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.

Made available in DSpace on 2014-12-17T14:47:00Z (GMT). No. of bitstreams: 1 PetalaTCOS_DISSERT.pdf: 3029424 bytes, checksum: 7f4d8e22f4b1bd2dfdeb31b4502e88e7 (MD5) Previous issue date: 2013-08-16 / This study aimed to understand the typical ideal of the nursing technician about the systematization of nursing care in the light of the theoretical framework of Alfred Schutz. It is a comprehensive phenomenological research, using the theoretical framework of Alfred Schutz. For the unveiling of the phenomenon (the typical ideal of the nursing technician about the systematization of nursing care), the search process was configured from the proposed guiding principles for a research methodology based on the work itself of Schutz held by Zeferino (2010) in his PhD. For data collection, we used the focus group technique, counting on the collaboration of thirteen practical nurses working in a university hospital in Rio Grande do Norte, who responded positively to the inclusion criteria: working in the study hospital, performing care direct to patients. Forty-four subjects showed interest in participating, being held a draw for selection of the research sample, consisting of 14 professionals, one of whom did not attend the gathering of data collection. The focus group, entitled "What I think about the systematization of nursing care", took place on February 15th, 2013, totaling 101 minutes. It was performed according to the Experiential Education Humanescent using building posters as projective technique, from the key question: "What is the systematization of nursing care for you?". In order to understand some of the biographical situation of the participants, a questionnaire was administered to study participants. From the agreement of the subjects, the focus group was recorded and photographed with the cooperation of one reporter and two other employees. We used Microsoft Word 2010 to perform the transcript of the meeting and Microsoft Excel 2010 for synthesizing the results via a spreadsheet. The study followed the ethical and legal principles that govern scientific research on humans, recommended in Resolution n? 196/96, it was approved by Opinion Embodied Ethics Committee in Research of UFRN (Federal University of Rio Grande do Norte), n? 98 424, of August 31th, 2012, CAAE No. 05906912.0.0000.5537. The analysis of the nursing staff speeches, along with the contemplation of their posters and their written descriptions, allowed from the guiding principles of Zeferino (2010), in light of the reference of Alfred Schutz, unveiling the typical ideal of nursing technicians about the systematization of nursing care, passing four themes: typing of the concept of systematization of nursing care; benefits, which resulted in the reasons to believe in the positivity of this working tool; experienced problems, revealing the world of everyday life of nursing professionals, and possibilities for improvement. It was concluded that the nursing technicians are unaware of the systematization of nursing care. However, they typify a very positive perception about the same, especially with regard to improvements that may foster care / Objetivou-se compreender o t?pico ideal do t?cnico de enfermagem acerca da sistematiza??o da assist?ncia de enfermagem, ? luz do referencial te?rico de Alfred Schutz. Trata-se de uma investiga??o fenomenol?gica compreensiva, utilizando o referencial te?rico de Alfred Schutz. Para o desvelamento do fen?meno (o t?pico ideal do t?cnico de enfermagem acerca da sistematiza??o da assist?ncia de Enfermagem), o processo de pesquisa configurou-se a partir da proposta de princ?pios orientadores de uma metodologia de pesquisa com base na pr?pria obra de Schutz, realizada por Zeferino (2010), em seu doutoramento. Para coleta de dados, utilizou-se a t?cnica do grupo focal, com a colabora??o de treze t?cnicos de enfermagem atuantes em um hospital universit?rio norte-riograndense, que responderam positivamente ao crit?rio de inclus?o: atuar no hospital de estudo e realizar cuidados assistenciais diretos aos pacientes. Quarenta e quatro sujeitos demonstraram interesse em participar, sendo realizado um sorteio para sele??o da amostra da pesquisa, composta por 14 profissionais, dos quais um n?o compareceu ao encontro de coleta de dados. O grupo focal, intitulado O que eu penso acerca da sistematiza??o da assist?ncia de enfermagem , aconteceu no dia 15 de fevereiro de 2013, totalizando 101 minutos. Foi realizado de acordo com a Pedagogia Vivencial Humanescente, utilizando a constru??o de cartazes como t?cnica projetiva, a partir da quest?o chave: O que ? sistematiza??o da assist?ncia de enfermagem para voc?? . A fim de compreender um pouco da situa??o biogr?fica dos participantes, foi aplicado um question?rio aos participantes. A partir da concord?ncia dos sujeitos, o grupo focal foi gravado e fotografado, contando com a coopera??o de um relator e de dois outros colaboradores. Foi utilizado o Microsoft Word 2010 para a realiza??o da transcri??o do encontro e o Microsoft Excel 2010 para sintetiza??o dos resultados por meio de uma planilha. O estudo seguiu os princ?pios ?ticos e legais que regem a pesquisa cient?fica em seres humanos, preconizados na Resolu??o n? 196/96, e foi aprovado pelo Parecer Consubstanciado do Comit? de ?tica em Pesquisa da UFRN, n? 98.424, de 31 de agosto de 2012, CAAE n? 05906912.0.0000.5537. A an?lise das falas dos t?cnicos de enfermagem, juntamente com a contempla??o de seus cartazes e de suas descri??es escritas, permitiu, a partir dos princ?pios orientadores de Zeferino (2010), ? luz do referencial de Alfred Schutz, desvelar o t?pico ideal dos t?cnicos de enfermagem acerca da sistematiza??o da assist?ncia de enfermagem, perpassando quatro eixos tem?ticos: tipifica??o do conceito da sistematiza??o da assist?ncia de enfermagem; benef?cios, que se traduziram nos motivos-para acreditar na positividade dessa ferramenta de trabalho; problemas vivenciados, reveladores do mundo vida cotidiano dos profissionais de enfermagem; e possibilidades de melhoria. Concluiu-se que o t?cnico de enfermagem t?pico ? um sujeito cr?tico e reflexivo, que, apesar de ter tido uma forma??o acad?mica que negligenciou os aspectos te?ricos essenciais concernentes ? sistematiza??o da assist?ncia de enfermagem, possui uma situa??o biogr?fica que o faz acreditar na positividade da sistematiza??o da assist?ncia de enfermagem

Historicamente, usuários de drogas são submetidos a tratamentos em instituições fechadas que enfocam a abstinência, sem que haja uma participação ativa do usuário nas escolhas e decisões. O Centro de Atenção Psicossocial para Usuários de Álcool e Drogas (CAPS-ad) é um serviço substitutivo ao hospital psiquiátrico que preconiza a participação do usuário em seu tratamento, no sentido de promover sua autonomia e reinserção social. Esta pesquisa tem como objetivo analisar a participação dos usuários de álcool e outras drogas na elaboração e condução de seu projeto terapêutico singular (PTS). Trata-se de uma pesquisa de abordagem qualitativa, do tipo estudo de caso, com usuários do CAPS-ad de um município do interior de Minas Gerais. Foram utilizados como instrumentos de pesquisa a entrevista semi-estruturada com usuários e profissionais do serviço, a análise de prontuários e do formulário de PTS, e a observação participante nos atendimentos de revisão de PTS. Buscou-se analisar se os planos de tratamento traçados consideram a participação efetiva do usuário na busca dos objetivos e metas compartilhados, com vistas à inserção social e ao resgate da cidadania. Pretende-se também entender o grau de responsabilização do usuário pelo próprio tratamento, avaliando os objetivos e as motivações dos usuários e profissionais do CAPS-ad. Divergências entre objetivos de usuários e de profissionais foram reveladas, demonstrando haver presença de caráter tutelar e pouca responsabilização de alguns usuários no seu tratamento. Observou-se também uma limitação no uso do instrumento PTS, com pouca participação dos usuários em sua elaboração, e sem apresentação de metas e propostas de ações singulares. Foi proposto um novo formulário de PTS que incentive o protagonismo do usuário no tratamento e que contemple diversos aspectos de sua vida. Nesta abordagem, torna-se necessário uma capacitação dos usuários sobre as premissas do tratamento, de forma a promover sua autonomia e participação efetiva na elaboração do PTS. / Throughout history, drug users have been treated in closed institutions that focus on abstinence, lacking an active participation from the user in choices and decisions. The Psychosocial Care Center for Alcohol and Drug Users (CAPS-ad) is a service that replaces the psychiatric hospital which advocates for the user’s participation in their treatment, in order to promote their autonomy and social reintegration. This research aims to analyze the participation of alcohol and other drugs users in the elaboration and conduction of their Singular Therapeutic Project (PTS). This is a qualitative, case study type research, with CAPS-ad users of a municipality in the countryside of Minas Gerais. The semi-structured interview with users and professionals from the field, the analysis of medical records and PTS form, and the participant observation in the PTS review visits were used as research instruments. This research aims to analyze whether the drawn treatment plans consider the effective participation of the user in the search of shared goals and objectives, aiming social insertion and citizenry reappropriation. It also seeks to understand the user’s responsibility degree for his or her own treatment, evaluating users and CAPS-ad professionals’ objectives and motivations. Divergences were found between the ones set by the users and the ones set by the professionals, revealing that there is a presence of tutelary character and little accountability for their treatment in the case of some users. A limitation was also observed in the use of the PTS instrument, with little participation of the users in its elaboration, and lacking presentation of goals and proposals for individual actions. A new PTS form has been proposed, one that encourages the user's role in the treatment and that contemplates several aspects of his or her life. In this approach, training users on the treatment premises becomes necessary, in order to promote their autonomy and effective participation in the PTS elaboration.

Historicamente, usuários de drogas são submetidos a tratamentos em instituições fechadas que enfocam a abstinência, sem que haja uma participação ativa do usuário nas escolhas e decisões. O Centro de Atenção Psicossocial para Usuários de Álcool e Drogas (CAPS-ad) é um serviço substitutivo ao hospital psiquiátrico que preconiza a participação do usuário em seu tratamento, no sentido de promover sua autonomia e reinserção social. Esta pesquisa tem como objetivo analisar a participação dos usuários de álcool e outras drogas na elaboração e condução de seu projeto terapêutico singular (PTS). Trata-se de uma pesquisa de abordagem qualitativa, do tipo estudo de caso, com usuários do CAPS-ad de um município do interior de Minas Gerais. Foram utilizados como instrumentos de pesquisa a entrevista semi-estruturada com usuários e profissionais do serviço, a análise de prontuários e do formulário de PTS, e a observação participante nos atendimentos de revisão de PTS. Buscou-se analisar se os planos de tratamento traçados consideram a participação efetiva do usuário na busca dos objetivos e metas compartilhados, com vistas à inserção social e ao resgate da cidadania. Pretende-se também entender o grau de responsabilização do usuário pelo próprio tratamento, avaliando os objetivos e as motivações dos usuários e profissionais do CAPS-ad. Divergências entre objetivos de usuários e de profissionais foram reveladas, demonstrando haver presença de caráter tutelar e pouca responsabilização de alguns usuários no seu tratamento. Observou-se também uma limitação no uso do instrumento PTS, com pouca participação dos usuários em sua elaboração, e sem apresentação de metas e propostas de ações singulares. Foi proposto um novo formulário de PTS que incentive o protagonismo do usuário no tratamento e que contemple diversos aspectos de sua vida. Nesta abordagem, torna-se necessário uma capacitação dos usuários sobre as premissas do tratamento, de forma a promover sua autonomia e participação efetiva na elaboração do PTS. / Throughout history, drug users have been treated in closed institutions that focus on abstinence, lacking an active participation from the user in choices and decisions. The Psychosocial Care Center for Alcohol and Drug Users (CAPS-ad) is a service that replaces the psychiatric hospital which advocates for the user’s participation in their treatment, in order to promote their autonomy and social reintegration. This research aims to analyze the participation of alcohol and other drugs users in the elaboration and conduction of their Singular Therapeutic Project (PTS). This is a qualitative, case study type research, with CAPS-ad users of a municipality in the countryside of Minas Gerais. The semi-structured interview with users and professionals from the field, the analysis of medical records and PTS form, and the participant observation in the PTS review visits were used as research instruments. This research aims to analyze whether the drawn treatment plans consider the effective participation of the user in the search of shared goals and objectives, aiming social insertion and citizenry reappropriation. It also seeks to understand the user’s responsibility degree for his or her own treatment, evaluating users and CAPS-ad professionals’ objectives and motivations. Divergences were found between the ones set by the users and the ones set by the professionals, revealing that there is a presence of tutelary character and little accountability for their treatment in the case of some users. A limitation was also observed in the use of the PTS instrument, with little participation of the users in its elaboration, and lacking presentation of goals and proposals for individual actions. A new PTS form has been proposed, one that encourages the user's role in the treatment and that contemplates several aspects of his or her life. In this approach, training users on the treatment premises becomes necessary, in order to promote their autonomy and effective participation in the PTS elaboration.

The construction industry has been hesitant for a long time to apply new technologies. In property development, the industry relies heavily on employees bringing experience from one project to another. These employees learn to manage risks in connection with the acquisition of land, but when these people retire, the knowledge disappears. An AI-based decision-support system that takes the risks and the market into account when acquiring land can learn from each project and bring this knowledge into future projects. In facility management, artificial intelligence could increase the efficiency of the allocation of staff in the ongoing operations. The purpose of the study is to analyse how companies in the real estate industry can improve their decision-making with the help of AI in property development and property management. In this study, two case studies of two different players in the real estate industry have been performed. One player, Bygg-Fast, represents property development and the other player, VGR, represents facility management. The study is based on interviews, discussions, and collected data. By mapping and then quantifying the risks and market indicators that are input data in the process, a basis can be created. The data can be used for a model that lays the foundation for an AI-based decision support system that will help the property developer to make calculated decisions in the land acquisition process. By mapping what a flow through a property looks like, measuring points can be set out to analyse how long the activities take in the specific business. These measured values provide a collection of data that makes it easier to plan the activities conducted in the property. A more efficient flow can be achieved by visualizing the entire process so staff can be allocated to the right part of the flow. By being flexible and being able to re-plan the business quickly if planning is disrupted, a high level of efficiency can be achieved. This could be done by an AI-based decision support system that simulates alternative day plans. / Byggbranschen har länge varit tveksamt till att applicera nya tekniker. Inom fastighetsutveckling bygger branschen mycket på att anställda tar med sig erfarenheter från ett projekt till ett annat. Dessa anställda lär sig hantera risker i samband med förvärv av mark men när dessa personer slutar eller går i pension försvinner kunskapen. Ett AI baserat beslutssystem som tar risk och marknad i beaktning vid förvärv av mark kan lära sig av varje projekt och ta med dessa kunskaper till framtida projekt. Inom fastighetsförvaltning skulle artificiell intelligens kunna effektivisera allokerandet av personal i den pågående verksamheten. Syftet med studien är att analysera hur företag i fastighetsbranschen kan förbättra sitt beslutstagande med hjälp av AI i utveckling av fastigheter samt fastighetsförvaltning. I denna studien har två fallstudier av två olika aktörer i fastighetsbranschen utförts. Ena aktören, Bygg-Fast, representerar fastighetsutveckling och den andra aktören, VGR, representerar fastighetsförvaltning. Studien bygger på intervjuer, diskussioner och insamlade data. Genom att kartlägga och sedan kvantifiera de risker samt marknadsindikatorer som är indata i processen kan ett underlag skapas. Underlaget kan användas för en modell som lägger grunden för ett AI baserat beslutsstödsystem som ska hjälpa fastighetsutvecklaren med att ta kalkylerade beslut i mark förvärvsprocessen. Genom att kartlägga hur ett flöde genom en fastighet ser ut kan mätpunkter sättas ut för att analysera hur lång tid aktiviteterna tar i den specifika verksamheten. Dessa mätvärden ger en samlad data som gör det lättare att planera verksamheten som bedrivs i fastigheten. Ett effektivare flöde kan uppnås genom att visualisera hela processen så personal kan allokeras till rätt del av flödet. Genom att vara flexibel och kunna planera om verksamheten snabbt ifall planering störs kan en hög effektivitet nås. Detta skulle kunna göras av ett AI baserat beslutsstödsystem som simulerar alternativa dagsplaneringar.

Negative consumer opinion poses a potential barrier to the application of nutrigenomic intervention. The present study has aimed to determine attitudes toward genetic testing and personalised nutrition among the European public. An omnibus opinion survey of a representative sample aged 14-55+ years (n 5967) took place in France, Italy, Great Britain, Portugal, Poland and Germany during June 2005 as part of the Lipgene project. A majority of respondents (66 %) reported that they would be willing to undergo genetic testing and 27 % to follow a personalised diet. Individuals who indicated a willingness to have a genetic test for the personalising of their diets were more likely to report a history of high blood cholesterol levels, central obesity and/or high levels of stress than those who would have a test only for general interest. Those who indicated that they would not have a genetic test were more likely to be male and less likely to report having central obesity. Individuals with a history of high blood cholesterol were less likely than those who did not to worry if intervention foods contained GM ingredients. Individuals who were aware that they had health problems associated with the metabolic syndrome appeared particularly favourable toward nutrigenomic intervention. These findings are encouraging for the future application of personalised nutrition provided that policies are put in place to address public concern about how genetic information is used and held.

No / Transition planning using a person-centred approach has, in the main, failed to shape service provision. We offer an alternative based on an ecological understanding of human development linked to public health approaches that prioritise whole system planning. A total of 43 young people with intellectual disabilities, in Bradford, England, who were approaching transition from school or college were recruited to a qualitative study. Their ethnic breakdown was as follows: 16 white British, 24 Pakistani, 2 Bangladeshi and 1 Black African. Each young person was interviewed twice, at recruitment and a year later, to observe any changes in their social networks during transition. Interviews were undertaken with a semi-structured interview schedule and with the pictorial approach of Talking Mats. Both the networks the young people live within, and their sense of what the future might hold for them, are described and linked to Bronfenbrenner's ecological model of human development. The importance of the family and school is emphasised, as is the absence of engagement in leisure activities and work. Transition planning needs to start with mapping the systems individuals live within, areas of strength should be supported and parts of the system, which are not fit for purpose for these young people, should be prioritised for interventions.

This study, quantitative determinants of need and demand for primary health care in the District of Columbia (DCPC), analysed data over a twenty-year period from 1985 to 2004, on need and demand for primary care using standard and epidemiologically innovative statistical measures for physician distributions and socio-demographic characteristics in the District of Columbia (DC). The study attempted to answer the question: Using U.S census-based small area aggregations, Census Tract Groupings (CTGs), that are not zip-code areas or legislative/political boundaries, can a multivariate predictive model be developed using physician distributions, primary care service index (PCSI) and composite need scores (CNS) to explain variations in primary care visits shortages? Primary care visits shortages and priority scores (PCPS) were calculated, analysed and presented for CTGs in the District of Columbia from 1985 to 2004. Results indicated that the abundant supply of DC-based physicians – indicated by decreasing population per physician ratios of 239 (1985) to 146 (2004) – appear to be a long-term trend. As raw physician counts increased, the ratio of satisfied visits to demand decreased, from 2.62 (1985) to 1.80 (in 2004). This result appears to indicate that, due to inequities in distribution of primary care physicians in DC’s small areas, the increasing numbers of primary care physicians were by themselves, not sufficient to address the city’s overall primary care visits need. Epidemiological profiles and physician distribution analytical methods appear to be useful for small area analysis of urban primary care shortage areas and for setting priorities. Physician rates per 1,000 pop may be a necessary but not sufficient statistic for estimating urban primary health care needs / Health Studies / D. Litt. et Phil. (Health Studies)

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / Background: In 1999, The International Study of Asthma and Allergies in Childhood (ISAAC) Phase One reported the prevalence of eczema symptoms in 715,033 children from 154 centers in 56 countries by using standardized epidemiologic tools. Objective: To update the world map of eczema prevalence after 5 to 10 years (ISAAC Phase Three) and include additional data from over 100 new centers. Methods: Cross-sectional surveys using the ISAAC questionnaire on eczema symptoms were completed by adolescents 13 to 14 years old and by parents of children 6 to 7 years old. Current eczema was defined as an itchy flexural rash in the past 12 months and was considered severe eczema if associated with 1 or more nights per week of sleep disturbance. Results: For the age group 6 to 7 years, data on 385,853 participants from 143 centers in 60 countries showed that the prevalence of current eczema ranged from 0.9% in India to 22.5% in Ecuador, with new data showing high values in Asia and Latin America. For the age group 13 to 14 years, data on 663,256 participants from 230 centers in 96 countries showed prevalence values ranging from 0.2% in China to 24.6% in Columbia with the highest values in Africa and Latin America. Current eczema was lower for boys than girls (odds ratio, 0.94 and 0.72 at ages 6 to 7 years and 13 to 14 years, respectively). Conclusion:ISAAC Phase Three provides comprehensive global data on the prevalence of eczema symptoms that is essential for public health planning. New data reveal that eczema is a disease of developing as well as developed countries. / Revisión por pares

Hospital admissions for patients close to the end of life are considered ‘inappropriate’ in contemporary English health policy. Hospitals are supposedly unable to offer a ‘good’ death for patients, and dying there is thought to contradict patient choice, since patients are assumed to want to die at home. However, almost half of all deaths in England in 2015 occurred in hospital, and of these, nearly a third died within three days of admission. This thesis seeks to explore why these admissions are considered to be a problem and how they occur. Through a systematic review of UK literature I found that it cannot be stated that most patients want to die at home, because of the extent of missing data (preferences not asked, expressed, reported or absent). This finding challenges the justification that admissions are inappropriate because they contravene patient choice. Similarly inconclusive evidence about the undesirability, cost, and lack of need for patients to be in hospital were also found in a review of policy. Together with analysis of historical trends in hospital and hospice provision, it is apparent that attitudes towards end-of-life admissions reflect existing tensions about the role of hospital as an acute provider, and as a place of death. An analysis of interviews conducted with healthcare staff and next-of-kin involved in the admission of patients (case-patients) who died shortly after being admitted to Meadowbridge, a large English hospital explored these tensions further. I found that whilst hospital was not recognised as a place where ‘good’ deaths typically occurred, it was acknowledged as an emergency place of care. In this context, patients without obvious need for hospital care were nevertheless admitted to the hospital and the environment was subsequently recognised to offer distinct benefits. The need for emergency care reflected the difficulties of providing end-of-life care in the community. For dying to occur appropriately, home had to be adapted and care organised by healthcare staff. Both tasks were complicated by the unpredictability of dying, and family carers helped to absorb much of the uncertainty and support patients to die at home. Ambulance staff became involved when patients had care needs that exceeded care quickly and easily available in the community. When called to the case-patients, ambulance staff instituted familiar practices in transferring them to hospital. Hospital was recognised as a default place of care because ambulance staff struggled to facilitate alternative care and lacked sufficient professional authority to keep patients at home. The admissions of the case-patients represent the best attempts of staff to navigate the tangled practices of end-of-life care. These practices are the result of the actions of the staff, which in turn both constrained and enabled their action in providing care to patients. The term ‘inappropriate’ to describe admissions does not encompass these attempts, and moreover, devalued the significant care provided by healthcare staff in the community and hospital.