The purpose of this study was to investigate whether elderly clients in an acute care setting perceived themselves as being treated with dignity and respect, and whether clients with a higher socioeconomic status are more likely than clients with a lower socioeconomic status to be treated with dignity and respect. Sixty-two elderly clients who had been in hospital at least five days, were alert and oriented during their hospitalization, and could speak English were selected for the study. Using a convenience sampling technique, the clients were selected from medical and surgical units of two major teaching hospitals. They were interviewed within three days after discharge to respond to items on a questionnaire selected from the Medicus Quality Assurance Tool. The results of the study show that elderly clients may not perceive that they are consistently treated with dignity and respect. Older clients (75+ years) are less likely than younger older clients (65-74) to be treated with dignity and respect, and elderly clients with a lower socioeconomic status and women, are less likely to be treated with dignity and respect. / Applied Science, Faculty of / Nursing, School of / Graduate

This study investigated the relationship between cognitive development and children’s understanding of the hospital nurse’s role. A group of 35 hospitalized children with chronic conditions and without neurological deficits, aged 4 to 10 years, were given three tasks (i.e., the Nurse’s Role Task, the Balance Beam Task, and the Task of Intrapersonal Understanding), scored for developmental level using Case’s (1992) neo-Piagetian theory of cognitive development as a framework. A full sample of 4—year—olds was not pursued due to the distracting hospital environment which, in combination with the shorter attention span of the 4-year-olds, rendered the interviews extremely difficult to complete. Descriptive results indicated a moderately advanced understanding of the hospital nurse’s role by 8— and lO—year—olds, being on the order of one—third of a substage (i.e., approximately 8 months ahead in development), whereas 4— and 6—year—olds showed an age— appropriate level of understanding of the hospital nurse’s role. Analysis of Variance indicated a statistically significant effect for age on all three tasks (p < .01). Six levels of social—cognitive development in understanding the hospital nurse’s role were found, which were, in successive order: (1) Roles of the nurse as scripted actions (i.e., 4-year-old level), (2) Roles of the nurse as motivated action sequences (i.e., 6—year—old level), (3) Roles of the nurse as planned action sequences (i.e., 8— year—old level), (4) Roles of the nurse as generalized dispositions toward action (i.e., 10—year-old level), (5) Roles of the nurse as demonstrating logically planned decisions towards action (i.e., 12-year—old level), and (6) Roles of the nurse as demonstrating logically planned action sequences (i.e., 14—year—old level). Furthermore, results indicate that a few 6- and 8-year-olds and the majority of l0—year—olds could give an accurate description of the duties of the hospital nurse, that is, 1) nurses are there to help children, 2) nurses have a responsibility for the well-being of their patients, 3) nurses want to improve the physical and emotional health of their patients, 4) nurses also see their own shortcomings in their care for children and have good intentions, and 5) nurses are human and have their own feelings, thoughts, doubts, and ideas. Suggestions for future research have been provided in order to further improve communication between health care professionals and hospitalized children with chronic conditions. / Education, Faculty of / Educational and Counselling Psychology, and Special Education (ECPS), Department of / Graduate

The United States (U.S.) is in the midst of an opioid overdose epidemic. In the U.S., overdose deaths related to opioid exposure are the leading cause of accidental death, yet life-saving treatments, such as methadone or buprenorphine (opioid agonist therapy [OAT]), are underused. OAT underused is due, in part, to complex regulatory and health services delivery environments. Public health officials and policymakers have focused on expanding OAT access in the community (e.g. office-based buprenorphine treatment, and opioid treatment programs); however, an often-overlooked component of the treatment pathway is the acute care delivery setting, in particular hospitals. Opioid use disorder (OUD)-related hospitalizations are increasing, and incurring significant costs; care delivered in this setting is likely sub-optimal. This study examined hospital-based services for OUD using a conceptual framework based on an interdisciplinary review of policy, organizational behavior, systems science, economics, and health services delivery scholarship. The study's primary research question was: How do supply-side attributes influence hospital OAT delivery, health outcomes, and health services utilization for persons hospitalized with OUD? Supply-side attributes refer to the contextual elements inside and outside of a hospital that may be associated with hospital OAT delivery performance, such as social structures (e.g., hospital standards of care, societal values) and resources and technologies (e.g., hospital staffing, federal treatment policies). A mixed methods study described, explored, and identified how patients with OUD are cared for in the hospital and the barriers and facilitators to delivering OAT during hospitalization. The sequential mixed methods approach (i.e., qualitative followed by quantitative analyses) included analysis of 17 key informant interviews with addiction medicine physicians from 16 non-federal U.S. hospitals, 25 hospital guidance documents from 10 non-federal U.S. hospitals, and administrative data from 12,407 OUD-related hospital admissions from the Veterans Health Administration (VHA) health system. The findings from the study's three aims and 16 research sub-questions were integrated to reach seven conclusions: 1) OAT is underused in the hospital; 2) OAT delivery varies within and across hospitals; 3) OAT is used ineffectively; 4) non-OAT modalities are inappropriately used during and after hospitalization; 5) supply-side attributes inside and outside the hospital facilitate and impede hospital OAT delivery; 6) demand-side attributes facilitate and impede hospital OAT delivery; and 7) the hospital is an important service delivery mechanism in the OUD care continuum. The study's findings could be extrapolated to improve policy and practice by implementing education and health service delivery interventions through regulatory and allocative policy mechanisms focused on physicians, medical trainees, and hospital and health system administrators. Understanding how OAT delivery may be improved within the acute care delivery system is an important element to support efforts to curb the ongoing drug poisoning crisis.

No description available.

Bakgrund: Stress påverkar individen både fysiologiskt och psykologiskt. Sjuksköterskans yrke kan upplevas stressigt och när denna stress påverkar sjuksköterskan kan omvårdnadsarbetet påverkas negativt. För att reducera stress och risken att patienternas omvårdnadsbehov ej uppfylls krävs ett gediget samarbete mellan hälso- och sjukvårdspersonalen. Syfte Syftet var att sammanställa studier som undersöker sjuksköterskors upplevelser av stress i omvårdnadsarbete. Metod: En litteraturstudie genomfördes med kvalitativ design har använts i studien. Detta för att få en djupare förståelse för sjuksköterskans upplevelser och tankar. Metoden vi utgått från var Forsberg och Wengströms sju steg. Databaserna som användes var PubMed och CINAHL. Resultatet baserades på 15 vetenskapliga studier. Resultat: Två teman identifierades i analysen av studierna. Dessa var: Sjuksköterskors upplevelse av stress och dess påverkan på omvårdnadsarbetet och Sjuksköterskors upplevelser av hur stress påverkar dem i yrket.Konklusion: Stressens påverkan på omvårdnadsarbetet hade många infallsvinklar. En del av faktorerna som spelade roll var arbetsbelastning, samarbete och den moraliska stressen. / Background: Stress affects the individual both physiologically and psychologically. Nurses occupation can be stressed at times and when this stress affects the nurse, nursing care can be adversely affected. In order to reduce stress and the risk that patient needs are not met, solid cooperation is required between healthcare professionals.Aim: The purpose was to compile common themes in studies that investigate nurses' experiences of stress in nursing care.Method: A literature review was conducted with a qualitative design. This design was used to gain a deeper understanding of the nurse's experiences and thoughts. The method that was used was Forsberg and Wengströms seven steps. The databases used were PubMed and CINAHL. The result was based on 15 scientific studies.Results: Two themes were identified in the analysis of the studies. These were: Nurses experience that the occurrence of stress affects nursing work and Nurses experiences of stress affecting in their work.Conclusion: Stress's impact on nursing care had many approaches. Part of the factors that played a part were workload, teamwork and moral distress.

Tidigare studier har inte undersökt hur olika typer av stöd från omgivningen hjälper individer att tillfriskna från en ätstörning. Syftet med den här studien var att undersöka vilken betydelse stöd från vården, familj och anhöriga samt individernas egna strategier haft för själva tillfrisknandet. För majoriteten av de tolv deltagarna hade vägledande samtal en betydande roll för tillfrisknandet. Några av deltagarna uttryckte sig om vårdens okunskap och dåligt bemötande, medan några nämnde vikten av psykoterapeutisk hjälp samt samtalsstöd. Resultatet visade att familj och vänners betydelse samt anpassning av stöd var essentiell i deltagarnas tillfrisknande. Individernas strategier att hantera sin problematik handlade om inställning såväl som individuell drivkraft. Slutsatsen var att stödet från familj och anhöriga var av största vikt, medan relationen till vården och dess betydelse för tillfrisknandet från ätstörningen var både positiv och negativ. Ytterligare forskning rekommenderas för att undersöka hur jämlik vård kan uppfyllas beroende på geografiskt läge.

Bakgrund: I Sverige vårdas cirka 10.000 barn och ungdomar på sjukhus per år. Att vara förälder till ett barn som vårdas på sjukhus väcker känslor. I slutet av 1800-talet ansågs föräldrarnas närvaro ha en negativ inverkan på barnets behandlingsprocess och familjen var därför separerade under barnets tid på sjukhuset. Under 1950-talet ändrades vårdens riktlinjer, föräldrarnas närvaro påverkade barnets välbefinnande och vården värderade föräldrarnas deltagande. Den vård som bedrivs idag under början av 2000-talet ses barnet, föräldrar och sjuksköterskan som ett samarbetande team där alla parters deltagande är viktiga för barnets omvårdnad.   Syfte: Syftet är att beskriva faktorer som påverkar föräldrars upplevelser av omvårdnaden när deras barn vårdas på sjukhus. Metod: En litteraturöversikt som grundar sig på 13 kvalitativa och kvantitativa vetenskapliga artiklar. Artiklarna är hämtade från databaserna Cinahl, PubMed och PsycInfo. Resultat: Analysen av dessa artiklar resulterade i fem centrala fynd och grundar sig på föräldrarnas upplevelse av omvårdnaden: behov av god kommunikation och information, bemötande i sjukvården, relation och delaktighet, sjuksköterskans kulturella kompetens och sjukhusmiljö.   Slutsats: Resultatet av denna litteraturöversikt visade att kommunikation, information, relation, delaktighet, bemötande, kulturell kompetens och sjukhusmiljö var av betydelse för hur föräldrarna upplevde omvårdnaden till sitt barn. / Background: In Sweden, approximately 10.000 children and youths are cared for in hospitals per year. Being the parent of a child being cared for arouses feelings. At the end of the 19th century the presence of parents was considered to have a negative impact on the child’s treatment process and the parents was therefore separated during the child’s time in the hospital. During that 1950s, the care guidelines were changed. Parent’s presence was considered important for the childrens wellbeing. The care during today from the early 2000s sees as a collaborative team where all parties participate in the childrens care, including the nurse.  Aimn: The purpose are to describe the factors that impact the parent’s experience of the child’s care in the hospital. Metod: A literature review based on thirteen qualitative and quantitative scientific articles. The articles are collected from the databases of Cinahl, PubMed and Psycinfo. Result: The result of the analysis resulted in five central findings and is based on the parents experience of nursing: communication and information, relationship, attendance, cultural competence and hospital environment.  Conclusion: The results of this literature review showed that communication, information, relationship, participation, attendance, cultural competence and hospital environment were important for the parent’s experience of the childs care.

Bakgrund: Föräldrars syn på omvårdnad styrs av känslor och skiljer sig mot sjuksköterskors syn på omvårdnad, som styrs av rutiner, arbetsstruktur, ideologiskt engagemang och den dagliga verksamhetens förutsättningar. Den skilda synen på omvårdnad orsakar lätt missförstånd och barriärer mellan föräldrar och sjuksköterskor som kan försämra föräldrars upplevelse av omvårdnad. Sjuksköterskan har som ansvar att anpassa omvårdnaden i största mån efter vad hälsa betyder för den enskilda individen. Sjuksköterskans kunskap om föräldrars upplevelser av omvårdnad är därför en förutsättning för att sjuksköterskan ska kunna leverera en god omvårdnad till en familj. Syfte: Litteraturstudien hade som syfte att belysa föräldrars upplevelse av omvårdnad när deras barn vårdas på sjukhus. Metod: Examensarbetet är utfört som en litteraturöversikt och innehåller 14 vetenskapliga artiklar. De vetenskapliga artiklarna har sökts fram i databaserna CINAHL och PubMed, har granskats enligt granskningsmallar och är godkända av etiska kommittéer. Resultat: Fyra olika huvudkategorier av föräldrars upplevelser kunde utformas i resultatet. 1. Kommunikation 2. Delaktighet i sitt barns vård 3. Sjuksköterskors bemötande 4. Sjukhusmiljön. Kommunikation kunde konstateras vara en viktig del för omvårdnaden där den återfanns som en förutsättning för en upplevelse av god omvårdnad inom alla huvudkategorierna. Slutsats: Föräldrars upplevelser av omvårdnad är viktiga för omvårdnadens grunder. En förbättrad kommunikation mellan sjuksköterskor och föräldrar kan bidra till att främja många av föräldrars upplevelser av omvårdnad när deras barn vårdas på ett sjukhus. Vidare behövs mer framtida forskning om föräldrars upplevelser av omvårdnad för en utökad kunskap och djupare förståelse inom området. / Background: Parents’ view of nursing care differs compared to the nurses’ view of nursing care. Parents’ view of nursing care is highly affected by emotions meanwhile the nurses’ view is based on routines, organizational structure, ideological commitment and the conditions of the daily activities. The different view could easily cause misunderstandings and barriers between them that could worsen the parents experience of the nursing care. The nurse have a responsibility to adapt the nursing care to the individual person’s perception of well being. The knowledge of parents’ experience of nursing care is essential for the quality of the nursing care for families. Aim: This study aimed to illustrate parents’ experience of nursing care when their child is hospitalized. Methods: The study is conducted as a literature review and contains 14 scientific articles whom been collected from CINAHL and PubMed as chosen databases. The articles have been analyzed with review templates and also approved by etichs committees. Findings: Four different main categories of the parents’ experiences of the nursing care where found. 1. Communication 2. Participation in their childs’ care. 3. The nurses’ treatment. 4. The hospital enviroment. Communication had a significant importance for the nursing care. The Communication could also be found as a requisite for a good experience in all the main categories. Conclusion: Parents’ experiences of nursing care are important for the fundamentals of nursing care. Improvement of communication between the nurse and the parents could enhance the parents’ experiences of nursing care when their child was hospitalized. Furthermore, future research on parents experiences of nursing care as a parent is needed to contribute to the gap of knowledge and create a deeper understanding of the subject.

Bakgrund: Autism är en neuropsykiatrisk funktionsvariation som en person har livet ut, 1.7 % av världens befolkning beräknas ha diagnosen autism. De autistiska dragen visar brister i social kommunikation och social interaktion, ett begränsat och upprepande beteendemönster samt fokuserade specialintressen. Autism har ofta en samsjuklighet med flera andra tillstånd, svårigheter och sjukdomar. Hela familjen påverkas emotionellt och ekonomiskt när en familjemedlem har autism. Syfte: Syftet med litteraturstudien var att beskriva föräldrars erfarenheter av sjukhusvård till deras barn med autism. Metod: Deskriptiv litteraturstudie som sammanställt tio vetenskapliga artiklar. Huvudresultat: I resultatet framkom det att föräldrar beskrev att deras barn med autism upplevde sensoriska utmaningar i sjukhusvården. Det innebar en stor sensorisk stress med en påfrestande ny miljö och vårdpersonalens beröring vid undersökning och behandling. Kommunikationssvårigheter gjorde att barnen hade svårt att förmedla känslor och smärta. Föräldrarna upplevde att vårdpersonalen därför hade svårt att göra en rättvis bedömning och behandling. Resultatet visade att enligt föräldrarna behövde vårdpersonalen kompetens om autism för att kunna ge rätt bemötande till varje enskilt barn. Det framkom också att föräldrarna hade stor kunskap om sitt barns beteende och strategier och att vårdpersonalen hade stor nytta av att respektera och använda denna kunskap. Slutsats: Det visade sig vara viktigt att sjuksköterskan minimerade de sensoriska intrycken genom att värdera om undersökningar, förflyttningar och ny personal verkligen behövdes. När en sjuksköterska hade kompetens om autism kunde föräldrarnas kunskap nyttjas, säker vård främjas samt att barnens vårdupplevelse förbättrades. / Background: Autism is a neuropsychiatric disability that a person has for life, 1.7% of the world population is estimated to have an autism diagnosis. The autistic features show shortcomings in social communication and social interaction, a limited and repetitive pattern of behavior and focused special interests. Autism often has a comorbidity with several other conditions, difficulties and diseases. The whole family is affected emotionally and financially when a family member has autism. Aim: The aim of the literature study was to describe parents' experiences of hospital care for their children with autism. Method: Descriptive literature study that compiled ten scientific articles. Main results: The results showed that parents described that their children with autism experienced sensory challenges in hospital care. This meant a great deal of sensory stress with a stressful new environment and the healthcare professionals touch during examination and treatment. Communication difficulties made it difficult for the children to convey feelings and pain. The parents experienced that healthcare professionals had difficulty making a fair assessment and treatment. The results showed that according to the parents, the healthcare professionals needed competence about autism in order to be able to give the right treatment to each individual child. It also emerged that the parents had a great deal of knowledge about their child's behavior and strategies and that the healthcare professionals benefited greatly from respecting and using this knowledge. Conclusion: It turned out to be important that the nurse minimized the sensory impressions by evaluating whether examinations, transfers and new staff were really needed. When a nurse had competence in autism, the parents' knowledge could be used, safety care promoted, and the children's care experience improved.

Currently, 6 million Americans have Alzheimer’s disease and Alzheimer’s disease-related dementias (AD/ADRD). As the segment of Americans aged 65 and older continues to increase, the number of older adults with AD/ADRD (referred to as Persons Living with Dementia [PLWD]) also grows. Additionally, the use of health care services, such as hospitalizations, is increasing among PLWD. Indeed, hospitalizations are more prevalent among PLWD compared to older adults without dementia. Some of these hospitalizations are ambulatory care sensitive condition hospitalizations that can be prevented if individuals have better access to high-quality primary care. However, delivering high-quality primary care is becoming increasingly challenging given the projected PLWD population increase and the shortage of primary care providers. On the other hand, the number of primary care nurse practitioners who can deliver high-quality and cost-effective care to older adults has grown in recent years and will continue to increase with demand. Nonetheless, little is known about how to strengthen essential practice features (i.e., structural capabilities) needed to deliver high-quality care in practices where nurse practitioners provide care to PLWD. Enhancing primary care delivery by strengthening structural capabilities in primary care, such as electronic health records, care coordination, community integration, and reminder systems, can be an effective way to reduce hospitalizations among PLWD. The overall objective of this dissertation is to assess the effects of primary care structural capabilities in practices employing nurse practitioners on both ambulatory care sensitive conditions and all-cause hospitalizations among PLWD. This dissertation entails five chapters. Chapter 1 describes the significance of structural capabilities and related outcomes among PLWD. Chapter 2 includes a systematic review of existing dementia care models in various ambulatory care settings and summarizes the impact of dementia care models on hospitalizations among community-residing PLWD in the United States. Chapter 3 describes the availability of the selected structural capabilities in primary care practices where nurse practitioners provide care to PLWD. The structural capabilities of practices that provide care to a high volume of PLWD are also compared to those caring for a low volume of PLWD in this chapter. Chapter 4 assesses the impact of structural capabilities in primary care practices employing nurse practitioners on hospitalizations among PLWD. Finally, Chapter 5 summarizes the findings from Chapters 2 to 4 and includes information on the strengths, limitations, and implications of the research and findings of the dissertation.