Darbo aktualumas. Šiandien sveikatos mokymas tampa viena iš prioritetinių veiklos sričių slaugoje. Slaugytojas privalo suteikti pakankamai žinių ir informacijos, kad žmogus išmoktų tinkamai rūpintis savo sveikata bei išsiugdytų gebėjimus ją saugoti. Siekiant teigiamo sveikatos mokymo rezultato būtina analizuoti pacientų poreikius ir motyvus sveikatos mokymuisi. Darbo tikslas: nustatyti pacientų sveikatos mokymosi poreikį ir motyvus Kaišiadorių ligoninės Vidaus ligų ir Slaugos ir palaikomojo gydymo skyriuose. Realizuojant tyrimą buvo atlikta teorinė mokslinės literatūros analizė ir įvykdytas momentinis tyrimas, apklausiant raštu 301 pacientą iš Kaišiadorių ligoninės. Tyrimo rezultatams pateikti naudojami metodai: kiekybinė aprašomoji statistikos analizė. Tyrimo rezultatai: vertinant sveikatos mokymo ypatumus Kaišiadorių ligoninės Vidaus ligų ir Slaugos ir palaikomojo gydymo skyriuose galima teigti, kad pacientų mokymu, individualių užsiėmimų metu daugiausia užsiima slaugytojos. Slaugytojų mokymas, pacientų nuomone, įvertintas kaip geras. Analizuojant pacientų mokymo poreikį paaiškėjo, kad pacientai daugiausia žino apie galimas ligos komplikacijas ir reikalingas slaugos priemones. Statistiškai reikšmingai (p < 0,05) daugiau apie galimas ligos komplikacijas ir reikalingas slaugos priemones žino Slaugos ir palaikomojo gydymo skyriaus pacientai negu Vidaus ligų skyriaus pacientai. Analizuojant pacientų mokymosi poreikį išryškėjo, kad statistiškai reikšmingai (p < 0,05) vidaus... [toliau žr. visą tekstą] / The work topicality. Today, health education is one of the first-priority areas of nursing. Nurse must provide the necessary knowledge and information that a person learn to properly take care of his health, and develop the capacity of its saving. It is necessary to analyze the needs of patients and reasons for learning for a positive outcome of health education. The aim of this work. Identify health training needs and reasons from the point of view of patiens in the department of Internal Medicine, and Nursing and supportive care at Kaišiadoriai Hospital. Unlocking the study was carried out theoretical analysis of scientific literature and carried out a snapshot survey by interviewing 301 patients in writing of Kaišiadoriai hospital. Quantitative Descriptive Analysis method was used to present the study results. The survey results. Then the health education features in the department of Internal Medicine, and nursing and supportive care at Kaišiadoriai hospital were estimated, we can affirm that nurses are teaching patients more then anybody else. From the point of view of patients the nurses‘ teaching is high. The analysis of patients' training needs shows that the most patients are aware of the possible complications of the disease and preservative care. Statistically significant (p <0.05) patients in the department of nursing and supportive care know more about the possible complications of the disease and the preservatives... [to full text]

Bakgrund: Kommunikation med vårdare ger förutsättning för patienter att vara delaktig i vården. Det är av stor vikt att relationen mellan patienter och vårdare byggs på tillit för att patienters behov och önskemål uppfylls. När patienter inte får möjlighet till delaktighet, kan det leda till ett onödigt lidande. Syfte: Beskriva patienters upplevelser av delaktighet i vården.                                  Metod: Tolv artiklar har analyserats utifrån en systematisk litteraturstudie med beskrivande syntes. Resultat: När patienter var prioriterade av vårdare skapades en relation av förtroende. Lyhördhet är även en viktig egenskap, eftersom att patienter kan känna sig uppmärksammade i relationen med vårdarna. Med stöd av öppenhet och lyhördhet ökar förtroendet vilket medför till minskad oro för patienter. När vårdare skapar lämpliga miljöer för patienterna att vistas på medför det till att patienter känner motivation till delaktighet. Slutsats: Upplevelsen av delaktighet utgår utifrån patientperspektiv. Relationen till delaktighet byggs upp med stöd av förtroende och motivation från vårdare. Det är viktigt att vårdare är lyhörd vid varje vårdtillfälle för att patienters behov ska uppfyllas. Genom att vårdare uppmärksammar varje patients behov medför till ökad delaktighet. / Background: Having a communication with the caregiver gives the patient an option to participate. It is of importance that the relationship between the two is built on trust due to the needs and wishing of patients fulfils. Aim: The purpose of the thesis is to describe patient’s experiences of participation in care. Method: Twelve articles have been analysed in accordance with a systematic literature study by a descriptive synthesis. Result: A relationship built in confidence was created when the patients were prioritized by the caregivers. Another important attribute is being responsive, since the patients feels appreciated in relation with the caregivers. By being open and responsive the confidence increases which leads to a decrease in anxiety for the patients. When a suitable environment is created it entails that the patients feel the motivation for participation. Conclusion: The experience of participation is based on the patient's perspective. The relationship to participation is built on the basis of trust and motivation from the caregivers. It is important that the caregiver is responsive at every care opportunity to satisfy the needs.  The caregivers pay attention to each patient's needs leads to increased participation

Bakgrund: Att få en stomi innebär en livsomställning där personen måste ändra på tidigare levnadsvanor. Människan måste anpassa sig till sin nya kroppsbild. Kroppsbilden, livskvaliteten och sexualiteten kan påverka varandra. Studier visar att sjuksköterskor saknar kunskap inom området sexualitet och att det upplevs svårt att prata med patienter kring detta.  Syfte: Att belysa sexualiteten hos människor som lever med tarmstomi. Metod: Metoden till denna studie var en litteraturöversikt med tio stycken kvalitativa och kvantitativa vetenskapliga artiklar som analyserades enligt Fribergs modell i tre steg. Resultat: Litteraturöversiktens resultat är uppdelad i tre huvudteman och tre underteman. Det första huvudtemat är Kroppsliga upplevelser relaterat till sexualitet. Det andra huvudtemat är Förändrad kroppsbild relaterat till sexualitet. Det tredje huvudtemat är Sociala upplevelser relaterat till sexualitet med tre underteman: Rädsla för att uppfattas annorlunda, Upplevelser i mötet med vårdpersonal och Att vara intim med andra. Diskussion: Resultatet diskuteras utifrån Callista Roys omvårdnadsteori om adaption. Patientens behov av stöd från vården efter en stomi-operation belyses samt hur det upplevs ur ett sjuksköterske- och samhällsperspektiv. / Background: To get a stoma involves a life setting where the person has to change previous living habits. The person must adapt to the new body image. Body image, quality of life and sexuality can affect each other. Studies show that nurses lack knowledge in the area of ​​sexuality and that it is difficult to talk with patients about it.  Aim: To illustrate the sexuality of patients living with a bowel stoma. Method: The method of this study was a literature review with ten qualitative and quantitative scientific articles analysed according to Fribergs model in three steps. Results: The results of the literature review are divided into three main themes and three sub-themes. The first main theme is Bodily experiences related to sexuality. The second main theme is Changed body image related to sexuality. The third main theme is Social experiences related to sexuality with three sub-themes: Fear of being perceived differently, Experiences in the meeting with healthcare professionals and Being intimate with others. Discussion: The result is discussed based on Callista Roy's nursing theory about adaption. The patient's need for support from the care after a stoma operation illustrates and how it is perceived from a nursing and social perspective.

Background: Cancer in the head and neck region is an unusual form of cancer. The treatment for this cancer can cause permanent damage to vital functions. Nurses' have expressed frustration about feeling insufficient to accommodate the patients' needs. Patients' with head and neck cancer are reported to have low quality of life. Aim Describe patients' experiences of undergoing treatment of cancer in the head and/or neck region. Method: A qualitative systematic literature review with descriptive approach of qualitative articles. Result: Undergoing treatment for cancer in the head and neck region created challenges for the patients'. Many patients' have had experienced that the time between the diagnose and treatment went fast. The treatment caused side effects that led to constraints in daily life and many created a new identity because they did not recognize themselves in the same way as before the diagnose. Patients became dependent to the medical care and made them omitted to others. They had to handle a new life situation, and to manage that, the patients created strategies. Conclusion: The treatment provided side effects that affected the everyday lives of the patients. The side effects impacted on patients both physically, psychologically, socially and existentially. More knowledge is needed in order to improve the health care for patients with head and neck cancer.

本研究主要在探討離島兩家公立醫院，在政府醫療整合政策下合併是否真能妥善利用當地有限資源並提升當地之醫療品質與醫療滿意度。本研究以澎湖醫療大樓落成啟用引進三軍總醫院及署立澎湖醫院醫事人力作為時間點，蒐集整理醫院經營管理資料，比較醫療大樓使用前後，醫療資源利用情形，對於民眾關切之四項議題：（一）醫療整合政策與提升當地醫療品質的關係。（二）醫療整合政策與成本效益的關係。（三）醫療整合政策與組織管理的關係。（四）醫療整合政策與民眾滿意度的關係之探討，採以質性田野調查方式作深入剖析與辯證，另對醫療品質滿意度觀察部分，則以門診就醫病患為調查對象，與質性調查結果作交叉驗證，分析探討整體社會對醫療服務品質滿意度之觀感。試圖從不同層面與角度來詮釋、剖析醫療整合政策與民眾對醫療服務品質滿意度間有無存在背後深層的意義及潛在的社會意涵。 / 本研究發現（一）政府的整合醫療政策，目的是將離島有限的資源作有效的運用，在方向上是正確的。，醫療大樓要做到何種規模須視其未來的定位與所開的床位數而定，若要求持續提供一定品質的醫療服務，政府常態性的預算補助是必要的。（二）假日緊急醫療需求無法在地圓滿解決，是澎湖地區長期以來醫療服務主要的缺口，兩院整合後目前仍未能解決該問題，是造成澎湖整體社會對醫療品質觀感不若預其的原因。（三）病患與醫療專業人員對醫療品質的認知是有差距的，這代表醫、病雙方所能掌握的醫療品質資訊是不對稱的，病患不瞭解醫界對醫療品質的評核標準，只能用直接的感受來體驗，是造成雙方在衡量醫療服務品質時出現落差的原因。（四）在組織重整過程中，「同工同酬」問題因不同公務體制無法於第一時間解決，造成員工內心不滿與不安，亦是影響整體社會對醫療服務觀感不若預其的因素。（五）在基本人口特質中，軍人、家人同住多者及醫療服務使用率較高者，這三類群體對醫療服務品質的認知有較客觀的認定，應與其對醫療服務的體驗有較多之經驗有關。（六）以模擬醫事人力供需情境分析，澎湖地區並非是一個醫事人力不足或醫療資源缺乏的地區，而是在健保制度下形成醫療資源分配不均的問題。本研究建議健保醫療給付應配合政府公共政策才是解決離島醫療問題有效的方式。（七）離島醫療成本相當昂貴，以侷限的地域、不足的消費人口及健保總額支付制度限制下，要發展在地醫療或提升至區域級醫療服務品質宜審慎考慮，建議遠距醫療合作、空中轉診後送結合軍方穩定的醫療人力支援，可能仍是最佳解決問題的模式。 / The purpose of this study is to explore how two public hospitals on Penghu Island can really make good use of limited local resources to improve medical quality and patient’s satisfaction under nation wide integration of health care policy. This study adopts qualitative research and interview method on the following four items that are of great concerns to the local general public: (1) the relationship between the integrated medical policy and improvement of local medical quality (2) the relationship between the integrated medical policy and hospital performance (3) the relationship between the integrated medical policy and organizational management (4) the relationship between the integrated medical policy and patient’s satisfaction. As to the observation of client satisfaction of medical treatment, the targets are out-patients with analysis of their satisfaction with the medical services. This study also intends to interpret from different aspects and perspectives the real social meaning presented by the relationship between the integrated medical policy and client satisfaction. / This study has discovered the following: (1) The decision of the integrated medical policy with purpose of effectively deploying limited resources on off-shore islands is correct. However to what extent a medical building should provide its service is dependent on its hospital beds capacity and the definition of its role. Regular budgetary support from the government is necessary if stable quality of medical services is desired. (2) One of the main reason about people’s satisfaction with overall medical services provided on Penghu has not met the expectation is that there still did not provide a good resolution to the urgent medical support on Holiday after the integration of two hospitals medical resources. (3) There is a gap between professional medical services providers and patients in recognizing the quality of medical services. This means that the information obtained by both parties regarding the quality of medical services is asymmetric. Patients do not understand the criteria used to review the quality of medical services and as a result, they depend on very direct feeling or experience to make the judgment, thus causing the gap. (4) During the process of reorganization, the issue of “equal work with equal compensation” did not receive appropriate attention and was not resolved properly by different governmental bureaucratic systems which led to the fact that the quality of medical services is not as good as expected. (5) Three fundamental elements of population, military personnel, families with most of their members living together, and frequent users of medical services, have possessed more objective recognition of the quality of medical services due to their more sufficient experience in using medical services. (6) a simulated analysis of demand and supply of medical services has indicated that Penghu Island shall not be regarded a region lack of medical personnel or barren of medical resources. This study suggests that the compensation provided under the National Health Insurance System must go hand in hand with government public policies to provide an effective way to resolve medical problems on off-shore islands. (7) The cost of medical services on off-shore islands is high. Under the conditions of limited population in limited areas and the per-quota-compensation provided by the National Health Insurance System, we need to carefully consider how to develop or upgrade its quality level. It is, therefore, suggested that distant medical cooperation, aerial medical transport together with stable supply of medical personnel from the military provides probably the best model for resolution of the problems.

Il sistema sanitario ha un ruolo fondamentale nella crescita economica di un paese e per tale motivo è oggetto di continue revisioni, nel tentativo di trovare il giusto equilibrio tra risorse necessarie e risorse disponibili. L’elevata complessità del settore spinge la ricerca scientifica a sviluppare modelli che spieghino al meno in parte l’insieme di attività che costituiscono il processo produttivo al fine di ottenere un miglioramento complessivo nella qualità del servizio offerto. Con questo lavoro viene proposto l’utilizzo congiunto di due strumenti quantitativi, utilizzati in geo-grafia spaziale e in ricerca operativa, che rappresentano in modo dinamico il flusso di pazienti all’interno di una specifica area geografica. / The health system has a fundamental role in the economic growth of a country and for this reason it is subject to constant revisions, in an attempt to find the right balance between resources. The high complexity of the sector pushes scientific research to develop models that explain at least part of the set of activities that constitute the manufacturing process in order to obtain an improvement in the overall quality of the service offered. In this paper we proposed the joint use of two quantitative tools used in geography and space operations research, which dynamically represent the flow of patients within a geographical area.

Information systems for medical data storing, managing and retrieving are specific, because of the data that has different in-between associations. This data consists of text and multimedia. The purpose of this work is to propose and develop a medical data system, which uses object oriented data base. The user could store various medical data and perform data mining by selecting desirable criterions. After analysis of object-oriented technologies, were chosen object-oriented programming environment and object-oriented data base management system. For its implementation, the suitable technologies were analyzed, according to the specifics of medical data. The advantages of these technologies where shown by an experiment. Developed information system is functional and flexible enough to work with evolving medical data.

In master study is analyzed the problem of code of doctor’s ethics in legal dimension. The relevance of doctor’s ethics is highlighted by the new viewpoints in Lithuanians’ lives, often not corresponding with the old understanding of ethics, which is natural for Lithuanian mentality. The objective of the research is to research the role of doctor’s ethics code in the formation of medical practice and while growing the society’s interest in the quality of doctor-patient relation and to analyze the interaction between Lithuania’s doctor’s ethics principles and law that fine-tunes health care in Lithuania. IN study was made the research with the purpose to analyze the interaction between the principles of doctor’s ethics code and the principles of Lithuania’s law that fine-tunes the health care. The results of the research show that the set of analyzed pieces of legislation does not guarantee the universal definition of doctor’s ethics norms and. For this reason the relevance of doctor’s ethics code exists.

The purpose of the research – to evaluate satisfaction of patients expectations in Vilnius emergency university hospital. The object of the research. In-patient expectations in Vilnius emergency university hospital. The hypothesis of the research- patient’s expectations are not successfully satisfied because of the organizational problems, their analysis is useful in order to make better organizational work. Conclusions. Patient's expectayions satisfaction is influenced by the structure of resources in healthcare organization and person's (patient's) individual characteristics.

A disease has consequences not only for the afflicted person but also for those who interact with him or her. A low-grade glioma is a brain tumour whose regarding its psychosocial implications for adult patients and their next of kin has received little attention in the literature. In the light of this the overall aim of the present thesis was to provide increased knowledge about how patients with low-grade glioma and their next of kin experience and deal with everyday life. The methods of the studies were mainly qualitative. Thirty-nine patients and 28 next of kin were interviewed and all except one next of kin completed a quality of life questionnaire. The onset of low-grade glioma was described from the patients’ perspective as a process, either rapid (up to a few months) or prolonged over several years. This phase of low-grade glioma encompassed repeated visits to physicians and care institutions. The onset of low-grade glioma was accompanied by stress, anxiety and uncertainty in the case of both the patients and those nearest. The symptoms and problems the patients experienced covered a broad range of consequences, physical, psychological and social. The patients presented a wide range of ways to cope with illness-related problems. The next of kin were often deeply involved in the patients’ situation and many of them experienced extremely stressful emotions mainly in the early period of the illness. They had experience of positive encounters in health care but more often they had had a sense both of powerlessness and of being invisible and neglected. Relations and roles changed in ways that mostly were experienced as negative. Enabling strength in everyday life had to do with alleviation of strain and having a positive outlook upon life. By means of the questionnaire Subjective estimation of Quality of Life (SQoL) the patients and those nearest estimated their quality of life as being comparatively high. Only one variable, among the patients the absence of work/meaningful occupation and among the next of kin the absence of own children, being estimated at below 60% of the maximum score.