Vårdsituationen i Sverige präglas av personalbrist, långa arbetsdagar och stress. Under dessa arbetsförhållanden uppstår det situationer som kan upplevas hjälplösa av vårdpersonal. Vårdpersonals tilltro till att hantera dessa situationer påverkas. Studiens syfte var att undersöka hur vårdpersonalen upplevde hjälplösa situationer, samt hur de upplevde sin tilltro till sin förmåga till att lösa eller hantera olika situationer på arbetet. Åtta personer som arbetade inom vården intervjuades. Resultat av en tematisk innehållsanalys visade att vårdpersonalen upplevde sin self-efficacy relativt god i hjälplösa situationer. Detta berodde på att vårdpersonalen gav stöd till varandra i dessa situationer. Erfarenhet och kunskap var faktorer som stärkte vårdpersonalens self-efficacy i hjälplösa situationer. Däremot så upplevde deltagarna att tilltron till att påverka beslut var bristande, då kommunikationen mellan undersköterskor och personal med högre status var bristfällig. Studien gav beskrivningar kring vårdpersonalens uppfattningar och förutsättningar i hjälplösa situationer. Vårdpersonalens beskrivningar kan bidra till en ökad kunskap om hur vårdpersonalen upplevde sin self-efficacy i hjälplösa situationer.

Background: Managers and health professionals, so-called stakeholders, at the system and clinical level in the acute care chain, are responsible for providing safe and high-quality care encompassing both nursing and medical aspects. In patients with acute abdominal pain (AAP), high-quality nursing care has been described as not always being delivered across the entire acute care chain. This patient group frequently seeks care across the acute care chain and the care procedures and quality may differ widely. The quality of nursing care provided to patients can be understood through the framework Fundamentals of Care. The framework is divided into three dimensions: establishing a relationship with the patient, integration of the patient’s fundamental care needs, and context of care. Stakeholders are one important part of the context of care and a prerequisite for delivery of high-quality care.  Aim: The overall aim was to explore managers’ and health professionals’ understanding of managing and conducting care of patients with AAP across the acute care chain.  Method: Individual interviews with open-ended questions were used in two studies and data were analysed with a conventional qualitative content analysis method. Participants represented ambulance services, emergency departments, and surgical departments. Managers at head nurse level (n=11) and operational level (n=6) at four hospitals were included in Study I. Registered nurses (n=11) and physicians (n=8) at five hospitals were included in Study II. Results: In Study I, managers described the adult patient group as challenging and heterogenous. The managers reflected on themselves as role models. Guidelines were used to organise care, but they often had a medical focus and the managers referred to others as being responsible for the guidelines. Managers who were registered nurses focused on the medical care of patients with AAP, while managers who were physicians underlined the value of nursing care to improve patient outcome. In Study II, health professionals described dedication to applying evidence-based practices. However, they used personal experience over guidelines in care provision. They described organisational barriers to delivering high-quality care, such as varying competence among colleagues, lack of available patient beds, and lack of collaboration across the acute care chain.  Conclusion: The stakeholders’ perspectives complemented each other, but their descriptions of managing and conducting care of patients with AAP did not always fit together, which revealed a gap in the everyday clinical practices as well as structural issues at the system level. These empirical descriptions of differing understanding may reveal some of the reasons why patients with AAP do not always experience high-quality care. To optimise patient care across the acute care chain, stakeholders need a shared understanding to meet patients’ fundamental care needs and enable provision of high-quality nursing and medical care.

Orientador: Ana Cláudia Bortolozzi Maia / Resumo: Pensar sobre a saúde sexual no processo do envelhecimento representa um desafio para os profissionais da saúde e para as políticas públicas no que concerne à necessidade de ampliar as discussões sobre sexualidade, as práticas sexuais no processo de envelhecimento, a prevenção de infecções sexualmente transmissíveis (IST) e o impacto dessas questões na promoção de saúde da pessoa idosa. Esta pesquisa investigou como a saúde sexual no período de desenvolvimento do envelhecimento é retratada em pesquisas e documentos no Brasil, a partir de dois objetivos específicos: (a) realizar um estudo de revisão sistemática da literatura (RSL) para verificar quais categorias temáticas aparecem quando se pensa em saúde sexual no envelhecimento nas produções de pesquisa no Brasil e (b) descrever e analisar os materiais disponibilizados pelo governo federal sobre saúde sexual e/ou sexualidade na idade avançada, para identificar a visão de envelhecimento, sexualidade, gênero, saúde, prevenção, etc. Trata-se de um estudo descritivo e exploratório de abordagem qualitativa e de natureza documental. O método foi de RSL em publicações nacionais na base de dados Scielo e localização e leitura de três materiais disponibilizados pelo Governo Federal sobre saúde sexual e envelhecimento no site do Ministério da Saúde, a partir de um “Guia” de análise elaborado pela pesquisadora. Os resultados encontrados foram um total de 68 artigos, entre 2001 e 2018, com maior concentração em 2015. A área de maior prod... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Thinking about sexual health in the aging process represents a challenge for health professionals and public policies regarding the need to expand discussions on sexuality, sexual practices in the aging process, the prevention of sexually transmitted infections (STIs) ) and the impact of these issues on health promotion for the elderly. This research investigated how sexual health in the period of development of aging is portrayed in research and documents in Brazil, based on two specific objectives: (a) to conduct a systematic literature review study (SLR) to verify which thematic categories appear when thinking about sexual health in aging in research productions in Brazil and (b) describing and analyzing the materials made available by the federal government on sexual health and/or sexuality in old age, to identify the vision of aging, sexuality, gender, health, prevention, etc. It is a descriptive and exploratory study with a qualitative and documentary approach. The method was SLR in national publications in the Scielo database and location and reading of three materials made available by the Federal Government on sexual health and aging on the Ministry of Health website, based on an analysis “Guide” prepared by the researcher. The results found were a total of 68 articles, between 2001 and 2018, with the highest concentration in 2015. The area of greatest production was in Nursing, followed by Health and Gerontology. The articles were divided into 4 categories: A) Viole... (Complete abstract click electronic access below) / Doutor

This study sought to better understand program evaluation capacity and competency amongst public health nurses. Program evaluation plays a vital role in public health and is an identified core competency for public health practice (Canadian Public Health Agency). In Part One, I conducted a scoping review to systematically map the current literature on this topic and to identify important areas for future research. Twenty-three articles were selected based on pre-established exclusion and inclusion criteria and the assistance of a secondary reviewer. The articles highlighted the value of program evaluation in public health and its importance as a nursing skill amidst the evolving health care sector. Themes identified included: a broader lack of public health competencies (including program evaluation) among all public health professionals; the complexities and challenges of evaluating public health interventions; and the uncertainty of what constitutes adequate evaluation competency in public health. Furthermore, my review noted inconsistent terminology to describe a public health nurse and the need for further exploration around the specific evaluation capacity of public health nurses. In Part Two, I explored the stated or expected evaluation competencies for public health nurses through a document review of relevant Canadian public health nursing core competencies, guidelines, and standards for practice. The identification of 52 stated evaluation competencies, demonstrates the assumption that public health nurses have competency and or capacity related to program evaluation and contrasts with the themes identified in my scoping review. Furthermore, the documents I reviewed included no specific reference to the Canadian Evaluation Society (CES), however some of the included content did align with the CES Program Evaluation Standards. This study demonstrates a misalignment between the discourse in the literature reviewed related to evaluation competency amongst public health nurses and the stated or assumed evaluation competencies put forth in leading public health nursing documentation. In the absence of any standardized evaluation training and preparation for public health nurses, further exploration is needed around what these broad evaluation competencies mean in practice and how they can be objectively assessed, exhibited, and better integrated into public health nursing education and evaluation capacity building activities. These questions warrant further investigation to ensure public health interventions are properly evaluated and that public health nurses have the competencies required for effective public health practice.

Philosophiae Doctor - PhD / The value of accountability as a key feature of strengthening health systems and reducing maternal, newborn and child mortality is increasingly emphasised globally, nationally and locally. Frontline health professionals and managers play a crucial role in promoting maternal, newborn and child health (MNCH) services in an equitable and accountable manner. They are at the interface between higher-level health system management and communities, facing demands from both sides and often expected to perform beyond their available means. Although accountability is a central topic in the governance of MNCH literature, it has mostly been approached at global and national levels, with little understanding of how accountability is integrated into the routine functioning of local health systems.

The article provides an overview of efforts to improve public health and health education training and on the potential use of Critical Component Elements (CCEs) for undergraduate health education programs toward more consistent quality assurance across programs. Considered in the context of the Galway Consensus Conference, the authors discuss the need for consistency in health education and public health quality assurance and curricular development. They discuss emerging quality assurance trends in relation to newly approved CCEs by the Association of Schools of Public Health after being developed by the Framing the Future Task Force: The Second 100 Years for Public Health. The CCE development process is discussed including its consideration as a tool program, which can be used to develop or refine undergraduate health education professional preparation programs. The authors suggest that CCEs should be "cross-walked" against existing health education undergraduate-level competencies. The authors conclude that CCEs may serve the long-term health education goal of accreditation for undergraduate health education and promote the tradition of strong undergraduate health education within a broader framework of public health and health promotion.

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The climate at the emergency room is stressful and the staff is under high pressure. Communication between staff and patients is suffering from this and the number of complaints about communication has increased in Sweden. Patients want to be seen as human beings, taken seriously and given attention. There are several factors that can affect the encounter. The purpose of this literature review is to describe the patient's experience of the encounter with the care staff at a visit to the emergency room.  Literature review based on 14 qualitative articles with descriptive design that’s been published between 1999-2019. The databases PubMed and CINAHL were used in the data collection. Joyce Travelbee's nursing theory formed the theoretical framework of the literature review.  Three categories were identified: The first encounter, information and communication, and vulnerable patient groups. The majority of patients feel that a good response includes active listening, good eye contact, respect for privacy and integrity as well as a common respect between patient and staff. A distinct difference between patients´ experience before and after the triage as identified and several felt lonely and forgotten while waiting for help.  Several factors that would improve patients' experience of the encounter at the emergency room were identified. However, there are difficulties in implementing these because the staffs´ situation is stressed and many show signs of burnout, leading to impaired treatment of patients. More research on the subject is needed to be able to draw stronger conclusions.

Many researchers have suggested positive patient-health provider relationships can positively impact patient outcomes. A few focused explicitly on bariatric weight loss surgery (BWLS) professional-patient interactions. This study is significant because BWLS is a recommended tool to combat obesity. The purpose of this study was to analyze the perceptions of BWLS education nurses regarding their patient encounters. This mixed methods research study used an online survey combining quantitative Likert scale questions and open-ended qualitative questions, with social cognitive theory as the theoretical foundation. These explored viewpoints relate to their patient relations expressed by a health professional. Health professional beliefs incorporated into patient interactions has merit within BWLS continuum from presurgery requirements, to the procedure, and post-surgery lifestyle. Many respondents are employed in obesity services programs and received 'snowballs' from other contacted health professionals. The analyzed written response word clouds favor patient-focused care. Participation reluctance by not answering or skipping short answer perspective questions was a quantitative trend. Data revealed survey specific noticeable qualitative tendencies favorable toward patient-centered care and patient health accountability. The anticipated positive social change is a better understanding of issues surrounding the choice for and against BWLS and improved healthcare and health professional-patient communications.

Interprofessional collaboration is recognized as the innovative, evidence-based strategy that strengthens health systems and improves performance and health outcomes. While resource-rich countries have benefited much from the implementation of this initiative, literature is scarce regarding sub-Sahara Africa. This quantitative cross-sectional descriptive study described the extent of interprofessional collaborative practice at the tertiary care level in Nigeria and its implications on patient health outcomes, professionals' performance, satisfaction, and healthy practice environment. The relational coordination theory (RCT) provided the conceptual framework for the study. Key research questions were on the association between the extents of interprofessional practice and each of the outcome implications. Data were collected using a questionnaire survey and were analyzed using means, standard deviations, t tests, correlation and regression statistics, and Chi-square tests. Results showed that the health professionals rated the practice of interprofessional collaboration low and perceived that the extents of the practice negatively affected patient's mortality, professionals' work performance, job satisfaction, and the frequency of interprofessional conflicts and strike actions. Recommendations included policy formulation and implementation, commitment and willingness by the health professionals to teamwork and patient-centered care. The implications for positive social change is that these results could be used as a tool to advocate for policy formulation and policy change for effective implementation of interprofessional collaboration; and as a database for future training intervention on collaborative practices among health professionals.