MSCPNT / Department of Nutrition

Aim: To explore how older people (>65 years), who have been granted home care services for the first time, experienced their contact with the municipal need assessor and the process of the need assessment. Method/data: Semi-structured interviews (n=7) have been conducted with first-time users of social care for older people (>65 years) living in one district in the City of Stockholm. The interviews were thematically analysed based on the theoretical approach by Braun & Clarke (2006).Findings: Applying for home care services affects several dimensions of thoughts and emotions related to the process of ageing. Compromised ability/health/independence and the accessibility of informal care influenced the respondent’s tendency to apply. Thoughts and emotions related to identity, autonomy and managing tasks on their own was significant. Both positive and negative emotions related to the contact with the municipal need assessor was found.Conclusions: Municipal home care services include several aspects beyond the practical matters. The contact with the municipal need assessor was not the main topic discussed, instead focus was put on the thought process/introspective process leading up to an application. In addition, applying for home care services is sometimes experienced as “the last resort” when other possibilities are exhausted.

Bakgrund: Sjuksköterskor inom hemsjukvård har till uppgift att bland flera andra arbetsuppgifter även symtomlindra patienter med palliativt vårdbehov som lider på grund av fysiska, psykiska, psykosociala eller existentiella orsaker. Palliativ vård innebär ett personcentrerat synsätt där kärnan ligger i att se hela människan och inte bara sjukdomen eller det för stunden framträdande symtomet. Palliativ vård bedrivs inom flera verksamheter med olika huvudmän. Syfte: Syftet var att beskriva sjuksköterskors erfarenheter av symtomlindring vid palliativ vård i hemsjukvård. Metod: En kvalitativ litteraturöversikt utfördes på 16 artiklar som hittades genom sökningar i databaserna CINAHL, PubMed och PsycInfo. Artiklarnas resultat analyserades med inspiration av integrativ metod. Genom analys framkom tre kategorier med sex underkategorier gällande sjuksköterskors erfarenheter av symtomlindring vid palliativ vård i hemsjukvård. Resultat: Resultatet visar att sjuksköterskor som arbetar inom hemsjukvård behöver kunskap och kompetens inom palliativ vård och symtomlindring. Det behöver även finnas ett fungerande samarbete med ansvarig läkare för att kunna erbjuda patienten en personcentrerad vård och symtomlindring. Att arbeta som sjuksköterska i hemsjukvård kan i arbetet med palliativ vård ge en känslomässig påverkan i form av frustration och oro. Slutsats: För att patienter med palliativt vårdbehov inom hemsjukvård ska få optimal symtomlindring krävs att sjuksköterskor har kunskap och tidigare erfarenhet, vilket påverkar i vilken utsträckning patienters symtom blir lindrade. Det är även viktigt att det finns en fungerande samverkan med ansvarig läkare i primärvård. Läkares engagemang, kunskap, tid och intresse för palliativ vård är avgörande för kvaliteten på vården. / Background: Nurses in home care have the task of among several other tasks, also relieving symptoms of patients with palliative care needs who suffer due to physical, menthal, psychosocial or existential causes. Palliative care involves a person centered approach where the core lies in seeing the whole person, not just the disease or the currently prominent symptom. Palliative care is conducted in many different activities with different principals. Aim: The aim was to describe nurses experiences of symptom management in palliative care in home care services. Method: A qualitative literature review was performed on 16 articles found through searches in the databases CINAHL, PubMed and PsychInfo. The result of the articles were then analyzed with inspiration from an integrative method. Through analysis three categories emerged with six subcategories regarding nurses experiences of symptoms relief in palliative care in home care. Results: The result showed that in order for nurses to be able to offer the patient optimal symptom relief, conditions were required in form of time, right prescriptions, commitment and collaboration with the district physician. Nurses' experience and knowledge of palliative care were also important for the outcome of the effect of symptom relief, as increased experience provided greater security in symptom relief. Regardless of previous experience and knowledge level, more training in symptom relief was requested. Deficiencies in collaboration with the district physician could create anxiety and frustration among the nurses. Conclusion: In order for patients with palliative care needs in home care to receive optimal symptom relief, it is required that nurses have knowledge and previous experience, which affect the extent to which patient´s symptoms are alleviated. It is also important that there is a functioning collaboration with the responsible doctor in primary care. The doctor's commitment, knowledge, time and interest in palliative care are crucial for the quality of care.

Bakgrund: Att arbeta som distriktssköterska inom hemsjukvården innebär ett självständigt och ansvarsfullt arbete. Hemsjukvård innefattar bland annat att vårda svårt sjuka patienter palliativt i deras hem. Den palliativa vården fokuserar på att lindra patientens lidande och främja livskvaliteten. Beslut om övergång till palliativ vård i livets slutskede fattas av läkare och ett brytpunktssamtal bör hållas med patienten och eventuella närstående. Distriktssköterskan ska kunna identifiera förändringar i patientens allmäntillstånd och bedöma övergång till palliativ vård i livets slutskede tillsammans med läkare. Syfte: Syftet med denna studie var att beskriva distriktssköterskors upplevelser och erfarenheter av att vara delaktiga i bedömningen av övergång till palliativ vård i livets slutskede för patienter inom hemsjukvård. Metod: Studien genomfördes empiriskt som en kvalitativ intervjustudie. Sju distriktssköterskor deltog i intervjuerna och materialet analyserades enligt Graneheim och Lundmans kvalitativa innehållsanalys. Resultat: Resultatet beskrev tre kategorier som påverkade distriktssköterskans upplevelser och erfarenheter: personliga faktorer, faktorer hos patient och närstående samt samverkansfaktorer. Personliga faktorer skildrade den egna inställningen och synen på arbetsuppgiften, vilka kunskaper distriktssköterskan hade samt hur stort ansvaret upplevdes vara. Faktorer hos patient och närstående skildrade patientens egna önskemål samt hur sjukdomsinsikten hos patienten och närstående påverkade distriktssköterskan. Samverkansfaktorer skildrade vårdrelationen mellan distriktssköterska och patient, samarbetet med läkare och brytpunktssamtalets betydelse. Slutsats: Distriktssköterskans samarbete med läkare i bedömningen av övergång till palliativ vård i livets slutskede är av stor betydelse för att kunna tillgodose patientens önskemål. Att ha erfarenhetsbaserad kunskap och en god vårdrelation med patient samt närstående bidrar till att distriktssköterskorna känner sig trygga i att utföra denna arbetsuppgift. / Background: Working as a district nurse in home care services implies independency and high responsibility. Home care service involves for instance giving palliative care for seriously ill patients in their homes. Palliative care focuses on alleviating the patient's suffering and promoting the quality of life. Decision-making about the transition to palliative care at the end of life relies on the doctor and end of life-discussions should be held with the patient and possibly next of kin. The district nurse should be able to identify changes in the patient's condition and make an assessment regarding the transition to palliative care at the end of life together with the doctor. Aim: The aim of this study was to describe experiences among district nurses’ regarding being involved in the assessment of transition to palliative care at the end of life for patients with home care services. Method: The study was conducted empirically as a qualitative interview study. Seven district nurses participated in the interviews and the material was analyzed according to Graneheim and Lundman's qualitative content analysis. Results: The result described three categories that affected the district nurse's experiences: personal factors, factors regarding the patient and next of kin as well as cooperation factors. Personal factors referred to one's own attitude towards the work assignment, what knowledge the district nurse had and how the burden of the responsibility was perceived. Factors regarding the patient and next of kin referred to the patient's own requests and how the patient's and next of kin's understanding of the disease affected the district nurse. Cooperation factors referred to the relationship between the district nurse and the patient, the cooperation with the doctor and the importance of end of life-discussions. Conclusions: The district nurse's cooperation with the doctor in the assessment of transition to palliative care at the end of life is of importance to be able to fulfill the patient's requests. Having experience-based knowledge and a good care relationship with the patient and next of kin contributes to the district nurses feeling confident when performing this work assignment.

Bakgrund: Strukturerad smärtskattning är en högprioriterad åtgärd under patienters sista levnadsvecka enligt Socialstyrelsens styrdokument för palliativ vård. Vården i hemmet ska bedrivas personcentrerat där patientens hälsotillstånd utreds och ska syfta till att lindra lidande. Detta innebär att distriktssköterskor behöver ha färdigheter och kunskaper kring smärta, dess orsak, smärtskattning och behandling. Smärta och dess skattning är betydelsefull och beskrivningen distriktsköterskors erfarenheter av smärtbedömning ökar möjligheten att hitta förbättrings- och förändringsområden.Syfte: Undersöka distriktsköterskors erfarenheter av smärtbedömning vid vård i livets slutskede inom hemsjukvård.Metod: Semistrukturerade intervjuer genomfördes genom videosamtal och bekvämlighetsurval användes under september-november 2022. Sammanlagt intervjuades 15 distriktsköterskor med vana av smärtbedömning vid vård i livets slutskede och analyserades utifrån kvalitativ innehållsanalys.Resultat: I resultatet belyser distriktsköterskorna olika erfarenheter kring användandet av smärtskattningsinstrument i vård i livets slutskede och vilka faktorer som påverkar användningen av smärtskattningsinstrument. Kategorierna som framkom var ”distriktsköterskornas erfarenhet av vikten av att smärtskatta”, ”distriktsköterskornas behov av samordning och kunskap” samt ”distriktsköterskornas erfarenhet av förbättrad smärtlindring”.Slutsats: Tydliga rutiner för användningen av smärtskattningsinstrument och dokumentation kan förbättra vård i livets slutskede inom hemsjukvård. Distriktsköterskorna efterfrågade utbildning i smärtskattningsverktygen anpassade för bedömningar av patienter i livets slutskede.

published_or_final_version / Social Work / Master / Master of Social Sciences

MPM / Oliver Tambo Institute of Governance and Policy Studies / See the attached abstract below

Volunteer caregivers provide essential services to people in the terminal stages of AIDS and their families. Volunteers are exposed to stress and burnout. This study investigated the relationships between stress, coping strategies, levels of burnout and resilience in this population. Volunteers from Societas ‘O Sosiale (SOS) Children Villages and community based organisation (CBO) partnerships, were selected using non-probability purposive convenience sampling. A total of 110 participants were given the Experience of Work and Life Circumstances Questionnaire (WLQ), Brief-Cope, Maslach’s Burnout Inventory (MBI), a Resilience scale and the Living Standard Measure to complete. Statistical analyses were performed on the data. This includes descriptive statistics, reliability analysis, factor analysis, correlations and multivariate analysis of variance. The study found that volunteer caregivers experience high stress levels and burnout related to stressors outside work, remuneration, personnel policies and high resilience. High burnout is associated with all forms of coping. Further it is shown that training in problem-solving skills, counselling, government and public lobbying for support, registration with relevant professional bodies, furnished offices, reasonable recruitment requirements and compensation are needed to help the care givers avert the effect of stressors and control stress by stopping it from turning to burnout. / Psychology / M.A. (Psychology - Research Consultation)

Background: The past two decades have witnessed transition from in-patient hospital settings to Community and Home Based Care in Zimbabwe. This is because of an increase in the number of people developing chronic health conditions such as diabetes, hypertension and cancers, and thus needing longer treatment durations. The increase in chronic conditions has mainly been attributed to the increase in incidence and prevalence of Human Immunodeficiency Virus and Acquired Immune-deficiency Syndrome in Sub-Saharan Africa. Many Governments, including that of Zimbabwe, endorsed and promoted community and home based care to provide a continuum of care to the chronically ill. Despite the implementation of Community and Home Based Care programmes, no studies known to the researcher have been done to investigate the congruency of service users’ needs and the programme goals. Purpose: The purpose of the study is twofold; firstly to explore whether Community and Home Based Care interventions provide services that effectively meet users’ goals in a dynamic social environment and secondly, to develop guidelines for enhancing care provision as well as congruency of service users’ needs and programme goals. Methods: A mixed-method approach combining qualitative and quantitative data collection and analysis was used. Concurrent collection of data with equal status was placed on both qualitative and quantitative data. For qualitative data interviews and focus groups were used with home based care service users, family care givers, and health providers. Structured questionnaires were used for the quantitative data. Framework: Imogene King’s Interacting Systems Framework and Theory of Goal Attainment were adopted to guide the study. These were utilised because of the assumption that mutual agreement on goals for effective care can be achieved through nurse-client interactions and communication Research findings: Community and Home Based Care programme in Zimbabwe does not comprehensively meet the needs of its service users. Service users have diverse needs and goals depending on the specific condition and symptoms they experience. They perceive access to medication for symptom management and pain control, food and financial stability, as priority needs. The study found that nursing services provided in Community and Home Based Care generally align with the physical needs of service users and was deficient in addressing the socio-economic and psycho-social needs of service users. Conclusion: No single sector can achieve the users’ and the programme`s goals of quality health on its own. The goals may only be realised when other stakeholders and relevant sectors contribute to the Community and Home Based Care programme, which requires diverse resources. Guidelines to enhance integration of Community and Home Based Care with social services were developed. / Health Studies / D.Litt. et Phil. (Health Studies)

Thesis (MBA)--University of Stellenbosch, 2010. / Since the first case was discovered in Africa in the late 80s, the HIV/AIDS epidemic has gradually increased at alarming proportions worldwide especially in sub-Saharan Africa which prompted the United Nations' World Health Organisation to declare it a global pandemic. This research undertakes to highlight the current composition of care given for HIV and Aids, and the strengths and weaknesses of such programmes. The aim of this is to establish a better home based care programme in Swakopmund, Namibia, for improving the quality of care as well as living conditions for the infected and affected. For this initiative to be of the highest quality there is need to pay special attention to various regional and national HIV/AIDS programmes and policies. As the HIV/AIDS epidemic continues to spread, organisations and communities are now considering engaging more programmatic approaches as sub-Saharan countries are looking for scaled-up responses and national strategies for home based care. Policy-makers and senior administrators must be involved in developing and monitoring home based care programmes, and the people who manage and run the programmes must share information and feedback with senior administrators. In this sense, policy and action are interrelated as each partner learns from and guides the other. The researcher saw the need to involve community members and home based care-givers in a participatory process to research this topic and engage them in a process on how to improve the programmes that already exist. 52 Pages.