Introduktion: Antalet äldre personer ökar vilket kräver anpassning av hälso- och sjukvården. Robotdjur är elektroniska gosedjur som är utvecklade för att likna sällskapsdjur och används som en omvårdnadsåtgärd hos äldre personer med kognitiv sjukdom. Syfte: Att beskriva omvårdnadspersonalens erfarenheter av att använda robotdjur i omvårdnaden av personer med kognitiv sjukdom på särskilt boende. Metod: Kvalitativ metod med induktiv ansats. 15 intervjuer utfördes där materialet analyserades utifrån tematisk analys enligt Braun & Clarke. Resultat: Två huvudteman och åtta underteman. Under huvudtemat En del i vardagen beskrevs hur robotdjuren användes i vardagen genom fem underteman. Under det andra huvudtemat Behov av kunskap och engagemang beskrevs vad som behövdes för att kunna använda robotdjuren i tre underteman. Konklusion: Robotdjur skapar lugn och gemenskap för äldre personer med kognitiv sjukdom. Robotdjuren ska inte ses som en generell åtgärd utan som ett av redskapen i en personcentrerad omvårdnad. För att detta ska fungera behöver distriktssköterskan ta den ledande rollen i implementeringen och utbildningen av personal och verka för att robotdjuren införs som en del i en personcentrerad omvårdnad. / Introduction: The number of elderly people is increasing, which requires adaptation of health care. Robotic pets are electronic stuffed animals that are designed to resemble pets and are used in nursing care of elderly people with cognitive illness. Aim: To describe nursing staffs’ experiences of using robotic animals in nursing care of people with cognitive illness in long term care. Method: Qualitative method with inductive approach. 15 interviews were conducted and were analyzed based on thematic analysis according to Braun & Clarke. Result: Two main themes and eight sub-themes. The main theme A part of everyday life describes how the robotic pets were used in everyday life in five sub-themes. The second main theme Need for knowledge and commitment describes what was needed to be able to use the robotic pets in three sub-themes. Conclusion: Robotic pets create calm and fellowship. The robotic pets should not be seen as a general intervention but as one of the tools in person-centered care. In order for this to work, the district nurse needs to be the leader of implementation and training of staff and work for the robotic pets to be introduced as part of a person-centered care.

The first chapter examines the impacts of health care provider exits on patient outcomes and subsequent reallocation. Using administrative data on the universe of nursing home patients, I estimate the mortality effects of 1,109 nursing home closures on incumbent residents with a matched difference-in-differences approach. I find that displaced residents face a short-run 15.7% relative increase in their mortality risk. Yet this increase is offset by long-run survival improvements, so the cumulative effect inclusive of the initial spike is a net decline in mortality risk. These gains are driven by patients reallocating to higher quality providers. I also find significant heterogeneity by local market conditions: the survival gains accrue only to patients in competitive nursing home markets, whereas residents in concentrated markets experience no survival improvements. I then develop and estimate a dynamic model of the nursing home industry with endogenous exit. Combining the model estimates with the mortality results, I examine the effects of counterfactual reimbursement policy experiments on nursing home closures and resident life expectancy. A universal 10% increase in the Medicaid rate decreases the frequency of closures, but causes some low-quality providers to remain open in competitive areas. In contrast, targeted subsidies for facilities in areas with limited alternatives improves overall life expectancy by averting the costliest nursing home closures. In the second chapter (co-authored with Szymon Sacher), we estimate a mortality-based Bayesian model of nursing home quality accounting for selection. We then conduct three exercises. First, we examine the correlates of quality, and find that public report cards have near-zero correlation. Second, we show that higher quality nursing homes fared better during the pandemic: a one standard deviation increase in quality corresponds to 2.5% fewer Covid-19 cases. Finally, we show that a 10% increase in the Medicaid reimbursement rate raises quality, leading to a 1.85 percentage point increase in 90-day survival. Such a reform would be cost-effective under conservative estimates of the quality-adjusted statistical value of life. The third chapter (co-authored with Michael Barnett and Adam Sacarny) examines why efforts to raise the productivity of the U.S. health care system have proceeded slowly. One potential explanation is the fragmentation of payment across insurers. Each insurer's efforts to improve care could influence how doctors practice medicine for other insurers, leading to unvalued externalities. We study these externalities by examining the unintended private insurance spillovers of a public insurer's intervention. In 2015, Medicare randomized warning letters to doctors to curtail overuse of antipsychotics. Even though the letters did not mention private insurance, they reduced prescribing to privately insured patients by 12%. The reduction to Medicare patients was 17%, and we cannot reject one-for-one spillovers. If private insurers conducted a similar intervention with their own limited information, they would stem half as much prescribing as a social planner able and willing to better target the intervention. Our findings establish that insurers can affect health care well outside their direct purview, raising the question of how to match their private objectives with their scope of influence.

Bakgrund: Idag lever cirka 55 miljoner människor med demensdiagnos i världen varav cirka 160 000 i Sverige. Demens finns i olika typer och saknar botande behandling däremot går symtomen att lindra. Syfte: Att beskriva omvårdnadspersonalens erfarenheter av att vårda personer med demensdiagnos i särskilt boende för äldre personer. Metod: Litteraturöversikt med kvalitativ design inkluderande 14 kvalitetsgranskade artiklar. Data analyserades med hjälp av en femstegsanalys. Resultat: Tre huvudteman yttrades; ”Att bedriva demensvård när organisationen brister”, ”Att samverka med anhöriga och personer med demens” och ”Att vårda demensens emotionella uttryck”. Resultatet visade att omvårdnadspersonalens kunskap är en viktig faktor i vårdandet av demens. Tidsbrist och tung arbetsbelastning är enligt omvårdnadspersonalen förekommande och beror ofta på att personalen är oerfaren. Omvårdnadspersonalen ansåg att kommunikationen mellan patient, personal och anhöriga kan habetydelse i vårdandet. Slutsats: Omvårdnadspersonalen upplevde brister i vårdandet av personer med demens och att förbättring behövdes. Att vårda personer med demens är utmanande och ger upphov till frustration, stress och sorg enligt omvårdnadspersonalen. Mer tid, resurser och utbildad personal behövs för att omvårdnadspersonalen ska kunna ge personerna en demensvård av bra kvalitet. Anhöriga bör synliggöras samt erbjudas delaktighet i vårdandet. Bristande kommunikation kan leda till negativa konsekvenser i vårdandet. / Background: Today, around 55 million people live with a diagnosis of dementia in the world, of which around 160,000 are in Sweden. Dementia comes in different types and lacks curative treatment, however, the symptoms can be alleviated. Purpose: To describe the nursing staff's experiences of caring for people with a diagnosis of dementia in special housing for the elderly people. Method: Literature review with qualitative design including 14 quality-reviewed articles. Data were analyzed using a five-step analysis. Results: Three main themes were expressed; “To provide dementia care when the organization fails”, "To cooperate with relatives and people with dementia" and "To care for the emotional expression of dementia" The results showed that the nursing staff's knowledge is an important factor in the care of dementia. According to the nursing staff, lack of time and heavy workload are common and are often due to the staff being inexperienced. The nursing staff considered that communication between patient, staff and relatives can be important in care. Conclusion: The nursing staff experienced deficiencies in the care of people with dementia and that improvement was needed. Caring for people with dementia is challenging and gives rise to frustration, stress and sadness according to nursing staff. More time, resources and trained personnel are needed for the nursing staff to be able to provide people with dementia care of good quality. Relatives should be made visible and offered participation in the care. Lack of communication can lead to negative consequences in care.

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No description available.

Bakgrund: Äldre personer med kognitiv sjukdom i behov av särskilt boende kommer att öka i framtiden. Personer med beteendemässiga och psykiska symtom vid kognitiv sjukdom förväntas därmed öka. Den främsta behandlingen för BPSD är omvårdnad och kommunikation medan medicinsk behandling kommer i andra hand. Omvårdnadspersonal som arbetar på demensavdelning använder dagligen olika kommunikationsstrategier i sitt arbete med äldre med kognitiv sjukdom. Syfte: Syftet med intervjustudien var att undersöka omvårdnadspersonalens erfarenhet av att kommunicera med personer med kognitiv sjukdom och hur de använder kommunikationen i det dagliga mötet. Metod: Åtta omvårdnadspersonal på demensboende i mellansverige intervjuades med semistrukturerade intervjuer. Kvalitativ innehållsanalys användes för att bearbeta och analysera materialet. Resultat: Omvårdnadspersonalens erfarenheter av att kommunicera med personer med kognitiv sjukdom resulterade i ett teman och tre subteman. Temat som identifierades var kommunikation som verktyg i mötet med personer med kognitiv sjukdom och de tre subteman som identifierades var; kommunikationsstrategier som omvårdnadsåtgärd, kommunikation som verktyg för att skapa relation samt bristen på kommunikation leder till svåra situationer. Slutsats: Kommunikationen är en avgörande faktor i mötet med den äldre med kognitiv sjukdom. Den kognitiva funktionsnedsättningen försvårar kommunikationen och ökar risken för svåra situationer. Omvårdnadspersonalen behöver därför kontinuerligt anpassa sin kommunikation och sitt bemötande för att hitta andra vägar och strategier för att kommunicera. / Background: Older people with cognitive disorders (dementia) in need of special accommodation will increase in the future. Various behavioral and psychological symptoms of cognitive disorder are thus expected to increase. The main treatment for the symptoms is care measures and communication, while medical treatment comes secondary. Assistant nurses working in dementia wards use different communication strategies on a daily basis in their daily work with older people with cognitive disorders. Aim: The purpose of the interview study was to investigate the assistant nursing staff's experience of communicating with people with cognitive illness and how they use communication in the daily meeting. Method: Eight assistant nursing staff at nursing homes in central Sweden were interviewed with semi-structured interviews.  Qualitative content analysis was used to process and analyze the material. Results: The assistant nursing staff's experiences of communicating with persons with cognitive disease resulted in one theme and three subthemes. The theme that was identified was communication as a tool in the meeting with people with cognitive disease and the three subthemes that were identified were communication strategies as a nursing measure, communication as a tool for creating relationships and lack of communication leads to difficult situations. Conclusion: Communication is a critical factor in encounters with older persons with cognitive disease. This since cognitive impairment makes communication difficult and increases the risk of difficult situations. Therefor assistant nursing staff continuously need to adapt and find other strategies to communicate.

Bakgrund Enligt Socialstyrelsen ska all omvårdnad av personer med demenssjukdom bedrivas personcentrerat. En stor del av denna omvårdnad sker i privata och kommunala särskilda boenden. Levnadsberättelsen för personer med demenssjukdom beskrivs som ett viktigt verktyg i den personcentrerade omvårdnaden. Syfte Syftet med studien är att beskriva undersköterskans erfarenheter av arbetet med levnadsberättelser i omvårdnaden av personer med demenssjukdom på särskilt boende. Metod Kvalitativ intervjustudie med tematisk analys. Semistrukturerade intervjuer genomförde med fyra undersköterskor som arbetade på särskilt boende för personer med demenssjukdom. Resultat Resultatet i föreliggande studie presenteras i form av tre huvudteman och sex underteman. Huvudtemana som presenteras är;  ”Stöd för personcentrering” som handlar om undersköterskans erfarenhet av att använda levnadsberättelsen som ett sätt att lättare utforma omvårdnaden på ett personcentrerat sätt. ”Att förstå människan bakom berättelsen” som handlar om undersköterskans erfarenhet av att genom levnadsberättelsen lättare kunna tolka och förstå reaktioner och beteenden hos den demenssjuke. ”Någon annans berättelse” som berör undersköterskans erfarenhet av att det är någon annan än den demenssjuke som styrt innehållet i levnadsberättelsen.  Slutsatser De slutsatser som dras av denna studie är att levnadsberättelsen är en grundpelare för personcentrerad omvårdnad. Levnadsberättelsen måste betraktas som och användas som ett levande dokument. Rutinerna för insamlande och revidering av levnadsberättelsen måste utvecklas. Levnadsberättelsen kan underlätta men aldrig ersätta relationsbyggandet mellan den demenssjuka personen och vårdaren. / Background The Swedish National Board of Health and Welfare states that all caring for people with dementia shall be done with a person-centered approach. A large amount of this care takes its place in private and community nursing homes. Using life stories for people with dementia is described as an important tool for person-centred care.  Aim The aim of this study is to describe the associate nurses' experience of life story work in caring for people with dementia in nursing homes.  Method Qualitative interview study with thematic analysis. Semi-structured interviews were conducted with four associate nurses working in a nursing home for people with dementia.  Results The result of the present study is presented in three main themes and six subthemes. The man themes presented is: “A support for person-centredness” which deals with the associate nurse’s experience of using the life story as a way to make the caring more personcentered. “To understand the person behind the story” which deals with the associate nurse’s experience of using the life story to easier interpretet and understand reactions and behaviours of the person with dementia. ”Someone else’s story” Which delas with the experience of the associate nurse that there is someone other than the person with dementia that have controlled the content of the life story.  Conclusions The conclusions drawn by this study is that the life story is a cornerstone in person-centered care. The life story must be looked upon and used as a living document. The routines for collection and revision of life stories need further development. The life story can help but never replace the building of relationships between the person with dementia and the carer.

No / There is a substantial body of evidence that prescribing for care home residents is suboptimal and requires improvement. Consequently, there is a need to identify effective interventions to optimise prescribing and resident outcomes in this context. OBJECTIVES: The objective of the review was to determine the effect of interventions to optimise prescribing for older people living in care homes. SEARCH METHODS: We searched the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register; Cochrane Central Register of Controlled Trials (CENTRAL), The Cochrane Library (Issue 11, 2012); Cochrane Database of Systematic Reviews, The Cochrane Library (Issue 11, 2012); MEDLINE OvidSP (1980 on); EMBASE, OvidSP (1980 on); Ageline, EBSCO (1966 on); CINAHL, EBSCO (1980 on); International Pharmaceutical Abstracts, OvidSP (1980 on); PsycINFO, OvidSP (1980 on); conference proceedings in Web of Science, Conference Proceedings Citation Index - SSH & Science, ISI Web of Knowledge (1990 on); grey literature sources and trial registries; and contacted authors of relevant studies. We also reviewed the references lists of included studies and related reviews (search period November 2012). We included randomised controlled trials evaluating interventions aimed at optimising prescribing for older people (aged 65 years or older) living in institutionalised care facilities. Studies were included if they measured one or more of the following primary outcomes, adverse drug events; hospital admissions;mortality; or secondary outcomes, quality of life (using validated instrument); medication-related problems; medication appropriateness (using validated instrument); medicine costs. Two authors independently screened titles and abstracts, assessed studies for eligibility, assessed risk of bias and extracted data. A narrative summary of results was presented. The eight included studies involved 7653 residents in 262 (range 1 to 85) care homes in six countries. Six studies were cluster-randomised controlled trials and two studies were patient-randomised controlled trials. The interventions evaluated were diverse and often multifaceted. Medication review was a component of seven studies, three studies involved multidisciplinary case-conferencing, two studies involved an educational element for care home staff and one study evaluated the use of clinical decision support technology. Due to heterogeneity, results were not combined in a meta-analysis. There was no evidence of an effect of the interventions on any of the primary outcomes of the review (adverse drug events, hospital admissions and mortality). No studies measured quality of life. There was evidence that the interventions led to the identification and resolution of medication-related problems. There was evidence from two studies that medication appropriateness was improved. The evidence for an effect on medicine costs was equivocal. Robust conclusions could not be drawn from the evidence due to variability in design, interventions, outcomes and results. The interventions implemented in the studies in this review led to the identification and resolution of medication-related problems, however evidence of an effect on resident-related outcomes was not found. There is a need for high-quality cluster-randomised controlled trials testing clinical decision support systems and multidisciplinary interventions that measure well-defined, important resident-related outcomes.

Little is known regarding registered nurse (RN) information management practice in long-term care (LTC) settings. This study identifies LTC RNs’ information management practice and needs, which are important for designing and implementing health information technology (HIT) in LTC settings. Methods: This descriptive qualitative study combines direct observations and semi-structured interviews, conducted at Alberta’s LTC facilities between May 2014 and August 2015. The constant comparative method of joint coding was used for data analysis. Results: Nine RNs from six nursing homes participated in the study. Based on the RNs’ existing information management system requirements, a graphic information flow model was constructed. Conclusion: This baseline study identified key components of LTC RNs’ information management system. The information flow model may assist HIT developers with future design and development of HIT solutions for LTCs, serve as a communication tool between RNs and developers to refine requirements and support further LTC HIT research. / Graduate

The purpose of the study was to develop a behavioral nursing intervention strategy for specific deficits in grooming performance of elders with dementia. A quasi-experimental two-group design using switching replications with removed intervention was employed. Three residents with severe cognitive impairments and three residents with mild cognitive impairments were chosen from a special dementia care unit of a long-term care facility. Three residents among six residents were randomly selected to receive the behavioral intervention early. Baseline and post-intervention assistance was provided by nurse aides. Each resident was asked to wash hands, brush teeth, wash face, and comb hair in a sequence. Ten intervention sessions were conducted by the trained intervener for two consecutive weeks. The intervention consisted systematic prompting and social reinforcement. A total of 21 sessions were collected in the morning using videotape recordings. Interobserver agreement for the instruments designed by the investigator was measured by the trained observers. Data were analyzed in two phases. First, the quantitative data were analyzed to determine the independent functional behaviors of individuals, and the change in the intensity of nursing effort associated with grooming of elders with dementia. Data were examined by individual graphic display throughout the three phases (baseline, nursing intervention, post-intervention). Second, the qualitative data were analyzed to determine the antecedents, consequences, and resident responses associated with grooming, the caregiver problem behaviors, and resident problem behaviors associated with grooming performance. The results show that the functional behaviors of even severely demented elders can be promoted, indicating the effectiveness of nursing care strategies on the ADL task of grooming. The data in this research suggest that maintaining or improving functional ability is possible with a behavioral nursing intervention, which was a highly structured and systematic approach that involved modifying the environmental and behavioral context, through strategies such as prompting and social reinforcement, when necessary. Furthermore, through the qualitative analysis, the functional relationships between antecedents, consequences, and behaviors of demented elders allowed the investigator to analyze the caregiver problem behaviors and resident behavior problems associated with grooming.