The increasing waiting times to access healthcare services are a major concern for pa-tients in hospitals. Due to the unpredictability of health issues, hospitals and clinical ser-vices are provided to patients even without prescheduled medical appointments. Unex-pected and random patient arrivals can result in high waiting times. Waiting occurs most-ly because of insufficient resources available compared to demanding service delivery requirements at a given time. Thus, appropriate management of resource scheduling over time can help reduce patient wait times. So far, simulation has mostly been used as a support for strategic decision making in healthcare environments. We are proposing a complementary approach, namely, real-time simulation, to support operational decision making rather than long-term strategic decision making. Real-time simulation is a technique used to get a timely prediction of the system status in a near future (e.g., a few hours). Hospitals can benefit from the capa-bilities of real-time simulations by predicting upcoming bottleneck occurrences in patient care processes and make effective decisions in the present time to avoid undesirable out-comes in the near future. This research presents real-time simulation capabilities for short-term operational decision making of patient care processes in hospitals and the possible ways to run alter-native scenarios and evaluate their results to come up with the most effective solution considering various factors. This thesis also provides tool support based on a leading simulation environment, namely Arena. The tool-supported methodology is evaluated through a realistic cardiac care process in an Ontario community hospital, with encourag-ing results.

The increasing waiting times to access healthcare services are a major concern for pa-tients in hospitals. Due to the unpredictability of health issues, hospitals and clinical ser-vices are provided to patients even without prescheduled medical appointments. Unex-pected and random patient arrivals can result in high waiting times. Waiting occurs most-ly because of insufficient resources available compared to demanding service delivery requirements at a given time. Thus, appropriate management of resource scheduling over time can help reduce patient wait times. So far, simulation has mostly been used as a support for strategic decision making in healthcare environments. We are proposing a complementary approach, namely, real-time simulation, to support operational decision making rather than long-term strategic decision making. Real-time simulation is a technique used to get a timely prediction of the system status in a near future (e.g., a few hours). Hospitals can benefit from the capa-bilities of real-time simulations by predicting upcoming bottleneck occurrences in patient care processes and make effective decisions in the present time to avoid undesirable out-comes in the near future. This research presents real-time simulation capabilities for short-term operational decision making of patient care processes in hospitals and the possible ways to run alter-native scenarios and evaluate their results to come up with the most effective solution considering various factors. This thesis also provides tool support based on a leading simulation environment, namely Arena. The tool-supported methodology is evaluated through a realistic cardiac care process in an Ontario community hospital, with encourag-ing results.

Bakgrund: Sömn är ett basalt behov och är en viktig faktor för tillväxt, vila och återhämtning. Intensivvårdsmiljön är inte gynnsam för patienternas sömn. Det finns tydliga omvårdnadsinterventioner för att främja sömn men sjuksköterskor upplever det svårt att organisera arbetet för att använda sig av dessa. Medicinforskare internationellt är kritiska till att det inte finns tydliga riktlinjer att ta del av. Syfte: Syftet var att beskriva intensivvårdssjuksköterskors upplevelser av strategier som är betydande för sömnen i det patientnära omvårdnadsarbetet. Metod: Kvalitativ design med induktiv ansats. Tio intervjuer med intensivvårdssjuksköterskor genomfördes. Transkriberat material analyserades med kvalitativ innehållsanalys. Resultat: Tre kategorier med underkategorier som beskriver intensivvårdssjuksköterskors upplevelser av strategier som är betydande för sömnen i det patientnära omvårdnadsarbetet skapades. Dessa huvudkategorier var Betydelsen av gemensamt arbetsssätt, Betydelsen av att skapa trygghet och Betydelsen av omvårdnadsmiljön. Det framkom i intervjuerna att rutiner som görs nattetid upplevs vara störande för sömnen och som sjuksköterskorna visade starkt missnöje till. Betydande för sömnen var ett gemensamt arbetssätt för att nå samma mål. Ett lugnt förhållningssätt och beröring upplevdes lugna patienterna och skapa trygghet så de kunde sova bättre. Intensivvården fokuserar på att rädda liv och miljön är anpassad därefter. Det framkom att det är svårt att tillgodose patienternas enskilda behov när de ligger i flersalar. Slutsats: Det krävs en förändring av rutiner och utveckling av riktlinjer för att öka medvetenhten om sömnens betydelse. Enkelrum skulle kunna underlätta för att skapa en miljö som tar hänsyn till patientens individuella sömnbehov. / Background: Sleep is a basic need and an important factor for growth, rest and recovery. Intensive care environment is not conducive to patients' sleep. There are clear nursing interventions to promote sleep but nurses find it difficult to organize the work in order to use these. Medical Scientists internationally are critical to the lack of clear guidelines to take note of. Objective: The objective was to describe the intensive care nurses experiences of strategies that are important to sleep in the patient-care process. Method: Qualitative design with inductive approach. Ten interviews with intensive care nurses were conducted. Transcribed material was analyzed using qualitative content analysis. Results: Three categories with subcategories that describe intensive care nurse experiences of strategies in the patient care around sleep were created. These main categories were The importance of a common approach, The importance of creating security and The importance of the nursing environment. It emerged in the interviews that the procedures done at night disrupts sleep which the nurses showed strong dissatisfaction towards. Significant for sleep was a common approach to achieve the same goal. A calm approach and touch proved to reassure patients and provide security so they could sleep better. Intensive care focus on saving lives and the environment is adapted accordingly. It was revealed that it is difficult to meet patient´s individual needs when they are treated in multi people rooms. Conclusion: It requires a change in practices and development of guidelines to increase awareness of sleep. Single rooms could help to create an environment that takes into account the individual patient needs.