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Bakgrund: Det finns brister i sjukvårdsystemet inom palliativ vård. En anledning är att vårdpersonalen saknar tillräcklig utbildning. Den palliativa vården kan ses som ett lotteri – där nitlotten är att få vårdas i slutet av sitt liv av någon som endast har några timmars utbildning. Familjer kan uppleva livets slut som den mest smärtsamma fasen. Det är av betydelse att vårdpersonalen identifierar när patienten går in i fasen, vård i livets slut. Familjerna är i en utsatt situation, är sårbara och upplever brist på stöd och förståelse från vårdpersonalen. Syfte: Syftet var att beskriva hur familjer i vård i livets slutskede vill bli bemötta av vårdpersonal. Metod: Studien är en litteraturstudie baserad på aktuell kvalitativ forskning inom ämnet. Resultat: Data genomsyrades av att vårdpersonalen skulle bry sig om familjerna. Familjer ville att vårdpersonalen skulle se dem som unika individer och inte bli lämnade utanför. Det var viktigt att de blev tagna på allvar och blev förberedda på slutet. Familjer ville att vårdpersonalen skulle kunna visa känslor och skapa en personlig relation med dem. Slutsats: Trots att familjer i vård i livets slut inte förväntar sig mycket av vårdpersonalen så är det betydelsefullt för dem om vårdpersonalen bryr sig om dem. / Background: There are deficiencies in the healthcare system regarding palliative care. A reason is that healthcarers lack of education. The palliative care can be seen as a lottery - the blank is to be treated by someone with only a few hours education. Families can experience end of life as the most distressing stage. It is therefore important that healthcarers identify when the patient enter the end of life stage. These families are exposed, vulnerable and other experience lack of support and understanding from the healthcarers. Aim: The aim was to describe how the families would like to be treated by the healthcarers. Methods: The study is a literature review based on qualitative articles from current research. Results: The major finding was that healthcarers should care for the families. The families needed to be seen as unique individuals and not to be left behind. It was important to be taken seriously and to be prepared for the end of life. The families wanted that the healthcarers were able to show emotions and create a personal relation to them. Conclusion: Despite that the families in the end of life stage does not expect much from the heatlhcarers it is significant for the families if the healthcarers care about them.

Abstract Facing the advent of the knowledge-based economy, enterprises realization that the continuous competitive advantages are no longer land, labor and capital, but have been replaced by knowledge capital such as intellectual and innovation. Knowledge has become the critical core capital in the age of a knowledge economy flowing from information technology. The sole source of competitive advantage today is an organization¡¦s capability to learn through value cognition to create innovation value. Knowledge management has become the primary focus for enterprises in the 21st century. Enterprises shall review the informative degrees of production and working process for the implementation of knowledge management. China Steel already has all production and working process data digitalized and acts as an e-business pioneer among domestic peers in the implementation of knowledge management. This study establishes knowledge management documentation as the basis for questionnaire design. The relationships among knowledge management, engineering professionals¡¦ core competence and job performance for engineers at China Steel were studied through quantitative analysis and case study with moderating variables such as personal initiative and contextual factor. After analyzing the data, the results of the study indicate that: 1.Variations from different educational levels: For the task performance, personal performance is higher when the educational level of the engineering professionals¡¦ is lower. For the operation consciousness, although all are willing to take action for the benefit of the organization, the engineering professionals¡¦ with a lower educational level is the more enthusiastic. 2.Variations from different seniority: For the control cognition, people of higher seniority are more capable of forecasting the relationship between effort and performance, are more confident in judging an event, and are under less stress to carry out a task. While people of lower seniority are the opposite. 3.Variations from different age: In the task performance, the personal performance of older staff is superior. In control cognition, older staff is more capable of forecasting the relationship between effort and performance, are more confident in judging an event, and are under less stress to carry out a task. 4.Variations from different positions: Staff holding managerial positions above superintendent typically shows the leadership ability to influence job performance and motivate the changing. 5.A significant positive correlation was identified among knowledge management, engineering professionals¡¦core competence and job performance. 6.Knowledge management and engineering professionals¡¦core competence was positively significant to job performance. 7.Engineering professionals¡¦core competence was found to have a significant mediating effect between knowledge transfer and job performance. 8.Personal initiative and contextual factor were found to have a significant moderating effect among relationships of knowledge management, engineering professionals¡¦core competence and job performance.

SAMMANFATTNING För att möjliggöra öppen hjärtkirurgi används hjärt-lungmaskin som leder blodet i en bana utanför kroppen sammankopplat med kroppscirkulationen. Möjliga komplikationer efter kirurgi med stöd av hjärt-lungmaskin kommer från det centrala nervsystemet och kan ge upphov till kognitiva symtom, dessa komplikationer har ökat sedan 70-talet. Kognitiva nedsättningar kan påverka både patientens livskvalitet och sjukvårdens ekonomi. Risker med att opereras med stöd av hjärt-lungmaskin är embolier, hypoperfusion, anestesi och inflammation. Detaljerad information till patienter som ska genomgå hjärtkirurgi gör dem mer förberedda på eventuella komplikationer. För att som vårdpersonal kunna bemöta och informera dessa patienter krävs kunskap om kognitiva nedsättningar postoperativt. Syftet var att belysa kognitiva förändringar hos patienter som opererats med stöd av hjärt-lungmaskin. Litteraturöversikt genomfördes där alla typer av hjärtkirurgi som utförts med stöd av hjärt-lungmaskin valdes att inkluderas. Originalartiklar på svenska och engelska eftersöktes med åtkomst via "full text", ingen begränsning på publikationsår gjordes. Både kvalitativa och kvantitativa artiklar eftersöktes. Sökord som användes var "cardiopulmonary bypass", "heart-lung machine", "cognition disorders", "neurobehavioral manifestations", "patients", "postoperative" och "experience". Databaser som användes var Cinahl, PsycINFO och PubMed. Slutresultatet blev 15 kvantitativa artiklar som granskades enligt mallar från Sophiahemmets högskola. Ingen artikel exkluderades pga. låg kvalitet, sju stycken bedömdes ha medelkvalitet och åtta bedömdes ha hög kvalitet. Artiklarnas resultat analyserades med studiens syfte som utgångspunkt för att sedan sammanfattas och sammanställas till rubriker. Bedömning gällande artiklarnas etiska ställningstagande har gjorts i samtliga inkluderade artiklar. Resultatet visade att kognitiva nedsättningar var vanligt förekommande. Typer som beskrevs var påverkan på minne, koncentration och visuomotorisk konstruktionsförmåga. Depressiva tillstånd beskrevs och även en koppling till nedsatt minne beskrevs. Det var vanligare att utveckla kognitiva nedsättningar med att opereras med stöd av hjärt-lungmaskin än att opereras utan dess stöd. Kognitiva nedsättningar beskrevs upp till fem år efter operation. Det beskrevs också kognitiv försämring som förvärrades efter ett år till tre år efter operation. Hjärt-lungmaskinen visade sig bidra till utveckling av kognitiva nedsättningar där det också framkom att aortatångtid var associerat med kognitiv nedsättning. Risker för att utveckla kognitiva nedsättningar var hög ålder. Kognitiva nedsättningar utgjorde inte ett hinder för arbete eller vardagliga aktiviteter. Kognitiva nedsättningar är förekommande både på kort och på lång sikt efter att ha genomgått hjärtkirurgi med stöd av hjärt-lungmaskin. Att symtom inte alltid är uppenbara, förutom vid tester ställer krav på att vårdpersonal erbjuder den information som krävs inför operation för att förbereda patienten. Då kognitiva symtom kan debutera senare kan detta tolkas som åldringsprocess och etiologin är inte säkerställd. För att kvalitetssäkra vården kring dessa patienter bör vårdpersonal vara uppmärksamma på kognitiva symtom postoperativt. / ABSTRACT To enable open heart surgery, a heart-lung machine is used which carry blood in a path outside the body coupled to the body circulation. Complications after surgery with support of the heart-lung machine may be derived from the central nervous system and can cause cognitive symptoms, these complications have increased since the 70's. Cognitive impairments can affect both patient quality of life and healthcare economics. Risks of surgery with the support of the heart-lung machine are emboli, hypoperfusion, anesthesia and inflammation. Detailed information for patients about to undergo cardiac surgery makes them more prepared for possible complications. For the nursing staff to respond and inform these patients requires knowledge of cognitive impairment postoperatively. The aim was to illuminate the cognitive changes in patients after undergoing cardiac surgery with the support of the heart-lung machine. Literature review was conducted where all types of heart surgery performed with the support of the heart-lung machine was chosen to be included. Original articles in Swedish and English whereabouts with access via the "full text", no restriction in years of publication was made. Keywords used was "Cardiopulmonary Bypass", "heart-lung machine", "cognition disorders", "neurobehavioral manifestations," "patient," "post-operative" and "experience". Databases used were Cinahl, PsycINFO and PubMed. The end result was 15 quantitative articles which underwent examination according to templates from Sophiahemmet University. No article was excluded due to low quality, seven were considered to have medium quality and eight were judged to be of high quality. Articles results were analyzed by the study's aim as a starting point and then summarized and compiled into headlines. Ethical consideration has been made in all included articles. The results showed that cognitive impairments were common. Cognitive impairments described were the impact on memory, concentration and visuoconstruction. Depressive condition was described and even a link to impaired memory was described. It was more common to develop cognitive impairments after undergoing cardiac surgery with the support of the heart-lung machine than to undergo surgery without its support. Cognitive impairment was described up to five years after surgery. It was also described cognitive decline that worsened after one year to three years after surgery. Heart-lung machine was found to contribute to the development of cognitive impairments, which also revealed that aortic cross-clamp duration was associated with cognitive impairment. Risks of developing cognitive impairment were advanced age. Cognitive impairments did not constitute an obstacle for work or everyday activities. Cognitive impairments are common in both the short and long term after undergoing cardiac surgery with the support of the heart-lung machine. That the symptoms are not always obvious, except when testing requires that health professionals provides the information required before surgery to prepare the patient. Cognitive impairments may have a later debut which can be interpreted as the aging process, and the etiology is not assured. In order to assure the quality of care of these patients, health professionals should be alert to the cognitive symptoms postoperatively.

Background: Demographic changes increase the financing needs of all social services. This change also generates new and complex demands on the medical staff. Accordingly, medical professionals in middle management positions hold a characteristic sandwich position between top management and the operational core. This sandwich position often constitutes new challenges. In the industrial field, the growing importance of the middle management for the company’s success has already been recognized. Accordingly, the growing demand on economy urges an analysis for the medical field. Discussion: While there are nearly no differences in the nature of the tasks of medical middle manager in the areas of strategy, role function, performance pressure and qualifications compared to those tasks of the industrial sector, there are basic differences as well. Especially the character of “independence” of the medical profession and its ethical values justifies these differences. Consequently, qualification of medical professionals may not be solely based on medical academic career. It is also based on the personal ability or potential to lead and to manage. Summary: Above all, the character of “independence” of the medical profession and its ethical values justifies medical action that is based on the patient’s well-being and not exclusively on economic outcomes. In the future, medical middle managers are supposed to achieve an optimized balance between a patient-centered medicine and economic measures. It will be a basic requirement that middle managers accept their position and the resultant tasks putting themselves in a more active position. Because of that, middle managers can become “value-added bridge-builders”.

Literature suggests that there are a growing number of ‘mental health professionals’ speaking out about their own experiences of using mental health services. Research suggests that these professionals face dilemmas when constructing their identity because they are drawing on two identities that are viewed as fundamentally different, i.e. ‘mental health professionals’ as powerful and ‘mental health service users’ as powerless. This study aimed to explore how ‘mental health professionals’ who are/have been ‘mental health service users’ construct their identity using a social constructionist epistemology, which views identity as fluid and continuously renegotiated in social contexts (Davies & Harré, 1990; Potter & Wetherell, 1987). Ten participants who self-identified as ‘mental health professionals’ who are/have been ‘mental health service users’ volunteered to take part. Interviews were transcribed and analysed using discourse analysis. Participants constructed their identity in a variety of ways, including as separate identities, i.e. a ‘professional identity’ and a ‘patient/mental health service user identity’ constructions, switching between the two in different contexts, therefore developing an ‘un-integrated identity’. Participants also developed an ‘integrated identity’ construction in some professional contexts. These results are discussed and implications for clinical practice and future research are explored.

In British Columbia (BC) foresters registered with the Association of BC Forest Professionals (ABCFP) have been given the exclusive right to practise professional forestry. As with all professions there is an expectation that Registered Professional Foresters (RPFs) conduct their activities in an ethical manner and are therefore obligated to act as an ethical agent on behalf of society regarding forest resources. If a certain level of ethical agency is desired of professionals we need to understand whether or not an RPF possesses the ability (defined as their discretion) to sufficiently fulfil this responsibility. Rule-based and principle-based standards of forest management, an RPF’s scope of practice, and the socio-political framework of public forest management in BC all come together to define an RPF’s discretionary context, which sets the limits to an RPF’s discretion. This context is highly idiosyncratic to a specific situation or decision and this makes the RPF’s discretion similarly idiosyncratic. This suggests that an RPF should not be accountable for a standard of ethical agency that does not reflect the context-dependent level of discretion they possess. Fifteen interviews of RPFs were conducted for this study to discuss their approach to ethical decision making. The analysis of the interviews revealed 12 major themes, several of which appear to be highly idiosyncratic to the situations described by the participants. The way these themes were perceived by the participants revealed the differences in the discretionary context of their situations. Several aspects of ethical deliberation emerged from the data that appear to be particular to broad employer categories, including delegated decision-making (government), economic and forest health considerations (industry), and the tension between personal and professional values (consultants).

This Master thesis analyzes how often the specialists of health care, education and law enforcement are facing suicidal behavior, what is their knowledge and attitude toward suicide and its prevention and possibilities to participate at suicide prevention. Aim: to analyze the attitudes, possibilities and readiness of different specialists towards suicide prevention. Objectives: 1. to assess how often the specialists of health care, education and law enforcement are facing suicidal behavior; 2. to evaluate knowledge and attitudes of specialists of health care, education and law enforcement toward suicide and its prevention; 3. to analyze to possibilities of different specialists to participate in suicide prevention; 4. to submit recommendations to regional community authority for community empowerment in suicide prevention. Methodology: Cross-sectional anonymous questionnaires were used for the survey. The questionnaire consists of 27 questions, including the open and closed type questions. The questionnaires were distributed in the institutions and were collected next day. The data was proceeded and analyzed using statistical data analysis batch SPSS 12,0 The research was made in the randomly chosen institutions; medical institutions of all types and police commissariats of the region. Results: the majority of specialists of health care, education and law enforcement of Rokishkis are facing the suicidal behavior of clients and patients at their work. All specialists admit... [to full text]

Management of Public Health Estimation of health care services quality in department of Cardiology Intensive Therapy of Kaunas University Hospital Vaida Rupšytė-Jucienė Supervisor J. Braždžionytė, Prof., Dr. Faculty of Public Health, Kaunas University of Medicine, Department of Social medicine, Kaunas 2005. P67. Key words: quality of health care services, patients, medical professionals, satisfaction. Object of work: to estimate the health care services quality in department of Cardiology Intensive Therapy of Kaunas University Hospital. Task: to examine the opinion of patients about health care services quality in department of Cardiology Intensive Therapy of Kaunas University Hospital; to examine the opinion of staff (doctors and nurses) about the health care services quality; to compare the opinions of patients and staff:; to establish the problems of the health care services; to prepare the offer how to solve these problems and improve the quality of health care services in department of Cardiology Intensive Therapy. Methods: The comparable analysis of health care services was made among patients and staff in department of Cardiology Intensive Therapy. All doctors and nurses, working in March of 2005, and patients, treated in the hospital within December of 2004 – January of 2005, were invited to participate in survey. In anonymous questionnaire participated 358 patients (the response rate 89 %), 10 doctors (response rate -77%) and nurses (response rate – 89%)... [to full text]

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