The objectives of this mixed-method intervention study were: (1) To examine idiosyncratic profiles of emotions and performance of 3-4 leading handball team players in successful and less successful games and identify their strengths and limitations in emotion-concentration regulation; (2) To develop, implement, and evaluate an intervention program aimed at optimizing the players' emotion-concentration regulation and performance. The participants (n= 4, age= 24,5) consisted of four female elite handball players from the same team. An emotion-performance profiling process was conducted to facilitate objective one. To facilitate objective two, a small group IZOF based short term intervention was developed and implemented. The participants’ emotion-performance profiles are presented. The evaluation of the intervention indicated that the intervention increased the participants’ awareness and knowledge, and stimulated psychological skills development (i.e., emotion regulation and concentration). Methodological issues,future directions, and implications are discussed.

<p>The aim of this study is to analyse conditions that either promote or hamper the implementation of methods for systematic documentation, follow-up and evaluation in social-work services with individuals and families. The theoretical framework consists of organization theories. Human Service Organizations (HSO) theory is complemented with concepts from the new institutionalism, domain theory, implementation theory, and theory about interventions.</p><p>A concrete case, a project has been studied. The purpose of project was to implement methods for systematic documentation in public social services. With the notation “integrated” is meant that the methods should be built in and adjusted to the social-work practice. The methods were ASI (Addiction Severity Index) and IUS (a locally based model for integrated evaluation by inspiration from Göran Sandell).</p><p>Data has been captured in a pretest/ posttest design (Marlow 2000). This means that “state of things” has been described before the intervention and after. The methods used were surveys and interviews (individual and group). The process has been documented through research notes proceeding records, protocols and some diaries written by social workers. Four municipalities from the middle of Sweden took part with five working groups. Two groups contained social workers acting with children and families and three groups were working with drug abusers. The population consisted of the social workers, the managers responsible for the individual and family entities, the politicians and the clients who were affected during the time of the project.</p><p>The implementation of ASI and IUS has not occurred in the extent that was stated in the intervention theory. This means that ASI and IUS were not used in all new cases that occurred during the time of the project. The interviews supposed to be done in the beginning of the clients contact with the agency tended to be done more often than the follow-up interviews. After the project ended, three of five working groups decided to continue to use ASI (one group) and IUS (two groups). The overall impression is that the respondents comprehend, they have the willingness but they do not have the capability of using ASI and IUS. The organization does not seem to have the capacity of imposing requirements and giving resources. The outcomes do not seem to be the most important issue for the social services. These conditions are discussed in the study by means of the theoretical concepts. In the end, there is an effort to adjust the implementation theory to human service organizations.</p>

Syftet med detta examensarbete är att undersöka ifall det är möjligt att bedriva undervisning i friluftsliv enligt Skolverkets kursplaner på ordinarie lektionstid i ämnet idrott och hälsa på högstadieskolor i urban miljö. För att undersöka detta har ett lektionsupplägg planerats och genomförts i form av en interventionsstudie för att sedan utvärderas med hjälp av aktionsforskning och fokusgruppintervju. Frågeställningarna som undersökningen sökt svar på är ifall det är möjligt att arbeta med friluftsliv på ordinarie lektionstid, samt ifall skolans direkta närmiljö är tillräcklig för att bedriva undervisning inom friluftsliv enligt kursplanernas krav, eller om det krävs att man lämnar den urbana miljön.Empirin som samlats in har analyserats och diskuterats utifrån tre lärandeteorier vilka ligger till grund för utomhuspedagogiken. Sociokulturellt perspektiv, konstruktivistiskt perspektiv samt variationsteori är de teorier som använts vid såväl planering av interventionsstudien som vid analysen av huruvida kursplanens delar om friluftsliv behandlats tillräckligt väl. Studien är av kvalitativ art och eftersom undersökningen endast är gjord med en klass i årskurs nio och enbart på en skola så är det inte möjligt att generalisera resultaten så att de blir allmänt giltiga. Detta är heller inte studiens avsikt, vilken istället är att utvärdera ifall ett tänkt lektionsupplägg fungerar vad gäller att minimera de hinder som idrottslärare och skolledare ofta anser att undervisning i friluftsliv innebär inom ämnet idrott och hälsa på högstadieskolor. På detta vis hoppas vi dels erhålla egna kunskaper som är användbara i yrket som idrottslärare och dels väcka intresse för frågan och öppna för vidare forskning. De hinder vi önskar minimera är ekonomiska begränsningar, brist på tid samt brist på lämplig undervisningsmiljö i skolans direkta närhet. De resultat som presenteras visar på möjligheten att bedriva friluftsliv med små medel både vad gäller tid och ekonomi samt att det går att genomföra i skolans direkta närmiljö. Det är till stor del synen på vad friluftsliv är, såväl hos idrottsläraren som hos eleverna som avgör hur undervisningen kan utformas och genomföras. / The purpose of this thesis is to investigate whether it’s possible to teach friluftsliv according to the curricula at regular class time in physical education in secondary schools in urban environments. To investigate this, a lesson structure was planned and implemented in the form of an intervention study and then evaluated using action research and focus group interviews. The questions that the study sought to answer are whether it is possible to work with friluftsliv at regular class time, and if the school's immediate local environment is sufficient to pursue teaching in outdoor activities according to curriculum requirements, or required to leave the urban environment. The empirical data collected has been analyzed and discussed based on three learning theories which underpin outdoor education. Sociocultural perspective, constructivist perspective and variation theory are the theories used in the planning of the intervention study and the analysis of whether the curriculum elements of friluftsliv were treated well enough.The study is qualitative in nature and because the investigation is made with only one ninth grade, and at just one school, it is not possible to generalize the results so that they are broadly valid. This is however not the intention of the study, which is to evaluate whether our hypothetical lessons works in terms of minimizing the barriers that physical education teachers and school leaders often believe that teaching friluftsliv involves in physical education in secondary schools. In this way, we hope to both obtain own skills that are useful in our profession as a physical education teachers and also arouse interest in the issue and open for further research. The barriers we wish to minimize are the financial constraints, the lack of time and the lack of suitable teaching environment in the school's immediate vicinity. The results presented demonstrate the ability to engage in friluftsliv with limited resources in terms of time and finances, and that it’s possible to implement in the school's immediate vicinity. It is largely the perception of what friluftsliv is both among physical education teachers and in students that determine how instruction can be designed and implemented.

Introdução: Frente à dependência funcional de idosos após um acidente vascular cerebral (AVC), os cuidadores familiares enfrentam a falta de conhecimento e de habilidades para realizarem os cuidados necessários no domicílio, o que tende a influenciar sua sobrecarga. Objetivos: Comparar o efeito de intervenção educativa no domicílio na sobrecarga de cuidadores familiares de idosos após AVC, com orientações usuais de cuidado no período de um mês. Métodos: Ensaio clínico randomizado (ECR), denominado Nursing Home Care Intervention Post Stroke (SHARE). O grupo intervenção (GI) recebeu o acompanhamento sistemático de enfermeiras por meio de três visitas domiciliares (VDs) no período de um mês, para preparo dos cuidadores na realização das atividades de vida diária (AVD) do idoso, suporte emocional e orientações para utilização dos serviços de saúde. O grupo controle (GC) contou com as orientações usuais de cuidado dos serviços de saúde. O desfecho primário foi a sobrecarga do cuidador, e os desfechos secundários foram a capacidade funcional e as reinternações hospitalares dos idosos, avaliados em sete dias e 60 dias após a alta. As análises foram realizadas por intenção de tratar e foi utilizado o programa SPSS 21.0. Para análise do efeito da intervenção nos desfechos foram utilizados os testes t-student pareado, com intervalo de confiança de 95% e t independente. Para verificação do efeito de interação foi realizada análise de variância (ANOVA) para medidas repetidas. / Introduction: Faced with the functional dependence of the elderly after a stroke, family caregivers face the lack of knowledge and skills to perform the necessary health care at home, which tends to negatively influence their overload. Objectives: Compare the effect of home educational intervention (SHARE), on the overload of family caregivers of the elderly with stroke when compared to usual care in one month. Methods: Randomized clinical trial denominated Nursing Home Care Intervention Post Stroke (SHARE). The intervention group (GI) receive a systematic follow-up of nurses through three home visits (VDs) during one month, to prepare the family caregivers in performing daily life activities of the elderly, emotional support and orientations for the use of health services. The control group (CG) did not receive the VDs and had the usual care of the health services. The primary outcome was a caregiver burden, and the secondary outcomes were functional capacity and hospital readmissions of the elderly, evaluete at 7 days and 60 days after discharge. The analyzes were performed by intention to treat and the SPSS 21.0 program was used. For the analysis of the effect of the intervention on the results we used the t-student paired tests, with 95% confidence interval and independent t. For analysis of the interaction effect, analysis of variance (ANOVA) was performed for repeated measures. A significant value was considered p <0.05. For the control of confounding factors, multivariate analyzes were used. The study was approved by the Research Committee of the Hospital de Clínicas of Porto Alegre (nº 160181). Results: From May 2016 to September 2017, 48 elderly and their family caregivers were randomized, 24 for the intervention group (GI) and 24 for the CG. Among the elderly, 54.1% were female, and 95.8% had ischemic stroke. Of the caregivers, 87.5% were women, mean of 53.3 ± 12.9 years. There was no statistically significant difference between the groups regarding burden (0.43 GI vs 0.78 GC, p = 0.717), functional capacity (16 GI vs 18.7 GC, p = 0.999) and hospital readmissions (17% GI vs. 8.3% GC, p = 0.854). Conclusion: The SHARE intervention seems to have not influenced in the outcomes. Other intervention compositions are suggested and evaluation of other outcomes. Clinical Trial Registration: NCT02807012.

Objetivo: O presente estudo objetivou comparar o efeito da intervenção de instrução complementar isolada e associada a recursos auxiliares, na adesão terapêutica medicamentosa de pacientes com epilepsia, além de verificar a correlação entre as medidas de adesão utilizadas - dosagem sérica de drogas antiepilépticas (DAEs), frequência de crises e autorrelato. Método: Realizou-se uma pesquisa clínica, experimental, incluindo 91 indivíduos com diagnóstico de epilepsia em acompanhamento ambulatorial que apresentavam alteração na adesão ao tratamento medicamentoso (Universal Trial Number- U1111-1142-3660). A alocação foi realizada de forma randomizada em Grupo Intervenção 1 (instrução complementar), Intervenção 2 (instrução complementar e lembrete da tomada da medicação por alarme de celular) e Intervenção 3 (instrução complementar e caixa organizadora de medicação). As mensurações da adesão foram realizadas imediatamente antes e quatro semanas após a implantação das intervenções. Resultados: A distribuição dos participantes quanto ao gênero foi similar. A idade média foi de 37,8 anos (dp= 12,1). A escolaridade foi, em média, de 9,8 anos (dp= 3,3). Cerca de metade dos pacientes era da raça negra, não tinha vínculo conjugal e não estava inserida no mercado de trabalho. A duração do tratamento com DAEs foi em média de 20,7 anos (dp=12,9), o Índice de Complexidade do Tratamento Medicamentoso em Epilepsia (ICTME) médio foi 18,8 pontos (dp= 9,8), predominou a politerapia (68,3%) e as crises do tipo focal sintomática (75,6%). Na avaliação inicial, 59,4% dos pacientes tinham percepção de que suas crises não estavam adequadamente controladas e os participantes da amostra informaram apresentar em média 4,9 crises no mês anterior (dp= 13,0). Indicação de baixa e média adesão pelo teste de Morisky foi um critério para inclusão na amostra e 84,6% dos participantes apresentou média adesão antes das intervenções. Na dosagem sérica inicial das DAEs, somente 42% dos participantes tiveram nível inferior ao terapêutico. Não houve correlação entre os resultados das medidas de adesão utilizadas, também não houve associação estatisticamente significativa das categorias do Morisky com a presença de crises e dosagem sérica inferior ao nível terapêutico. Além de tudo, a presença de crise foi independente da dosagem sérica abaixo da desejável. Segundo o teste de Morisky, os três grupos apresentaram melhora na adesão, significativa (p<0,001) e similar (p=0,870), após as intervenções. A frequência de crises e a dosagem sérica indicaram que somente o grupo de intervenção 2 apresentou aumento na adesão na avaliação final; entretanto, quando o efeito clínico desejado com as intervenções foi analisado, não se observou diferença estatisticamente significativa entre os três grupos. Conclusão: A instrução complementar, sobre a doença e regime terapêutico prescrito, aplicada isoladamente apresentou efeito similar ao seu uso associado com o lembrete de tomada de medicamentos por alarme de celular e caixa organizadora de medicamentos. Não obstante, os valores das medidas de adesão não convergiram e, enquanto o escore do teste de Morisky indicou o aumento da adesão dos três grupos após as intervenções, a dosagem sérica e a frequência de crises apontaram essa melhora somente no grupo em que o alarme de celular foi utilizado. / Goal: This studys purpouse is compare the effect of the intervention of additional instruction alone and its association to ancillary resources to the medication adherence of patients with epilepsy, as well as investigate the correlation between the adherence measures used - serum levels of antiepileptic drugs (AEDs), frequency of crisis and self-report. Method: We performed a clinical, experimental research, including 91 individuals with a diagnosis of epilepsy in outpatient following with altered adherence to drug treatment (Universal Trial Number- U1111-1142-3660). The allocation was done randomly in Intervention Group 1 (supplementary statement), Intervention 2 (supplementary investigation and medication reminder alarm of mobile phone) and Intervention 3 (supplementary instruction and medication organizer box). Measurements were taken immediately before and four weeks after the implantation of the interventions. Results: The distribution of participants according to gender was similar. The average age was 37,8 years (SD = 12,1). Schooling was on average 9,8 years (SD = 3,3). About half of patients were black, had no marital bond and were not inserted in the labor market. The treatment with AEDs lasted on average 20,7 years (SD = 12,9), the Epilepsy Medication and Treatment Complexity Index (EMTCI) average was 18,8 points (SD = 9,8), polytherapy (68,3%) and symptomatic focal seizures (75,6%) were predominant. At baseline, 59,4% of patients thought that their seizures were not adequately controlled and the sample reported an average of 4,9 seizures the previous month (SD = 13,0). Indication of low and intermediate adherence by Morisky test was a criterion for inclusion in the sample and 84,6% of participants showed an average adherence before interventions. Considering the initial serum levels of AEDs, only 42% of participants had less than the therapeutic level. There was no correlation between the results of the adherence measures used, and there was no statistically significant association of the categories of Morisky on the presence of seizures and serum level less than the therapeutic level. Above all, the frequency of crisis was independent of the serum level below the desired dosage. According to the Morisky test, the three groups showed improvement in adherence, significant (p <0,001) and similar (p = 0,870) after the intervention. The frequency of seizures and the serum level indicated that only the intervention group 2 showed increase in adherence at the final evaluation; however, when the desired clinical effect with the interventions was analyzed, no statistically significant difference among the three groups was seen. Conclusion: The additional instruction on the illness and prescribed treatment regimen applied alone had similar effect to its use associated with medication reminder alarm by mobile phone and medication organizer box. Nevertheless, the values of the adherence measurements have not converged, and while the score of the Morisky test indicated increased adherence of the three groups after intervention, the serum level and the frequency of seizures showed improvement only in the group where the alarm cell was used.

<p>The purpose of this thesis was to study different aspects of nursing content in patient records with special reference to nursing home care. The thesis focused on the content, comprehensiveness, accuracy and auditing of records, as well as the practice and perceptions of nurses in relation to recording. A national sample of nurses was asked to complete a questionnaire. The effects on recording and nurses' practice and perceptions in nursing homes following educational intervention were studied. Accuracy was examined through record reviews and interviews with nurses and patients. A literature review of record auditing methods was performed and findings from this search were applied in the assessment of a set of records.</p><p> The results indicate that the VIPS model, as a structure for nursing recording, is widespread and shows validity across various areas in Swedish health care. After the educational intervention program, documentation in nursing home care improved significantly in the study group concerning notes on nursing history, nursing status, nursing diagnoses, interventions and discharge notes. Systematic and comprehensive assessment grounded in research-based criteria were not used in the records. Accuracy varied considerably and was significantly better for some areas in the study group. After intervention, the nurses in the study group indicated that they recorded assessments of patients with greater frequency, showed greater satisfaction with their documentation and spent less time on oral reports. Procedures in auditing patient records were found to encompass four approaches: formal structure, process comprehensiveness, knowledge based and accuracy. </p><p> In conclusion, the evidence suggests that there are serious flaws in the nursing content of nursing home records though improvements can be achieved through educational means. Presently, there are serious limitations in using the patient record as the sole source of data for care delivery, quality assessment and evaluation of care.</p>

The purpose of this thesis was to study different aspects of nursing content in patient records with special reference to nursing home care. The thesis focused on the content, comprehensiveness, accuracy and auditing of records, as well as the practice and perceptions of nurses in relation to recording. A national sample of nurses was asked to complete a questionnaire. The effects on recording and nurses' practice and perceptions in nursing homes following educational intervention were studied. Accuracy was examined through record reviews and interviews with nurses and patients. A literature review of record auditing methods was performed and findings from this search were applied in the assessment of a set of records. The results indicate that the VIPS model, as a structure for nursing recording, is widespread and shows validity across various areas in Swedish health care. After the educational intervention program, documentation in nursing home care improved significantly in the study group concerning notes on nursing history, nursing status, nursing diagnoses, interventions and discharge notes. Systematic and comprehensive assessment grounded in research-based criteria were not used in the records. Accuracy varied considerably and was significantly better for some areas in the study group. After intervention, the nurses in the study group indicated that they recorded assessments of patients with greater frequency, showed greater satisfaction with their documentation and spent less time on oral reports. Procedures in auditing patient records were found to encompass four approaches: formal structure, process comprehensiveness, knowledge based and accuracy. In conclusion, the evidence suggests that there are serious flaws in the nursing content of nursing home records though improvements can be achieved through educational means. Presently, there are serious limitations in using the patient record as the sole source of data for care delivery, quality assessment and evaluation of care.

The purpose of this research study was to test the effects of an education/behavioral intervention on knowledge, perceived risk, and self-efficacy for sexually transmitted infections (STIs) prevention in women. Additionally, the instruments that measured knowledge of sexually transmitted infections and perceived risk were tested for reliability. Instruments used to test the effects of the intervention at pretest and following the intervention included the Sexually Transmitted Infection Knowledge Survey (Johnson-Mallard, 2002); the Perceived Risk for Sexually Transmitted Infection Survey (Johnson-Mallard, 2002); and the Sexual Self-Efficacy Survey (Heather and Pinkerton, 1998). Participants included 89-women seeking family planning services, sexually transmitted infection services or prenatal care at three county health units. Participants were randomly assigned to a treatment (n = 47) or control (n = 42) group. The treatment group received the theory based STI education/behavioral intervention. A logic model and Banduras Social Cognitive Theory were used to test the effects of an education/behavioral intervention on decreasing individual exposure to sexually transmitted infections by increasing individual knowledge, perceived risk, and self-efficacy. Data were analyzed using Analysis of Variance. Significantly differences from pretest to posttest was obtained between the experimental and control group on knowledge of STIs F (1, 87) = 73.66, p [less than] .001. Test results for the effect of the education/behavioral intervention on sexual self-efficacy resulted in significance difference between groups at posttest on refusing sexual intercourse F (1, 87) = 50.18, p [less than] .001; questioning potential sex partners F (1, 87) = 15.48, p [less than] .001; and condom use F (1, 87) = 19.60 p [less than] .001; indicating the brief (30-minute) education/behavioral intervention had an effect on the experimental group. However, posttest on STI perceived risk for women receiving the education/behavioral intervention did not approach significance F (1, 87) = .02 p [less than] .901 indicating the education/behavioral intervention did not have a statistically significant effect on the experimental group. The findings of the study indicate the importance of healthcare providers reinforcing STI information during clinical encounters with women.

Aim: Overall aims were to evaluate a stress management intervention with a stepped care approach among women with breast cancer and to explore distress, emotional reactivity and fatigue, both using a theoretical approach and self-reported assessment. Methods: A total of 821 women were approached, 372 women rejected participation, 23 women failed to return the questionnaire and one died, hence, 425 patients (52%) accepted participation. Study I evaluated the cognitive processing model with the aid of an untreated patient group, including 189 women according to the main study protocol. Sixty-six of these women were ineligible for the intervention, as they did not report clinical levels of distress. The remaining 123 women were eligible but they declined participation. Study II explored the validation of the ELSS and emotional reactivity among women with breast cancer. The population comprised of all 425 women (breast cancer sample) and 176 women randomly selected from the PAR register (random women sample). Studies III and IV evaluated the intervention and included all 425 women. Main findings: Study I: avoidance does not mediate the relationship between intrusion and later psychological distress in an early stage breast cancer population. Study II: the ELSS has acceptable validity and reliability. The factor structure of the ELSS was similar in both samples and correlated well with the STAQ (gold standard). Younger age was the only variable associated with emotional reactivity at the start of curative treatment. Studies III and IV: a stepped care approach did not reduce the number of women who require a more extensive treatment at three-months post-diagnosis. Both intervention groups (group/individual) reduced their levels of distress, but there were no significant differences between them. Only about half of the women who were randomised in the second step of the intervention accepted participation. Conclusions: The present thesis provides information regarding distress, emotional reactivity and fatigue among women with breast cancer. A majority of women with early stage breast cancer seem to process the trauma of a cancer diagnosis in a satisfactory way but may experience some emotional reactivity, and younger women may experience more emotional distress. The results also highlight the need for validated measures and carefully planned psychosocial interventions.

The aim of this study is to analyse conditions that either promote or hamper the implementation of methods for systematic documentation, follow-up and evaluation in social-work services with individuals and families. The theoretical framework consists of organization theories. Human Service Organizations (HSO) theory is complemented with concepts from the new institutionalism, domain theory, implementation theory, and theory about interventions. A concrete case, a project has been studied. The purpose of project was to implement methods for systematic documentation in public social services. With the notation “integrated” is meant that the methods should be built in and adjusted to the social-work practice. The methods were ASI (Addiction Severity Index) and IUS (a locally based model for integrated evaluation by inspiration from Göran Sandell). Data has been captured in a pretest/ posttest design (Marlow 2000). This means that “state of things” has been described before the intervention and after. The methods used were surveys and interviews (individual and group). The process has been documented through research notes proceeding records, protocols and some diaries written by social workers. Four municipalities from the middle of Sweden took part with five working groups. Two groups contained social workers acting with children and families and three groups were working with drug abusers. The population consisted of the social workers, the managers responsible for the individual and family entities, the politicians and the clients who were affected during the time of the project. The implementation of ASI and IUS has not occurred in the extent that was stated in the intervention theory. This means that ASI and IUS were not used in all new cases that occurred during the time of the project. The interviews supposed to be done in the beginning of the clients contact with the agency tended to be done more often than the follow-up interviews. After the project ended, three of five working groups decided to continue to use ASI (one group) and IUS (two groups). The overall impression is that the respondents comprehend, they have the willingness but they do not have the capability of using ASI and IUS. The organization does not seem to have the capacity of imposing requirements and giving resources. The outcomes do not seem to be the most important issue for the social services. These conditions are discussed in the study by means of the theoretical concepts. In the end, there is an effort to adjust the implementation theory to human service organizations.