This research addressed change management and learning in a multidisciplinary addictions chronic care environment in order to prepare for shared care planning within an electronic health record. It used a Developmental Work Research approach and was able to use insights from Bernstein’s theory of knowledge structures, Bakhtin’s work on social language and a Critical Realism approach to address weaknesses in the base Activity Theory approach. In these ways problems concerning fragmented, demarcated silo working across clinical and non-clinical addictions services could be examined. The objective of the study was to identify tensions and contradictions in working environments and to engage multidisciplinary workers in a collaborative change laboratory environment via the use of co-configuration and expansive learning. The working group examined past and current practice and were able to formulate new forms of practice, based on the use of a shared care plan tool, to address identified problems and national policy aims. It was able to use the aforementioned theoretical insights to illuminate the multiple utility of the shared care plan tool as a pedagogic device. This enabled the production of new practice possibilities, paradigms and planning to be undertaken, and the consideration of these within the context of ‘real time’ multidisciplinary activity within a forthcoming national IT system. This research has explored, identified and formulated new practice to improve multidisciplinary working between clinical and non-clinical workers across diverse sectors. This will have significant health and cost benefit gains for clients, workers and organisations as well as translating policy aims into effective practice. The next stage will be to manage the roll-out of the forthcoming IT system using the theoretical and methodological developments crafted in this research endeavour.

O propósito deste estudo foi desenvolver um software-protótipo, que possibilite aos enfermeiros atender ao planejamento da assistência de enfermagem, prescrição de intervenções de enfermagem e toda sua documentação de forma informatizada.A equipe multiprofissional envolvida no desenvolvimento deste software-protótipo foi constituída pela pesquisadora, um analista de sistema e um programador. A metodologia utilizada fundamentou-se no ciclo de vida de desenvolvimento de sistema, baseando-se no conceito de prototipação. Sedimentou-se em duas fases: a fase de definição e a de desenvolvimento. A fase de definição iniciou-se com a etapa de planejamento, seguido pela definição e análise dos requisitos necessários para sua construção e culminou com a produção da especificação de requisitos do software. A fase de desenvolvimento traduziu o conjunto de requisitos em um modelo informatizado, estruturado em 10 módulos, referentes ao processo de sistematização da assistência de enfermagem. Os módulos denominados: Ficha de Identificação, Dados Clínicos, Internações, Informações adicionais e Entrevista armazenam dados relativos às necessidades humanas básicas e abrangem: o índice de massa corpórea, situação clínica, resumo de admissão, internações anteriores e os dados para identificação do paciente. O módulo para Coleta de Dados foi desenhado para cadastrar informações diferenciadas sobre os sinais e sintomas e gerar, automaticamente, o módulo Lista de Problemas. Este viabiliza a elaboração da prescrição de enfermagem específica para cada paciente por meio da utilização de uma base de dados previamente estabelecida pelo sistema. Para propiciar maior comodidade e agilidade nas atividades de documentação, o módulo sobre Sinais Vitais permite transformar, eletronicamente, os valores atribuídos à pressão arterial, pulso, respiração e temperatura em gráficos individualizados. O ambiente Balanço Hidroeletrolítico permite implementar, automaticamente, o balanço parcial e total oferecendo aos enfermeiros simplicidade na execução desta tarefa, bem como realizar seu acompanhamento posterior. A avaliação deste recurso inovador na performance da Sistematização da Assistência de Enfermagem nos diferentes estágios do seu processo será objeto de um estudo posterior. / The purpose of this study is to develop a software-prototype to help the nurses to plan the nursing care, to make nursing interventions and all documentation in a computerized way. The multi- professional team is involved in the development of this software-prototype and constituted by the researcher, a system analyst and a programmer. The methodology is based in the life cycle of system development, basing on the prototype concept. It is following up into two phases: the definition and the development one. The definition phase began with the planning stage, following for the definition and analysis of the requirements for the construction and it culminated with the specification of the software requirements.The development phase translated the group of requirements in a computerized model, structured in 10 modules, regarding the process of nursing care system. The Identification, Clinical Data, Interview and additional Information modules store data related to the basic human needs and they include: the index of corporal mass, clinical situation, admission summary, and the patient's identification. The Data Collection module was design to register information related to the signs and symptoms and to generate, automatically, the List of Problems module. This makes possible the elaboration of the nursing prescription of each patient using the data base established previously by the system. To make better the documentation activities, the Vital Signs module allows to transform, electronically, the values attributed to the blood pressure, pulse, breathing and temperature in individualized graphs.The fluid and electrolyte metabolism balance module allows to implement, automatically, the partial and total response helping the nurses in the execution of this task, as well as to accomplish the subsequent attendance. The evaluation of this innovative resource in the performance of Nursing Care System will be object of a subsequent study.

<p>Trots att det finns en lag om att bevara patientens rättigheter, finns ändå bemötandeproblem i vården som har varit en följetong i svensk media. Bemötande i vården bör anpassas till patientens behov, där empati är en grundläggande aspekt inom vården. Syftet med denna studie var att studera hur bemötande sker mellan vårdpersonalen och de äldreboende. Fyra timmars fältobservationer gjordes med tio vårdpersonalen och fyra intervjuer med fyra vårdanställda på ett äldreboende. Rådata analyserades och en triangulering gjordes med grundad teori. Resultaten visade att bemötande skedde med empati och kärnprocessen handlade om att empati är bundet till psykisk samt fysisk närhet. Det förhållningssätt som uttrycks i lagar, policybeslut och i själva professionen samverkar med vårdpersonalens individuella attityder och värderingar i hur man bemöter människor i beroendeställning. I studien diskuteras hur empati och närhet är en förutsättning för att vårdpersonalen ska lyckas i sitt arbete som professionella hjälpare.</p>

Trots att det finns en lag om att bevara patientens rättigheter, finns ändå bemötandeproblem i vården som har varit en följetong i svensk media. Bemötande i vården bör anpassas till patientens behov, där empati är en grundläggande aspekt inom vården. Syftet med denna studie var att studera hur bemötande sker mellan vårdpersonalen och de äldreboende. Fyra timmars fältobservationer gjordes med tio vårdpersonalen och fyra intervjuer med fyra vårdanställda på ett äldreboende. Rådata analyserades och en triangulering gjordes med grundad teori. Resultaten visade att bemötande skedde med empati och kärnprocessen handlade om att empati är bundet till psykisk samt fysisk närhet. Det förhållningssätt som uttrycks i lagar, policybeslut och i själva professionen samverkar med vårdpersonalens individuella attityder och värderingar i hur man bemöter människor i beroendeställning. I studien diskuteras hur empati och närhet är en förutsättning för att vårdpersonalen ska lyckas i sitt arbete som professionella hjälpare.

Innan en patient som bedöms vara i behov av insatser från kommunens socialtjänst eller annan öppenvård med mera skrivs ut från slutenvården måste en vårdplanering utföras. Vårdplaneringen utförs av patientansvarig sjuksköterska tillsammans med ett antal representanter från öppenvården. Syftet med studien är att belysa hur sjuksköterskor inom landstinget upplever samordnad vårdplanering. Metoden som användes var en kvalitativ enkätundersökning. Resultatet baseras på tio enkäter ifyllda av sjuksköterskor på lungmedicin på KSS i Skövde. Dessa enkätsvar gick sedan igenom en kvalitativ innehållsanalys för att urskilja upplevelser hos sjuksköterskorna. I resultatet framkom att sjuksköterskorna upplevde stress, frustration, dåligt samvete samt bristande samarbete men att sjuksköterskorna accepterade situationen och jobbade vidare. / A coordinated care plan must be carried out before a patient in closed care, that need help from the municipality social services or other open care institutions, can be discharged. This coordinated care planning is accomplished by a team consisting of the nurse responsible for the patient together with a number of representatives from the municipal care. The aim with the study is to elucidate how nurses within the county council experience the coordinated care planning. The method used in this study was a qualitative questionnaire survey and the answers were assessed by using a qualitative content analysis. The results are based on ten questionnaires answered by nurses working at the lung medicine ward in Kärnsjukhuset, Skövde. This study revealed that the nurses experienced stress, frustration, bad conscience and inadequate cooperation in the coordinated care planning; however, they accepted the situation and kept on working.

<p>Innan en patient som bedöms vara i behov av insatser från kommunens socialtjänst eller annan öppenvård med mera skrivs ut från slutenvården måste en vårdplanering utföras. Vårdplaneringen utförs av patientansvarig sjuksköterska tillsammans med ett antal representanter från öppenvården. Syftet med studien är att belysa hur sjuksköterskor inom landstinget upplever samordnad vårdplanering. Metoden som användes var en kvalitativ enkätundersökning. Resultatet baseras på tio enkäter ifyllda av sjuksköterskor på lungmedicin på KSS i Skövde. Dessa enkätsvar gick sedan igenom en kvalitativ innehållsanalys för att urskilja upplevelser hos sjuksköterskorna. I resultatet framkom att sjuksköterskorna upplevde stress, frustration, dåligt samvete samt bristande samarbete men att sjuksköterskorna accepterade situationen och jobbade vidare.</p> / <p>A coordinated care plan must be carried out before a patient in closed care, that need help from the municipality social services or other open care institutions, can be discharged. This coordinated care planning is accomplished by a team consisting of the nurse responsible for the patient together with a number of representatives from the municipal care. The aim with the study is to elucidate how nurses within the county council experience the coordinated care planning. The method used in this study was a qualitative questionnaire survey and the answers were assessed by using a qualitative content analysis. The results are based on ten questionnaires answered by nurses working at the lung medicine ward in Kärnsjukhuset, Skövde. This study revealed that the nurses experienced stress, frustration, bad conscience and inadequate cooperation in the coordinated care planning; however, they accepted the situation and kept on working.</p>

Advance care planning (ACP) is defined as a process of open communication and information sharing between the health care team, the patient, and his/her family to enable patient’s wishes for future care and medical treatment to be explored and supported. The purpose of this study was to investigate the knowledge, attitudes, and experiences of medical-surgical nurses working in Winnipeg, Manitoba in relation to ACP. This cross-sectional descriptive study involved the use of a questionnaire developed and used in Singapore and assessed for face validity by local experts. A sample of 218 registered nurses responded to the web-based survey. Nurses were found to have: a sound understanding of foundational ACP concepts; communal and also varied attitudes toward ACP; and reported variable levels of involvement in ACP with patients and families. The results of this study can be used to inform change within both the educational and clinical care settings. / October 2015

The study evaluated the cost-effectiveness of community based Nurse Case Management (NCM) utilizing existing hospital information systems data. Program outcomes of intensive NCM were compared with those of existing hospital programs for a group at high risk for readmission. Thirty-one elderly patients were assigned to one of three groups. A retrospective pretest-posttest design was used and multivariate analyses were performed. Outcomes were measured at six month intervals before and after NCM. The intensive NCM group had a higher length of stay and inpatient costs than the other two groups. Direct costs of NCM were estimated at $1.55 per active case per day. The study found that cost-effectiveness of NCM cannot be determined accurately unless health risk assessments are quantified, NCM is clearly translated into categories of intervention, and direct costs of NCM are measured consistently. These factors must be integrated into routine hospital information system reports.

Physical and psychosocial symptoms in advanced chronic obstructive pulmonary disease (COPD) are cumulative and profound; global financial and human costs are huge. COPD in late stages runs an unpredictable downward course of increasing, potentially fatal exacerbations. Nevertheless many physicians avoid advance care planning in this context, a choice that tends to promote last minute crisis decision-making. To explore a more ethically sound proactive approach to end-of-life care decision-making I conducted a qualitative study informed by the question: “What is required for meaningful and effective advance care planning in the context of advanced COPD?” Fifteen participants (eight patients with advanced COPD plus seven intimate others) participated in two in-home advance care planning discussions that incorporated patient-centred care principles. Session transcripts were analyzed using "interpretive description." Despite initial wariness, participants were able to discuss their care-related hopes and preferences and reported that the process was a positive one. Interpretation of the positive feedback suggested participants experienced the process as a chance to: a) talk with an attentive clinician, b) learn, c) consider care-related goals and preferences, and, d) have intimate others hear about these goals/preferences. Interpretation of the process that led to this positive assessment is described in terms of a thematic network. The overarching global theme of this network was "advance care planning as collaborative care," which involved three organizing themes--partnering, negotiating ambiguity, and being a resource--and a cluster of basic themes related to each of these. The "collaborative care" approach is discussed as a guide to advance care planning in advanced COPD. Like other advance care planning models, the study approach included a skilled clinician facilitator, provision of targeted information, and attention to readiness. There were four new elements: focus on caring, engaging hope, facilitator reflective praxis, and contextual sensitivity. While potentially enhancing the "care" dimension in advance care planning, the study approach may incidentally improve resource allocation and satisfaction with outcomes. Done well it may enhance decision-making and care planning, and, just as importantly, be experienced as care itself at a time and by those often neglected in this regard.

Documentation of care plans by Registered Nurses (RN) within acute care is imperative. There is scant research related to the experiences of nurses with written care plans within this context. The purpose of this study was to describe RN’s experiences with care plan practice. Qualitative descriptive methodology informed by a socio-ecological perspective was used to conduct this inquiry. Ten participants were recruited from four medical/surgical settings. Six RNs, two Clinical Educators and two Health Service Managers participated in semi-structured interviews. Two themes with associated sub-themes were derived utilizing thematic analysis: Unwritten Care Planning and Modernizing Care Planning. Study findings concluded that unwritten care planning was the experience described by participants. Factors influencing participant’s experiences of care planning included unclaimed accountability, care delivery processes and context of care. Participants also described strategies to enhance care planning practice. This research can guide practice improvements and builds upon existing care plan research.