<p><p><strong>Syfte:</strong> Syftet med denna studie är att bland patienter med långvarig smärta, som är remitterade till en smärtmottagning, undersöka förväntningar avseende det första besöket, i vilken utsträckning patienterna anser att dessa uppfylldes samt att undersöka vilka förväntningar patienterna har på den fortsatta vården och kontakten med Smärtmottagningen. <strong>Metod:</strong> En empirisk studie med kvalitativ deduktiv ansats. Datainsamling skedde genom att tio personer intervjuades på Smärtmottagningen efter deras första besök. Materialet bearbetades med manifest innehållsanalys.<strong> Resultat:</strong> Patienter vid Smärtmottagningen hade i olika stor utsträckning förväntningar inför det första besöket och den fortsatta vården. Patienterna ansåg i varierande utsträckning att deras förväntningar på det första besöket hade uppfyllts, dock uttryckte alla patienter att minst någon förväntning uppfyllts. Gällande den fortsatta vården förväntade sig patienterna bland annat smärtlindring, stöd samt att upprätta en kontakt med Smärtmottagningen. <strong>Slutsats:</strong> Patienter vid en smärtmottagning har förväntningar på vården och att känna till dessa kan underlätta mötet med patienten för sjukvårdspersonalen. Föreliggande studie ger en inblick i tio patienters förväntningar och huruvida de blivit uppfyllda och tyder på att det är av värde att fråga patienter om deras förväntningar. Detta är något som smärtmottagningar kan överväga att implementera i vården.</p></p> / <p><p><strong>Aim:</strong> The aim of this study was to investigate expectations on the first appointment among patients with chronic pain referred to an outpatient pain clinic. The aim was also to investigate to which extent the expectations on the first appointment were fulfilled and to investigate the patients’ expectations on the continuing care and contact with the outpatient pain clinic.<strong> Method: </strong>An empirical study with qualitative design was used. The data was collected through interviews with ten patients after their first appointment at the clinic. Data was processed using manifest content analysis.<strong> Result:</strong> The patients had expectations in various extents prior to their first appointment and on the further care. The patients thought that their expectations were fulfilled to various extent, however all patients expressed that at least one expectation had been fulfilled. Regarding the continuing care the patients expected, among other things, to receive functioning pain treatment and support as well as to establish a contact with the outpatient pain clinic.<strong> Conclusion:</strong> Patients have expectations and awareness of these among the medical staff might facilitate the meeting between the medical staff and the patient. This study provides an insight in ten patients’ expectations and to which extent they have been fulfilled. The study also suggests that it would be of value to ask patients about their expectations, which outpatient pain clinics can consider implementing.</p></p>

The aim of the study was to examine the competence of dental hygienists among Clinic Director´s within the Public Dental Service and Private dentists in the county of Skåne . The study was quantitative and consisted of an electronic questionnaire sent out to all Clinic Directors in the county of Skåne. A total of five hundred and thirty eight questionnaires were sent out. The inclusion criteria were the Clinic directors who employed dental hygienists who had obtained their professional degree during the last four years. Twenty nine Clinic directors responded to the study. The results showed that in general clinic directors are pleased and feel that dental hygienists are proficient in periodontology and dental caries diagnostics. There were two clinic directors who felt that dental hygienists should have more knowledge in the fields of endodontics and pedodontics. The Clinic directors were asked if they wanted to add a certain skill or specialty to the competence of dental hygienists. Two of the clinic directors said that they would like to see dental hygienists be able to measure blood and sugar levels if needed. In conclusion, this study shows that most of the clinic directors thought that the dental hygienists had good knowledge and skills within their operating range. The result of this study must be interpreted with caution because of the low response rate. / Syftet med studien var att undersöka vad klinikchefer inom Folktandvården i Region Skåne och Privattandläkarna i Skåne län ansåg om tandhygienistens kompetens. Studien var kvantitativ och bestod av en elektronisk enkät som skickades ut till samtliga klinikchefer inom Folktandvården och Privattandläkarna i Skåne län. Det skickades ut totalt 538 enkäter. Inklusionskriterierna var de klinikchefer som anställt en tandhygienist som tagit sin yrkesexamen under de senaste fyra åren. Tjugonio klinikchefer besvarade enkäten. Resultatet av studien visade att klinikcheferna ansåg tandhygienisten kunnig inom parodontologi och kariesdiagnostik. Det var två klinikchefer som önskade att tandhygienisten skulle ha ökad kompetens inom endodonti och pedodonti. Klinikcheferna fick svara på en fråga i enkäten om de önskade lägga till något i tandhygienistens kompetensområde och där svarade två klinikchefer att blodsocker- och blodtrycksmätning skulle ingå i tandhygienistens kompetensområde. Slutsatsen av studien visar att merparten av klinikcheferna ansåg att tandhygienisterna hade bra kompetens inom sitt arbetsområde. På grund av låg svarsfrekvens måste reultatet tolkas med stor försiktighet.

Primary care clinics play a vital role in the US healthcare system, providing preventative and cost-effective care. New trends in healthcare such as the development of the medical home model for care, the application of electronic medical records (EMRs), the effort to increase access to care, and the need to adhere to the Health Insurance Portability and Accountability Act (HIPAA) will have direct impacts on the work flow and spatial delineation of primary care clinics. To ensure the success of primary care practices, the architectural design of primary care clinics needs to address these changes to satisfy both patients and staff, and to improve efficiency and outcomes of care. There is limited literature on the design usability (efficiency, effectiveness, and user satisfaction) of primary care clinics. This study developed a set of building usability evaluation tools to collect, analyze and interpret the “usability” of a primary care facility. The study used previous literature as well as a case study primary care clinic in Maryland as a basis to develop these tools. In the clinic, data were collected through an initial interview with the head nurse, a forty-hour behavioral observation, and a staff survey. A behavioral observation tool and a survey questionnaire were developed for the data collection. For data analysis, JMP Pro 9 software was used to analyze the data collected through behavioral observation and the staff survey. The literature review developed a “Building Usability Framework” specifically for healthcare design. A data analysis tool, the “Usability Matrix” was created to integrate and understand the analyzed data within the Building Usability Framework. Integrating the analyzed data from the case study within the Usability Matrix, a primary care clinic usability evaluation survey was developed at the end of the study. This survey along with the behavioral observation tool and design analysis tools were compiled together to produce the “Building Usability Evaluation Tool-Kit for Primary Care Clinics.” This tool-kit can be used by architects and researchers interested in designing and analyzing “usable” primary care clinics.

Health care is increasingly complex, which increases the demand for knowledge and expertise. Despite this, the share of specialized nurses, including anaesthesia nurses, has decreased from 65% to 48% from year 1995 to year 2008, according to statistics from the National Board of Health and Welfare (Socialstyrelsen) in 2010. Studies indicate that there may be various factors in the work environment that anaesthesia nurses, choose to leave the anaesthesia profession. The purpose of this study was to examine how anaesthesia nurses experienced the physical and psychosocial work. The study was conducted as a descriptive study with qualitative approach. The question guide consisted of semistructured questions relevant to the purpose of the study. The interviews were transcribed and analyzed using manifest content analysis. A total of 20 anaesthesia nurses from five Central Swedish hospitals of varying size were interviewed. Anaesthesia nurses' physical and psychosocial work environment includes many stressors such as physical hard work in confined spaces, production and fulfillment, requirements and lack of control, varying relations to managers, hierarchies, team work, a lot of responsibilities, including supervision of students. The deep interest in the work, and the experience of doing an important work, offsetting to a minor part the anaesthesia nurses' work environment's negative expressions, and was a driving force to continue to work on. The results of this study should be supported by further research and investigate both the psychosocial and physical work environment for anaesthesia nurses and the impact on their psychosocial health. / Sjukvården blir alltmer komplex, vilket ökar kraven på kunskap och specialistkompetens. Trots detta har andelen specialistutbildade sjuksköterskor, däribland anestesisjuksköterskor enligt statistik från Socialstyrelsen 2010, minskat från 65% till 48% åren 1995-2008. Studier indikerar att det kan finnas faktorer i arbetsmiljön som gör att anestesisjuksköterskor av olika orsaker väljer att lämna anestesiyrket. Syftet med denna studie var att undersöka hur anestesisjuksköterskor upplevde sin fysiska och psykosociala arbetsmiljö. Studien genomfördes som en deskriptiv studie med kvalitativ ansats. Frågeguiden bestod av semistrukturerade frågor relevanta för studiens syfte. Intervjuerna transkriberades och analyserades med manifest innehållsanalys. Totalt intervjuades 20 anestesisjuksköterskor från fem mellansvenska sjukhus av varierande storlek. Anestesisjuksköterskors vardag som innebar hårt fysiskt arbete i begränsade utrymmen, höga produktionskrav, bristande kontroll, varierande förhållande till chefer, hierarkier, teamarbete, handledning av studenter och mycket ansvar för patienten var en bra grogrund för stress. Det djupa intresset för arbetet, och upplevelsen av att vara betydelsefull, uppvägde till viss del anestesisjuksköterskornas arbetsmiljös negativa yttringar, och var en drivkraft att arbeta vidare.     Resultatet av denna studie bör styrkas med ytterligare forskning med syfte att undersöka både den fysiska och psykosociala arbetsmiljön för anestesisjuksköterskor, då resultat visar att fysiska faktorer även ger utslag på den psykosociala hälsan.

Thesis (M.S. in Operations Research)--Naval Postgraduate School, June 2004. / Thesis advisor(s): Samuel E. Buttrey. Includes bibliographical references (p. 161). Also available online.

Hospital ambulatory patients are seen in outpatient departments (OPDs) located in the hospital. 83.3 million visits were made to these departments in 2002. Many sources of patient waiting time exist including: poor coordination of information, inefficient scheduling, inaccurate time estimation and others. Well-designed and executed patient scheduling has the potential to remedy some of these problems. To properly schedule patients, variability in demand must be addressed. Patients may cancel appointments, arrive late and arrive without appointments. We address this problem based on a Multi-attribute Decision Making (MADM) approach. Decision models are developed using the Simple Additive Weighting (SAW) method to address scheduling decisions for late-arrival and walk-in patients and the operational decision of calling back patients from the waiting room.The models are developed as part of a case study at H. Lee Moffitt Cancer Center and tested in a single-clinic computer simulation against the current clinic system decision process with respect to various performance measures.The proposed decision models successfully made walk-in and late patient scheduling decisions. The contributions of this research include identifying, defining and weighting of relevant decision making criteria at H. Lee Moffitt. Our decision models guaranteed all of the defined criteria are included every time a walk-in or late patient decision must be made. Based on the findings, implementation of the models with no reduction in number of patients would improve scheduling and operational decisions while not affecting clinic output measures.Using criteria to restrict the number of late and walk-in patients, on average, the clinic closed between 36.20 minutes and 47.95 minutes earlier. However, practitioner and room utilization suffered. The tradeoff among number of patients seen, resource utilization, waiting time and clinic close time should be considered but cannot be fully assessed solely on the information gathered in this research. As a case study of H. Lee Moffitt Cancer Center, the decision models successfully incorporated all relevant patient criteria without adversely affecting the clinic system. Future research is needed to better understand what factors will impact system measures and expand the decision models to other outpatient clinic settings.

A partir d’une intervention auprès de médecins du travail, cette thèse explore les conditions de développement des sentiments au travail. Elle stabilise une conceptualisation de l’affectivité distinguant affect, émotion et sentiment qui pose des rapports entre l’affect lié aux conflits de l’activité (conflits liés à la conception de l’activité comme triade vivante sujet/objet/autrui et conflits liés aux rapports entre le déjà vécu et le vivant) et les sentiments et émotions qui en sont les instruments de réalisation. Le sentiment est défini comme l’instrument de réalisation de l’affect détaché de l’événement affectif et relié à l’activité de pensée. Une analyse multimodale de nos matériaux s’attache à repérer des indices de l’affect dans trois modalités étudiées (regard, voix, mot) et des indices de développement de la pensée (développement des significations des mots et des objets de discours). Nous concluons que l’intervention en clinique de l’activité par l’exposition de l’activité qu’elle autorise et la production de débats sur les critères du travail bien fait qu’elle organise peut provoquer des affects et contribuer au développement du sentiment du travail bien fait. / Based on an intervention with occupational health physicians, this thesis explores the developmental conditions of sentiments at work. The thesis seek to stabilize a conceptualisation of affectivity distinguishing affect, emotion and sentiment, and lays the relationships between affect, which is related to conflicts of activity (conflicts related to activity as a living triad subject/object/others and conflicts related to relationships between the « already lived » and the « living »), and sentiments and emotions, which constitute its instruments of realization. Sentiment is defined as instrument of affect realization, detached of affective event, and related to thinking activity.Multimodal analysis of research materials allows the identification of affect indices, based on three studied modalities (gaze, voice, word), and development of thinking indices (development of signification of word, and discourse objects).We conclude that intervention in clinic of activity, by exposing activity and producing disputations on quality of work criteria, can cause affects and contributes to develop the sentiment of « well-done-work ».

Syfte: Syftet med denna studie är att bland patienter med långvarig smärta, som är remitterade till en smärtmottagning, undersöka förväntningar avseende det första besöket, i vilken utsträckning patienterna anser att dessa uppfylldes samt att undersöka vilka förväntningar patienterna har på den fortsatta vården och kontakten med Smärtmottagningen. Metod: En empirisk studie med kvalitativ deduktiv ansats. Datainsamling skedde genom att tio personer intervjuades på Smärtmottagningen efter deras första besök. Materialet bearbetades med manifest innehållsanalys. Resultat: Patienter vid Smärtmottagningen hade i olika stor utsträckning förväntningar inför det första besöket och den fortsatta vården. Patienterna ansåg i varierande utsträckning att deras förväntningar på det första besöket hade uppfyllts, dock uttryckte alla patienter att minst någon förväntning uppfyllts. Gällande den fortsatta vården förväntade sig patienterna bland annat smärtlindring, stöd samt att upprätta en kontakt med Smärtmottagningen. Slutsats: Patienter vid en smärtmottagning har förväntningar på vården och att känna till dessa kan underlätta mötet med patienten för sjukvårdspersonalen. Föreliggande studie ger en inblick i tio patienters förväntningar och huruvida de blivit uppfyllda och tyder på att det är av värde att fråga patienter om deras förväntningar. Detta är något som smärtmottagningar kan överväga att implementera i vården. / Aim: The aim of this study was to investigate expectations on the first appointment among patients with chronic pain referred to an outpatient pain clinic. The aim was also to investigate to which extent the expectations on the first appointment were fulfilled and to investigate the patients’ expectations on the continuing care and contact with the outpatient pain clinic. Method: An empirical study with qualitative design was used. The data was collected through interviews with ten patients after their first appointment at the clinic. Data was processed using manifest content analysis. Result: The patients had expectations in various extents prior to their first appointment and on the further care. The patients thought that their expectations were fulfilled to various extent, however all patients expressed that at least one expectation had been fulfilled. Regarding the continuing care the patients expected, among other things, to receive functioning pain treatment and support as well as to establish a contact with the outpatient pain clinic. Conclusion: Patients have expectations and awareness of these among the medical staff might facilitate the meeting between the medical staff and the patient. This study provides an insight in ten patients’ expectations and to which extent they have been fulfilled. The study also suggests that it would be of value to ask patients about their expectations, which outpatient pain clinics can consider implementing.

Ett använt begrepp när det gäller tonårstjejer och sexualitet är sexuell agens, att handla efter egna beslut. Avsikten med denna studie är att nå en ökad förståelse av vad som påverkar utvecklingen av sexuell agens hos tonårstjejer, utifrån berättelser av två professioner vid ungdomsmottagningar. Syftet är också att göra en kritisk analys och en sociologisk teoretisering av upplevelsen av sexuell agens samt utifrån ett maktperspektiv utreda dess disciplinerande och frigörande potential. Tidigare forskning visar främst att det finns en avsaknad av lust och kunskap hos tonårstjejer samt att deras förmåga att ta självständiga beslut i relation till sexualitet är avhängt deras agens. I denna studie genomfördes kvalitativa intervjuer med barnmorskor och kuratorer vid ungdomsmottagningar. Tematisk analysmetod användes vid tolkningsförfarandet. Det empiriska materialet visade bland annat att tonårstjejers agens är influerat av yttre påverkan, gränssättning, skam, självförtroende och kunskap. För att nå en sociologisk förståelse av det empiriska materialet har sociologiska perspektiv på sexualitet, makt samt Foucaults teori om kroppens disciplinering använts. Baserat på professionerna vid ungdomsmottagningarna visade analysen att utvecklingen av sexuell agens gynnas av kunskap och självförtroende, hämmas av påverkan och skam samt både gynnas och hämmas av gränssättning. Den fördjupade analysen visade att sexuell agens kan skapa autonoma beslut, vilket minskar sårbarheten för maktens disciplin och därmed verkar frigörande inom disciplinens egendefinierade gränser. En avslutande slutsats var att upplevelsen av sexuell agens bör förstås som främst disciplinerande. / A concept that has been used in relation to teenage girls and sexuality is sexual agency, to act upon independent decision. The purpose of this study is to reach a better understanding of what influences the development of sexual agency in teenage girls, based on narratives of two professions at youth clinics. It also aims to make a critical analysis and a sociological theorization of the perception of sexual agency and from a power perspective investigate its disciplining and liberating potential. Previous research’s primary conclusion is that there is a lack of desire and knowledge among teenage girls. Their ability to take independent decisions in relation to sexuality depends on their agency. In this study qualitative interviews were conducted with midwives and counselors at youth clinics. Thematic analysis was used in the interpretation process. The empirical material showed that teenage girls’ agency is influenced by external influences, limit-setting, shame, self-confidence and knowledge. To reach a sociological understanding of the empirical material sociological perspectives on sexuality, power and Foucault's theory of disciplining the body have been used. Based on professions at youth clinics, the analysis showed that the development of sexual agency benefit from knowledge and confidence is hampered by influence and shame, and both benefits and hampers by boundaries. The enhanced analysis showed that sexual agency may create more autonomous decisions, reducing vulnerability to disciplining forces and thereby has liberating effects within the self-defined boundaries of the discipline. One final conclusion was that the perception of sexual agency should be understood as primarily disciplining.

Hypertoni beskrivs vara en riskfaktor bland annat för hjärtkärlsjukdomar som tenderar att öka och patienter med hypertoni når i allt större utsträckning inte behandlingsmålen enligt Socialstyrelsens nationella riktlinjer. Tidigare studier har visat att distriktssköterskeledda hypertonimottagningar med strukturerade strategier har haft positiv effekt för patienter med hypertoni, men inte beskrivit vilka stödjande insatser som distriktssköterskorna utför. Syftet var att beskriva distriktssköterskans erfarenhet av att bedriva stödjande insatser vid en hypertonimottagning inom primärvården. Urvalet bestod av fyra distriktssköterskor som bedrev hypertonimottagning i primärvården. Materialet till pilotstudien samlades in via intervjuer. Kvalitativ innehållsanalys med induktiv ansats valdes som metod. I resultatet framkom att de stödjande insatserna utgjordes av distriktssköterskans förhållningssätt i bemötandet och att kunskap och färdighet utnyttjades i ett individbaserat mottagande. Genom att uppmärksamma och synliggöra hur de stödjande insatserna påverkar patienten kan hälsofrämjande metoder utvecklas ytterligare. Detta i sin tur skulle kunna leda till förslag på hur stödjande insatser som ämne skulle kunna implementeras i vårdutbildningar på alla nivåer med ännu större fokus på det holistiska synsättet på hälsa. / Hypertension is increasing worldwide and it is a risk factor for cardiovascular disease. There are an increased frequency of patients with hypertension who do not reached treatment goals according to The National Board of Health and Welfare. Previous studies have shown that district nurse hypertension clinics with structured strategies have had a positive impact on patients with hypertension. However, these studies have not described the supportive interventions that district nurses´ perform. The aim of this study was to explore the district nurses´ experiences of doing supportive interventions at a hypertension clinic in primary care. The sample consisted of four district nurses who were carrying of hypertension clinic in primary care. The material for the pilot study was collected through interviews. Qualitative content analysis with an inductive approach was chosen as the method. The results showed that the supportive interventions consisted of standing for a supportive attitude in facing and using knowledge and skills in individualized reception. By paying attention to and make visible how the supportive interventions affect the patient can health-promoting methods be further developed. This in turn could lead to proposals for supporting efforts that topic could be implemented in nursing programs at all levels with greater focus on the holistic approach to health.