The purpose was to elucidate the reactions of formal carers as witnesses and helpers in situations of elder abuse, to illuminate abusive situations and to reflect on the findings from an ethical point of view. Twenty-one district nurses from one county council were interviewed (I, II, III, IV). They described the problems they had when dealing with cases of elder abuse, the uncertainty they felt when they approached the family, identified the abuse and intervened (I). They used no distinct definition of elder abuse but described it as ’overstepping the boundaries of a person’s integrity/autonomy’ (II). In the 44 cases narrated the elderly people were mostly physically and/or psychologically impaired, the person abused could either be the impaired elderly person, the informal carer or both. Abuse was related to the inability of one party to meet the demands made on him/herself, the other person, or to a history of violence (III). The cases narrated were analysed for reliability and were considered reliable (IV). Questionnaires submitted to 163 district nurses revealed 33 cases of elder abuse (V) and to home service assistants 97 cases (VI). The abused elderly people were often very old women, mostly healthy or unhealthy in equal proportions. The perpetrators were mostly close relatives, responsible or not responsible for the caring. The abusive acts often involved a combination of psychological, physical, and financial abuse and neglect. Mental disturbance and alcohol abuse, as well as financial reasons were reported as contributing to the abuse (V, VI). The attitudes of general practitioners, district nurses and home service assistants towards elder abuse and the interventions suggested in hypothetical cases of elder abuse were investigated (VII). All groups were uncertain about their attitudes towards elder abuse. Their suggested interventions were amalgamated into three groups; sparse and of the social type, more specific and of the health care and voluntary type, or overall types of intervention. The situation, profession and organization seemed to result in different interventions (VII). The findings were reflected on using Lögstrup’s ethic as a framework, and the conclusion was that in order to be able to intervene successfully formal carers need to find solutions on a meta-level. Conventions and norms must be developed and public responsibility is needed. / <p>S. 1-82: sammanfattning, s. 85-199: 7 uppsatser</p> / digitalisering@umu

The impact of the pharmacist in elderly patient healthcare management is developing. In our study, the interventions made by community pharmacists in the RESPECT study (Randomised Evaluation of Shared Prescribing for Elderly people in the Community over Time) were analysed and evaluated. In our study, the study sample was chosen according to specific criteria. The outcomes of these pharmacist interventions were measured by a clinical panel which scored and categorised each intervention into one of five categories. The study also investigated the percentage of interventions implemented or not implemented by GPs. In our study, initially 398 patients and of these 52 were excluded because their files did not contain the entry criteria information, leaving 346 patients who were identified with a mean (SD) of 8.9 (3.3) pharmaceutical care plans which contained mean (SD) 8.2(7.2) pharmaceutical care issues. Of these 43% were males and 57% were females with a mean (SD) age of 81(3.7) years. There were many missing data about drugs prescribed due to poor documentation by community pharmacists in the RESPECT study particularly at post study period (T5). The mean (SD) for all drugs prescribed was 35.9 (12.38) for each patient and for the whole study period including the post period (T5). In our study a total of 2879 individual pharmaceutical care issues were identified. A clinical panel judged that 43% of the interventions prevented harm, 31% improved the efficacy of management, 3% were detrimental to the patient's management plan, 12% only provided information and there was insufficient information to make a decision on the remaining 11%. For the classifications prevented harm to the patient and improve efficacy of management, the panel gave a score of 7 or more to 264 and 103 respectively which were classed as potential prevented hospital admissions. The outcome of 1628 could not be determined from the data and the pharmacist did not intervene on 361 occasions. Of the remaining 890 (30.9%) GPs accepted 715 and did not accept 175. The cost effectiveness of providing pharmaceutical care to older people by community pharmacists could be estimated (£620,000) by calculating reduction in expenditure of hospital admissions. In addition, there would be the possibility of reduced pressure on other NHS resources such as availability of hospital beds. The involvement of a clinical pharmacist in elderly patient health care, within the setting of a community pharmacy, provided positive healthcare outcomes and therefore should be encouraged in line with the new white paper for England "Building on strengths-delivering the future" (2008). The study emphasises the importance of revising the nature and period of postgraduate training for community pharmacists who are going to provide pharmaceutical care for elderly patients. This raises the possibility of specialised competency based postgraduate training for community pharmacists with a special interest in the care of older people (PhwSI). This would enable community pharmacists practising as generalists to become advanced practitioners in the specialist clinical area of older people and ensure a consistent level of service for elderly patients in line with government expectations.

In healthcare encounters, patients communicate wide-ranging concerns relating to their health and illness experience, treatment or wider psychosocial world. This research draws upon a normative understanding of patient centred approaches which recognise the clinical and psychotherapeutic value in having the opportunity to talk to someone who will listen empathetically and to have expressed concerns acknowledged and understood. The aim of this research was to understand how GPs, nurse and pharmacist prescribers manage patients’ emotional cues and concerns in healthcare encounters. This research employed a mixed method study underpinned by an interpretative epistemology to understand, in particular, how nurse and pharmacists as ‘new prescribers’ manage emotionality during consultations in primary care. The study also critically reflected on the value and limitations of the study methodology to explore this topic. Phase one employed a coding framework to code 528 consultations with 20 GPs, 19 nurses and 12 pharmacist prescribers. The nature and content of patients’ cues and concerns and healthcare professionals’ responses were coded and analysed quantitatively. Phase two undertook qualitative analysis on a sub-sample of 30 transcribed recordings to understand barriers and facilitators to offering emotional labour during the consultation process. Phase one found that patients communicate on average 3.4 cues and concerns per consultation and of those concerns expressed, half related to biomedical concerns. Other cue and concern types related to medication, the impact of a patient’s condition/symptoms on their day-to-day life and cues and concerns related to psychosocial issues, including job stress, family problems, or bereavement. Phase one found that there were significant differences between the type of positive/missed responses to patients’ cues and concerns across the groups. 81% of pharmacists’ responses were coded as positive compared with 72% of nurse prescriber responses and 52% of GP responses. Male GPs were significantly more likely to miss patients’ cues and concerns compared to female GPs. Phase two drew upon emotion work theory and models of patient centred care to identify the ways in which emotions are communicated and managed within healthcare encounters recorded for this study. Phase two identified facilitators (such as attuning to the patient’s world, evidence of listening, providing space, validating and legitimising patients’ concerns) and barriers (emotional disengagement, task focused and structured/agenda driven consultations) to the employment of emotional labour. These findings identify that a complex inter-play of individual, socio-cultural and political factors have potential to influence the way in which emotionality is managed during the consultation process. The findings reinforce the importance of patient centred approaches and communication skills training and the need for support, supervision and training to enable healthcare professionals to manage their emotionality and that of their patients.

Doctor of Philosophy (PhD) / Understanding factors that enhance or diminish performance levels of individuals is instrumental for achieving individual (low level) and organisational (high level) goals. In this study, the effect of social network structure, position, ties and information and communication technologies (ICT) use on performance attitudes of knowledge intensive workers in dispersed occupational communities is investigated. Based on social network theories of strength of weak ties and structural holes, and the social influence model of technology use, a theoretical framework is developed. In conjunction with qualitative interviews conducted with subject matter experts, the framework is used to further develop and refine a valid and reliable survey instrument. Secondly, network measures of degree centrality, density, structural holes (constraint and efficiency), tie strength and tie diversity are applied for exploring the association with ICT use and performance from a sample of 110 rural general practitioners. Empirical results suggest that network structure, position and ties of knowledge workers play a crucial role in individual performance and ICT use. In particular, degree centrality and task-level ICT use was found to be positively associated with performance while ego-network constraint was found to be negatively correlated with performance. In terms of ICT use, functional diversity and degree centrality were positively associated with task-level ICT use whereas ego-network efficiency was found to be negatively correlated with ICT use at the communication-structure level. Among the variables that showed significance, degree centrality best explained overall variance for performance, and functional diversity best explained overall variance for task-level ICT use, although professional accreditations remains a potent indicator also. The results from this study resonate with findings from past literature and extend traditional theory of social networks and performance within the micro level to include geographically dispersed individuals involved in knowledge intensive work. For individuals in such non-competitive settings, traditional network theories such as structural holes theory still apply. However, a key finding is that network structure is a much more potent predictor of performance although network position is important. The second key finding addresses a major gap in the literature concerning understanding social processes that influence ICT use. As the technology acceptance and the social influence models lack empirical evidence from a social networks perspective, this research shows that rather than the strength of ties which functions as a conduit of novel ideas and information, it is the functional tie diversity within individual professionals networks that increase ICT use at the task-level. Methodologically, the study contributes towards a triangulation approach that utilises both qualitative and quantitative methods for operationalising the study. The quantitative method includes a non-traditional “networks” method of data collection and analysis to serve as a fine complement to traditional research methods in behavioural studies. The outcome is a valid and reliable survey instrument that allows collection of both individual attribute and social network data. The instrument is theoretically driven, practically feasible to implement, time-efficient and easily replicable for other similar studies. At the domain level, key findings from this study contradict previous literature which suggests that professionals in occupational communities such as general practitioners decline in performance as they age. In fact, findings from this study suggest that age and experience do not affect for performance; rather, there is a negative relationship between experience and task-level ICT use, and that task-level ICT use is positively associated with performance in terms of attitudes to interpersonal care. Furthermore, degree centrality is also positively associated with professional accreditations, such as fellowship of the Royal Australian College of General Practitioners, which is conducive to performance in terms of attitudes to interpersonal and technical care. The contextual implication from the quantitative and qualitative evidence of this study is that while contemplating strategies for optimising ICT use or for improving attitudes to quality of care at the technical and interpersonal level, the importance of social structure, position and relations in the practitioner’s professional network needs to be considered carefully as part of the overall individual and organisation-level goals.

Psychotropic drugs are mind affecting compounds. They range in type from illegal narcotic analgesics such as heroin, to prescribed major tranquillisers used for treatment of psychotic states, to prescribed minor tranquillisers such as the benzodiazepines, Valium and Mogadon, to the freely available, over the counter drugs, Aspirin and Panadol. Overseas and Australian data show the minor tranquilliser group, benzodiazepines, first introduced on the pharmaceutical scene in the early 1960s, to be the most commonly prescribed psychotropic drugs. Their popularity with medical practitioners as prescription drugs for conditions of anxiety, stress, insomnia and some forms of epilepsy, arises from the advertised inference by drug companies that they are free from any side effects in the patient such as dependence, tolerance and on termination of treatment, absence of withdrawal syndrome. Benzodiazepines were first introduced as a substitute for the well known dependence producing barbiturate based sedatives. Overseas and Australian data show women are prescribed psychotropic drugs, particularly benzodiazepines, twice as often as men and in many instances for conditions unrelated to those for which the drugs are recommended. Australian data comes from two sources, official statistics such as the Pharmaceutical Benefits Scheme and from surveys of drug use. Both sources of data are incomplete, inaccurate and in many cases misleading. The true picture of prescribed psychotropic drug use in Australia therefore lacks resolution and in all probability underestimates prevalence and patterns of use in the community. There is no data on the prevalence and patterns of use of prescribed psychotropic drugs in the Australian Capital Territory. It was therefore deemed appropriate to conduct a survey to determine their prevalence and patterns of use. The survey was confined to women for several reasons: Women are a target group in the Commonwealth and State Government 'Drug Offensive'; evidence from studies overseas and in Australia shows that women are prescribed psychotropic drugs, particularly benzodiazepines, twice as often as men; Australian data suggests that this trend is uniform and therefore the Australian Capital Territory should be no different. Data shows that doctors, particularly General Practitioners, are the main source of prescribed psychotropic drugs. The main psychotropic drugs prescribed by general practitioners are benzodiazepines. It was therefore deemed appropriate to conduct a survey of general practitioner's attitudes, knowledge and beliefs about the appropriate use of benzodiazepines as these factors carry weight in a doctor's prescribing habits. The survey of women was conducted using a standardised, structured, telephone survey on a random sample of 120 women in the Australian Capital Territory. The results of the survey show that 40% of the sample had used prescribed psychotropics at some stage in their lives. Most users were older women, married, well educated and working full time. Level of knowledge about the drug was low, compliance with respect to use was high. Most prescribed psychotropic drugs were obtained from a doctor. There appears to be little drug sharing or concurrent drug use. Half of the prescribed psychotropics were benzodiazepines the other half were mostly anti-depressants. Use of over the counter psychotropics was very high. The survey of general practitioners was conducted using a standardised, structured mailed questionnaire distributed to a random sample of 25 general practitioners in the Australian Capital Territory. The results show the majority of doctors prescribe the drugs for common indications (anxiety, stress, insomnia and some forms of epilepsy) in excess of one week. For specific anxiety states however, most prescribe the drugs along with some form of counselling. The majority of doctors (77%) think counselling is not as effective as drug treatment. All doctors surveyed think patients should be advised of the drugs effects on driving and machinery operation; the drugs should not be shared with others; that the drugs should not be terminated abruptly; the drugs should not be used concurrently with alcohol. The majority (92%) believe benzodiazepines are over prescribed and most doctors (77%) believe the drugs produce dependence in patients. The majority (58%) believe women of child bearing age are at risk using benzodiazepines while 50% think pregnant women are at risk. The majority of doctors did not believe that people older than 60 years of age are at risk but most believe children are at risk. The findings of both surveys have implications for health educators and others with a concern for drug education in the community. Recommendations arising from this study have been made. They are presented at the conclusion of this thesis.

Syftet med avhandlingen var att beskriva diagnostiken och utvärdera handläggningen i primärvård av patienter med subacromial smärta. Avhandlingen omfattar fyra studier. I den första studien användes ett frågeformulär och resultaten beskriver hur distriktsläkare och distriktssjukgymnaster i ett svenskt län diagnosticerar och handlägger primärvårdspatienter med subacromial smärta. Den andra studien beskriver distriktsläkares och distriktssjukgymnasters tilltro till effekten av olika behandlingsmetoder för dessa patienter. Med utgångspunkt från de tilltrodda behandlingsmetoderna genomfördes en systematisk litteraturöversikt. Den tredje studien utvärderar intra- och interbedömar reliabilitet för ett styrketest som ingår i ett utvärderingsinstrument ‘the Constant-Murley shoulder assessment’. Den avslutande studien är en randomiserad klinisk studie som utvärderar och jämför effekten av två behandlingsstrategier, akupunktur och ultraljud, båda i kombination med hemträning. Distriktsläkare och distriktssjukgymnaster visade sig använda en likartad diagnostik. Det troligaste valet av behandling för distriktsläkare var antiinflammatoriska läkemedel och kortisoninjektion i den subacromiala bursan och för distriktssjukgymnaster rörelseträning samt ergonomiska åtgärder. Dock var de flesta behandlingsalternativen troliga val, vilket tolkas som en osäkerhet om behandlingarnas effekt. Med utgångspunkt från de behandlingsmetoder som distriktsläkare och distriktssjukgymnaster tilltrodde som effektiva för patienter med subacromial smärta, genomfördes en systematisk kritisk litteraturöversikt. Fyrtio studier inkluderades och deras evidensnivå utvärderades. Endast kortisoninjektion i den subacromiala bursan visade sig ha definitiva bevis för effekt. Akupunktur visade sig ha troliga bevis för effekt och ultraljudsbehandling konkluderades som ineffektivt för patienter med subacromial smärta. Det förelåg en låg grad av samstämmighet mellan tilltro och tillgängliga vetenskapliga bevis. En digital dynamometer kan ersätta den konventionella fjädervågen i det standardiserade styrketestet. En nästan perfekt överensstämmelse vad gäller både intra- och interbedömarreliabilitet vid test av unga skulderfriska personer, oberoende av om en ”håll emot-” eller ”dragteknik” användes eller om medel- eller maxvärden användes vid beräkningen av överensstämmelse. I den randomiserade kliniska studien inkluderades 85 patienter. Tre utvärderingsinstrument, kombinerade i resultatanalysen, utvärderade förändringen under en uppföljningsperiod på 12 månader tillsammans med patienternas subjektiva skattning av resultatet. Resultaten visade att akupunktur i kombination med hemträning är att föredra. Båda behandlingsgrupperna förbättrades signifikant och fortsatte förbättras över tid oberoende av behandling. De flesta patienter uppnådde ett tillfredställande behandlingsresultat efter 12 månader. Åtminstone tre fjärdedelar i varje behandlingsgrupp skattade sig mycket förbättrade eller helt återställda. Detta tolkas som en behandlingseffekt i kombination med naturalförloppet. Avhandlingen har beskrivit handläggningen i primärvård av patienter med subacromial smärta och har bidragit med vetenskapliga bevis för distriktsläkare att behandla med kortisoninjektion i subacromiala bursan och för distriktssjukgymnaster att behandla med akupunktur kombinerat med hemträning. / The aim of the thesis was to describe the diagnostic approach and evaluate primary care management of patients with subacromial pain. The thesis includes four different studies, a questionnaire study describing attitudes among general practitioners and physiotherapists in a Swedish county toward the diagnostic approach and management of primary care patients with subacromial pain; a combination of a systematic review and general practitioners and physiotherapists beliefs in interventions for patients with subacromial pain; a study of intra- and inter-observer reliability for the strength test in the Constant-Murley shoulder assessment; and a randomised clinical trial to evaluate and compare the efficacy of two treatment strategies for patients with subacromial pain, acupuncture combined with home exercises and continuous ultrasound combined with home exercises. In the questionnaire study we described that general practitioners and physiotherapists have a uniform diagnostic approach. The most probable choice of treatment was non-steroidal anti-inflammatory drugs and corticosteroid injection into the subacromial bursa for general practitioners and movement exercises together with ergonomics/adjustments at work for physiotherapists, but most treatments were probable choices, reflecting an uncertainty about their effectiveness. The treatments trusted by general practitioners and physiotherapists were systematically reviewed. Forty studies were included and the level of evidence was summarised. Only corticosteroid injections into the subacromial bursa, had definitive evidence for efficacy. Acupuncture had tentative evidence for efficacy and therapeutic ultrasound was concluded as ineffective for patients with subacromial pain. The association between trusted treatments and available scientific evidence was weak. A digital dynamometer can replace the conventional spring-balance in the standardised strength test. An almost perfect agreement was found for intra- and inter-observer reliability in young shoulder-healthy persons, regardless of whether a 'resisted-force' or a 'pull-force' was used or if calculated with mean or maximum values. Eighty-five patients were included in the randomised clinical trial. Three shoulder scores, combined in the analysis, measure change during a 12 months follow-up together with a ‘patient self-evaluation’ of the experienced result. The results favoured acupuncture combined with home exercises. Both groups improved significantly and continued to improve over time independent of treatment and most of the patients reached a satisfactory result at 12 months. At least three fourths of the patients, in each treatment group, reported large improvements or felt completely recovered. This is interpreted as a combination of treatment effect and the natural course. This thesis has described the primary care management of patients with subacromial pain and provided scientific evidence for general practitioners to use corticosteroid injection and for physiotherapists to use acupuncture combined with home exercises, when treating these patients. / On the day of the defence date the status on article III was Accepted and article IV was Submitted.

Background: The focus of this study is on how far GPs' perceptions of dementia map onto the components and contributing factors to stigma as described by Link and Phelan (2001; 2006) and Jones et al. (1984). Aim: The study explores GPs' perceptions of dementia as a stigma, develops a specific conceptualization of the stigma of dementia and considers implications for timely diagnosis. Methods: Data from twenty-three GPs in northern England were collected by semistructured telephone interviews. Within the context of a qualitative design, a combined process of grounded theory and framework analysis was adopted to collect and analyse data. Results: The findings reveal that GPs' perceptions of dementia map onto Link and Phelan and Jones' identification of contributing factors and components of stigma and may hinder timely diagnosis. Three themes emerged reflecting a dynamic process of making sense of dementia, relating perceptions to oneself and considering the consequences of dementia. Within those themes, certain categories had particular salience for GPs, namely the characteristics of the attribute, existential anxiety and discrimination. The themes and categories are inter-related and can be considered as parts of a system. Perceived lack of reciprocity could be detected in most categories which suggests that it is influential in the social construction of the stigma of dementia. Conclusion: The data suggest that current conceptualizations of stigma are insufficient to fully account for the stigma of dementia. A specific conceptualization of the stigma of dementia is proposed and the implications of GPs' perceptions for timely diagnosis are discussed.

Darbo tikslas- įvertinti Vilniaus miesto šeimos gydytojų požiūrį į farmacinės kompanijos atstovo vizitus. Tyrimo metodika. 2012 metų rugpjūčio – gruodžio mėnesiais, buvo apklausti Vilniaus miesto šeimos gydytojai dirbantys pirminės šeimos sveikatos priežiūros centruose. Buvo išdalinta 200 anketų, atsakė - 132 respondentai (atsakas – 66 proc.). Anketiniai duomenys analizuoti naudojant statistinę analizės programą SPSS 14.0 . Statistinis duomenų reikšmingumas tikrintas pagal Chi kvadrato kriterijų, laisvės laipsnių skaičių ir statistinį reikšmingumą (p). Statistinių hipotezių reikšmingumui įvertinti pasirinktas statistinio reikšmingumo lygmuo p<0,05. Dviejų nepriklausomų imčių vidurkių skirtumų patikimumui įvertinti buvo naudojamas Stjudento t kriterijus. Rezultatai. Geriausiai gydytojų vertinami informacijos šaltiniai yra konferencijos bei individualūs medicinos atstovų vizitai. Net 87 proc. Vilniaus miesto respondentų gydytojų farmacinių kompanijų atstovų vizitus vertina teigiamai, nes jų metu medicininė informacija pateikiama trumpai ir glaustai, sudaroma galimybė gauti naujausių žinių apie jau rinkoje esamus ir naujus vaistus bei medicinos priemones. Daugiau nei pusė apklaustų gydytojų teigia, jog dažnesni farmacinių kompanijų atstovų vizitai ir pakartotinas vaisto ar medicininės priemonės priminimas turi reikšmės jų skyrimui. Išskirtinai svarbūs farmacinės kompanijos atstovo vizito veiksniai yra... [toliau žr. visą tekstą] / Aim of study. To evaluate the approach of general practitioners to visits of pharmaceutical company representatives in Vilnius city. Methods. In the period from August to December 2012 general practitioners, working in primary family health care centres in Vilnius city were anonymously questioned. There were 200 questionnaires distributed, 132 of which were answered and returned (the response rate was 66% ). Statistical analysis of the obtained data was performed using the SPSS 14.0. software package. The statistical significance of data was tested by Chi-square criterion, the number of degrees of freedom and statistical significance. Statistical significance level of p <0.05 was chosen for assessment of statistical hypothesis. A t-test was applied to evaluate the reliability of the differences in mean of two independent samples. Results. The most highly rated information sources mentioned by practitioners are conferences and individual visits of representatives of the medical sales. As much as 87 percent of respondents in Vilnius assess visits of representatives of pharmaceutical companies positively due to the fact that during such visits the medical information is given in a brief and concise manner, spreading the latest knowledge about the drugs and medical devices already existing in the market as well as about the new ones. More than half of the... [to full text]

Doctor of Philosophy (PhD) / Understanding factors that enhance or diminish performance levels of individuals is instrumental for achieving individual (low level) and organisational (high level) goals. In this study, the effect of social network structure, position, ties and information and communication technologies (ICT) use on performance attitudes of knowledge intensive workers in dispersed occupational communities is investigated. Based on social network theories of strength of weak ties and structural holes, and the social influence model of technology use, a theoretical framework is developed. In conjunction with qualitative interviews conducted with subject matter experts, the framework is used to further develop and refine a valid and reliable survey instrument. Secondly, network measures of degree centrality, density, structural holes (constraint and efficiency), tie strength and tie diversity are applied for exploring the association with ICT use and performance from a sample of 110 rural general practitioners. Empirical results suggest that network structure, position and ties of knowledge workers play a crucial role in individual performance and ICT use. In particular, degree centrality and task-level ICT use was found to be positively associated with performance while ego-network constraint was found to be negatively correlated with performance. In terms of ICT use, functional diversity and degree centrality were positively associated with task-level ICT use whereas ego-network efficiency was found to be negatively correlated with ICT use at the communication-structure level. Among the variables that showed significance, degree centrality best explained overall variance for performance, and functional diversity best explained overall variance for task-level ICT use, although professional accreditations remains a potent indicator also. The results from this study resonate with findings from past literature and extend traditional theory of social networks and performance within the micro level to include geographically dispersed individuals involved in knowledge intensive work. For individuals in such non-competitive settings, traditional network theories such as structural holes theory still apply. However, a key finding is that network structure is a much more potent predictor of performance although network position is important. The second key finding addresses a major gap in the literature concerning understanding social processes that influence ICT use. As the technology acceptance and the social influence models lack empirical evidence from a social networks perspective, this research shows that rather than the strength of ties which functions as a conduit of novel ideas and information, it is the functional tie diversity within individual professionals networks that increase ICT use at the task-level. Methodologically, the study contributes towards a triangulation approach that utilises both qualitative and quantitative methods for operationalising the study. The quantitative method includes a non-traditional “networks” method of data collection and analysis to serve as a fine complement to traditional research methods in behavioural studies. The outcome is a valid and reliable survey instrument that allows collection of both individual attribute and social network data. The instrument is theoretically driven, practically feasible to implement, time-efficient and easily replicable for other similar studies. At the domain level, key findings from this study contradict previous literature which suggests that professionals in occupational communities such as general practitioners decline in performance as they age. In fact, findings from this study suggest that age and experience do not affect for performance; rather, there is a negative relationship between experience and task-level ICT use, and that task-level ICT use is positively associated with performance in terms of attitudes to interpersonal care. Furthermore, degree centrality is also positively associated with professional accreditations, such as fellowship of the Royal Australian College of General Practitioners, which is conducive to performance in terms of attitudes to interpersonal and technical care. The contextual implication from the quantitative and qualitative evidence of this study is that while contemplating strategies for optimising ICT use or for improving attitudes to quality of care at the technical and interpersonal level, the importance of social structure, position and relations in the practitioner’s professional network needs to be considered carefully as part of the overall individual and organisation-level goals.

The diploma thesis addresses the issue of increasing the authorities of nurses of general practitioners in primary care. The theoretical part summarizes the information about primary and community care, defines authorities and professional activities of general nurses and physicians, and deals with the roles of nurses in primary care and the relations between general nurses and physicians. The objective of the diploma thesis was to survey the opinions of nurses of a possible increase in their professional powers, and to ascertain whether nurses are ready to assume certain authorities. It was also ascertained what physicians think of a possible transfer of certain authorities to nurses, and whether nurses are satisfied with their growing independence and responsibilities in connection with the increasing requirements for their profession. The results of the qualitative survey were evaluated by their summarizing in thematic areas and subareas; the text also contains authentic quotes of respondents (written in italics). The research set consisted of 15 respondents who were selected systematically. The set consisted of six physicians (general practitioners specialized in adult or paediatric medicine and general dentists). The set of general nurses consisted of nine nurses working for general practitioners. The selected general nurses had the work experience of various duration and various educational backgrounds ? they had either secondary or higher professional education and one nurse had university education. It has clearly followed from the research that the nurses do not wish to assume any activities falling within the authorities of physicians. A large number of respondents are very busy and any other authorities would be beyond bearable. Physicians would not transfer many medical activities to the nurses; they would rather transfer most of paperwork to them, such as writing opinions in respect of traffic accidents, spa treatment requests and other requests. Nurses are not afraid of increased authorities but agree that the authorities will mostly result in greater responsibilities and paperwork. The nurses think that there are clear boundaries between the authorities of nurses and physicians. Clear boundaries are seen mostly in diagnostic and therapeutic activities, nursing treatments, prescription of medicines, application of intravenous injections, and statement of diagnosis. Above the scope of their authorities, general nurses are charged to perform activities of a mostly administrative nature, write requests and sick certificates, administer intravenous medicines without expert supervision, write various recommendations, and monitor warfarinisation of patients.