In response to the striking health and social inequalities existing across communities within a large Southern Ontario City the McMaster University School of Nursing has partnered with the local family health team, municipal government, and other community partners to evaluate a pilot program designed to enhance health and social outcomes within a specific priority neighbourhood. The innovative pilot program is a nursing-based system navigation role, grounded concurrently in the community and a local Primary Care Practice. The role is uniquely designed as the nurse provides navigation for individuals and families while functioning as a networker to facilitate improved service integration at a systems level. This study serves as a narrative person-centered evaluation of the program, emphasizing the impact on the lives of community members. This study employed the Three-Dimensional Narrative Inquiry Space method as described by Clandinin and Connelly (2000) to explore the experience of nine community residents utilizing navigation services through the Community Nurse Navigator/Networker (CNN). Programs tell a story; therefore, the collection and analysis of participants’ life stories, in conjunction with field notes, observations, and documents, created a common narrative of the experience of navigation in a community setting. A thematic analysis of participants’ life stories was conducted to present a common narrative of community members’ experience of navigation. The major finding of this study was the positive experience residents shared interacting with the CNN. Participants valued the development of a therapeutic relationship through social interactions, the significance of place on the impact of the CNN role, and the effect of the navigation role to address health disparities over time. Study findings have implications for continued development of the CNN role and other community-based nurse navigation roles in priority neighbourhoods to address health inequities. / Thesis / Master of Science in Nursing (MSN)

Introduktion: Antalet personer som insjuknar i kognitiv sjukdom ökar varje år. Detta betyder att anhöriga får en betydande roll i vårdandet av sina närstående med kognitiv sjukdom i hemmet. Anhöriga önskar få stöd i hur deras närstående kan tas hand om och distriktssköterskan behöver därför veta hur stödet kan ges. Syfte: Syftet med studien var att undersöka hur distriktssköterskan inom hemsjukvården kan stödja anhörig som vårdar sin närstående med kognitiv sjukdom i hemmet. Metod: Metoden utgick från Polit och Beck’s. Den valda metoden för litteraturstudien är en integrativ litteraturstudie med induktiv design. I Cinahl och Pubmed genomfördes databassökningar vilket resulterade i 12 artiklar. Dataanalys baserades på Whittemore och Knafl. Resultat: Tre huvudteman framkom vilka var Att skapa en god relation, Att använda samtal som stöd och Att möta utmaningarna. Slutsats: En god relation som innebär delaktighet och kontinuitet är av vikt för hur distriktssköterskan kunde stödja anhöriga. Kommunikationen mellan distriktssköterska och anhörig ska vara stödjande och rådgivande. Distriktssköterskan är också en viktig del i förmedling av kunskap och kan på så sätt stödja anhöriga som vårdar närstående med kognitiv sjukdom i hemmet genom strategier för att hantera sjukdomen och komplexa vårdsituationer. / Introduction: The number of people suffering from cognitive disorders increases every year. This means that relatives have a significant role in caring for their loved ones with cognitive illness at home. Relatives wish to receive support in how their loved ones can be cared for, and the district nurse therefore needs to know how support can be provided. Purpose: The purpose of the study was to explore how the district nurse in home health care can support relatives who care for their loved one with cognitive illness at home. Method: The method was based on Polit and Beck's. The chosen method for the literature study is an integrative literature study with an inductive design. Cinahl and Pubmed were searched, and 12 articles were found through analysis based on Whittemore and Knafl. Results: Three main themes emerged which were To create a good relationship, Using conversations as support and Meeting the challenges. Conclusion: A good relationship that involves participation and continuity is important for how the district nurse can support relatives. The communication between the district nurse and the relative must be supportive and advisory. The district nurse is also an important part of imparting knowledge and can support relatives who care for family members with cognitive illness at home through strategies for managing the illness and complex care situations.

Bakgrund: Vaccinering mot allvarliga, smittsamma sjukdomar är en av de mest effektiva åtgärderna till god folkhälsa i världen. Det förhindrar många dödsfall och svåra komplikationer av sjukdomarna varje år. Sverige har en hög vaccinationstäckning, och en av distriktssköterskans roller är att nå ut till tveksamma föräldrar med information om varför barnvaccinering är viktig. Syfte: Att belysa vilka strategier distriktssköterskor tillämpar i mötet med föräldrar som tvekar till att vaccinera sina barn enligt vaccinationsprogrammet. Metod: Studiedesignen var en semistrukturerad intervjustudie med enskilda eller gemensamma intervjuer, och metoden var en kvalitativ innehållsanalys med induktiv ansats. Resultat: Distriktssköterskorna beskrev att det viktigaste i mötet med tveksamma föräldrar var att vara påläst, att inte stressa utan låta det ta den tid det tar. Att de först bygger på en relation och skapar förtroende, och sedan genom att vara lyhörd och respektfull kunna få förmedla en anpassad information. Viktigt var också att ha stöd och hjälp av kollegor och BHV-team. Diskussion: Det distriktssköterskorna beskrev visar på att det regionalt finns ett bra nätverk och fortbildning, samt nationellt kunskapsunderlag, som stöd som de kan ta del av för att anpassa sina strategier, oavsett vilken erfarenhet de har av möten med tveksamma föräldrar. Slutsats: Denna studie visar på olika tips och strategier som en distriktssköterska kan ha användning av i sitt arbete oavsett vilket BVC de arbetar på. / Background: Vaccination against serious, contagious diseases is one of the most effective interventions for public health in the world. It prevents many deaths and serious complications of these diseases every year. Sweden has a high vaccination rate, and one of the roles of the Community Health nurse (CH nurse) is to reach hesitant parents with information about the importance of child vaccination. Aim: To illustrate which strategies CH nurses use in meeting parents who hesitate to vaccinate their children according to the National Child Vaccination Program. Method: Design of the study was a semi-structured interview study containing single and joint interviews, and the method was a qualitative content analysis with an inductive approach. Results: The CH nurses described that what was most important in the meeting with hesitant parents was to be well informed, not to stress but to take the required time necessary. The nurses found that by first building a relationship and a trust, by being responsive in listening and respectful, they could receive permission to give individualized information. Also of importance was to have support and help from colleagues and the regional Child Health Care Team. Discussion: What the CH nurses described show that they have a working regional network and access to further education, and also that there is a national base of knowledge, as support to adjust their strategies, no matter what experience they have in meeting hesitant parents. Conclusion: This study presents different tips and strategies that a CH nurse may have of use, no matter which Child Health Care Center they work on.Keywords: / <p>Godkännandedatum: 2019-11-12</p>

Bakgrund: Palliativ vård omfattar inte bara vård av patienten utan innefattar även stöd till närstående, både under vårdtiden och efter dödens faktiska inträffande. Ett efterlevandesamtal är en möjlighet för distriktssköterskan att följa upp hur de närstående mår en tid efter dödsfallet och hur de upplevde vården under sjukdomstiden. Syfte: Att beskriva distriktssköterskors och sjuksköterskors erfarenheter av efterlevandesamtal inom kommunal hemsjukvård. Metod: Studien hade en kvalitativ deskriptiv design med en induktiv ansats. Åtta individuella semi-strukturerade intervjuer genomfördes via videomöte. Insamlat material analyserades genom en kvalitativ innehållsanalys med fokus på det manifesta innehållet. Resultat: I resultatet framkom att efterlevandesamtal erbjöds efter alla dödsfall. Arbetsuppgiften beskrevs vara värdefull och mångsidig samt något som distriktssköterskan fått lära sig på egen hand. Efterlevandesamtalet hade en avslutande funktion från både distriktssköterskans och de närståendes perspektiv. Efterlevandesamtalets syfte ansågs vara att identifiera de närstående som var i behov av stöd samt ta emot synpunkter ifrån de närstående och reda ut eventuella frågor. Synpunkterna ansågs viktiga att ta vara på för att kunna kvalitetsutveckla vården. Slutsats: Betydelsen av efterlevandesamtalet var utifrån distriktssköterskornas perspektiv viktig för både distriktssköterskorna och de närstående. Distriktssköterskornas inställning till att genomföra efterlevandesamtal varierade. Framförallt ansågs det vara en värdefull arbetsuppgift men beskrevs även kunna vara svår och krävande. Vår studie skulle kunna hjälpa distriktssköterskor som känner en oro inför efterlevandesamtalet att se på det ur ett annat perspektiv. / Background: Palliative care includes not only the care of the patient, but also support for family members, both during the period of care and after the actual occurrence of death. A bereavement follow-up is an opportunity for the community health nurse to follow up on how the family members feel some time after the death and how they experienced the care during the illness. Aim: To describe the community health nurses experiences of bereavement follow-up in home care services. Method: The study had a qualitative descriptive design with an inductive approach. Eight individual semi-structured interviews were conducted via video meeting. The collected material was analyzed through a qualitative content analysis with a focus on the manifested content. Findings: The results revealed that bereavement follow-up are offered after all deaths. The task was perceived to be valuable and versatile, as well as something that the community health nurse had to learn on their own. The bereavement follow-up had an ending function from both the community health nurses and the family members perspective. The purpose of the bereavement follow-up was to identify the family members in need of support and to receive comments from the family members and sort out any issues. The comments were considered important to take advantage of to improve the quality of the care. Conclusion: From the perspective of the community health nurses the bereavement follow-up was important for both community health nurses and family members. Among the community health nurses the attitude to have bereavement follow-up varied. Above all, it was considered a valuable task but could also be difficult and demanding. Our study could be helpful to those who are anxious about the bereavement follow-up, to look at it from a different perspective.

Personer med funktionsnedsättning är en utsatt grupp som lider av sämre hälsa än övriga befolkningen, vilket ser lika ut i hela världen. I Sverige är ohälsa hos personer med funktionsnedsättning vanligt förekommande och relaterad till ohälsosamma levnadsvanor, vilka till stor del skulle kunna förebyggas. Distriktssköterskan har ett ansvar att arbeta hälsofrämjande och är den profession som vanligen ansvarar för hälso- och sjukvården hos personer med funktionsnedsättning som bor på en LSS-bostad. Syftet med studien var att beskriva distriktssköterskans upplevelse av hälsofrämjande arbete hos personer som bor på LSS-bostäder. En kvalitativ studiedesign användes och data insamlades vid tio semistrukturerade intervjuer, vilka analyserades med kvalitativ innehållsanalys utifrån en induktiv ansats. Resultatet visar på att distriktssköterskor upplevde det hälsofrämjande arbetet som komplext med flera faktorer som påverkar. Många distriktssköterskor upplevde en frustration utifrån brist på resurser i form av tid och organisatoriskt stöd. Personalen som arbetar på LSS-bostäder var en viktig komponent i det hälsofrämjande arbetet och utgjorde en positiv faktor när kompetens och engagemang fanns, likväl som ett hinder när dessa delar saknades. Resultatet visade att bristande kommunikativa förmåga och insikt i hälsosamma levnadsvanor hos personer med funktionsnedsättning kunde utgöra ett hinder i det hälsofrämjande arbetet. Slutligen visar resultatet på brister i distriktssköterskans hälsofrämjande arbete hos personer som bor på LSS-bostäder. Det behövs fortsatt forskning i hur distriktssköterskan bör arbeta hälsofrämjande och hur distriktssköterskans förutsättningar för det arbetet kan förbättras. / People with disabilities are an exposed group who are less healthy and more likely to suffer from illness than the rest of the population. In Sweden, there is a clear connection between people with disabilities and an unhealthy lifestyle. This health issue can be prevented though. Community health nurses are responsible to promote health for people with disabilities living in residence with special services in group housing. The intention with this study is to learn about the experiences community health nurses have while promoting health in group housing. 10 semi-structured interviews have been conducted with community health nurses working with disabled persons living in group housing. Qualitative content analysis was used to analyze the interviews. The result showed that all nurses experienced their health promoting work as complexed and challenging. They were frustrated with the inadequacy of support from their employer and lack of time to set aside for these tasks. The nurses described the staff working in group housing as essential for health promoting. The staff was described as a positive influence when they were engaged and competent in their field but could also work as an obstacle when they lacked those capacities. The result showed that the nurses experienced the lack of communication abilities and understanding in a healthy lifestyle of the persons with disabilities as the biggest obstacle in their work. Lastly, the results show deficiency in the health promoting work at the residences with special services in group housing led by the nurses. Further research is needed, both regarding the way health promoting work can be conducted by the community health nurse and how the work conditions best could be adapted. / <p>Godkännandedatum: 2020-11-04</p>

OBJECTIVE/ METHOD The study examined implementation challenges faced by primary health care workers within the Ekurhuleni Metropolitan Municipality in Gauteng South Africa. Data collection was based on semi-structured interviews carried out on a purposive sample (n=19) of frontline clinicians working within the district as primary health care practitioners. RESULTS Participants confirmed that work within the primary health care service disproportionately focussed on curative and rehabilitative functions of their roles with little prioritisation of preventive and promotive interventions. Primary identified reasons included, institutional culture that prioritised short-term curative approaches. Clinicians also cited a range of other organisational barriers, such as – poor strategic planning, and a lack of understanding of health promotion and illness prevention. CONCLUSIONS Although the challenges that exist in implementing primary health care are clearly understood, clinicians perceive the solutions for these as being within the control of policy makers and those with power within the organisation. / Health Studies / M.A. (Public Health)

OBJECTIVE/ METHOD The study examined implementation challenges faced by primary health care workers within the Ekurhuleni Metropolitan Municipality in Gauteng South Africa. Data collection was based on semi-structured interviews carried out on a purposive sample (n=19) of frontline clinicians working within the district as primary health care practitioners. RESULTS Participants confirmed that work within the primary health care service disproportionately focussed on curative and rehabilitative functions of their roles with little prioritisation of preventive and promotive interventions. Primary identified reasons included, institutional culture that prioritised short-term curative approaches. Clinicians also cited a range of other organisational barriers, such as – poor strategic planning, and a lack of understanding of health promotion and illness prevention. CONCLUSIONS Although the challenges that exist in implementing primary health care are clearly understood, clinicians perceive the solutions for these as being within the control of policy makers and those with power within the organisation. / Health Studies / M.A. (Public Health)