Bakgrund: Enligt nationella patientenkäten är patienterna nöjda med vården, däremot skattas inte delaktigheten lika högt.  Ett sätt att öka delaktigheten är personcentrerad vård, som dessutom kan ge en mer effektiv vård med högre kvalitet.  Syfte: Studiens syfte var att beskriva och analysera ett förbättringsarbete om att öka patientens delaktighet genom införande av personcentrerad vård på en kardiologisk vårdenhet. Metod: Förbättringsarbetet genomfördes enligt Nolans förbättringsmodell. Studien var en fallstudie med induktiv ansats. Kvantitativ datainsamling skedde genom enkäter till patienter och medarbetare före och efter fem månaders förbättringsarbete. Kvalitativ datainsamling skedde genom foksugruppsintervjuer med medarbetare. Resultat: Enkäterna visade inga tydliga skillnader efter fem månaders förbättringsarbete. Både patienter och medarbetare skattade patientdelaktigheten högt. Det som skattades lägst av båda grupper var hänsynstagande till arbete, levnadsvanor och tidigare erfarenhet av sjukhusvård. Fokusgruppsintervjuerna visade att välinformerade patienter i större utsträckning kunde vara mer delaktiga. Medarbetarna fick en bättre förståelse av patienten, samtidigt fanns oro över att missa viktig information. Viljan fanns till personcentrering, men förutsättningarna saknades. Slutsats: Förbättringsmodellen är lämplig för införande av personcentrerad vård för att kunna testa vad som fungerar praktiskt. För att lyckas behövs tid och stöd från ledningen. Medarbetarna behöver träning, coaching och få vara delaktiga i förbättringsarbetet.

To ensure the provision of good and safe nursing care in the ward, the nursing needs of each patient should be established and clearly documented in the form of care plans in his/her medical record. There is a lack of scientific evidence of the benefits of this method of working as well as why this part of the nursing process is not always successful. The main aim of this thesis was to describe the assessment and decision-making process pertaining to nursing needs performed by nurses, to evaluate the consequences of planned, process oriented nursing care and to identify the factors and conditions that have had an impact on the implementation of individual care plans (ICP) and standardized care plans (SCP).   In studies I and III, qualitative methods were used. In study I, data collection and analysis were carried out by means of Grounded theory. Study III was conducted by means of directed content analysis and guided by “The Promoting Action on Research Implementation in Health Services framework”. In studies II and IV, quantitative methods were employed.   The benefits of a planned, process oriented method of working involving documentation of care plans have been investigated from the perspective of both the patient and the nurse. Nurses who applied the process oriented method adopted a nursing perspective in the assessment of and decision making pertaining to the patient’s nursing needs, which was not the case with nurses who did not work in this way and who instead exhibited a more medical approach (I). Patients cared for in wards where care plans were documented reported being more involved and that the care was more tailored to their individual needs compared to those not cared for in this manner (II). Leadership that prioritises the development of nursing care is essential for the implementation and continued use of ICPs and SCPs. Another important factor was the presence of internal facilitators in the ward in the form of nurses with a clear mandate to work with these issues. The nurses reported that they did not discuss scientific evidence as a basis for performing planned process oriented nursing care and that they did not listen to patient experiences to any great extent (III, IV).   The conclusion is that structured, process oriented nursing care based on written care plans probably promotes the nursing perspective and enables patient participation. Leadership as well as facilitators with a clear role and mandate are important factors in the implementation of this method of working and scientific evidence is of less importance.

Sammanfattning  För att förhålla sig till en modern och föränderlig omgivning genomgår idag många offentliga  verksamheter stora förändringar i sina sätt att styra organisationen. En av de största förändringar  som skett är möjligheten för privata aktörer att köpa upp och bedriva verksamheter, något som  tidigare bedrivits i kommunal regi. Äldreomsorgen är en av de sektorer som idag står inför stora  organisatoriska utmaningar där omsorg ska kombineras med strategier som tidigare främst tillhörde  marknaden.  Den forskning som har gjorts på området är tvetydig och ger inga klara besked om de effekter som  privatiseringen har för varesig personal eller vårdtagare. Vi ville därför undersöka ett privatiserat  äldreboende för att studera vilka marknadsmässiga tendenser det kan uppvisa samt hur personalen  upplever sin arbetssituation.  Uppsatsens resultat visar att äldreboendet har flera marknadsmässiga inslag och att personalen i det  stora hela verkar mycket nöjda med sin arbetssituation. Vidare framgår de fördelar en privatisering  kan innebära för både anställda och vårdtagare beträffande kvalitet och utbud, men även de  svårigheter som uppstår i omsorgsarbetet då omsorg som en relativt oförutsägbar verksamhet inte  tillfullo kan anpassas till företagsmässiga visioner och strategier.  Nyckelord: Äldreomsorg, privatiseringens effekter, standardisering, individuell omsorg,  omsorgspersonal. / Abstract  To respond to a changing and contemporary environment many organisations in the public sector  changes in their way of controlling the organisation. One of the biggest changes is the ability of  private actors to buy and practice care, which were previously conducted by the municipality.  Elderly care is one of the sectors which are currently facing major organisational challenges where  care will be combined with strategies that previously belonged to the market sector.  The research that has been done in this area is ambiguous and gives no clear answer about the  effects that privatisation has. Therefore we wanted to investigate a privatised home for the elderly to  study the market trends that can exhibit and how staff perceives their work situation.  The result shows that the home for the elderly has market elements and their staff seems very  pleased with their work situation. The study shows that there are benefits of privatisation for both  employees and patients regarding quality and supplies, but the study also shows the difficulties that  occur in the care work when care, which is an unpredictable activity, not fully can be adapted to  market visions and strategies.  Keywords: Elderly care, effects of privatisation, standardisation, individual care, care workers.

Darbo tikslas. Įvertinti P.Mažylio gimdymo namų akušerijos skyriaus pacienčių požiūrį į teikiamų paslaugų kokybę ir jų lūkesčių patenkinimą. Uždaviniai. 1. Nustatyti pacienčių motyvaciją pasirenkant gydymo įstaigą. 2. Įvertinti pacienčių požiūrį į akušerijos stacionaro paslaugų kokybę. 3. Nustatyti pacienčių lūkesčių patenkinimą akušerijos skyriuje. 4. Įvertinti akušerijos skyriaus pacienčių žinias apie gimdymo eigą ir galimas komplikacijas. Tyrimo metodika. 2007m. birželio-rugpjūčio mėnesiais P.Mažylio gimdymo namų akušerijos skyriuje buvo atlikta anoniminė anketinė pacienči�� apklausa. Išdalinta 350 anketų, iš jų grįžo 311. Atsakas 89 proc. Duomenys analizuoti naudojant SPSS 10,0 versijos statistinę programą. Pacienčių nuomonė apie įvairius paslaugų kokybės ir lūkesčių patenkinimo aspektus įvertinta balų vidurkiais ir jų 95 proc. pasikliautinaisiais intervalais. Maksimalus Likert skalės įvertinimas buvo 5 balai. Rezultatai. Pagrindiniai motyvai pasirenkant gydymo įstaigą yra artimųjų ir pažįstamų rekomendacijos (4,21 balų), patogi vieta (4,16 balų), atsiliepimai internete (3,72 balo). Vertinant paslaugų kokybę pacienčių didžiausi vertinimo vidurkiai yra švariai aplinkai (4,92 balai), kokybiškoms paslaugoms (4,82 balai), gydytojo dėmesiui (4,79 balo). Patirtis gimdykloje, gimdymo skyriuje ir pacienčių lūkesčių patenkinimas įvertintas aukštais balais (daugiau nei 4 iš 5 galimų)... [toliau žr. visą tekstą] / Aim of the study. To evaluate attitude of female patients of obstetrics department of P. Mazylis maternity hospital towards the quality of provided services and evaluation of their expectations. Objectives. 1. To determine motivation of female patients choosing maternity hospital. 2. To analyze the quality of services of obstetrics stationary in the point of view of female patients. 3. To set satisfaction of female patients’ expectations in the department of obstetrics. 4. To evaluate knowledge of female patients of obstetrics department about process of childbirth and possible complications. Methods. Anonymous questionnaire survey of female patients was performed in obstetrics department of P. Mazylis maternity hospital during June-August, 2007. It was delivered 350 questionnaires, 311 of them were returned. Response was 89 percent. Data were analyzed using SPSS 10,0 version statistic program. Opinion of female patients about various aspects of service quality and satisfaction of expectations was evaluated in average of points and their 95 percent trustworthy intervals. Results. The main motivations choosing the maternity hospital were recommendations of relatives and acquaintances (4,21 points), convenient place (4,16 points), responses on the internet (3,72 points). Evaluating the quality of services the biggest averages of... [to full text]

Made available in DSpace on 2016-04-29T14:16:07Z (GMT). No. of bitstreams: 1 Sandra Eloiza Paulino.pdf: 1106669 bytes, checksum: bea1b9513d108fc706eaec481f5a6c9e (MD5) Previous issue date: 2011-11-09 / This thesis seeks to critically analyze the meaning of professional practice on social work services with individuals and groups, to locate it historically and to reframe it from a theoretical and methodological standpoint, in view of its importance in the daily practices of social workers. The work also intends to identify those skills required for the professional application of social work. Therefore, my hypothesis is that individual and social care practice occurs in accordance with the personal skills and knowledge of each professional. Meanwhile little or nothing has been written or discussed about the knowledge related to this activity. Aiming to that goal, I have carried out a qualitative research based on empirical and theoretical investigative methods. Our sample has been divided into three groups: a) important Social Work scholars: professors with theoretical productions relevant to their profession; b) postgraduate students who are currently pursuing a Master or PhD degree and working as social workers in their daily life; and c) social work practitioners who are daily providing individual and social care services. The result of this research allowed me to "re-look" at Social Work individual practices,and pointed to the urgent need for academic spaces so as to produce technical knowledge that serves as reference for this important professional action / Esta tese tem como objetivo analisar criticamente o significado da prática profissional do atendimento sócio-individual em Serviço Social, situá-la historicamente, bem como ressignificá-la, do ponto de vista teórico-metodológico, tendo em vista sua importância no cotidiano das ações dos assistentes sociais. Pretendemos, com este trabalho, identificar quais são os conhecimentos necessários para o exercício profissional qualificado. Partimos, assim, da hipótese de que a prática de atendimento sócio-individual ocorre em acordo com as habilidades e conhecimentos pessoais de cada profissional, uma vez que pouco ou quase nada se discute e produz acerca dos conhecimentos relativos a esta atividade. Para tanto, realizamos uma pesquisa qualitativa, de caráter teórico empírico. Nossa amostra foi constituída por 3 grupos: a) sujeitos expoentes do Serviço Social (docentes com produções teóricas de relevância para a profissão); b) sujeitos cursando o mestrado ou o doutorado e atuam como assistentes sociais; e, c) sujeitos da prática, assistentes sociais que no dia-a-dia realizam o atendimento sócio-individual. O resultado desta pesquisa permitiu um re-olhar sobre as práticas individuais em Serviço Social e reafirmou a necessidade de a academia encontrar, urgentemente, reflexões e pesquisas que venham reforçar e reformular os conhecimentos desta prática profissional

This thesis deals with nutrition in palliative care. The main aim is to introduce the issue of nutrition in palliative care, to help with a comprehensive perception of the context and the application of a palliative approach in nutritional care. The aim is to monitor and examine the current state of nutrition in facilities providing palliative care in the Czech Republic. The work is divided into theoretical and practical part. The theoretical part is focused on the issues of palliative care, nutrition and hydration. The practical part contains the objectives of the work, hypotheses and research with evaluation and analysis of the obtained data. There were two hypotheses established and evaluated. From a methodological point of view, a combination of several research methods of a quantitative nature was used. As a means of obtaining data, the use of the survey in the form of an internet survey was sent to the management of individual facilities providing palliative care in the Czech Republic. The obtained data were processed using standard statistical methods. Using descriptive statistics procedures in the form of analysis of the obtained results, especially with the use of absolute and relative frequency. The total number of 97 questionnaires were distributed. 18 questionnaires for hospices, 70...

Bakgrund: Studier visar på att användandet av omvårdnadsdiagnoser har flera fördelar för sjuksköterskans omvårdnadsarbete. De främjar patientens delaktighet i vården samt uppmärksammar sjuksköterskan på patientens omvårdnadsbehov. Andra studier visar på att standardvårdplaner upplevs effektivisera sjuksköterskans omvårdnadsdokumentation och bidra till en likvärdig och god kvalité på vården. Dock kan de anses vara oflexibla och därför behöva kompletteras med en individuell vårdplan.  Syfte: Syftet var att undersöka i vilken utsträckning omvårdnadsdiagnoser och -åtgärder dokumenterades och utfördes. Vidare undersöktes vilken typ av vårdplan som användes och om det gick att se någon skillnad mellan avdelningarna avseende omvårdnadsdokumentationen. Metod: Det utfördes en retrospektiv journalgranskningsstudie med innehållsanalys och kvantitativ analys, även en statistisk analys Mann-Whitney U test användes. Studien utfördes på två medicinska avdelningar och undersökningsgruppen var patienter med hjärtsvikt. Resultat: Totalt ingick 43 patientjournaler i studien. Det förekom omvårdnadsdiagnoser endast i ringa utsträckning. Det identifierades 259 omvårdnadsproblem som indelades i 34 olika kategorier. Det identifierades 193 omvårdnadsåtgärder, de delades in i 28 olika kategorier. På avdelning 1 var majoriteten av SVP-er kopplade till undersökningar/ingrepp, på avdelning 2 gällde majoriteten hjärtövervakning och utskrivningsplanering. Individuella vårdplaner förekom endast i ringa utsträckning. Det fanns en signifikant skillnad mellan avdelningarna gällande antalet utförda omvårdnadsåtgärder/journal och förekomsten av individuella vårdplaner. Slutsats: Omvårdnadsdokumentationen var bristfällig. Avdelningarna skulle behöva göra en översyn och utveckla arbetet med journalföringen. Flera och mer djupgående studier behöver genomföras inom området. / Background: The use ofnursing diagnoseshas severalbenefits fornursing care. Previous studies showthat they promotepatientparticipationin the nursing careand increase nurses’ awareness ofthe patient'scare needs.Other studies showthatstandardized care plansare perceived as promoting theefficiency ofnursingdocumentation andcontribute to anequitable andquality of the nursing care.However,by some nurses they are considered inflexible, andtherefore they have to be supplementedwith an individualcare plan. Aim: The aim of this study was to examine to what extent nursing diagnoses and interventions were documented and executed. Furthermore there was an examination as to what kind of standardized care plan was used and whether it was possible to see any differences between the departments regarding nursing documentation. Method: A retrospective medical record study with content analysis and quantitative analysis was conducted, even a statistical analysis, Mann-Whitney U test, was used. The studywas conducted ontwo medicalwards andthe study groupconsisted of patients with heart failure. Results: In total,43patient records were included in the study.Nursing diagnoses appearedonlyto a negligible extent. 259nursing problems were identified and divided into34different categories and 193nursing interventions were identified and partitioned into28 differentcategories.Onsection 1, the majority of the standardized care plansconcernedtreatments/interventions. The majority of standardized care plans onsection 2 concerned cardiac monitoringand dischargeplanning.Individualcare plansappeared only to a smallextent.There was asignificant difference between the departments regardingthe number of executednursing interventions per recordand the occurrence ofindividual care plans. Conclusion: The nursing documentation was inadequate. It would be advisable for the departments to conduct a reviewand developthe work ofthe nursing documentation. A greater number of studies, with additional depth, would have to be conducted.

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No. of bitstreams: 5 Dissertação.pdf: 1036493 bytes, checksum: 0f4de423e6502fa54831f918402b9739 (MD5) carta de encaminhamento para autodeposito.pdf: 307302 bytes, checksum: 8413ca47e9d90cd0147d45f671d8395a (MD5) Ata de Defesa.pdf: 474088 bytes, checksum: 4738c347272db401283b0543ed259a77 (MD5) parecer final.pdf: 203377 bytes, checksum: e667c579ef8b37e2b9a1f92884e10f5b (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2018-10-23 / The objective was to analyze the application of the psychodynamic of work’s theory to medical care. The study was based on the theory of the Psychodynamics of Work by Dejours, characterizing itself as qualitative research. The method used was the clinic of work adapted for individual care, which provides a space for listening and experiences of pleasure and work, making an interface with the services of brief psychodynamic psychotherapy. Four case studies were performed, the material being collected through documentary analysis and clinical care, being submitted to the psychodynamic analysis of the work. The results were divided into two parts, a first time being a work clinic in individual care, and one last time a discussion about the technique of individual work attendance. In the first part, the results of the individual care clinic for the cases studied pointed to an organization of work as essential in the process of sickness of the workers. Moral harassment, violence in various forms, lack of cooperation and recognition, presence of competition, degradation of solidarity and, above all, humiliation are the elements that most contribute to the exercise of the pathogen. Moral harassment is not carried out without all the knowledge about the participants, presenting itself in several ways: horizontal, vertical descending and ascending. Still in its results, in the second part, a trail was explored so that the subject found resources to subvert the work and free of actions for health. The objective of the care was given through the psychodynamic work clinic, considering the central axis of the restructuring of the subject’s health. For this, the psychotherapeutic technique of the brief dynamic psychotherapy were auxiliary in this work, however the fundamental bases having been derived from the psychodynamic of work. However, the psychotherapeutic techniques of the psychological emergency were used as working techniques. The importance of teaching is not restricted to the new model of task attendance without work, but mainly regarding the patient's clinical listening at work. Regardless of psychological hierarchy, whether public or private, a patient's clinical listening is not essential to the role of the psychologist as a health agent. In this sense, the present research proves to be important, in order to subsidize a method of psychological care for suffering at work that serves not only for CERESTs, but also any public or private institution. / O objetivo desta pesquisa foi analisar a aplicabilidade da teoria psicodinâmica do trabalho ao atendimento clínico individual a trabalhadores em sofrimento no trabalho. O estudo se baseou na teoria da Psicodinâmica do Trabalho proposta por Dejours, caracterizando-se como pesquisa qualitativa. O método utilizado foi a clínica do trabalho adaptada para atendimentos individuais, que propicia um espaço da fala e da escuta das vivências de prazer e sofrimento no trabalho, realizando uma interface com os dispositivos técnicos da psicoterapia breve psicodinâmica. Foram realizados quatro estudos de caso, sendo o material coletado por meio de análise documental e atendimento clínico, sendo submetido à análise psicodinâmica do trabalho. Os resultados foram divididos em duas partes, sendo a primeira relativa à clínica do trabalho em atendimento individual e a última destinada à discussão da técnica do atendimento individual ao sofrimento no trabalho. Na primeira parte, os resultados da clínica do trabalho em atendimento individual para os casos estudados apontaram para a organização do trabalho como essencial no processo de adoecimento dos trabalhadores. O assédio moral, a violência em diversas formas, a ausência de cooperação e reconhecimento, a presença de competição, a degradação da solidariedade e, sobretudo, a humilhação, são os elementos mais presentes que levaram os trabalhadores ao sofrimento patógeno. O assédio moral no trabalho surgiu no estudo em meio aos relatos dos participantes, apresentando-se de várias maneiras: horizontal, vertical descendente e ascendente. Ainda relativo aos resultados, na segunda parte, explorou-se uma trilha para que o sujeito encontrasse recursos para subverter o sofrimento no trabalho e possa transformar ações em prol da saúde. O objetivo do atendimento foi dado através da clínica psicodinâmica do trabalho, tendo em vista o eixo central da reestruturação da saúde do sujeito. Para isso, as técnicas psicoterápicas da psicoterapia breve dinâmica foram auxiliares nesse trabalho, porém as bases fundamentais tendo sido provenientes da psicodinâmica do trabalho. A importância do estudo não se restringe ao novo modelo de atendimento ao sofrimento no trabalho proposto, mas principalmente no que se refere a escuta clínica do sofrimento no trabalho. Independente de abordagem psicológica, de instituição pública ou privada, a escuta clínica do sofrimento no trabalho é essencial para o papel do psicólogo como agente de saúde. Nesse sentido que a presente pesquisa se revela importante, a fim de subsidiar um método de atendimento psicológico ao sofrimento no trabalho que sirva não somente aos CERESTs, como para qualquer instituição pública ou privada.

The thesis deals with saturation of spiritual needs of elderly in residential houses through the perspective of activationists. In the preliminary part are treated questions about ageing, adaptation to ageing, human needs and spiritual needs at first. After that is discussed the activity in elderly, not only in relation with the adaptation to ageing but also as a place of activation. At the last part of this chapter it´s question of residential houses and activationists. In the practical part there is an analysis and evaluation of approaches to the saturation of spiritual needs in activating programs of chosen activationists. The selection of responders represents different characteristics of residential houses in the Pilsen region. The different approaches to spiritual needs in the activating programmes are induced by the personal knowledge, experience and abilities of activationists.

Abstrakt: Okontrollerade symptom och upprepade sjukhusinläggningar kännetecknar den sista tiden i livet hos en del patienter med mycket svår KOL. Trots att det finns en växande insikt att tidig integration av palliativ vård förbättrar patientens symtombehandling och livskvalitet, dör majoriteten av patienter med KOL utan tillgång till palliativ vård. Sjuksköterskor i hemsjukvården har en central roll när det gäller att identifiera och hantera patienternas palliativa vårdbehov. Syfte: Syftet med denna studie är att belysa hur sjuksköterskor i hemsjukvården upplever den palliativa vården av patienter med mycket svår KOL. Metod: Kvalitativ studie där 11 semistrukturerade intervjuer bearbetats med kvalitativ innehållsanalys. Resultat: Insamlat datamaterial resulterade i tre kategorier som påvisar förutsättningar för god palliativ vård i hemmet: 1) Personella och organisatoriska resurser i hemsjuk- och primärvården där stora brister i samarbetet med primärvården samt bristande resurserna för god vård i hemmet noteras. 2) Planering och kommunikation där bristande kommunikation med patienten och mellan olika vårdinsatser samt planering kring patientens vård poängteras. 3) Kunskap där ett behov av att utöka kunskapen om KOL och palliativ vård hos alla yrkeskategorier uppmärksammas. Konklusion: Patienter med mycket svår KOL får ofta en god palliativ vård i livets absoluta slutskede. Resultatet visar dock att patientens vård under de sista månaderna i livet ofta upplevs som oklar och diffus, vilket pekar på att palliativ vård behöver integreras tidigare i vården av patienter med mycket svår KOL. I kommunikations- och planeringsprocessen med patienten har sjuksköterskor en samordnande roll som behöver specificeras och utrustas med de erforderliga personella och organisatoriska resurserna, kunskaperna och befogenheterna. / Abstract: Uncontrolled symptoms and repeated hospitalizations characterize the last period of life in some patients with very severe COPD. Although there is a growing recognition that early integration of palliative care improves the treatment of patient's symptoms and quality of life, the majority of patients with COPD dies without access to palliative care. Nurses in home care have a central role in identifying and managing patients' palliative care needs. Aim: The purpose of this study is to examine how nurses in home care and in nursing homes experience palliative care of patients with severe COPD. Method: Qualitative study in which 11 semi-structured interviews processed using qualitative content analysis. Results: Collected data resulted in three categories that indicate conditions for good palliative care in the home: 1) Human and organizational resources in home- and primary care, where serious deficits within primary care and resources for good home care is noted. 2) Planning and communication, where the lack of communication with the patient and between different health care institutions as well as care planning is emphasized. 3) Knowledge, where a need to improve knowledge of COPD and palliative care for all care professions is recognized. Conclusion: The result shows that the patient's care during the last months of life is often perceived as vague and diffuse, suggesting that palliative care needs to be integrated earlier in the care of patients with very severe COPD. In the communication process and care planning with patients, nurses have a coordinating role that needs to be specified and equipped with the requisite human and organizational resources, skills and competences.