Thesis (Ph. D.)--University of Rhode Island, 2003. / Typescript. Includes bibliographical references (leaves 249-255).

No / Aims and objectives; We report findings from a qualitative study to identify patient views of community hospital care. We consider how far these were in accord with the hospital staffs' views. This constituted part of a wider randomized controlled trial (RCT). The methodological challenges in seeking to identify patient satisfaction and in linking qualitative findings with trial results are explored. Design A sample of 13 patients randomized to the community hospital arm of the RCT joined the qualitative study. Official documentation from the hospital were accessed and six staff interviewed to identify assumptions underlying practice. Results Analysis of interviews identified a complex picture concerning expectations These could be classified as ideal, realistic, normative and unformed. The hospital philosophy and staff views about service delivery were closely in harmony, they delivered rehabilitation in a home-based atmosphere. The formal, or 'hard', process of rehabilitation was not well understood by patients. They were primarily concerned with 'soft' or process issues ¿ where and how care was delivered. Conclusions We identify a model of community hospital care that incorporates technical aspects of rehabilitation within a human approach that is welcomed by patients. If patients are to be able to participate in making informed decisions about care, the rationale for the activities of staff need to be more clearly explained. Recommendations are made about the appropriate scope of qualitative findings in the context of trials and about techniques to access patient views in areas where they have difficulty in expressing critical impressions.

Ao se considerar a importância da busca de indicadores que determinam, tanto a alta dos pacientes das unidades de terapia intensiva (UTIs) como o risco de óbito e readmissão dos internados nessa unidade, este estudo teve como objetivos: caracterizar os pacientes internados em UTIs de hospitais que tenham unidades intermediárias quanto aos dados demográficos e clínicos; descrever a mortalidade e a unidade de destino após a alta da UTI e a freqüência de readmissão nessas unidades; comparar as médias do Nursing Activities Score (NAS), Simplified Acute Physiology (SAPS II) e Logistic Organ Dysfunction (LODS) no primeiro e último dia de internação na UTI; identificar os fatores associados com a alta, óbito e readmissão dos pacientes em UTI na mesma internação hospitalar. Trata-se de um estudo prospectivo longitudinal de pacientes adultos internados em UTIs gerais de dois hospitais governamentais e dois não governamentais do Município de São Paulo que possuíam unidades intermediárias. A casuística compôs-se de 500 pacientes adultos admitidos nessas UTIs. Os dados coletados foram referentes as primeiras e últimas 24 horas de permanência na UTI, porém os pacientes foram acompanhados até a alta hospitalar para identificação das readmissões. Os resultados mostraram predomínio de indivíduos idosos (55,80%), do sexo feminino (56,60%), a maior parte procedente do Pronto-Socorro/Atendimento (37,60%) e tempo de permanência na UTI entre um e dois dias (36,60%). Os antecedentes e os motivos de internação mais freqüentes foram relacionados às doenças do aparelho circulatório. As médias dos escores, no primeiro dia de internação na UTI, foram SAPS II, 37,41, LODS, 4,32 e NAS, 62,13. No último dia de internação, o valor médio do SAPS II foi de 36,15, do LODS, 4,2 e do NAS, 52,17. Os pacientes com alta da UTI apresentaram no último dia de internação, a média desses escores inferior à de admissão. Nos indivíduos que morreram, as médias dos escores SAPS II e LODS foram superiores no último dia de internação na UTI em relação aos valores de admissão; já as médias do NAS foram similares. Os pacientes readmitidos apresentaram na alta da UTI diminuição da média dos escores, porém essa diferença só alcançou níveis significativos quando o NAS foi o indicador utilizado. A mortalidade foi 20,60% durante a internação na UTI, a maioria dos pacientes foi transferida para unidade intermediária e aproximadamente, 9% foram readmitidos. Os pacientes que foram encaminhados à unidade intermediária diferiram dos que foram para unidade de internação em relação à idade, procedência, antecedentes, motivo de internação, SAPS II na admissão e NAS na admissão e alta. Os pacientes que morreram, apresentaram maior tempo de internação, escores de gravidade mais altos na admissão e, imediatamente, antes do óbito. No último dia de internação na UTI, o NAS foi mais elevado entre os que morreram. Para o grupo de readmitidos, somente antecedentes relacionados a doenças infecciosas e parasitárias, doenças do aparelho geniturinário e o LODS na admissão foram diferentes se comparados aos não readmitidos / Considering the relevance of collecting indicators to define either the discharge of patients from the Intensive Care Units (ICUs) or risk of death and readmission of interned patients into these units, this study had as objectives: - to characterize the patients interned in ICUs in hospitals with intermediate care units according to demographical and clinical data; - to describe mortality, unit of destination after ICU discharge and frequency of readmission into these units - to compare the averages of the Nursing Activities Score (NAS), Simplified Acute Physiology (SAPS II) and Logistic Organ Dysfunction (LODS) during the first and the last day of internment in the ICU; - to identify the factors associated with the discharge, death and readmission of patients into the ICU, during the same hospital internment. This is a longitudinal prospective study of adult patients interned in general ICUs of two public hospitals and two private hospitals of the City of São Paulo, which had intermediate care units. The casuistry was composed of 500 adult patients who were interned in these ICUs. The collected data referred to the first and the last 24 hours spent in the ICU, however, a follow-up of the patients was made until their discharge in order to identify readmissions. The results show a predominance of elderly individuals (55.8%), of female gender (56.6%), with the larger number coming from the Emergency Room (37.6%) and patients who spent between one and two days in the ICU (36.6%). The previous problems and the main motives for internment were related to circulatory system diseases. The average scores during the first day in the ICU were SAPS II (37.41), LODS (4.32) and NAS (62.13%). During the last day of internment, the average scores were SAPS II (36.15), LODS (4.2), and NAS (52.17%). Patients who had been discharged from the ICU presented, during the last day of internment, an average in these scores inferior to those registered on their entry day. For the individuals who died, the average SAPS II and LODS scores were superior to those of the entry day in the ICU, nevertheless, the NAS averages were similar. The readmitted patients had, at the time of discharge from the ICU, less than average scores in SAPS II, LODS and NAS. This difference, however, only reached significant levels when the NAS indicator was applied. The death rate was 20.6% during the ICU internment, the majority of the patients were transferred to an intermediate care unit and approximately 9% were readmitted. Patients, who were transferred to the intermediate care unit, differed from those who went to a general nursing unit according to age, origin, antecedents, motive for internment, SAPS II during their entry, NAS during their entry and discharge. Patients who died presented longer internment time and had more severe scores at their entry into the ICU and immediately before death. The NAS during the last internment day in the ICU was higher for those who died. For the readmitted group, only antecedents related to contagious and parasitic diseases, genitourinary system diseases, and LODS at entry were different when compared to those of patients who were not readmitted into the ICU

Ao se considerar a importância da busca de indicadores que determinam, tanto a alta dos pacientes das unidades de terapia intensiva (UTIs) como o risco de óbito e readmissão dos internados nessa unidade, este estudo teve como objetivos: caracterizar os pacientes internados em UTIs de hospitais que tenham unidades intermediárias quanto aos dados demográficos e clínicos; descrever a mortalidade e a unidade de destino após a alta da UTI e a freqüência de readmissão nessas unidades; comparar as médias do Nursing Activities Score (NAS), Simplified Acute Physiology (SAPS II) e Logistic Organ Dysfunction (LODS) no primeiro e último dia de internação na UTI; identificar os fatores associados com a alta, óbito e readmissão dos pacientes em UTI na mesma internação hospitalar. Trata-se de um estudo prospectivo longitudinal de pacientes adultos internados em UTIs gerais de dois hospitais governamentais e dois não governamentais do Município de São Paulo que possuíam unidades intermediárias. A casuística compôs-se de 500 pacientes adultos admitidos nessas UTIs. Os dados coletados foram referentes as primeiras e últimas 24 horas de permanência na UTI, porém os pacientes foram acompanhados até a alta hospitalar para identificação das readmissões. Os resultados mostraram predomínio de indivíduos idosos (55,80%), do sexo feminino (56,60%), a maior parte procedente do Pronto-Socorro/Atendimento (37,60%) e tempo de permanência na UTI entre um e dois dias (36,60%). Os antecedentes e os motivos de internação mais freqüentes foram relacionados às doenças do aparelho circulatório. As médias dos escores, no primeiro dia de internação na UTI, foram SAPS II, 37,41, LODS, 4,32 e NAS, 62,13. No último dia de internação, o valor médio do SAPS II foi de 36,15, do LODS, 4,2 e do NAS, 52,17. Os pacientes com alta da UTI apresentaram no último dia de internação, a média desses escores inferior à de admissão. Nos indivíduos que morreram, as médias dos escores SAPS II e LODS foram superiores no último dia de internação na UTI em relação aos valores de admissão; já as médias do NAS foram similares. Os pacientes readmitidos apresentaram na alta da UTI diminuição da média dos escores, porém essa diferença só alcançou níveis significativos quando o NAS foi o indicador utilizado. A mortalidade foi 20,60% durante a internação na UTI, a maioria dos pacientes foi transferida para unidade intermediária e aproximadamente, 9% foram readmitidos. Os pacientes que foram encaminhados à unidade intermediária diferiram dos que foram para unidade de internação em relação à idade, procedência, antecedentes, motivo de internação, SAPS II na admissão e NAS na admissão e alta. Os pacientes que morreram, apresentaram maior tempo de internação, escores de gravidade mais altos na admissão e, imediatamente, antes do óbito. No último dia de internação na UTI, o NAS foi mais elevado entre os que morreram. Para o grupo de readmitidos, somente antecedentes relacionados a doenças infecciosas e parasitárias, doenças do aparelho geniturinário e o LODS na admissão foram diferentes se comparados aos não readmitidos / Considering the relevance of collecting indicators to define either the discharge of patients from the Intensive Care Units (ICUs) or risk of death and readmission of interned patients into these units, this study had as objectives: - to characterize the patients interned in ICUs in hospitals with intermediate care units according to demographical and clinical data; - to describe mortality, unit of destination after ICU discharge and frequency of readmission into these units - to compare the averages of the Nursing Activities Score (NAS), Simplified Acute Physiology (SAPS II) and Logistic Organ Dysfunction (LODS) during the first and the last day of internment in the ICU; - to identify the factors associated with the discharge, death and readmission of patients into the ICU, during the same hospital internment. This is a longitudinal prospective study of adult patients interned in general ICUs of two public hospitals and two private hospitals of the City of São Paulo, which had intermediate care units. The casuistry was composed of 500 adult patients who were interned in these ICUs. The collected data referred to the first and the last 24 hours spent in the ICU, however, a follow-up of the patients was made until their discharge in order to identify readmissions. The results show a predominance of elderly individuals (55.8%), of female gender (56.6%), with the larger number coming from the Emergency Room (37.6%) and patients who spent between one and two days in the ICU (36.6%). The previous problems and the main motives for internment were related to circulatory system diseases. The average scores during the first day in the ICU were SAPS II (37.41), LODS (4.32) and NAS (62.13%). During the last day of internment, the average scores were SAPS II (36.15), LODS (4.2), and NAS (52.17%). Patients who had been discharged from the ICU presented, during the last day of internment, an average in these scores inferior to those registered on their entry day. For the individuals who died, the average SAPS II and LODS scores were superior to those of the entry day in the ICU, nevertheless, the NAS averages were similar. The readmitted patients had, at the time of discharge from the ICU, less than average scores in SAPS II, LODS and NAS. This difference, however, only reached significant levels when the NAS indicator was applied. The death rate was 20.6% during the ICU internment, the majority of the patients were transferred to an intermediate care unit and approximately 9% were readmitted. Patients, who were transferred to the intermediate care unit, differed from those who went to a general nursing unit according to age, origin, antecedents, motive for internment, SAPS II during their entry, NAS during their entry and discharge. Patients who died presented longer internment time and had more severe scores at their entry into the ICU and immediately before death. The NAS during the last internment day in the ICU was higher for those who died. For the readmitted group, only antecedents related to contagious and parasitic diseases, genitourinary system diseases, and LODS at entry were different when compared to those of patients who were not readmitted into the ICU

BACKGROUND: A comprehensive Primary Health Care approach includes clear referral and continuity of care pathways. South Africa lacks data that describe Intermediate Care (IC) services and its role in the health system. This study aimed to describe the model of service provision at an IC facility and the role it plays in the continuity of care in Cape Town. METHODS: Sixty-eight patients (65% Response Rate) were recruited in a prospective cohort design over a one-month period in mid-2011. Patient data were collected from a clinical record review and an interviewer-administered questionnaire, administered at a median interval between admission and interview of 11 days to assess primary and second ary diagnosis, knowledge of and previous use of Home Based Care (HBC) services, reason for admission, demographics and information on referring institution. A telephonic interviewer-administered questionnaire to patients or their family members post-discharge recorded their vital status, use of HBC post-discharge and their level of satisfaction with care received at the IC facility. A Cox regression model was run to identify predictors of survival and the effect of a Care-plan on survival. Seventy staff members (82%) were recruited in a cross-sectional study using a self-administered questionnaire to describe demographics, level of education and skills in relation to what they did for patients and what they thought patients needed. RESULTS: Of the 68 participants, 38 % and 24% were referred from a secondary and tertiary hospital, respectively, and 78% were resident of a higher income community. Stroke (35%) was the most common single reason for admission at acute hospital. The three most common reasons reported by patients why care was better at the IC facility than the referring institution was the caring and friendly staff, the presence of physiotherapy and the wound care. Even though a large proportion of the IC inpatients had been admitted in a health facility on the year preceding the study, only 13 patients (21%) had used a Community Health Worker (CHW) ever before and only 25% (n=15) of the discharged patients had a confirmed CHW visit post-discharge. The presence of a Care-plan was significantly associated with a 62% lower risk of death (Hazard Ratio: 0.380; CI 0.149-0.972). Notably, 46% of staff members reported performing roles that were outside their scope of practice and there was a mismatch between what staff reported doing and their actual tasks. In addition, of the 57 patients that could be traced on follow-up 21(37%) had died. CONCLUSION: Patients and family understood this service as a caring environment that is primarily responsible for rehabilitation services. Furthermore, a Care-plan which extends beyond admission could have a significant impact on reducing mortality. IC services should therefore be recognised as an integral part of the health system and it should be accessed by all who need it.

Thesis (MA)--University of Stellenbosch, 2002. / ENGLISH ABSTRACT: The aim of this pilot study was to do a needs analysis with a selected group of nurses with regard to the following three aspects: nurses' experiences of their involvement in termination of pregnancy (TOP) services, the effects of their involvement in TOP service provision on a personal, familial and career level, as well as their needs with regard to support. An important aspect of the needs analysis was to develop a questionnaire which can be used as basis for future research purposes. A qualitative, explorative, descriptive and contextual research design was applied in order to conduct this study. Participants were recruited from a health care facility in the Western Cape, v~ and the small sample group (seven out of a possible fifteen) consisted of a selected group of nurses who are currently involved in performing TOPs, as well as nurses involved in pre- and/or post-procedure care of patients. Each participant completed a self-administered biographical dataand semi-structured questionnaire, which was compiled specifically for the purpose of the pilot study. Specific guidelines according to previous research findings were incorporated. The results of the pilot study revealed that most of the participants experience some sort of cognitive, emotional and/or behavioural reaction before, during and after TOP procedures are performed. -Feelings of anxiety, sadness, anger, depression and guilt were reported in some cases, as well as moral-ethical conflicts. With regard to the effect on a personal, familial and career level, it was confirmed that the work has an effect on the majority of respondents' personal life and career to a certain extent, although family life did not seem te be affected significantly. The results conveyed that the majority of the nurses experienced that the impact of their work with TOPs seemed to be different from that of their other nursing duties. It was found that participating nurses are in need of some sort of support service, and that the practicality of the services which are currently provided, should be investigated further. Although the ability to generalise the results, was limited by the small research sample, valuable information was gained with regard to nurses' needs for support, as confirmed by other South African research findings. Suggestions for improvements in the questionnaire, as well as other further research possibilities, are provided. / AFRIKAANSE OPSOMMING: Die doel van hierdie loodsstudie was om 'n behoeftebepaling te doen met 'n geselekteerde groep verpleegpersoneel met betrekking tot die volgende drie aspekte: verpleegpersoneel se ervaring van hul betrokkenheid by terminasie van swangerskap (TOP) dienste, die effek van hul betrokkenheid by TOP diensvoorsiening op 'n persoonlike, gesins- en beroepsvlak, sowel as hul behoeftes met betrekking tot ondersteuning. 'n Belangrike aspek van die behoeftebepaling was om 'n vraelys saam te stel wat as basis vir toekomstige navorsingsdoeleindes sou kon dien. 'n Kwalitatiewe, eksploratiewe, beskrywende en kontekstuele navorsingsontwerp is toegepas ten einde hierdie loodsstudie uit te voer. Deelnemers is gewerf by 'n gesondheidsorgfasiliteit in die Wes-Kaap en die klein steekproef (sewe uit 'n moontlike vyftien) het bestaan uit 'n geselekteerde groep verpleegpersoneel wat tans betrokke is by die uitvoering van terminasie van swangerskappe, sowel as verpleegsters wat betrokke is in pre- en/of post-prosedurele versorging van pasiente. Elke respondent het 'n selfgeadministreerde biografiese en semi-gestrulctureerde vraelys voltooi, wat spesifiek vir die doel van die loodsstudie saamgestel is. Spesifieke riglyne op grond van vorige navorsingsbevindinge is geinkorporeer. Die resultate van die loodsstudie het aan die lig gebring dat die meeste van die respondente een of ander kognitiewe, emosionele en/of gedragsreaksie ervaar voor, tydens en na die uitvoering van TOP prosedures. Gevoelens van angs, hartseer, woede, depressie en skuld is gerapporteer in sornmige gevalle, sowel as moreel-etiese konflikte. Wat betref die effek op 'n persoonlike, gesins- en beroepsvlak, is dit ook bevestig dat die werk 'n effek blyk te he op respondente se persoonlike en beroepslewe tot 'n sekere mate, alhoewel dit geblyk het dat gesinslewe nie beduidend bemvloed word nie. Dit het ook uit die resultate van die studie geblyk dat die meerderheid van verpleegsters die impak van hul werk met TOP as anders as die van hul ander verplegingstake ervaar. Daar is bevind dat deelnemende verpleegpersoneel 'n behoefte het aan een of ander tipe ondersteuningsdiens en dat die praktiese aspekte van die dienste wat tans voorsien word, verder ondersoek behoort te word. Alhoewel die veralgemeenbaarheid van die resultate deur die klein steekproef beperk word, is waardevolle inligting bekom met betrekking tot verpleegpersoneel se behoeftes aan ondersteuning, soos bevestig deur ander Suid-Afrikaanse navorsingsbevindinge. Aanbevelings vir verbeteringe aan die vraelys, sowel as verdere navorsingsmoontlikhede word gemaak.

A localização de instalações é uma das principais decisões que devem ser tomadas pelos gestores, sejam eles públicos ou privados, quando existe a necessidade de ampliação ou criação de uma nova unidade de negócios ou serviços. Tal tarefa se enquadra dentro de uma visão estratégica, quando analisada pela ótica de um sistema logístico. A decisão locacional tomada de forma sub-ótima pode acarretar prejuízos e problemas graves, dado que tal decisão tem consequências no médio e longo prazo. Desta forma, a tomada de decisão voltada para a localização de instalações deve ocorrer sob critérios e restrições específicos a cada situação. Neste sentido, a utilização de métodos multicritérios de tomada de decisão minimiza a possibilidade de erros e aumenta a eficácia no processo decisório. Partindo dessa premissa o presente estudo objetivou desenvolver a aplicação de método multicritério de tomada de decisão na localização de uma Unidade de Pronto Atendimento - UPA 24h no município de Amparo-SP, a partir de critérios e subcritérios definidos em conjunto com gestores públicos, profissionais da saúde e representantes da sociedade. O método multicritério utilizado neste estudo foi o Analytic Hierarchy Process AHP. A condução da pesquisa utilizou uma abordagem qualitativa, aplicando o método AHP a partir de seminários e da definição dos critérios considerados relevantes. Após o desenvolvimento da aplicação do método chegou-se a um ordenamento dos locais ideais, sugerindo-se o local 1 como o mais adequado para a localização da UPA 24h no município de Amparo-SP. / The facility location is one of the main decisions to be taken by managers, whether in the public or private system, when it comes to an expansion or creation of a new business unit or service. This task could be fitted in a strategic vision when analyzed in the perspective of a logistics system. The locational decision is taken in a sub-optimal way and may result in losses and serious problems, since this kind of decision carry medium and long term effects. Therefore, the decision-making related to the location of facilities must take place under rules and specific restrictions in each situation. In this context, the use of multicriteria methods of decision-making minimizes the possibility of errors occurrence and enhance efficiency in this specific process. Considering this context, the main objective of this paper is to develop an application of multicriteria method in the process of decision-making in an Intermediate Care Unit - UPA 24h in Amparo-SP, regarding to criteria and sub-criteria defined with public authorities, health professionals and civil society representatives. The multicriteria method used in this study was the Analytic Hierarchy Process AHP. The research brings a qualitative approach, applying the AHP method from seminars and definition of criteria considered relevant. After development of the method we have reached a ranking of ideal locations, suggesting site 1 as the most suitable for the location of UPA 24h in the city of Amparo SP

A localização de instalações é uma das principais decisões que devem ser tomadas pelos gestores, sejam eles públicos ou privados, quando existe a necessidade de ampliação ou criação de uma nova unidade de negócios ou serviços. Tal tarefa se enquadra dentro de uma visão estratégica, quando analisada pela ótica de um sistema logístico. A decisão locacional tomada de forma sub-ótima pode acarretar prejuízos e problemas graves, dado que tal decisão tem consequências no médio e longo prazo. Desta forma, a tomada de decisão voltada para a localização de instalações deve ocorrer sob critérios e restrições específicos a cada situação. Neste sentido, a utilização de métodos multicritérios de tomada de decisão minimiza a possibilidade de erros e aumenta a eficácia no processo decisório. Partindo dessa premissa o presente estudo objetivou desenvolver a aplicação de método multicritério de tomada de decisão na localização de uma Unidade de Pronto Atendimento - UPA 24h no município de Amparo-SP, a partir de critérios e subcritérios definidos em conjunto com gestores públicos, profissionais da saúde e representantes da sociedade. O método multicritério utilizado neste estudo foi o Analytic Hierarchy Process AHP. A condução da pesquisa utilizou uma abordagem qualitativa, aplicando o método AHP a partir de seminários e da definição dos critérios considerados relevantes. Após o desenvolvimento da aplicação do método chegou-se a um ordenamento dos locais ideais, sugerindo-se o local 1 como o mais adequado para a localização da UPA 24h no município de Amparo-SP. / The facility location is one of the main decisions to be taken by managers, whether in the public or private system, when it comes to an expansion or creation of a new business unit or service. This task could be fitted in a strategic vision when analyzed in the perspective of a logistics system. The locational decision is taken in a sub-optimal way and may result in losses and serious problems, since this kind of decision carry medium and long term effects. Therefore, the decision-making related to the location of facilities must take place under rules and specific restrictions in each situation. In this context, the use of multicriteria methods of decision-making minimizes the possibility of errors occurrence and enhance efficiency in this specific process. Considering this context, the main objective of this paper is to develop an application of multicriteria method in the process of decision-making in an Intermediate Care Unit - UPA 24h in Amparo-SP, regarding to criteria and sub-criteria defined with public authorities, health professionals and civil society representatives. The multicriteria method used in this study was the Analytic Hierarchy Process AHP. The research brings a qualitative approach, applying the AHP method from seminars and definition of criteria considered relevant. After development of the method we have reached a ranking of ideal locations, suggesting site 1 as the most suitable for the location of UPA 24h in the city of Amparo SP

Urinmätning inom intensivvården är ett viktigt hjälpmedel för att få larm om dysfunktionalitet hos njurarna. Patienters urinproduktion är något som till största delen fortfarande mäts manuellt genom att samla upp urin från urinkatetern ner i en mätbehållare. I rapporten utvärderas en automatisk urinmätare (Sippi®) på en barnintensiv- och barnintermediärvårdsavdelning. Målen med förstudien var att undersöka vilka förbättringar som krävs för att produkten ska vara lämplig att använda på barn samt att ta reda på om Sippi® kan underlätta den fysiska arbetsmiljön och patientkomforten, utan att försämra mätnoggrannheten jämfört med den mätaren som används idag. Detta undersöktes i två delar, intervjuer samt genom kontrollmätningar. Mätnoggrannhetsstudien utfördes genom att den volym som erhölls från respektive mätare kontrollmättes i en mätcylinder. Detta gjordes på 6 patienter där totalt 52 mätningar utfördes med den manuella urinmätaren och 48 med den automatiska. Enligt slutsatsen bör slangen till den automatiska urinmätaren vara kortare än 149 cm men längre än 110 cm. Slangens flöde behöver förbättras och utrustas med en klämma som kan användas för att fästa slangen vid sängen. Angående mätnoggrannheten kunde ingen slutsats dras då signifikanta mätdata saknas. / Measuring urine output within the intensive care unit is a helpful tool finding renal dysfunctions. Urine output is a parameter that is in most cases still measured manually, by collecting the urine into a measuring chamber. In this study we have evaluated an automatic device (Sippi®) that measures urine output both at the pediatric intensive care unit and the pediatric intermediate care unit. The aim of the study was to find improvements making Sippi® appropriate for children’s care and to see whether this type of device can ease the work load for the nurses and improve the comfort for patients without having lower accuracy than the manual urinometer used today. The study was divided into two parts, control measurements and interviews. The control measurements compared the value of the urine output given by one of the two urinometers separately with a cylinder measurement. 52 measurements were made with the manual device and 48 with the automatic, altogether collected from six patients. No conclusion could be drawn about the accuracy of the urinometers since the number of data were too few. However from interviews and observations a few enhancements were derived for the automatic urinometer. The hose’s length needs to be shorter than 149 cm but longer than 110 cm, have a better flow and a clamp that allows the hose to be attached to the bed.

The aim of the study was to create a greater understanding concerning social workers'experience and their discretion to balance between voluntary and compulsoryinterventions in child welfare. Furthermore, we wanted to investigate social workers'attitudes regarding the implementation of an intermediate compulsory care accordingto the law regarding compulsory care of children and adolescents. Previous researchhas identified a problem where the child is between voluntary and compulsorylegislation which can lead to the child continuing living in harmful conditions. Theempirical data is based on nine interviews with social workers in child welfareinvestigations units in Sweden. Lipsky's (2010) theory of street-level bureaucrats andthe term discretion were used to analyze the data and interpret the results obtainedfrom the study. The results showed that social workers' experience limited discretion.Strategies that were most successful were the relationship-building between socialworker and caregivers, communicative skills, and the application of the law. Thestudy also revealed that social workers had different points of view regarding animplementation of an intermediate care. Some find the implementation hard toenforce in practice, even though it could result in increased child protection. Theconclusion of the study was that the social workers would rather add moreinterventions than an implementation of an additional compulsory law. / Syftet med studien var att skapa en förståelse för socialsekreterares erfarenheter och deras förmåga att balansera mellan frivilliga och tvingande insatser inom den sociala barnavården. Dessutom ville vi undersöka socialsekreterares inställning till implementeringen av ett mellanvårdstvång enligt 2 § i lagen om särskilda bestämmelser om vård av unga. Tidigare forskning har identifierat ett problem där barnet befinner sig mellan frivilliga- och tvångsinsatser, vilket kan leda till att barnet fortsätter att leva under skadliga förhållanden. Empirin baseras på nio intervjuer med socialsekreterare inom den sociala barnavården i Sverige. Lipskys (2010) teori om street-level bureaucrats och begreppet handlingsutrymme användes för att analysera data och tolka de resultat som erhållits från studien. Resultaten visade att socialsekreterarna upplevde ett begränsat handlingsutrymme. Strategier som var mest framgångsrika var relationsskapande mellan socialsekreterare och vårdnadshavare, kommunikativa färdigheter och tillämpning av lagen. Studien visade också att socialsekreterare hade olika inställningar om implementeringen av ett mellanvårdstvång. Vissa tycker att det är svårt att genomföra i praktiken, även om det skulle kunna leda till ökat skydd för barnet. Slutsatsen av studien var att socialsekreterare hellre vill ha tillgång till fler insatser än en implementering av ytterligare en tvångslagstiftning.