FundaÃÃo Cearense de Apoio ao Desenvolvimento Cientifico e TecnolÃgico / A coordenaÃÃo dos cuidados pela atenÃÃo primÃria à saÃde (APS) ocupa uma posiÃÃo de destaque na agenda das polÃticas de saÃde de vÃrios paÃses. à uma alternativa possÃvel para o problema da segmentaÃÃo em sistemas de saÃde, que gera iniquidade e ineficiÃncia, desarticulaÃÃo da rede assistencial e prejuÃzo no acesso aos nÃveis de atenÃÃo mais complexos. O objetivo geral do estudo foi comparar a induÃÃo centralizada da coordenaÃÃo dos cuidados pela APS em dois sistemas de saÃde universais. Estudo de abordagem quanti-qualitativa, à classificado como exploratÃrio-descritivo, valendo-se de dados documentais e orÃamentÃrios e da realizaÃÃo de nove entrevistas semiestruturadas com sujeitos-chave correspondentes ao National Health Service (NHS), do Reino Unido, e ao Sistema Ãnico de SaÃde (SUS), do Brasil. Foi utilizada anÃlise de conteÃdo temÃtica, estatÃstica descritiva e anÃlise comparativa. A pesquisa obedeceu à ResoluÃÃo 196/96 do Conselho Nacional de SaÃde e obteve parecer favorÃvel (nÃmero 198.092). A pesquisa identificou que o fortalecimento da APS à a base inicial para viabilizar a coordenaÃÃo dos cuidados no Brasil. O MinistÃrio da SaÃde do Brasil vem desenvolvendo polÃticas nacionais que impactam indiretamente na coordenaÃÃo dos cuidados - PolÃtica Nacional de AtenÃÃo BÃsica, NÃcleos de Apoio à SaÃde da FamÃlia e Programa Nacional de Melhoria do Acesso e da Qualidade da AtenÃÃo BÃsica. A polÃtica de Redes de AtenÃÃo à SaÃde revelou-se fator limitante ao papel coordenador da APS. As Tecnologias de InformaÃÃo e ComunicaÃÃo surgiram com menos Ãnfase no Ãmbito federal. O incremento estrutural no TelessaÃde Brasil Redes e os Cadernos de AtenÃÃo BÃsica sobressaÃram por sua capacidade de induzir mudanÃas organizacionais nos serviÃos. O NHS estruturou a coordenaÃÃo dos cuidados pela APS a partir do contrato dos general practitioners e busca empoderÃ-los para gerir 60% do orÃamento do sistema. A pesquisa concluiu que o modelo de Estado federativo brasileiro dificulta a coordenaÃÃo dos cuidados pela APS, em comparaÃÃo ao Estado unitÃrio inglÃs. A municipalizaÃÃo e descentralizaÃÃo tornaram complexo o processo de coordenaÃÃo dos cuidados, cabendo ao MinistÃrio da SaÃde o papel de induzir, de forma vertical, e aos municÃpios, operar o sistema em cada ponto de atenÃÃo de forma horizontal, situaÃÃo que nÃo ficou bem alinhada e configurou um modelo oblÃquo, gerando uma contradiÃÃo no desenho federativo brasileiro e dificultando a coordenaÃÃo dos cuidados. / The coordination of care for the primary health care (PHC) occupies a prominent position on the agenda of the health policies of various countries. It is a possible alternative to the problem of segmentation of health systems, which generates inequity and inefficiency, disarticulation of the care network and impaired access to more complex levels of care. The general objective of this study was to compare the centralized induction of coordination of care by PHC in two universal health systems. This study has a quantitative and qualitative approach and it is classified as exploratory and descriptive, by using documental and budgetary data and performing nine semistructured interviews with key subjects corresponding to National Health Service (NHS), from the United Kingdom, and the Unified Health System (SUS) in Brazil. The thematic content analysis, descriptive statistics and e comparative analysis were used. The research followed the Resolution 196/96 of the National Health Council and obtained its assent under number 198 092. The research identified that the strengthening of PHC is the initial basis to facilitate the coordination of care in Brazil. The Ministry of Health of Brazil has been developing national policies which impact indirectly on coordination of care - National Policy for Primary Care, Centers of Support for Family Health and the National Program for Improving Access and Quality of Primary Care. The Politics of Health Care Networks proved to be limiting factor for coordinating role of the PHC. The Information and Communication Technologies have emerged with less emphasis on the federal level. The structural increase in BrazilÂs Telehealth Networks and Protocols Notebooks of Primary Care, stood by their ability to induce changes in the organizational processes of the services. The NHS structured care coordination by PHC from the contract of general practitioners and seeks to empower them to manage 60% of the budget system. The research concluded that the brazilian federal State model complicates the coordination of care by PHC, compared to the english unitary State. The municipalization and decentralization made the process of coordination of care more complex, leaving to the Ministry of Health the role of inducing vertically and, to the municipalities, operate the system at each point of care in a horizontal manner, a situation which was not well aligned and configured an oblique model, generating a contradiction in the brazilian federal design and bringing difficulties to the coordination of care.

The main of objective of this diploma thesis is to define health care as economic goods based on the theoretical definitions. The fact whether health care should be considered as private goods or public goods plays a vital role in this debate. The initial hypothesis presupposes that health care is (based on the basic economic criteria) private goods; however there is objective evidence demonstrating that health care should be understood in terms of public goods. The author defines the necessary terminology and theoretical concepts. According to several expert concepts the author concludes that based on the basic economic definitions health care could be understood as private goods, admitting that in the real world objective limitations exist, which prevent keeping health care exclusively in the economic sphere. The thesis also evaluates the role of individual health care sectors, including their drawbacks. The author demonstrates all concepts on the Czech health care system. In the analytic part of the thesis the author demonstrates discrepancies between theoretical concepts and practice on specific models, including the risks of exclusively private financing of health care. For this purpose three income groups has been defined. The author compares expenditures of these groups on selected medical services with different levels of their savings. The thesis also deals with methods of economical analysis and its limitations in health care system analysis.

Doctor of Philosophy / Department of Horticulture, Forestry, and Recreation Resources / Richard H. Mattson / Subjects of this research were 64 adolescents receiving treatment at two behavioral health service institutions located in an urban mid-western city. Both institutions provided horticultural therapy and non-horticultural therapy programs. Research subjects were adolescents with diverse treatment needs and their responses on research questions were inconsistent compared to other related studies with general population. Current research assessed the adolescents with horticultural therapy treatment and without horticultural therapy treatment in three aspects. First, the levels of psychological aspects of adolescents were assessed with the Rosenberg Self-Esteem Scale and Nowicki-Strickland Locus of Control Scale for Children. The levels of self-esteem and locus of control of adolescents with horticultural therapy treatment were not significantly different from those of adolescents without horticultural therapy treatment at both institutions. Based on the different level of worthiness and competence factors, it is recommended to design horticultural therapy programs focused on improving the worthiness factor of self-esteem. Second, the pastoralism disposition of the Children's Environmental Response Inventory was used to assess the level of environmental attitude of the adolescents with and without horticultural therapy treatment. Horticultural experience and environmental attitude had a positive relationship with most subjects. At one institution, the level of environmental attitude of the adolescents with horticultural therapy treatment was significantly higher than the adolescents without horticultural therapy treatment. The adolescents at the horticultural therapy program which was scheduled more frequently showed higher environmental attitude scores. To improve environmental attitude of adolescents, horticultural therapy program should provide diversity and abundant opportunities of horticultural experiences. Third, basic horticultural knowledge was tested with the Basic Horticultural Knowledge Questionnaire. Vegetable/fruit consumption and preference were described with the Vegetable and Fruit Preference and Consumption Survey. Basic horticultural knowledge scores of the horticultural therapy group were significantly higher than that of the non-horticultural therapy group at one institution, but the scores were similar between the two groups at the other institution. Basic horticultural knowledge of subjects was significantly correlated to their vegetable and fruit consumption. To increase vegetable/fruit consumption, horticultural therapy programs should set goals to incorporate nutrition education.

Avhandlingen, som är en kvalitativ studie, rör yrkesgruppen undersköterskor inom hälso- och sjukvården. Syftet med studien har varit att studera och bidra med ökad kunskap, dels om villkoren för lärande och kunskapsbildning i arbetslivet, dels mer specifikt om undersköterskors arbete, arbetsvillkor samt villkor för lärande och utveckling på arbetsplatsen. Avhandlingens teoretiska referensram utgår från tidigare forskning och teoribildning om arbetsrelaterat lärande som kunnat sammanfattas i en modell, i vilken fyra olika grupper av faktorer, som är betydelsefulla för lärande i och genom arbetet, beskrivs. De fyra är: 1) Arbetets och organisering 2) Formell och icke-formell utbildning 3) Sociala aspekter och 4) Individuella faktorer. Tre olika sjukvårdsenheter; en akutsjukvårdsenhet, en barnsjukvårdsenhet och en operationssjukvårdsenhet, samtliga vid ett större sjukhus, ingår i studien. 17 undersköterskor och 5 vårdenhetschefer har intervjuats. Avhandlingen visar att undersköterskor som verkar inom akut eller traumatisk sjukvård också har ett varierat och oförutsett arbete, vilket ger dem goda möjligheter till lärande och utveckling. Vidare har undersköterskor som arbetar med uppgifter inom vårdens kärnverksamhet möjlighet att lära i arbetet. Avgörande i sammanhanget är att dessa arbetsuppgifter uppfattas som intressanta, meningsfulla och stimulerande. Lärande underlättas för de undersköterskor som arbetar vid en vårdenhet där de görs delaktiga i vårdarbetet och arbetsgemenskapen. Undersköterskor som arbetar tillsammans med andra yrkesgrupper kan ha möjlighet att lära i arbetet. Även delegering av arbetsuppgifter har betydelse för möjligheterna att lära. Avhandlingen visar också att undersköterskor kan hindras från att lära i arbetet om den sjuksköterska som de arbetar närmast (i vårdpar eller i team) inte tillåter dem att utföra vissa arbetsuppgifter. Det framkommer också att undersköterskor som saknar intresse, eller ork hindras från att lära och utvecklas i arbetet. Undersköterskor har begränsade möjligheter att delta i, och utvecklas genom formella läraktiviteter. Kursutbudet är litet och en del av de kurser som erbjuds rör inte vårdens kärnverksamhet. / The dissertation, which is a qualitative study, concerns auxiliary nurses in the health care. The aim of the study has partly been to generate knowledge about the prerequisites for learning and knowledge development in working life and partly to specifically study the work of auxiliary nurses, their working conditions and the prerequisites for learning and development in the workplace. The dissertation’s theoretical frame of reference is based on previous research and theories of workplace learning and have been summarised in a model. Four different groups of factors that are significant for learning in and through the work are described. The four groups are: 1) Work and organisation 2) Formal and non-formal learning activities, 3) Social aspects and 4) Individual factors. Three different health care units – an emergency care unit, a children’s unit and an operating unit – in a large hospital were included in the study. 17 auxiliary nurses and 5 care unit managers were interviewed. The dissertation shows that the work of auxiliary nurses involved in emergency care or the treatment of trauma is varied and unpredictable, which creates good opportunities for learning and development. Further, auxiliary nurses who are involved in core care activities are able to learn on the job. What is crucial here is that these duties are perceived as interesting, meaningful and stimulating. Learning is facilitated for auxiliary nurses who work in a care unit where they are involved in both the work and the work community. Auxiliary nurses who collaborate with other professional groups may find it easier to learn on the job. The delegation of tasks also affects the possibilities to learn. The dissertation also shows that auxiliary nurses can be prevented from learning on the job if the nurse with whom they work (in a nursing pair or team) does not allow them to perform certain tasks. It is also clear that auxiliary nurses who lack interest or stamina are prevented from learning and developing. Auxiliary nurses have limited opportunities to take part in and develop through formal learning activities. Few courses are available for auxiliary nurses, and those offered are seldom dealing with core care work.

This thesis examines the implications of the changes introduced by the NHS and Community Care Act 1990 for mental health services. It focuses on two main issues. Firstly, the impact on mental health services of the 'market' system of purchasers and providers introduced by the 1990 Act. Second.ly, the extent to which the 1990 changes had led to any increase in user participation and involvement in the planning and delivery of psychiatric services. Analysis of the existing theoretical literature found that there had been little research which focused on the specific implications of health care 'markets' for mental health services. In addition, much of the work on the development of psychiatry had not focused on the role of the local context in influencing the nature of mental health service provision. In this thesis these issues are explored through a case study of the mental health services of one English county. Semistructured, qualitative interviews were und.ertaken with managers, professionals and individuals in purchaser, provider and voluntary sector organisations. People using community mental health services in the county were also interviewed. This contrasts with many previous studies which have tended to concentrate exclusively on users of in-patient services. The study found that local circumstances played a significant role in the relationships between those purchasing, providing and participating in mental health services. The imminent closure of a large Victorian psychiatric hospital and the uncertainty about which services would replace it had been a source of tension between the newly formed purchaser and provider organisations in the county under study. The lack of any strong existing groups in the local area representing users of mental health services was also significant. It meant that increased user participation in the county after the 1990 Act was reliant on initiatives by managers and professionals rather than organised pressure from user groups and users themselves. The variety of different local mental health agencies purchasing and providing mental health services in the county called for a degree of cooperation between organisations which conflicted with the competition encouraged by the 'market' system introduced by the 1990 Act. The focus, first, on psychiatric services in the examination of 'markets' and, second, the importance of the local context in mental health service development provides the basis for the study's contribution to theoretical and policy debates both about the 1990 Act and psychiatric services in general.

Syfte: Syftet med denna studie var att undersöka  i vilken utsträckning rektorer medverkar i elevhälsans systematiska hälsofrämjande arbete i svenska grundskolor. Metod: En deskriptiv, kvantitativ tvärsnittsstudie användes som metod för att besvara studiens syfte. Datainsamlingen genomfördes med hjälp av egenkonstruerade webbenkäter för att samla in data från 200 slumpmässigt utvalda rektorer från grundskolor från hela Sverige. Enkäterna skickades ut till rektorernas e-postadresser tillsammans med ett missivbrev. Av de 200 valda rektorerna deltog 28 % i studien och besvarade enkäten. Resultat: 88 % av rektorerna svarade (n= 51) att elevhälsan aktivt bedriver ett systematiskt hälso-främjande utvecklingsarbete. Majoriteten av rektorerna (n=52) angav att elevhälsan, aktivt bedriver samtliga faser av det systematiska arbetet. Svarsfrekvensen om rektorernas medverkande vid faserna analys, planering, och uppföljning var relativt lika då hälften av rektorerna angav att de medverkade ofta och hälften medverkade varje gång. En skillnad uppstod då 31 % av rektorerna svarade att de sällan medverkade i genomförandefasen.  Den yrkeskategori som nämndes flest gånger som initierar majoriteten av hälsofrämjande insatser var elevhälsoteamen på skolorna som bestod av skolsjuksköteterskor, rektorer, kuratorer, lärare och elever.  51 % av rektorerna angav att det var på rektorns egna initiativ som elevhälsan bedrev ett systematiskt hälsofrämjande utvecklingsarbete på skolan. Fyra rektorer nämnde att elevhälsan var de som utförde hälsofrämjande arbete i skolorna. 80 % av rektorerna ansåg även att deras medverkan var betydelsefull för att elevhälsan ska kunna bedriva ett systematiskt hälsofrämjande arbete i grundskolor. Slutsats: Rektorer initierar, bedriver och medverkar i hälsofrämjande arbete och elevhälsans systematiska hälsofrämjande arbeten inom skolorna. Elevhälsoteam eller elevhälsogruppen som fanns lokalt placerade på skolorna var de som initierade hälsofrämjande insatser. Elevhälsan initierade mycket sällan hälsofrämjande insatser på skolorna. Detta kan ifrågasätta ifall det hälsofrämjande elevhälsoarbete som bedrivs är övergripande eller möter elevernas behov. / Purpose: The purpose of this study was to explore the extent of headmasters’ participation in the systematic health promoting work carried out by the student health service. Method: A quantitative descriptive cross-sectional survey was used to collect the data. The data collection was preformed using a self-designed web survey, through email addresses to collect data from 200 randomly selected headmasters of primary schools from all over Sweden. Of the 200 selected headmasters, 28% (n = 53) attended, and answered the questionnaire.  Result: 88 % of the headmasters reported that the student health service conducted a systematic health promoting work. The majority of the headmasters (n=52) reported that the student health service conducts all of the different stages of the systematic work. The response rate was equal regarding headmaster’s participation, often and every time in the different stages; analyze, planning and follow up. The stage implementation showed a divergence from the other stages when 31 % of the headmasters reported that they rarely participate in this stage. The main profession who initiated health promotion work according to the headmasters was student health teams in the schools, consisting school health nurses, headmasters, teachers, pupils and psychologist. 51 % of the headmasters declared that it was on their initiative that the student health service started the health promotion work. Only four headmaster’s named that the student health service conducted health promotion work in the schools. 80 % of the headmasters felt that their participation was important for the student health service to manage a systematic health promoting work in primary school’s settings. Conclusions: The headmaster’s initiates, conducts and participates in the systematic health promotion work and with the student health service in the primary schools. Student health teams are placed locally at the schools and were the ones who initiated health promotion work. The student health service was very rarely the ones who initiated health promotion work in schools. This may question if the health promoting work witch is conducted in schools are overall or meets the students' health needs.

In the UK there has been growing concern about the relationship between levels of alcohol consumption and offending behaviour. The Alcohol Treatment Requirement (ATR) was introduced to the UK in 2007 and was piloted in a District in the north of England in July 2007. The ATR is a coercive form of treatment delivered jointly by the probation service and the National Health Service (NHS) and was funded by the NHS. The ATR centres on supporting offenders to cease their offending behaviour and reduce or end their alcohol misuse. Two female alcohol treatment workers have been appointed to specifically deliver the ATR. Therefore this study aimed to investigate the delivery of the ATR, and more specifically, aimed to explore what impact the ATR might have in relation to positive behaviour change and rehabilitation for offenders with alcohol problems. In order to meet the expectations of producing 'outcome' data for the NHS funders, and indepth theoretical data worthy of an academic PhD, this research took a pragmatic methodological approach which enabled different social realities of the ATR to be explored. To this end, a mixed methods design was employed involving quantitative and qualitative data collection methods. The data for this research was generated in three phases with Phase One aiming to explore quantitatively the characteristics, impacts and outcomes of those sentenced to the ATR. This phase revealed that the ATR is being delivered to predominantly young, male, alcohol dependent, violent, persistent offenders. This analysis further revealed that the ATR was effective in bringing about positive treatment outcomes and in reducing reoffending. In order to explore further how this positive change was occurring, Phase Two consisted of qualitative participant observations of the treatment interaction involving the female alcohol treatment workers and the male offenders. By drawing on positioning theory, the analysis considered the complexity of the gendered interactions that occurred during these encounters. It was found that the two female alcohol treatment workers resisted positions of 'feminine carer' offered up by these young men in order to occupy positions of control. Indeed this analysis provided great insight into the constant flow of negotiations and manoeuvring of positions that occurred between the alcohol treatment worker and the offender, argued to be vitally important in working towards positive behaviour change. During Phase Three ten offenders were interviewed in order to explore through a dialogical lens (Bakhtin, 1982) how they constructed and experienced treatment on the ATR. In exploring the offenders' stories dialogically, the analysis highlighted how the ATR was enabling, in that it offered a 'space' for these offenders to engage and internalise a dialogue that draws on the authoritative voice of therapy. Therefore it was revealed that through dialogue with the 'other', offenders were able to re-author a more 'moral' and 'worthy' self. Moreover, the ATR has been found to be successful in enabling the offenders' hegemonic masculine identities to be both challenged and protected as a result of the multilayered interactions that occurred during these treatment encounters. This research therefore concludes that coercive treatment, rather than being a concern, should be embraced as a way of enabling change for offenders with alcohol problems. Furthermore, this research has highlighted the value of the relational aspect of treatment in bringing about positive behaviour changes. Finally this research has shown that community sentences offer a more constructive way of engaging with offenders than those who receive a custodial sentence.

Home physiotherapy is a valid service option for the patient who was recently discharged from hospital after sustaining a stroke, as it enhances functional independence in friendly and familiar surroundings, as opposed to an outpatient clinic (Bader 2008). The aim of this study was to investigate the system responses to the planning and implementation of a home physiotherapy service as an innovation within the Maltese Public Health Service, uncovering barriers or constraints that influenced the introduction and development of state-run home physiotherapy in Malta. Method A qualitative approach was used for this research. A case study design was selected because it possessed contextual, descriptive and heuristic characteristics. Study participants planned and implemented the service using the available resources. Policy makers, physiotherapists, stroke patients and caregivers contributed to the study through their responses to, and experiences of, this service innovation. It was both an exploration and an opportunity to learn about service innovation from a Maltese perspective. A group of stakeholders were interviewed during the planning stage (Phase 1) of the home physiotherapy service. The main purpose of these interviews was to inform the design of the service. Another group of participants was interviewed in the active service stage (Phase 2) - at the beginning and at the end. The purpose here was to gather data from their direct experiences with home physiotherapy. Documents relevant to home rehabilitation were accessed and analysed hermeneutically. These included newspaper media, as it was considered a sensitive instrument to understand social context (Catalán Matamoros 2007; Davis 1990). Findings and discussion Data analysis identified categories of findings such as 'barriers to the implementation of a new service', 'attitudes to home physiotherapy' and 'fragmented rehabilitation service'. The category components were discussed and linked to the hermeneutical analysis of documents, offering a deeper understanding of the categories within the local context, and revealing a reinforcement of establishment-based health care. Conclusion The findings of this study provided an insight into the constraints that would appear if home physiotherapy, indeed home rehabilitation, were introduced by the Maltese Public Health Service. This research had an impact on the state physiotherapy services. Recommendations to help mitigate the constraints in an overarching manner were offered at the end of the thesis. To the international reader with experience in organised home physiotherapy, this study gives a glimpse into how issues that would seem trivial and obvious at first glance become significant challenges - challenges that the uninitiated would need to overcome.

Praktisering av brukermedvirkning krever at sykepleierne ser på brukerne som likeverdige partnere. Det bryter med det tradisjonelle sykepleier–pasientforholdet og krever andre arbeidsmetoder og holdninger. For å kunne få til en slik endring forutsetter det at sykepleierne har nødvendig kunnskap og forståelse for brukermedvirkning og den bakenforliggende ideologien. Hensikt: Hensikten med studiet var å studere sykepleiernes teoretiske forståelse av begrepet brukermedvirkning og kartlegge hvordan sykepleierne selv opplever at de praktiserte brukermedvirkning i kommunens omsorgstjeneste. Metode: Det har blitt gjennomført en kvalitativ studie med halvstrukturerte intervjuer. Analysemetode var meningsfortettning og meningskategorisering etter beskrivelse av Kvale. Studien har 20 respondentern fra sykehjem og hjemmetjenesten i en stor norsk kommune. Resultater: Sykepleiernes kunnskap om brukermedvirkning var i stor grad situasjonsbestemt. Den ble beskrevet ut fra pasientene de selv arbeider med, situasjonene og konteksten. Det ble knyttet usikkerhet til den teoretiske forståelse av begrepet. Brukermedvirkning blir i hovedsak beskrevet som samråd og må forstås som symbolsk deltagelse der pasientenes deltar og gir uttrykker behov eller gir råd uten at de har reell innflytelse eller myndighet. Langt færre beskrev brukermedvirkning som brukerinnflytelse i form av partnerskap der pasienten gis anledning til å ta avgjørelse og oppleve kontroll.I hvilken grad brukermedvirkning praktiseres avhenger av avveininger i tjenesteutforming, institusjonelle forhold og strukturelle rammer. Sykepleiere opplevde ved håndtering av meningsforskjeller mellom pasient og pårørende en lojalitet overfor pasienten samtidig som de viser forståelse overfor pårørende. Konklusjon: Sykepleiernes forståelse av brukermedvirkning handler i stor grad om symbolsk deltagelse fordi de gis mulighet til å uttrykke ønsker men ikke fatte endelig avgjørelse. Implementering av brukermedvirkning på systemnivå og en kombinasjonen av teoretisk kunnskap og refleksjon over praksis, vil kunne styrke bevisstheten og vektleggingen av brukermedvirkning. / The practice of user participation requires nurses to regard users as equal partners. It breaks with the traditional nurse-patient relationship and demands different working methods and attitudes. Achieving such a change requires nurses to have the necessary knowledge and understanding of user participation and the ideology behind it. Objective: This study aimed to investigate nurses’ understanding and practice of user participation in the municipal care service. Method: We implemented a qualitative study by conducting semi-structured interviews with 20 respondents from nursing homes and home care services in a major Norwegian municipality.Analysis involved consolidating and categorizing the subjects’ intent, as described by Kvale. Results: The nurses’ knowledge of user participation was situational (i.e., they based their descriptions on current patients, situations, and context). Their theoretical understanding of the concept was uncertain. Most described user participation as a consultation that must be understood as symbolic participation, where the patients express their needs or give advice without having any real influence or authority. Far fewer nurses described user participation as user influence in the form of a partnership, where patients are given the opportunity to make decisions and experience control. The extent to which nurses practice user participation depends on trade-offs among services, institutional situations, and structural frameworks. When faced with differing opinions between patients and their relatives, nurses experienced loyalty toward their patients and simultaneously showed empathy for the relatives. Conclusion: Nurses’ understanding of user participation largely deals with symbolic participation because it enables patients to express desires without making any final decisions. Implementing user participation at the system level and combining theoretical knowledge and reflection in practice would strengthen awareness and focus attention on user participation / <p>ISBN 978-91-85721-73-3</p>

The Issue of the Just Distribution of Limited Resources in the Health Sector The aim of this thesis is to evaluate the current state and development of the principal legal institutes concerning health care financing and to define their relationship to the main principles of distributive justice. Health care financing is a specific issue, from both the economic as well as legal point of view, especially because human life is dealt with in this domain. The first chapter therefore deals with distributive justice in health care as a potentially leading principle for elaborating legislation. The history of philosophy has provided legislators with some useful tools which can help them to decide whether a norm can be labelled as "just". The following part of the text consists of three chapters which deal with different levels of redistribution. In the first chapter, the national level is focused on, the key issues being the evolution of health care systems, their typology according to the financial sources (taxes, insurance or private financing) and main advantages and disadvantages of each of the options. Furthermore, this part of the text discusses the total amount of money provided for health care by the state, extra financial resources and the question of the right to health. A characteristic...