvårdspersonal i sin bedömning utifrån planerad vård och begränsningar, för att kunna erbjuda en god och personcentrerad vård. Syfte: Syftet var att undersöka olika aspekter av utlarmning av ambulans till patienter som har en samordnad individuell plan (SIP) och hur dessa larm hanteras av ambulanssjukvården. Metod: Studien är en kvantitativ retrospektiv studie i form av journalgranskning. Resultat: SIP-ärenden förekommer dagligen där SOS Alarms prioritering oftast inte går i linje med sjuksköterskans triage. Patienterna har en mycket hög biologisk ålder. Statistisk signifikanta skillnader erhölls med att patienter ej transporterades till sjukhus med ambulans i relation till högre ålder (p= &lt;0,02), lågt triage enligt RETTS (p= &lt;0,001), samt tydlig SIP (p=&lt;0,001). Slutsats: Sjuksköterskor inom ambulanssjukvård har god följsamhet till SIP på basis av att den är korrekt dokumenterad. / Bakgrund: Det är en lagstadgad skyldighet att en individuell plan (IP) ska skrivas när en person är i behov av hälso- och sjukvård eller socialtjänst. En IP är ett samarbetsverktyg som ger komfort och ökar patientsäkerheten. Det är också ett viktigt dokument för vårdpersonal när de fattar medicinska beslut så att säker och optimal vård kan erbjudas utifrån patienternas preferenser. Syfte: Syftet var att undersöka olika aspekter när ambulans kallas till en patient med IP och hur dessa samtal hanteras av ambulanstjänsten. Metoder: Studien är en kvantitativ retrospektiv observationsstudie, en tidskriftsöversikt. Resultat: IP-samtal sker dagligen. Nödcentralernas prioritet för samtalet korrelerar med en mycket låg grad med den triage som patienten får från den registrerade sjuksköterskan på plats. Patienter som har en IP är generellt mycket gamla. Statistiskt signifikanta skillnader hittades när det gäller att inte transporteras till sjukhus med ambulans när det gäller högre ålder (p = &lt;0,02), låg triage enligt RETTS (p = &lt;0,001) och en tydlig individuell plan (IP) (p = &lt;0,001). Slutsats: Registrerade sjuksköterskor från ambulanstjänsten har en hög överensstämmelse med en IP om den är korrekt dokumenterad.

In 2018, a new welfare law was implemented in Sweden aiming to increase the collaboration between hospital care, primary care and municipalities in cases where patients are in need of continued care and attention after they have been discharged from inpatient care (the Collaboration Act, my translation). The legislation contains instructions on the division of responsibilities between the different actors involved in the collaboration, but also provisions about municipal payment responsibility in cases where patients can´t be discharged from inpatient care at hospital within three days from the day he or she has been assessed as medically finished by the responsible doctor. This study aimed to describe and analyze the significance of the Collaboration Act for care managers in cases where elderly people have been discharged inpatient care. The empirical material was collected through qualitative interviews with six care managers. In order to analyze the empirical material a theoretical framework has been used consisting of Lundquists theory on officials as guardians of democracy and Lipskys theory on street-level bureaucrats. The result indicates that the care managers working methods are unchanged, but that the pace has increased in the care planning process. This means that the same amount of work must be performed as before, but with a more limited time before the municipal payment responsibility arises which has led to a consequence with inadequate investigations and needs assessments for the elderly client. To handle this dilemma, care managers overcompensate the elderly client with care interventions to create a feeling of security when they are dischared from inpatient care.

The number of individuals aged more than 65 years in the United States and their life expectancy has been increasing in the past decades. In spite of the presence of federal and accreditation policies recommending completion of advance directive documents by patients admitted to health care settings, advance directive completion rates are low in most health care organizations. The purpose of this study was to determine the level of advance directive completion among home health patients. The health belief model provided the theoretical framework that guided this study. A retrospective chart review was carried out in a home health agency with about 51 patients. Demographic details, including age, gender, ethnicity, nature of illness and type of health insurance were collected. Descriptive statistics were used to determine the percentage of home health patients with existing advance directives and those who do not have an advance directive. The study revealed that only 25% of the patients in the home health care agency had a completed advance directive. The finding indicate a disconnect between the recommended and the actual practice with regards to end of life issues. There is a pressing need for more complete documentation of the patient's desires and wishes regarding end of life care at home health care facilities. Documenting the patient's end of life preferences and wishes may potentially ease the decision-making process, making the end of life days less stressful for the patients and their families at the same time promoting the provision of personalized health care at the end of life.