While some individuals can successfully age at home, others with similar levels of need may require facility based long-term care (LTC). The question addressed in this thesis is: “What factors determine whether or not older persons age at home?” I argue that in addition to the characteristics and care needs of individuals (the demand side); access to home and community care (H&CC) at the local level (the supply side) determines whether or not older people receive care at home relative to other settings. In emphasizing the role of the supply side, I draw on Neoinstitutional Theory and the Theory of Human Ecology to examine how institutions of the state (policies, norms, values, and organizational structures) facilitate or constrain opportunities to age at home across urban and rural areas. In conducting my analysis I draw on the Balance of Care (BoC) framework to analyze the characteristics of individuals waiting for LTC placement in Thunder Bay (urban community) and the surrounding Region (rural communities) of Northwestern Ontario. The BoC framework provides the means to estimate the extent to which their needs could potentially be met in the community if home and community care (H&CC) services were available. The results show that individuals waiting for LTC placement in Thunder Bay experienced higher levels of impairment than those in the Region. However in both areas, most individuals required assistance with instrumental activities of daily living (e.g. housekeeping, meal preparation, etc). In both areas there was limited access to informal caregivers. If a H&CC package were to be made available, 8% of those waiting for facility based LTC in Thunder Bay could potentially be supported safely and cost-effectively at home compared to 50% in the surrounding Region. The results confirm that the supply side matters. When H&CC cannot be accessed, LTC may become the default option, particularly in rural and remote areas. If given access to H&CC, a significant proportion of individuals can potentially age at home.

While some individuals can successfully age at home, others with similar levels of need may require facility based long-term care (LTC). The question addressed in this thesis is: “What factors determine whether or not older persons age at home?” I argue that in addition to the characteristics and care needs of individuals (the demand side); access to home and community care (H&CC) at the local level (the supply side) determines whether or not older people receive care at home relative to other settings. In emphasizing the role of the supply side, I draw on Neoinstitutional Theory and the Theory of Human Ecology to examine how institutions of the state (policies, norms, values, and organizational structures) facilitate or constrain opportunities to age at home across urban and rural areas. In conducting my analysis I draw on the Balance of Care (BoC) framework to analyze the characteristics of individuals waiting for LTC placement in Thunder Bay (urban community) and the surrounding Region (rural communities) of Northwestern Ontario. The BoC framework provides the means to estimate the extent to which their needs could potentially be met in the community if home and community care (H&CC) services were available. The results show that individuals waiting for LTC placement in Thunder Bay experienced higher levels of impairment than those in the Region. However in both areas, most individuals required assistance with instrumental activities of daily living (e.g. housekeeping, meal preparation, etc). In both areas there was limited access to informal caregivers. If a H&CC package were to be made available, 8% of those waiting for facility based LTC in Thunder Bay could potentially be supported safely and cost-effectively at home compared to 50% in the surrounding Region. The results confirm that the supply side matters. When H&CC cannot be accessed, LTC may become the default option, particularly in rural and remote areas. If given access to H&CC, a significant proportion of individuals can potentially age at home.

Lietuvoje, kaip ir daugelyje pasaulio šalių sparčiai vyksta gyventojų senėjimo procesas. Todėl yra labai svarbios įvairios socialinės pagalbos rūšys pagyvenusiems žmonėms, o ypatingai pagalba namuose, tam, kad senyvas žmogus galėtų kuo ilgiau gyventi jam įprastoje pažįstamoje aplinkoje. Šis tyrimas yra skirtas atskleisti pagalbą namuose gaunančių pagyvenusių asmenų socialinį tinklą ir tinklo funkcijas. Darbe analizuojamos socialinės politikos pagyvenusiems žmonėms prielaidos ir asmens senėjimo procesų poveikis pagyvenusio žmogaus socialiniam tinklui. Buvo iškelta hipotezė, kad, kuo senyvo žmogaus socialinis tinklas siauresnis, tuo svarbesnė tampa formalių teikėjų socialinė parama. Darbo tikslas - analizuoti pagyvenusių žmonių socialinio tinklo platumo ir gaunamos socialinės paramos sąryšį. Uždaviniai: analizuoti senyvo žmogaus socialinės paramos tinklo ypatumus socialinės politikos kontekste; identifikuoti senyvo žmogaus socialinio tinklo platumą; identifikuoti senyvo žmogaus gaunamą socialinę paramą. Pagalbą namuose gaunančių pagyvenusių asmenų socialinio tinklo analizei atlikti buvo taikomas kiekybinis tyrimo metodas. Siekiant atsakyti į tyrimo tikslą, tyrimo respondentais buvo pasirinkti pagyvenę, vyresni nei 60 metų amžiaus žmonės, kurie gauna pagalbos namuose paslaugas X rajono savivaldybės teritorijoje. Tyrimo tikslui pasiekti buvo sudarytas klausimynas. Jame pateiktas 51 klausimas. Tyrimas atliktas 2008 metų rugpjūčio – rugsėjo mėnesiais X socialinių paslaugų centre... [toliau žr. visą tekstą] / In Lithuania and also in many other world countries the population is rapidly aging. Therefore it is important to provide various kinds of social care services for elderly, in particular homecare, so that the senior could as long as possible live his/her life in familiar surroundings. This investigation aims to reveal the social network of elderly receiving homecare and its functions. The thesis analyses assumptions of social policy for elderly and influence of problems related to person aging to the social network of the senior. Hypothesis was formulated: the narrower social network of the senior is the more important formal social care becomes. The purpose of the thesis is to analyze the relationship between the broadness of social network of the elderly and received social care. The objectives are: to analyze peculiarities of the social care network of the senior in the context of the social policy; identify broadness of the social network of the senior; identify social care received by the senior in the network. Social network of the elderly receiving homecare services was analyzed using quantitative research method. To respond the goal of the research the respondents were older than 60 years, who receive homecare services in the area of municipality of X region. Questionnaire was used to achieve the research goal. It consists of 51 questions. The survey was carried out in since August to September, 2008 in X social services centre. 80 women and 20 men were questioned... [to full text]

Bakgrund: Distriktssköterskor har i Sverige haft förskrivningsrätt sedan mitten av 1990-talet. Anledningen från början var att underlätta för läkarna, framför allt på landsbygden där läkartätheten var låg. Socialstyrelsen genomförde år 2000 en uppföljning av hur förskrivningsrätten användes. Författarna ville se om och/eller hur förskrivningen har förändrats samt hur förskrivningen ser ut i Sverige jämfört med andra länder. Syfte: Syftet med studien var att beskriva distriktssköterskans erfarenheter av att förskriva läkemedel i hemsjukvården samt deras uppfattning om förskrivningsrättens framtida utveckling inom distriktssköterskeproffessionen. Metod: Författarna valde att använda en kvalitativ metod i studien och som datainsamlingsmetod användes intervjuer med öppna frågor. Vid datanalysen användes en induktiv ansats där författarna bearbetade materialet med stöd av kvalitativ innehållsanalys. Resultat: Distriktssköterskan upplever att förskrivningsrätten är en bra kompetens att ha och att den underlättar i det dagliga arbetet. Olika faktorer påverkar hur väl förskrivningen fungerar. Möjlighet till regelbunden fortbildning och kontinuitet i arbetslaget främjar förskrivningen. Däremot saknas till viss del funktionella IT-system som underlättar förskrivningen. Dessutom finns många av de läkemedel som får förskrivas redan att tillgå utan recept. Därför upplever distriktssköterskan förskrivningsrätten ibland som en otillräcklig resurs inom distriktssköterskeprofessionen som skulle kunna utnyttjas på ett effektivare sätt. / Background: Since the middle of the 1990’s district nurses in Sweden have had the ability to prescribe drugs. In the beginning the reason was to help the physicians. The Swedish Social Board monitored in the year 2000 how this prescribing was used. The authors wanted to investigate if and/or how the prescribing has changed and also how the prescribing is used in Sweden compared to other countries. Aim: The aim with the study was to describe the district nurses’ experiences of prescribing drugs in homecare nursing and their opinion of the future development of prescribing in their profession. Method: The authors chose to use a qualitative method in the study and the method of data gathering was interviews based on open questions. At the analysis of data an inductive approach was used and the authors processed the material using qualitative content analysis. Results: District nurses experience that the prescribing facilitates their daily work. Access to regular education and continuity in the working team promotes the prescribing. Some essential IT systems are missing which would facilitate prescribing. Furthermore a large amount of the drugs that can be prescribed are already available without prescription. Therefore prescribing drugs is sometimes perceived as an insufficient resource in district nurses profession that could be utilized in a more effective way.

En meningsfull tillvaro Syftet med denna studie har varit att undersöka i vilken grad en omsorgsmottagare upplever en meningsfull tillvaro utifrån beviljade hemtjänstinsatser. Studien har bedrivits genom en halvstrukturerad, kvalitativ intervjumetod med omsorgsmottagare, omsorgsgivare samt biståndshandläggare och analyser av empirin har utgått från symbolisk interaktionism och dramaturgisk rollteori. Vi har funnit att det som är centralt för den enskilde för att känna meningsfullhet är den sociala interaktionen tillsammans med andra människor, att boendemiljön är trivsam och önskvärd samt att den enskilde har en känsla av trygghet. Trots det faktum att omsorgs- och serviceinsatser, i olika grad, påverkar dessa aspekter är studiens viktigaste slutsats att de enskilda vanligtvis inte sammankopplar beviljade insatser med känslan av meningsfullhet. / A meaningful existence The purpose of this study was to examine the degree to which a care recipient is experiencing a meaningful existence by established homecare services. The study was conducted through a structured, qualitative interview method with care recipients, carers and care managers, analysis of empirical data has been based on symbolic interaction and dramaturgical perspective. We have found that crucial for the individual to feel meaningfulness is social interaction with other people, that the living environment is satisfying and desirable, and that the individual also possesses a sense of security. Despite the fact that the home care services, to varying degrees, affect these aspects, the study's main conclusion is that individuals usually do not associate the granted proceedings with the sense of meaningfulness

No description available.

Att arbeta som sjuksköterska/distriktssköterska (SSK/DSK) innebär arbetsuppgifter som varierar mycket. Denna arbetsmiljö kan vara väldigt krävande och kan påverka SSK/DSK på ett negativt sätt vilket kan leda till fysisk och psykisk påverkan. Copingstrategier är hur personer hanterar krävande situationer, utan effektiva copingstrategier finns risk att personen drabbas av utbrändhet. Syftet med denna studie var att beskriva graden av skattad utbrändhet och vilka copingstrategier SSK/DSK använder sig av i sitt arbete inom hemsjukvården (HSV). Studien undersökte också om det fanns några skillnader gällande grad av utbrändhet och förekomst av copingstrategier beroende på vilket län SSK/DSK arbetade i samt om det fanns samband mellan copingstrategier och grad av utbrändhet hos SSK/DSK. Två standardiserade formulär användes i studien; Maslach Burnout Inventory (MBI) och Jalowice Coping Scale -60 (JCS). MBI mäter graden av utbrändhet relaterat till arbetsmiljö och JCS är ett formulär som mäter vilka copingstrategier som respondenten använder. Undersökningsgruppen till föreliggande studie var SSK/DSK inom hemsjukvården (HSV) i två län i Mellansverige. SSK/DSK skattade sig ha en medelmåttig grad av emotionell utmattning och en låg grad av depersonalisation samt en medelmåttlig grad i personlig prestation. Konfrontativ, optimistisk och självtillits coping var de mest använda copingstrategierna i båda länen. Skillnader framkom inte mellan de två länen men statistisk signifikanta resultat framkom i samband mellan använda copingstrategier och utbrändhet.  Sammanfattning:   SSK/DSK skattade sig har en medelmåttig grad av utbrändhet i två dimensioner, detta trots att de mest använda copingstrategierna fanns inom konfrontativ coping och visade sig ha samband med minskad grad av utbrändhet. Med de två undersökningsgrupperna som liknade varandra i bakgrundsdata och storlek framkom inga skillnader mellan de två länen. Statistiska signifikanta samband framkom mellan copingstrategierna; undvikande, lindrande, känslomässig, självtillit och dimensionerna inom utbrändhet. Sambanden visade ökad risk för utbrändhet. Detta styrker vikten av att använda passande copingstrategi för situationen. / To work as a nurse or a district-nurse entails varied responsibilities. This work environment can take a toll on the nurse/district nurse, which can result in both physical and mental strain for the person. To use coping strategies is the way a person responds to demanding situations, and to use ineffective coping strategies can result in that a person experience burnout. The aim of the study was to describe the degree of burnout the nurses/district nurses experience as well as what coping strategies they use in their profession in homecare. The study also examined if there were any differences in the degree of burnout and coping strategies between the two counties included in the study, as well as relationships between coping and burnout. The Method used was two standardized questionnaires. Maslach Burnout Inventory (MBI) and the Jalowiec Coping Scale-60 (JCS). MBI measures the degree of burnout the participant experiences related to his/hers working environment. The JCS measures coping strategies the participant uses in a situation. The participants in the study were 56 nurses or district nurses working in district homecare in two counties in the middle of Sweden. The participants rated their degree of burnout to be average in emotional burnout, low in depersonalization and average in personal accomplishment. The most used coping strategies were in the subscales confrontational, optimistic and self-reliant. There were no differences in burnout and coping strategies between the two counties, however there were statistically significant correlations between coping strategies and burnout. As a conclusion, the nurses/district nurses reported average burnout in two dimensions although the most used coping strategy was in the subscale of confrontative coping. Confrontative coping showed relationships with a lowered risk of burnout. The two samples were very similar in background data sample size and no differences were found between the two counties. Statistically significant relations existed between the coping subscales: evasive, palliative, emotive, self-reliant and burnout. The relations showed an increased risk of burnout. This emphasizes the importance for suitable coping depending on the situation.

Abstract The aim of the study was to describe district nurses experiences meeting intimate of cancer patients in home care. The study had a qualitative approach with a descriptive design. The sample consisted of ten district nurses employed in primary health care, working in emergency duty in a district in the Middle of Sweden. The results are presented from the two categories; to communicate and being competent, which was formulated to one theme. The theme “Being safe in one´s professional role, being aware of possibilities and difficulties when encountering intimates in home care”. The district nurses experienced that they had an important role since they had to notice and understand the needs of the intimates as well as to refute and confirm them. To act like ‘a guest’ in the patient's home was important and regarded a respectful behavior towards the family, according to the district nurses. To give intimates ‘time’ was stated urgent and described possible during the nightshifts. According to the district nurses well informed intimates felt more secure in their situation. The district nurses experienced that it is important to observe and understand the intimate’s body language and empathized that both verbal and non verbal communication must be paid attention. They stated that encountering intimates included answering their questions as well as they could. The district nurses felt that it was not always easy to refute the questions asked and they could feel deficiencies in their own capability and competence. Sometimes, encountering intimates, the districts nurses experienced difficulties being professional since they felt lack of ‘tools’.         Keywords: Intimates, cancer, district nurses, nightshift, homecare, encounter

<p>Sjuksköterskor har idag en arbetsledande roll framförallt inom den kommunala hälso- och sjukvården. Syfte: Att belysa sjuksköterskors upplevelse av teamarbete kring patienten i hemvården. Bakgrund: Sedan Ädelreformen 1992 har sjuksköterskor blivit mer framträdande medarbetare i den kommunala sjukvården. Att arbeta inom kommunal hemvård är en utmaning då det krävs en stor kunskapsbredd för sjuksköterskor. Sjuksköterskors arbete regleras av lagar och författningar som betonar att hon bör ha en arbetsledande förmåga och att hon bör arbeta för teamsamverkan. Tidigare forskning tyder på att teamarbete främjar både arbetskamraters trivsel med varandra och kvalitén på vården. Metod: Kvalitativ ansats. 10 berättelser från sjuksköterskor verksamma i kommunal hemvård analyserades. Analysen gjordes med inspiration av Dahlbergs tre analysfaser.Resultat: Sex kategorier framkom under analysen: Samarbete, Kommunikation, Relation, Ansvar, Tidsbrist, Patient. Kommunikation framstår som en viktig del som både hindrar och möjliggör gott samarbete. Att se varandras kompetens och att lita på den framgick också som viktigt. Att brister i samarbetet kunde leda till att patienten ej fick den vård han/hon bör få framkom också i studien. Studien antyder att det kan vara av vikt att i framtiden belysa teamarbete inom hemvården då det tycks finnas brister i samarbetet mellan sjuksköterskor och undersköterskor, vilket kan påverka omvårdnaden.</p> / <p>Nurses today have a supervising role primarily in the community health services. Aim: To illuminate nurse’s experience of team work around the patient in home care. Background: Since Ädelreformen 1992, nurses have become a more prominent employee in the community health care. Working within the community homecare is a challenge because it requires a wide knowledgebase for nurses. Nurses are regulated by laws and constitutions that stresses her role as supervisor and her work for the team interaction. Previous research suggests that teamwork promotes both work colleagues' comfort with each other and the quality of care. Method: Qualitative approach. 10 stories from nurses working in homecare were analyzed with inspiration from Dahlberg`s three analysis phases Results: Six categories emerged in the analysis: Cooperation, Communication, Relation, Responsibility, Shortage of time, Patient. Communication appears to play an important role both as obstacles and as possibilities for teamwork. To see each other's competence and to trust it is important. Lack of cooperation could lead to patients not receiving the care he/she should get emerged in the study. The study suggests that it may be important in the future to highlight teamwork in homecare because there seems to be lack of co-operation between nurses and assistant nurses, which may affect the nursing care.</p>

Abstract This dissertation aimed at developing a multi-modal sensing u-healthcare system (MSUS), which reflects the unique properties of a healthcare application in a wireless sensor network. Together with health parameters, such as ECG, SpO2 and blood pressure, the system also transfers context-aware data, including activity, position and tracking data, in a wireless sensor network environment at home or in a hospital. Since packet loss may have fatal consequences for patients, health-related data are more critical than most other types of monitoring data. Thus, compared to environmental, agricultural or industrial monitoring, healthcare monitoring in a wireless environment imposes different requirements and priorities. These include heavy data traffic with wavelike parameters in wireless sensor network and fatal data loss due to the traffic. To ensure reliable data transfer in a wireless sensor network, this research placed special emphasis on the optimization of sampling rate, packet length and transmission rate, and on the traffic reduction method. To improve the reliability and accuracy of diagnosis, the u-healthcare system also collects context-aware information on the user’s activity and location and provides real-time tracking. Waveform health parameters, such as ECG, are normally sampled in the 100 to 400 Hz range according to the monitoring purpose. This type of waveform data may incur a heavy burden in wireless communication. To reduce wireless traffic between the sensor nodes and the gateway node, the system utilizes on-site ECG analysis implemented on the sensor nodes as well as query architecture. A 3D VRML viewer was also developed for the realistic monitoring of the user’s moving path and location. Two communication methods, an 802.15.4-based wireless sensor network and a CDMA cellular network are used by sensors placed on the users’ bodies to gather medical data, which is then transmitted to a server PC at home or in the hospital, depending on whether the sensor is within or outside the range of the wireless sensor network.