Abstrakt   En stor del av de cancerpatienter som behandlas i Sverige upplever att de får bristfällig information i samband med sjukdomsbesked och behandling. Tidigare forskning har visat att en majoritet av dessa patienter upplever att de fått för lite information och att de inte förstått informationen de fått.   Syftet med detta projekt är att undersöka om informationsteknik, i form av en applikation, kan bidra till att cancerpatienter kan erhålla personifierad kontextbaserad information av god kvalitet närhelst behov uppstår. Applikationen ska även göra det möjligt för patienten att kunna komma i kontakt med vårdgivaren, via mail, telefon eller röst- och videosamtal.   Att få ett cancerbesked innebär så gott som alltid att den drabbade går in i en traumatisk kris, vars fyra faser i olika grad bland annat innebär begränsningar i förmågan att tillgodogöra sig information. Detta, sammantaget med en ofta mycket krävande behandling, såväl fysiskt som psykiskt, bidrar till att patienten befinner sig i en mycket utsatt situation. Att vara välinformerad om sjukdom och behandling kan bidra till att patienten lättare kan hantera sin situation och till ett bättre psykiskt välbefinnande.   I detta arbete har färdigbehandlade cancerpatienter intervjuats för att utröna vad de anser är viktigt för att cancerpatienter ska känna sig väl informerade och på vilket sätt en applikation skulle kunna bidra till detta. I samtliga intervjuer framkom att deltagarna upplevt att det brast i information i samband med deras sjukdom och behandling. De intervjuade var medvetna om att de fått information under sjukdomstiden men deras upplevelse var att den var inkomplett och framförd vid en tidpunkt då de inte kunde tillgodogöra sig den.   I intervjuerna framkom förslag på innehåll i en tänkt applikation, vilka alla på ett eller annat sätt rörde information. Förslagen sorterades in under sex rubriker vilka sedan blev ingångarna på den tänkta applikationens startsida. En mockup utformades för att visa ett förslag på startsida. / Abstract   Much of cancer patients treated in Sweden feel that they receive inadequate information in connection with disease notification and treatment. Previous research has shown that a majority of these patients feel that they received too little information and they do not understand the information they received.   The purpose of this project is to investigate whether information technology, in the form of an application,  can obtain personalized context-based quality information whenever the need arises. The application should also make it possible for the patient to be able to come in contact with the caregiver, via email, telephone or voice and video calls.   To get a cancer diagnosis usually leads to a traumatic crisis which, in varying degrees, limit the ability to assimilate information. This, together with a very demanding treatment, both physically and mentally, places the patient in a very vulnerable situation. Being well-informed about the disease and treatment may help patients to more easily manage their situation and to improve mental well-being.   In this work, pre-treated cancer patients were interviewed to determine what they feel is important for cancer patients to feel well informed, and the way in which an application could contribute to this. All the interviews showed that participants experienced that there was inadequate information in connection with their disease and treatment. The interviewees were aware that they had received information during their illness but their experience was that it was incomplete and performed at a time when they could not assimilate it.   The interviews revealed proposals on the content of an imaginary application, all in one way or another related to information. The proposals were sorted under six headings which then became the inputs on the intended application's home page. A mockup was designed to demonstrate a proposal on the home page.

Bakgrund: Befolkningen i Sverige blir allt äldre och äldre personer med komplexa vårdbeho vökar. År 2014 var cirka 500000 personer 80 år eller äldre i Sverige och detta beräknas öka till 800000 år 2030. Allt fler äldre vårdas i ordinärt boende och många av dem har komplexa vårdbehov som kräver vård både från landsting, primärvård och kommunal hälso-och sjukvård. Av den anledningen är samarbetet mellan dessa verksamheter en avgörande faktor för att omvårdnaden ska uppnå den kvalitet som de äldre med komplexa vårdbehov har rätt till. Specialistsjuksköterskorfrån de olika verksamheterna har här en viktig roll och det är en utmaning både för denne men även övrig vårdpersonal. Syfte: Syftet med studien är att beskriva specialistsjuksköterskors erfarenheter av samarbete mellan verksamheter i omvårdnaden av äldre med komplexa vårdbehov. Metod: Kvalitativ innehållsanalys med induktiv ansats användes för att kunna besvara studiens syfte. Sju intervjuer genomfördes med både specialistsjuksköterskor och sjuksköterskor som arbetade inom primärvård eller kommunal hälso- och sjukvård. Intervjuerna spelades in, transkriberades och analys gjordes enligt Graneheim och Lundman (2004). Resultat: I resultatet framkom att samarbete mellan olika verksamheter är komplex. Det framkom många faktorer som försvårar vården av den äldre med komplexa vårdbehov och det krävs engagemang och vilja från all vårdpersonal för att samarbetet ska fungera. Slutsats: Personcentrerad vård har stor betydelse för samarbetet mellan verksamheter i omvårdnaden av äldre med komplexa vårdbehov. Att bedriva ett samarbete mellan verksamheter är komplex och flera faktorer påverkar hur det fungerar. / Background: The population in Sweden is getting older and the number of olderpeople is increasing with complex care needs. In 2014, approximately 500,000 people were80 years or older in Sweden and this is estimated to increase to 800,000 by 2030. More and more older people are being cared for in ordinary housing and many of them have complex care needs that require care from county councils, primary care and municipal health and healthcare. For this reason, the collaboration between these activities is a decisive factor for the nursing to achieve the quality to which the older with complex care needs are entitled. Specialist nurses from the various activities have an important role and it is a challenge both for them but also for other care staff. Aim: The aim of this study is to describe specialist nurses’/nurses’ experience of collaboration between establishments in nursing care of older people with complex care needs. Method: Qualitative content analysis with inductive approach was used to answer the aim of the study. Seven interviews were conducted with both specialist nurses and nurses working in primary care or municipal health care. The interviews were recorded, transcribed, and analyzed according to Graneheim and Lundman (2004). Results: The results showed that collaboration between different activities is complex. Many factors emerged that make it more difficult to care for the older with complex care needs. The commitment and willingness of all care staff is required for the collaboration to work. Conclusion: Person-centered care is of great importance for the collaboration between activities in the care of the older with complex care needs. Conducting a collaboration between establishments is complex and several factors affect how it works.

Bakgrund Andelen äldre personer ökar i Sverige och den grupp bland äldre som ökar mest är över 90 år. Antalet äldre som är i behov av vård- och omsorgsinsatser från både socialtjänsten och hälso- och sjukvård förväntas därmed också öka. Ökad efterfrågan på kommunal hjälp i hemmet ställer höga krav på god samverkan och kommunikation mellan de olika instanserna för att minska risken för brister och vårdskador hos den äldre personen med komplexa vårdbehov. Komplexa vårdbehov innebär samtidig närvaro av förändringar som kommer av åldrandet, multisjuklighet, polyfarmaci och skörhet. Syfte Syftet med studien var att undersöka sjuksköterskors erfarenhet av kommunikation kring den äldre patienten med komplexa vårdbehov inom den kommunala hälso- och sjukvården. Metod Studien var en kvalitativ intervjustudie med induktiv ansats. Deltagarna i studien arbetade inom kommunal hälso- och sjukvård i två sydsvenska kommuner. Sex av deltagarna var grundutbildade sjuksköterskor, tre av deltagarna var distriktssjuksköterskor och en var specialistsjuksköterska inom vård av äldre. Datan som samlats in analyserades med hjälp av kvalitativ innehållsanalys. Resultat Resultatet ledde fram till tre huvudkategorier och sju underkategorier. Huvudkategorierna var Samverkan och dialog, Organisatoriska förutsättningar samt Utbildning, Språk och Kompetens. En nära relationen till omvårdnadspersonalen, rätt kompetens och erfarenhet hos omvårdnadspersonalen samt regelbundna möten och träffar var faktorers som ansågs underlätta kommunikationen. Slutsats  Sjuksköterskorna beskrev att teamsamverkan med planerade teamträffar och fysiska möten med personalen var viktigt för fungerande kommunikation. Att minska distansen mellan personalen och ha fungerande rutiner kring kommunikationen var andra värdefulla aspekter som framkom. Det som ansågs försvåra kommunikationen var stress och tidsbrist samt brister i språket hos omvårdnadspersonalen men även organisatoriska hinder så som dålig täckning på mobiltelefoner, laghinder och bristande kontinuitet hos omvårdnadspersonalen. / Background  The proportion of elderly people is increasing in Sweden, and the group among the elderly that is increasing the most is over 90 years of age. The number of elderly people who need care and care interventions from both social services and health care is therefore also expected to increase. Increased demand for municipal help in the home places high demands on good cooperation and communication between the various agencies to reduce the risk of deficiencies and care injuries in the elderly person with complex care needs. Complex care needs mean the simultaneous presence of changes that come from aging, multimorbidity, polypharmacy and frailty. Purpose The purpose of the study was to investigate nurses' experience of communication regarding the elderly patient with complex care needs within the municipal health care system.  Method The study was a qualitative interview study with an inductive approach. The participants in the study worked in municipal health care in two municipalities in southeast of Sweden. Six of the participants were basic nurses, three of the participants were district nurses and one was a specialist nurse in the care of the elderly. The data collected was analyzed using qualitative content analysis. Results The result led to three main categories and seven subcategories. The main categories were Collaboration and dialogue, Organizational conditions and Education, Language and Competence. A close relationship with the nursing staff, the right skills and experience of the nursing staff and regular meetings were considered to facilitate communication. Conclusion  The nurses described that team cooperation with planned team meetings and physical meetings with the staff was important for effective communication. Reducing the distance between staff and having working routines around communication were other valuable aspects that emerged. What was considered to make communication difficult was stress and lack of time as well as deficiencies in the language of the nursing staff, but also organizational obstacles such as poor mobile phone coverage, legal obstacles and a lack of continuity among the nursing staff.

Complex rehabilitative care for pre-school children undergoing c urative stays is the care of which the main task is to promote the health of a child as a whole or, if impaired, to bring it back to normal. A child sanatorium is a health care facility providing long-term preventive care for child patients through its complex therapeutic and rehabilitative methods during the child{\crq}s entire curative stay. It strives for reaching the optimum health condition of a child and for the elimination of possible fallouts. Curative stays are recommended by pediatricians. Generally, curative stays are designed for children between 3 and 15 years of age. They are covered by all health insurance companies. The aim of the thesis was to find out the current possibilities of the use of curative stay offers in the Czech Republic and how the offer of such stays is used, specifically in the mountainous climatic conditions. Also, the work aimed at the factors leading to the fact that some children use the curative stays repeatedly. In order to gather the necessary data to define the aim of the thesis, the method of questionnaire was used and the technique of written questionnaire was used to collect the data. The research used parents and other relatives of the pre-school children who at least once participated in the curative stay together with their child or children. The research was conducted at the Child Sanatorium of Javorník in Šumava during the months of January and February 2007. The hypothesis based on the presumption that the opportunity to use the offer of curative stays for pre-school children is influenced mostly by socio-economic factors was not confirmed. It has been detected that the physicians play an important role in this field. The second hypothesis concerning the repetitive use of the curative stays offer as not being directly linked to the curative effect of the previous stays was also not confirmed because the reasons leading the guardian escort to the decision to send the child or children for a repetitive curative stay are directly linked to the fact that the recently undergone stay has helped the health condition of their child or children.

Background: Previous studies have shown that an integrated care approaches for older people with complex care needs comes with less hospitalization and the reduced cost for the community (Eklund & Wilhelmssons, 2009). Since the new reform about coordinated care (2017:612) took place higher demand was put on the professionals in the health care system to collaborate. The reform indicates that a coordinated care plan should be establish to people with complex care needs when they go from in- to outpatient care (SKR, 2018) Aim: To describe health professionals in municipality, institutional care and primary experience of coordinated care plans to older people with complex care needs and describe their opinion of which elements that facilitated and embarrass the process.Method: The study was conducted whit a qualitative study design in form of interviews. Nine respondents were included in the study. A content analysis with a deductive approach was used (Elo & Kyngäs’s. 2018). Widmarks et al; s (2011) model was used as a theoretical framework.Result: The key factors: allocation of responsibilities, confidence and the professional encounter was found in the analyses. And there were areas in al of them were barriers to collaboration occurred and made collaboration difficult. Conclusion: The result indicates that there is a lack of clarity due to the guidelines of the collaboration process. These guidelines must be improved to facilitate collaboration for older people with complex care needs.

No description available.

This study explored the perspectives of children whose complex health needs included respiratory technology dependence, and that of their parents, regarding community life and helpful patterns of coping and relationship. In-depth interviews were conducted with 7 children (3-18 yrs. old) and 8 parents. Survey data collected from 31 parents contributed to a convergent mixed methods design. Findings showed that children viewed themselves as normal, but experienced "a constricted life". Parents' active engagement in their child's life, as system navigators and advocates, was necessary to ensure their child's wellbeing. Key relational components included "authentic engaged presence", caring, competence, communication and collaboration. Effective coping patterns included reliable social support and both emotion-focused and problem-focused strategies. Contextual factors significantly affecting parental coping and relationships included family structure and child’s dependence on invasive respiratory technology (tracheostomy). Respite reported inadequate. Findings have practice and policy implications for health, respite and education systems, professionals and parents.

This study explored the perspectives of children whose complex health needs included respiratory technology dependence, and that of their parents, regarding community life and helpful patterns of coping and relationship. In-depth interviews were conducted with 7 children (3-18 yrs. old) and 8 parents. Survey data collected from 31 parents contributed to a convergent mixed methods design. Findings showed that children viewed themselves as normal, but experienced "a constricted life". Parents' active engagement in their child's life, as system navigators and advocates, was necessary to ensure their child's wellbeing. Key relational components included "authentic engaged presence", caring, competence, communication and collaboration. Effective coping patterns included reliable social support and both emotion-focused and problem-focused strategies. Contextual factors significantly affecting parental coping and relationships included family structure and child’s dependence on invasive respiratory technology (tracheostomy). Respite reported inadequate. Findings have practice and policy implications for health, respite and education systems, professionals and parents.

One of the central challenges for the healthcare system today is how to manage care for patients with complex needs. This patient group is not well-defined but covers patients with serious diseases and comorbidities, or with a limited ability to perform basic daily functions due to physical, mental or psychosocial challenges. This group has a high service and resource utilisation resulting in high costs for the healthcare system and, typically, poor health outcomes. To improve care for these patients, it is necessary to implement strategies to manage the differentiated care needs, the additional support needs, the uncertainty in care delivery, and the coordination needs of the involved providers and the patient. Care pathways are increasingly used internationally to make care more patient-centred and to structure and design care processes for individual patient groups. Important elements in care pathways include structuring care activities, by defining their content and sequence; coordinating between providers and professionals; and involving patients in their care process. In this thesis, care pathways are proposed as the overall strategy for managing care for patients with complex care needs. The purpose of this thesis is thus to contribute with knowledge on how care pathways can be managed for patients with complex care needs. This is achieved by analysing how the practices coordination, standardisation, customisation and personalisation can support management of care pathways and by discussing how these practices influence quality of care. The quality of care dimensions discussed are accessible, timely, equitable, and patient-centred care. The empirical context in this thesis is the Standardised Cancer Care Pathways (CCPs) which were implemented in Sweden from 2015 to 2018. CCPs is the umbrella term for the national initiative to shorten waiting times, decrease regional differences and reduce fragmentation in care processes. CCPs include elements such as diagnosis-specific pathways and guidelines, introduction of CPP coordinators, and mandatory reporting of waiting times. Focus has been on implementing care pathways for 31 cancer diagnoses in all Swedish healthcare regions. Both qualitative and quantitative research methods have been used. A case study was conducted to examine standardised and customised care pathways, and coordination and multidisciplinary work in care pathways. A document study of regional reports on CCPs was analysed to study effects of care pathways on accessibility, timeliness and equitability. Finally, a national survey was conducted to deepen the understanding of the role of coordination, as performed by coordinators, in care pathways. This thesis argues that standardised and customised care pathways should be combined to manage care for patients with complex care needs. The customised pathway in particular benefits patients with serious unspecific symptoms, unknown primary tumour or more complex care needs, while patients with care needs that can be treated independently of the main diagnosis benefit from following a standardised care pathway. Coordinators are an important means to manage coordination, customisation and personalisation in the care pathway. The coordinators’ role is twofold: the first role is to manage care pathways by customising the care pathway and coordinating involved providers; the second role is to support and guide patients through the care pathway. This can be achieved by adapting interpersonal communication with patients through personalisation. This thesis further argues that care pathways have most potential to positively influence accessibility, timeliness, equitability, and patient-centredness. Accessibility has been positively influenced, especially for patients with ambiguous symptoms where symptoms indicating cancer have improved their chances of accessing cancer diagnostics. A negative aspect of prioritising patients who follow CCPs has been the potentially longer waiting times for other patient groups in equal need of urgent care. Notwithstanding, prioritised access to care is perceived to positively influence timeliness for patients following CCPs. Care pathways are perceived to have positively influenced patient-centredness by shifting the focus from what to deliver to how to deliver it.

No description available.