<p>Technology of today makes it possible to change the way traditional healthcare is conducted. As the population grows older, and the elderly is becoming an increasing part of the whole population, the need for cost efficient and personalised care increases. By implementing home healthcare IT projects, it is possible for more patients to be treated at home with sustained quality of care.</p><p>This thesis documents the work of a master’s degree project carried out during the autumn of 2005. The project is part of a research project within the Department of Biomedical Engineering at Linköping University. The project aims at developing a data model for storing medical data. The model should be general and easy to expand. This model is intended to be used within a larger system allowing a patient to measure medical data from a remote location.</p>

Technology of today makes it possible to change the way traditional healthcare is conducted. As the population grows older, and the elderly is becoming an increasing part of the whole population, the need for cost efficient and personalised care increases. By implementing home healthcare IT projects, it is possible for more patients to be treated at home with sustained quality of care. This thesis documents the work of a master’s degree project carried out during the autumn of 2005. The project is part of a research project within the Department of Biomedical Engineering at Linköping University. The project aims at developing a data model for storing medical data. The model should be general and easy to expand. This model is intended to be used within a larger system allowing a patient to measure medical data from a remote location.

<p>Healthcare is very information-intensive. Hence, it has become necessary to use the support of computers in order to efficiently improve such an information-intensive organisation.</p><p>This thesis points out deficiencies in the area of information security in home healthcare regarding personal integrity and secrecy. Home healthcare is, in Sweden, performed by the municipalities. The work is based on the recommendations and common advice for processing of personal data compiled by the Data Inspection Board. Two municipalities in the Västra Götaland Region have been investigated. One of the municipalities has a manual system and the other has a computerized system for personal data management.</p><p>The work includes a field study where persons from both municipalities have been observed. It also includes interviews based on the comprehensive questions from the Data Inspection Board and questions arisen from the observations.</p><p>The work shows that a very clear need of training among personnel involved in home healthcare. It also shows the need for elaborate security measures including levels on access profiles. A weak point concerning security is also the heavy use of facsimile transmission for information distribution.</p>

This report presents a series of models that can be used to find weekly schedules for therapists who provide ongoing treatment to patients scattered around a geographical region. In all cases, the patients’ appointment times and visit days are known prior to the beginning of the planning horizon. Variations in the model include single vs. multiple home bases, homogeneous vs. heterogeneous therapists, lunch break requirements, and a nonlinear cost structure for mileage reimbursement and overtime. The single home base and homogeneous therapist cases proved to be easy to solve and so were not investigated. This left two cases of interest: the first includes only lunch breaks while the second adds overtime and mileage reimbursement. In all, 40 randomly generated data sets were solved that consisted of either 15 or 20 therapists and between roughly 300 and 540 visits over five days. For each instance, we were able to obtain the minimum cost of providing home healthcare services for both models using CPLEX 12.2. The results showed that CPU time increases more rapidly than total cost as the total number of visits grows. In general, data sets with therapists who have different starting and ending locations are more difficult to solve than those whose therapists have the same home base. / text

Bakgrund: Sedan år 2014 ansvarar kommuner runt om i landet för patienter i hemsjukvården. Sjuksköterskan har till uppgift att arbeta för kvalitet, säkerhet och förebygga vårdskador. Vårdskador som uppkommit på grund av brister i läkemedelshanteringen är vanligt förekommande inom vården och leder till stora kostnader. Många brister grundar sig i kommunikationsproblem mellan olika vårdgivare. Flera förbättringsarbeten pågår kring faktorer som anses vara bidragande till bristerna i kommunikationen så som samverkan och spridda informationskällor. Syfte: Syftet med studien var att belysa sjuksköterskor i hemsjukvårdens erfarenheter av informationsöverföring vid läkemedelsförändringar som görs av olika vårdgivare. Metod: En kvalitativ intervjustudie genomfördes med nio stycken sjuksköterskor. Innehållsanalys valdes för bearbetning av insamlade data. Resultat: Vanligt förekommande var att information kring läkemedelsförändringar inte rapporterades till sjuksköterskan från vårdgivare utan framkom istället genom andra källor. Det var ett tidskrävande arbete och sjuksköterskorna upplevde att skilda journalsystem samt icke förankrade rutiner var något som förhindrade dem i arbetet och gav en negativ inverkan på patienterna. För att säkerställa att vården skulle vara patientsäker var det viktigt att det skapades en tydlighet och god samverkan mellan vårdgivare. Slutsats: Resultatet överensstämmer med tidigare forskning om att det föreligger brister i informationsöverföring och att det riskerar patientsäkerheten. Bristerna sågs kunna åtgärdas genom förbättrad samverkan och tydligare rutiner, vilket även uppmärksammats som problemområden av Sveriges Riksdag med efterföljande åtgärder i form av nya föreskrifter som träder i kraft år 2018. / Background: Since 2014, municipalities around the country are responsible for home healthcare patients. The nurse has the task of working for quality, safety and prevention of injuries. Healthcare injuries that arise due to deficiencies in drug management are commonplace in healthcare and leads to high costs. Many deficiencies are based on communication problems between different healthcare providers. Several improvement efforts are taking place around factors that are considered to contribute to the shortcomings of communication, such as collaborative and disseminated sources of information. Objective: The aim of the study was to illustrate nurses in home healthcare’s experiences of information transmission in drug changes between healthcare providers. Method: A qualitative interview study was conducted with nine nurses in the field of home healthcare. Content analysis was the chosen method of processing collected data. Results: Common occurrence was that information about drug changes was not reported to the nurse from the healthcare provider but instead appeared through other sources. It was a time-consuming job, and the nurses felt that separate journals and unassigned routines were something that prevented them at work and had a negative impact on patients. In order to ensure that healthcare was patient-safe, it was important that clarity and good cooperation between healthcare providers were created. Conclusion: The result is consistent with previous research that there are shortcomings in information transmission and that it risks patient safety. The shortcomings were seen to be corrected through improved cooperation and clearer procedures, which were also noted as problem areas of the Swedish Parliament with subsequent measures in the form of new regulations that will enter into force in 2018.

Healthcare is very information-intensive. Hence, it has become necessary to use the support of computers in order to efficiently improve such an information-intensive organisation. This thesis points out deficiencies in the area of information security in home healthcare regarding personal integrity and secrecy. Home healthcare is, in Sweden, performed by the municipalities. The work is based on the recommendations and common advice for processing of personal data compiled by the Data Inspection Board. Two municipalities in the Västra Götaland Region have been investigated. One of the municipalities has a manual system and the other has a computerized system for personal data management. The work includes a field study where persons from both municipalities have been observed. It also includes interviews based on the comprehensive questions from the Data Inspection Board and questions arisen from the observations. The work shows that a very clear need of training among personnel involved in home healthcare. It also shows the need for elaborate security measures including levels on access profiles. A weak point concerning security is also the heavy use of facsimile transmission for information distribution.

Bakgrund: Palliativ vård ges till patienter vars sjukdom inte längre kan behandlas kurativt. Målet med palliativ vård är att ge bästa möjliga livskvalité för patienter. Vården är utformad efter fyra hörnstenar: symtomlindring, kommunikation och relation, samarbete och stöd till anhöriga. Att arbeta utifrån personcentrerad vård är viktigt för att kunna anpassa och tillgodose patientens behov och önskemål.  Syfte: Att beskriva sjuksköterskors erfarenheter av att vårda patienter inom palliativ vård i hemmet. Metod: Litteraturöversikten är en sammanställning av 13 vetenskapliga artiklar med kvalitativ metod som analyserats med en induktiv ansats. Sökningar till resultatet gjordes i PsychINFO, Cinahl och MEDLINE. Artiklarna analyserades enligt Fribergs analysprocess i fem steg. Resultat: Två teman och sju subteman framkom i analysen. Sjuksköterskorna strävade efter att erbjuda human vård och få patienterna och anhöriga delaktiga i vården. Känslor väcktes hos sjuksköterskorna när de vårda palliativa patienter i hemmet. Sjuksköterskorna kunde känna sig utelämnade och såg personal- och tidsbrist som ett problem i deras arbete.    Slutsats:  Sjuksköterskor har en betydelsefull roll i att bedriva vård till patienter som är palliativa. För att kunna bedriva en personcentrerad vård krävs ett bra samarbete mellan vårdprofessionerna. Samarbetet kunde vara bristfälligt och är något som kan förbättras. / Background: Palliative care is administered to patients when illness is terminal and can no longer be cured.  The goal of palliative care is to provide the best possible quality of life for patients during their remaining days and is designed with four cornerstones in mind: symptom relief, communication and relationship, collaboration, and support to close relatives.  Providing “person-centered” care is of utmost importance to successfully adapt and meet patients' needs and wishes. Aim: To describe nurses' experiences of caring for patients in palliative care at home. Method: The literature review is a compilation consisting of 13 articles with a qualitative method that was analyzed with an inductive approach. Searches were made on PsychINFO, Cinahl and MEDLINE. and analyzed according to Friberg's analysis process in five steps. Results: Two themes and seven subthemes emerged in the analysis.  The nurses strived to offer optimal humane care by actively involving patients and their relatives. Various psychological /emotional responses arose in the nurses while caring for palliative patients in home settings.  Nurses could feel left out and saw staff and time shortages as a problem in their work.  Conclusion:  Nurses have an important role in providing care to patients who are palliative. In order to be able to conduct person-centered care, good collaboration between the health care professionals is required. Cooperation could be inadequate and is something that can be improved.

Bakgrund: Befolkningen i Sverige ökar och blir allt äldre och många väljer att bo kvar i sina ordinära boenden. Vård- och omsorgspersonal inom hemsjukvården har en viktig roll i att förmedla trygghet och att anpassa omvårdnaden utifrån de äldres behov så att de äldre kan bo kvar i hemmet så länge de vill. Syftet: Var att beskriva distriktssköterskans upplevelse av vad som skapar trygghet hos äldre inom hemsjukvården. Metod: Kvalitativ design med induktiv ansats användes där data samlades in med fokusgruppsintervjuer. Det var totalt tio deltagare i fokusgrupperna. Åldern var 27-65 år och de hade en arbetslivserfarenhet på 18,6 år tillsammans. Analysen som användes var kvalitativ innehållsanalys. Resultat: För att skapa trygghet var det viktigt att vara närvarande i stunden, att skapa en tillitsfull relation och att kunna tillgodose de äldres behov. Diskussion: Kommunikation och förtroende var centrala områden för att främja tryggheten hos äldre. Slutsats: För att äldre ska uppleva trygghet behöver ett förtroende skapas. Viktiga faktorer var kontinuitet bland vård- och omsorgspersonal och god kommunikation med närstående samt de yrkesgrupper som fanns kring den äldre. Detta kan medföra att äldre kan bo kvar och känna sig trygga med omvården i sina ordinära boenden. / Background: The population in Sweden is increasing and getting older and many people choose to stay in their ordinary homes. Home care and nursing staff have an important role to play in delivering security and adapting care based on the needs of the elderly so that the elderly can stay in the home for as long as they want. The Aim: Was to describe the district nurse´s experience of what creates security for the elderly in home care. Method: Qualitative design with an inductive approach was used where data were collected in focus groups interviews. There were a total of ten participants in the focus groups. The age was 27–65 years and they had a working experience of 18, 6 years together. The analysis used was qualitative content analysis. Findings: In order to create security, it was important to be present in moments, to establish a trusting relationship and to be able to meet the needs of the elderly. Discussion: Communication and trust are the key areas for promoting the safety of the elderly. Conclusion: In order for the elderly to experience security, a trust is created. Important factors was continuity among nursing staff and good communication with close relatives as well as the professional groups that exist around the elderly. This can mean that the elderly ca stay and feel safe in the care in their ordinary homes. / <p>Godkännandedatum: 2019-11-05</p>

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