Bakgrund: Covid-19 är en luftburen infektionssjukdom med hög smittorisk som främst överförs via droppsmitta. Nationella samt internationella försiktighetsåtgärder har framtagits i syfte att minska smittspridningen av viruset. Folkhälsomyndigheten har skärpt rekommendationerna för gravida samtidigt som omprioriteringar görs inom hälso- och sjukvården. Syfte: Syftet med denna studie var att undersöka barnmorskors erfarenheter av att arbeta i patientnära vård under virusutbrottet covid-19. Metod: Studien var en tvärsnittsstudie med kvantitativ ansats. Datainsamling har gjorts via en webbenkät som besvarats anonymt. Resultat: Av de 159 respondenter som svarat på studien upplevde majoriteten en ökad stress samt en oro att bli smittad av covid-19 och föra smittan vidare. En femtedel av barnmorskorna upplevde ett nedsatt psykiskt välbefinnande. Slutsats: Riktlinjer på nationell nivå för simulering, skyddsutrustning och tydlig information för barnmorskor kring arbetet i patientnära vård under covid-19 efterfrågas. Detta i syfte att skapa trygghet i arbetet, att inte bli smittade eller föra smittan vidare. / Background: Covid-19 is a highly contagious airborne infectious disease which primarily spreads via droplets when throat or nasal secretions are released into the air. Precautions have been implemented worldwide with the intent to minimize the spread of the disease. The Public Health Agency of Sweden has implemented new and improved recommendations. Purpose: The aim for this study was to investigate the midwife’s firsthand experiences working intimately with patients during the outbreak of the covid-19 pandemic. Method: The study was a cross- sectional study with a quantitative method. The data was gathered throughout anonymous online questionnaires answered by midwives in Sweden. Result: Of the 159 respondents in the study, the majority reported an increased level of stress and anxiety related to becoming ill or transferring the virus to others. One in five respondents experienced a decrease in mental wellbeing. Conclusion: National guidelines for midwives regarding practice simulations, protective gear and comprehensive information concerning the work in near proximity to the patient was desired. Midwives called for this to ensure a safe working environment, and to avoid transferring the virus to their colleagues and patients.

<p><b>Background:</b> Shared decision-making (SDM) increases patients’ involvement in their healthcare, extending the goal of patient-centered care provision. However, SDM is underexplored in women’s reproductive health, where choices about contraception and pregnancy are frequently value and lifestyle-dependent. Furthermore, limited research exists on SDM outside of the patient-physician dyad, preventing insight into how non-physician community-based healthcare professionals (HCPs) engage women in practice. Finally, little research takes a social-ecological approach to SDM, despite interaction of multiple levels of influence in women’s reproductive healthcare decision-making. Therefore, the purpose of this study was to explore women’s and HCPs’ experiences with SDM, including the various factors associated with how women make their reproductive healthcare choices.</p><p> </p><p><b>Methods: </b>This study consisted of three distinct, but interconnected phases. Phase 1 consisted of 6 focus groups (Sept-Dec, 2019) with women aged 18-45 living in Indiana who sought community-based or private healthcare for women’s reproductive healthcare needs. Phase 2 included 20 key-informant interviews with non-physician HCPs (i.e., NP, RN, CNM, doula, pharmacist, chiropractor) living in Indiana (September 2019-May 2020) who provided community-based women’s reproductive healthcare. Focus groups and interviews were audio-recorded, transcribed, and analyzed using an expanded grounded theory framework. Constant comparative analysis identified emergent themes in both phases. Phase 3 consisted of an online survey. Women (18-45 years) living in Indiana who sought reproductive healthcare completed the survey (N=432). Multiple linear regression, chi-square analyses, and structural equation modeling were utilized to identify ecological factors associated with pregnancy and contraceptive shared decision-making.</p><p> </p><p><b>Results:</b><i> Phase 1)</i> Participants (n=22) wanted to be invited into healthcare discussions. Additionally, they wanted conversations to proceed organically, where HCPs listened to their needs, and supported and validated their choices. Though these behaviors did not always occur, they provided recommendations to enhance these experiences. Additionally, participants described quality of time was more important than quantity of time during appointments. Prior negative healthcare experiences specifically tied to HCP-interactions decreased women’s healthcare engagement. Additionally, social support system experiences were influential on women’s choices. Race also emerged as impactful toward decision-making, including Black women feeling less respected in care and making choices about their reproductive healthcare to ensure their voices were heard, such as enlisting Black doulas. <i>Phase 2)</i> HCPs noted patient-centered care was important to community-based care. They also noted the importance of contextualized decision-making approaches to ensure they could meet women’s varied needs. Results identified that outcome-oriented SDM concepts, including patient buy-in and investigative listening, were important for increasing SDM. HCPs suggested SDM improved healthcare experience beyond one visit. <i>Phase 3) </i>Structural equation modeling revealed access, social support, and patient-HCP relationship had significant relationships with contraceptive and pregnancy SDM. These models demonstrated good global and component fit, suggesting the importance of context in women’s health choices. Further, regression results demonstrated SDM was associated with higher reproductive healthcare quality. Additionally, utilizing community-based healthcare for reproductive health was associated with decreased contraceptive SDM scores.</p><p> </p><p><b>Conclusion: </b>Findings from this study provide practical considerations for extending SDM work in women’s reproductive health. In particular, results supported shifting SDM beyond the patient-physician dyad to include non-physician HCPs and HCPs in community-based healthcare settings. Women frequently access these services when seeking reproductive healthcare; thus, findings improve our understanding of the practical considerations researchers, policy-makers, and HCPs must make when promoting SDM in these settings. Furthermore, results revealed SDM use across multiple touchpoints, including community-based services, is imperative for women to achieve partnership in their healthcare. Thus, SDM provides a broader opportunity to enhance patient involvement across the spectrum of women’s reproductive healthcare. Incorporating women’s contextual needs and preferences improves HCPs’ insight into women’s experiences to further personalize care. Findings emphasize the importance of decisional space that include the various factors, agents, healthcare settings, and options that exist in reproductive health decision-making as these can shape women’s choices, and, subsequently, their SDM experiences. This mixed methods study allowed thorough insight into multiple stakeholder groups engaged in healthcare decision-making; thus, the results offer guidance on the verbiage, resources, and strategies to engage in SDM and strengthen patient involvement reflective of women’s lifestyle needs and HCPs’ existing workflow. Findings drive SDM practice into community-based healthcare and position it as the standard of care across healthcare settings.</p><br>

Efter en kartläggning som Socialstyrelsen utfört över hälso- och sjukvårdens nyttjande avArtificiell Intelligens (AI), har det konstaterats att det finns utrymme och potential för ett mereffektivt användande av tekniken. Men trots att potential och fördelar med AI presenteras,möter branschen motgångar och utmaningar vid införandet av tekniken. I rapportenpresenteras några av de utmaningar som kan uppstå vid arbetet med att införa AI-teknik inomhälso- och sjukvården samt varför de förväntade effekterna inte uppnås. Studien har utgåttfrån en kvalitativ forskningsansats i syfte att genomföra empirisk datainsamling genomsemistrukturerade intervjuer och det insamlade materialet har bearbetats utifrån en tematiskanalys. Därefter presenteras och sammankopplas resultatet med tidigare forskning ochlitteratur för att avslutningsvis presentera bakomliggande anledningar till utmaningar vidimplementering av AI inom hälso- och sjukvården. / The National Board of Health and Welfare (Socialstyrelsen) has mapped in which extent thehealthcare is using Artificial Intelligence (AI) and it’s been established that there is potentialfor a more efficient use of the technology. But despite the potential and benefits that AI couldentail, the Healthcare industry faces setbacks and challenges with implementing thetechnology. This paper presents some of the challenges that may arise in the process ofintroducing AI technology to healthcare and also why the expected effects are not achieved.The study is based on a qualitative research approach, with the aim of conducting empiricaldata collection through semi-structured interviews. The collected material was then processedbased on a thematic analysis. The results are then presented and linked to previous researchand literature, in order to finally present the underlying reasons for challenges withimplementing AI in healthcare.

Situation of families in which a child with spinal muscular atrophy was born, is the topic of this thesis. This rare genetic disease affects neuromuscular system of children and shortens their lives. In most severe cases the failure of respiratory functions comes in the first year of child's life. This thesis is focused on support that Czech system of social and medical services provides to families with this disease. Next, it looks into needs of these families and examine the extent to which the system is able to saturate them. Very important point in this research is also families' perception of quality of care. The research was implemented with use of qualitative methods, mostly by semi-structured interviews which followed families' journey through the system of social and medical services. Then there is a comparison of experience of families with theories, policy and other normative framework and suggestion of steps that should be taken to improve families' satisfaction with services they receive concerning the child's disease. Key words: spinal muscular atrophy, rare diseases, patient's autonomy, patient- centered care, patient journey, quality of care.

No description available.

This study explored the needs and challenges faced by diabetics and healthcare personnel in the context of diabetes consultations in Sweden, with the aim of identifying improvements for Clinical Decision Support Systems (CDSS). Given the global prevalence of diabetes, understanding the use and implications of CDSS in patient consultations is crucial. This research aimed to fill that knowledge gap by exploring ways to improve CDSS, considering the needs of both diabetics and healthcare workers. A qualitative approach was used, including 12 interviews, 1 observation, and 6 document reviews. A thematic analysis revealed four key themes which highlighted various challenges and needs, experienced from both diabetics and healthcare personnel. The underlying causes of these challenges were linked to recent technological advancements and the increase in available data points. This results infrustration, suboptimal care outcomes, and an increased reliance on alternative solutions by both parties. The DeLone and McLean IS Success Model was used to identify potential technological solutions and provides a clear recommendation on what needs to be improved for future solutions. The findings contribute significantly to understanding the utilization of CDSS in diabetes care and associated challenges. The study is particularly relevant for healthcare personnel, diabetics, policymakers, entrepreneurs, and scholars interested in healthcare information systems. Future studies should focus on generalizing these findings by exploring other healthcare systems and to what extent this findings are applicable for type 2 diabetics, as well as practically exploring how new systems can address the identified needs in this study. Ultimately, this study contributes to the potential for improved care and quality of life for diabetics. / Denna studie utforskade behov och utmaningar som diabetiker och sjukvårdspersonal står inför i samband med diabeteskonsultationer i Sverige, med målet att identifiera förbättringar för kliniska beslutsstödssystem (CDSS). Med tanke på diabetes globala prevalens, är det avgörande att förstå användningen och implikationerna av CDSS i patientkonsultationer. Denna forskning syftade till att fylla detta kunskapsgap genom att utforska möjligheter att förbättra CDSS, med hänsyn till både diabetikers och vårdgivares behov. Kvalitativa metoder användes, inklusive intervjuer, observationer och dokumentgranskningar. En tematisk analys identifierade fyra nyckelteman som belyste flera utmaningar och behov från både diabetiker och sjukvårdspersonal. De underliggande orsakerna till dessa utmaningar var kopplade till tekniska utveckling och ökningen av tillgängliga datapunkter. Detta resulterade i frustration, suboptimala vårdresultat och en ökad användning av alternativa lösningar från båda parter. DeLone och McLean IS Success Model användes för att översätta behoven till tekniska krav för potentiella framtida lösningar. Studiens resultat bidrar till förståelsen av användningen av CDSS inom diabetesvård och relaterade utmaningar. Studien är särskilt relevant för sjukvårdspersonal, diabetiker, politiker, entreprenörer och forskare som är intresserade av hälso- och sjukvårdsinformationssystem. Framtida studier bör fokusera på att generalisera dessa resultat genom att undersöka andra sjukvårdssystem och i samband med typ 2 diabetes, samt utforska hur mer praktiskt utveckling av nya system kan gå till för möta de identifierade behoven i denna studie. Slutligen bidrar denna studie till potentialen för förbättrad vård och livskvalitet för diabetiker.

Bakgrund   Allmänsjuksköterskor kommer ofta i kontakt med personer med venösa bensår. Behandling och vård av dessa personer sker ofta inom primärvård, öppenvård eller hemsjukvård, men även på vårdavdelningar och andra sjukvårdsinstanser. Venösa bensår är en följd av underliggande kronisk venös insufficiens. Det är därför stor risk att såren återkommer efter läkning och behandlingen måste därför i många fall bli livslång. Trots detta finns få studier som fokuserar på personers upplevelser av behandling och vård vid venösa bensår.   Syfte  Syftet är att beskriva personers upplevelser av behandling och vård vid venösa bensår. Metod  För att sammanfatta den forskning som i dagsläget finns kring ämnet har en litteraturöversikt gjorts. Sökningar har utförts i de vetenskapliga databaserna Pub Med och CINAHL och 16 artiklar identifierades. Dessa har kvalitetsgranskats genom Sophiahemmet Högskolas bedömningsinstrument. Resultat Litteraturöversiktens tre huvudkategorier, förhoppning och uppgivenhet, att leva ett begränsat liv och att inte bli sedd som person berättar om upplevelser som många personer med venösa bensår har av behandling och vård. Personer upplever att behandling och vård på något sätt begränsar eller påverkar dem. Vårdens kontinuitet, god kommunikation, och relationen till sjuksköterskan är av betydelse för upplevelsen av behandling och vård. Det finns brister i individanpassningen av behandling och vård som påverkar personer med venösa bensårs förtroende för vården. Många personer uppger en ovisshet som gör det svårt att hantera behandlingen psykologiskt. En stark önskan om läkning av de venösa bensåren är gemensamt för många studiedeltagare. Slutsats Det fattas specifik forskning om personers upplevelser. Sjuksköterskor som behandlar personer med venösa bensår saknar kunskaper om deras tillstånd och rekommenderad behandling. I denna litteraturöversikt framkommer ett behov av att skifta fokus från läkning av det venösa bensåret till personens livskvalitet. Sjuksköterskor behöver mer kunskaper om venösa bensår och en större förståelse för den livssituation som många personer med venösa bensår befinner sig i. Ökad nivå av personcentrering i behandling och vård av personer med venösa bensår bör därför eftersträvas, och förutsättningar måste skapas för sjuksköterskor att kunna erbjuda den specialiserade och kvalitativa vård som krävs. / Background Registered nurses frequently come into contact with persons living with venous leg ulcers, as these wounds are primarily treated and cared for by nurses. Persons with venous leg ulcers often experience underlying chronic venous insufficiency, which is the main cause of venous leg ulcers. This means that even once healed venous leg ulcers are likely to reoccur, and treatment is often life-long. In spite of this, very few studies and research projects focus on the person’s experiences of their ailment in relation to the treatment they receive. Aim To highlight persons’ experiences related to the treatment and care of venous ulcers.  Method To summarize the research knowledge of this subject, a review of current literature was undertaken. Searches have been conducted in several online-based databases. Through the databases PubMed and CINAHL 16 articles were identified and then analyzed. Results Many persons with venous leg ulcers feel that treatment and care affects or impedes them in some way. Three core categories were identified as signifying for the result: hopefulness and uncertainty, an impaired life, and not being viewed as a person. Continuity of care, quality of communication, and the nurse-patient relationship are all key contributors to the experiences of treatment and care that persons with venous leg ulcers describe. The result implies that treatment and care of persons with venous leg ulcers is not satisfyingly individualized, which reduces the level of confidence that these persons feel for their healthcare providers. Persons with venous leg ulcers report that experiences of uncertainty make the treatment hard to handle psychologically. A strong desire for permanent healing is shared by persons with venous leg ulcers.  Conclusions There is a shortage of specific research aimed at the experiences of persons with venous leg ulcers of aspects relating to their treatment and care. Many nurses lack vital knowledge regarding the treatment and care of these individuals. In this review a need for a shift of focus is perceived, from simply the healing of the venous leg ulcer, into also considering the quality of life of persons with venous leg ulcers. Nurses are in need of more knowledge of the condition, and more insight into the lives of persons with venous leg ulcers. A person-centred approach should therefore be sought, and conditions must be provided for nurses to expand their knowledge and be able to offer a more specialized and qualitative level of treatment and care.

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No description available.

BACKGROUND: Despite large investments in maternity care services, perinatal health outcomes in the U.S. are among the worst compared to other industrialized countries, with documented perinatal health disparities disproportionately impacting racial and ethnic minorities. Midwifery-led freestanding birth centers (FSBC) have emerged as an underutilized model for the safe and cost-effective care of women with low-risk pregnancies. Despite approximately 85% of all US pregnancies being considered low-risk, only 0.5% of all US births occurred in a FSBC in 2016. The goal of the study is to elucidate strategies used to develop and sustain freestanding birth centers (FSBCs) that are seeking to serve high proportions of publicly-insured women and women of color. METHODS: I conducted an embedded unit case study, including semi-structured in-depth interviews and focus groups with 49 stakeholders from three exemplary FSBCs. Supplemental interviews were led with five key informants from three additional FSBCs and a relevant national membership organization. Additional data sources used to complete this case study include, where relevant and permitted, observations of maternity care settings, patient-provider encounters, management meetings, community events, and review of pertinent documents. Qualitative analysis methods were used to identify common themes and variations. FINDINGS: Midwifery-led birth center care can improve the experience and outcomes of maternity care among publicly insured women of color. The study revealed persistent multi-level challenges, as well as the use of common approaches to overcome these organizational, financial, and cultural barriers, resulting in greater, yet still fragile, access to family-centered intrapartum care within the communities in which these FSBCs operate. CONCLUSIONS: The careful integration of FSBCs into health systems such as a Federally Qualified Health Center (FQHC) may contribute to the broad scale-up of this underutilized model of care. While integrating FSBCs into FQHCs may be helpful in expanding equitable access to birth center care, it is not necessary, and also not sufficient. Expansion efforts should include additional deliberate processes and strategies to ensure equitable uptake and sustainability of birth center care. / 2020-10-23T00:00:00Z