Australia�s policy on Quality Use of Medicines (QUM) aims to achieve appropriate use of medicines and improved health outcomes. Drug and Therapeutics Committees (DTCs) are educators, policy makers as well as financial gatekeepers in matters relating to medicine use. Increasingly, DTCs are also involved in risk management and clinical governance. As such, DTCs could be considered to be QUM advocates in the institutions in which they function. In a health care arena where there are escalating demands on high standards of clinical practice, quality assessment and improvement is essential in ensuring safe and effective patient care. Given the role DTCs play in safeguarding the interests of the stakeholders of the health care system, research into ways in which DTC performance could be enhanced is required. Although indicators specific to DTCs exist, the literature does not seem to provide straightforward answers to the question of what is currently being done in terms of quality assessment and quality improvement of DTCs. In the absence of such data, an opportunity for research is clearly identified. The first aim of this research project was to gain insight into the current activities undertaken by, and challenges facing Australian DTCs. Following this, the second aim was to explore ways in which DTC performance could be augmented. In addressing the first aim of this project, a national survey of Australian DTCs was conducted. These findings reinforce the evidence in the literature about the roles, structure and stakeholder expectations of DTCs. Our research also documents DTCs� quality improvement initiatives and barriers to DTC activities. It appears that there is little support available to Australian DTCs. Further, a case study was undertaken in order to gain an understanding of the depth and detail of DTC operations. An audit of a DTC in an Australian hospital was conducted. This study revealed that DTC decisions are being implemented in an ad hoc manner. In fact, there were no strategies (or action) planned to implement the majority of their decisions. This could have an impact on DTC performance. In view of this finding, qualitative methods were used to explore stakeholder opinions regarding the implementation of DTC decisions and policies. Stakeholders believed that strategies used to implement DTC policies should be targeted (to the audience as well as the type of decision/policy being implemented), timely, and delivered at the point of care. Face-to-face strategies were perceived to be more effective than printed materials, particularly when an influence on clinical practice was desired. Stakeholders also felt that the lack of resources was a significant barrier to DTC performance augmentation. This probably contributed to a lack of follow-up (or review) of implemented policies. According to stakeholders, other barriers to policy implementation include a lack of ownership of policies, low DTC profile, and an over-reliance on pharmacy to implement DTC decisions. Stakeholders felt one of the ways in which DTC performance could be improved was to prioritise DTC decisions for implementation. In pursuit of a method to prioritise DTC decisions, a survey was conducted. Stakeholders identified patient safety, cost, and the practice of evidence-based medicine as domains of important DTC decisions. The results also suggest that stakeholders recognise the need for the prioritisation of DTC decisions for implementation. Stakeholders implied that higher priority would be assigned to DTC decisions considered to be important. In a follow-up survey, stakeholders (including doctors, nurses, pharmacists, and DTC members) seemed to have agreement of the primary domains of DTC decisions. Higher levels of importance and higher priority were assigned to decisions involving the primary domains of patient safety and cost. However, level of importance and priority assignment were not consistently correlated. The work presented in this thesis suggests that there are ways to improve DTC performance. Although conducted primarily on hospital-based DTCs, it is anticipated that the lessons learnt could be applied to state-based, or even, Area Health-based DTCs. In conclusion, this research found that there was a range of views regarding �importance� and prioritisation for implementation. Social, organisational, as well as environmental factors may contribute to this. Future research should examine other possible factors contributing to the importance and priority of DTC decisions, so that DTC policy could be appropriately implemented into practice.

<p>The welfare of the elderly population is one of the most important goals of the public health services. At macro level the Swedish National Board of Health and Welfare state that the premier goal is for elderly people to have dignified and comfortable lives. They should have a life with a sense of value and feel confident. These ethical values which are expressed on macro level or as normative ethics are expected to prevail at micro level. In our study the micro level is the caring encounter between the elderly patient, next of kin and nurses. Ethical values and morals are important aspects that influence the quality of care, videlicet in empiric ethics.</p><p>The aim of study (I) was to identify and describe the ethical values experienced by the older person in the daily interaction with nurses in a ward for older people during caring encounters. In study (II) the aim was to identify and describe the governing ethical values that next of kin experience in interaction with nurses who care for elderly patients at a geriatric clinic. Study (I) which was an empirical observational study included follow-up interviews. Twenty-two older people participated voluntarily. In study (II) interviews with fourteen next of kin were conducted. In both studies Constant comparative analysis, the core foundation of grounded theory was used.</p><p>Five categories; Being addressed, receiving respect, desiring to participate, increasing self-determination and gaining self-confidence formed the basis for the core category in study (I): Approaching. Approaching concerns the way people become closer to each other in a physical space .It also includes how people become closer to each other in a dialogue, which involves verbal or bodily communication. Approaching indicates the ethical values that guide nurses in their caring encounters with older people. This ethical value is noted by the older person and has an individual value, as well as leading to improved quality of their care. The older person will be confident and satisfied with the caring encounter if the desired components in the nurse’s approaching are exhibited.</p><p>Four categories were identified in study (II): Receiving, showing respect, facilitating participation and showing professionalism. These categories formed the basis of the core category: “Being amenable”, a concept identified in the next of kin’s description of the ethical values that they and the elderly patients perceive in the caring encounter. Being amenable means that the nurses are guided by ethical values; taking into account the elderly patient and next of kin. Nurses who focus on elderly patients’ well-being as a final principle will affect next of kin and their experience of this fundamental situation.</p>

This dissertation explores how children communicate their experiences of place. It focuses on the qualitative methods of group interviews, walks, drawings and photographs, and asks how children communicate different aspects of place. Drawing on feminist theory and qualitative methodology, the importance of situated knowledge for understanding children’s narratives is argued. Through studies in Sweden and England, it is shown how children’s place experiences are multi-dimensional, consisting of both concrete and abstract processes, places and objects. The different methods reveal different aspects of these dimensions and the children provided rich evidence of their experience of place in regard to physical, social and cultural aspects. It is found that children’s individuality affects the success of the methods, rather than factors such as gender, age or nationality. The methods’ different characteristics, such as creative and interactive aspects, and how power relations are reflected through them are determining factors as to how and what children communicate. Place-interactive methods allow children to communicate the direct experience of place and include subconscious actions as communication occurs through movement and play. The creative aspects of the methods allow children to focus more on their abstract experiences and to include experiences based on a wider time perspective than the present. Walking is discussed as a critical method for the researcher to include place as an active and multi-sensuous phenomenon. As it is shown that the methods reveal different aspects of the children’s place experiences, it is also discussed how this can be used from an adult perspective.

According to the Canadian Study of Health and Aging most of the 12,630 Canadians living with advanced dementia reside in long-term care facilities. This number is rising due to an aging population. The purpose of this study is to address an identified gap in our knowledge about what creates pleasure in people with advanced dementia, through first understanding family caregivers’ ways of eliciting and interpreting positive emotions in their relatives and then having the personal support worker (PSW) try these same approaches to see if similar responses are achieved. This study used a qualitative multiple case study design. Data collection methods included digitally recorded interviews and video-recorded observations of interactions between residents and caregivers. A case is defined as a resident with moderately to severely advanced dementia. Each case had two informants: a family member and a PSW meeting inclusion criterion. There were seven cases. The resident participants spanned a range from moderately advanced to severely advanced dementia. Data analysis used both inductive and deductive coding with sensitizing concepts of selfhood, personhood, continuity of personality and well-being. The results of this study centred on four main themes related to the research questions about the sources and indicators of pleasure and the potential for PSWs to replicate what family members did with residents. Some sources of pleasure were lost, some were maintained and new ones developed post-illness in all of the residents. Both family members and PSWs were knowledgeable about sources and indicators of pleasure for the people with dementia they were involved with. The analysis demonstrated that for individuals with very advanced dementia, the concept of pleasure or enjoyment is not applicable. The family members of the two residents with very advanced dementia used music, touch and sweets to elicit a pleasurable response but the resident did not display indicators of pleasure in response; instead, the residents responded with grasping or other responses which require further research to understand fully. Future research should build upon these findings in order to further understand the concept of positive affect: pleasure, interest and enjoyment in people with advanced dementia of the Alzheimer type.

According to the Canadian Study of Health and Aging most of the 12,630 Canadians living with advanced dementia reside in long-term care facilities. This number is rising due to an aging population. The purpose of this study is to address an identified gap in our knowledge about what creates pleasure in people with advanced dementia, through first understanding family caregivers’ ways of eliciting and interpreting positive emotions in their relatives and then having the personal support worker (PSW) try these same approaches to see if similar responses are achieved. This study used a qualitative multiple case study design. Data collection methods included digitally recorded interviews and video-recorded observations of interactions between residents and caregivers. A case is defined as a resident with moderately to severely advanced dementia. Each case had two informants: a family member and a PSW meeting inclusion criterion. There were seven cases. The resident participants spanned a range from moderately advanced to severely advanced dementia. Data analysis used both inductive and deductive coding with sensitizing concepts of selfhood, personhood, continuity of personality and well-being. The results of this study centred on four main themes related to the research questions about the sources and indicators of pleasure and the potential for PSWs to replicate what family members did with residents. Some sources of pleasure were lost, some were maintained and new ones developed post-illness in all of the residents. Both family members and PSWs were knowledgeable about sources and indicators of pleasure for the people with dementia they were involved with. The analysis demonstrated that for individuals with very advanced dementia, the concept of pleasure or enjoyment is not applicable. The family members of the two residents with very advanced dementia used music, touch and sweets to elicit a pleasurable response but the resident did not display indicators of pleasure in response; instead, the residents responded with grasping or other responses which require further research to understand fully. Future research should build upon these findings in order to further understand the concept of positive affect: pleasure, interest and enjoyment in people with advanced dementia of the Alzheimer type.

Background: Food nourishes us, sustains us, and has the potential to both heal us and make us sick. Among many Indigenous cultures, traditional activities, ceremonies, events and practices often involve or use food, grounding Indigenous peoples within the context of their local, natural surroundings. This suggests that food is important not only for physical health, but also emotional, mental and spiritual health. The relationships that Indigenous peoples have with food can help us to understand the health of individuals, and the communities in which they live. Purpose: The following qualitative study explores how three generations of adults who live in one Labrador Inuit-Metis community experience and understand their relationships to food in a context of global change. Theoretical Orientation: The research is guided by Two-Eyed Seeing. Two-Eyed Seeing acknowledges that there are many different ways of seeing and understanding the world, some of which can be encompassed through a Western eye and some through an Indigenous eye. If we learn to see through both eyes, we can gain a perspective that looks very different than if we only view the world through a single lens. Methods: For the study, twenty-four people from the south-eastern Labrador community of St. Lewis participated in individual and joint story-telling sessions. A group story-telling session also took place where community members could share their stories with one another. During many of the story-telling sessions, participants shared photographs, which helped to illustrate their relationships to food. Findings/Discussion: Historically, the people of St. Lewis relied almost entirely upon their own wherewithal for food, with few, if any, government services available and very little assistance from the market economy. This fostered and upheld an Inuit-Metis culture that promoted sharing, reciprocity and respect for the natural world. Currently, greater access to government services and the market economy has led to the creation of certain policies and programs that undermine or ignore established social and cultural norms in the community. Conclusions: Existing Inuit-Metis knowledge should work alongside non-Indigenous approaches to policy and program development. This would serve to protect and promote the health of both individuals and communities.

Older people should have a life with a sense of value and should feel confident. These ethical values, which are expressed in normative ethics, are expected to prevail in empirical ethics. Central components of nursing are the ethical issues of autonomy, beneficence, non-maleficence and the principles of justice. The general aim of this thesis is to identify and describe the ethical values that are apparent in the caring encounter and their influence on the people involved. This is done from the perspective of the older person in study (I), next of kin in study (II) and nurses in study (III). In study (IV) the aim was to synthesize the concepts from empirical studies (I- III) and analyze, compare and interrelate them with normative ethics. Studies (I, III) were empirical observational studies including follow-up interviews. Twenty-two older people participated voluntarily in study (I), and in study (III) 20 nurses participated voluntarily. In study (II) fourteen next of kin were interviewed. In studies (I- III) constant comparative analysis, the core foundation of grounded theory, was used. Five concepts were used in the analysis in study (IV); three from the grounded theory studies (I- III) and two from the theoretical framework on normative ethics i.e. the ICN code and SFS law. Five categories; being addressed, receiving respect, desiring to participate, increasing self-determination and gaining self-confidence formed the basis for the core category ‚Approaching‛ in study (I). ‘Approaching’ indicates the ethical values that guide nurses in their caring encounters with older people. These ethical values are noted by the older people and are greatly appreciated by them, and also lead to improved quality of care. Four categories were identified in study (II): Receiving, showing respect, facilitating participation and showing professionalism. These categories formed the basis of the core category ‚Being amenable‛, a concept identified in the next of kin’s description of the ethical values that they and the older patients perceive in the caring encounter. In study (III), three categories were identified: showing consideration, connecting, and caring for. These categories formed the basis of the core category ‚Corroborating‛. Corroborating deals with support and interaction. Empirical ethics and normative ethics are intertwined, according to the findings of this study (IV). Normative ethics influence the nurse’s practical performance and could have a greater influence in supporting nurses as professionals. Criteria of good ethical care according to this thesis are: showing respect, invitation to participation, allowing self-determination, and providing safe and secure care. These criteria are elements of the concept of being professional. Professionalism of nurses is shown by: the approach nurses adapt to the performance of their duties, and their competence and knowledge, but also how they apply laws and professional codes

The welfare of the elderly population is one of the most important goals of the public health services. At macro level the Swedish National Board of Health and Welfare state that the premier goal is for elderly people to have dignified and comfortable lives. They should have a life with a sense of value and feel confident. These ethical values which are expressed on macro level or as normative ethics are expected to prevail at micro level. In our study the micro level is the caring encounter between the elderly patient, next of kin and nurses. Ethical values and morals are important aspects that influence the quality of care, videlicet in empiric ethics. The aim of study (I) was to identify and describe the ethical values experienced by the older person in the daily interaction with nurses in a ward for older people during caring encounters. In study (II) the aim was to identify and describe the governing ethical values that next of kin experience in interaction with nurses who care for elderly patients at a geriatric clinic. Study (I) which was an empirical observational study included follow-up interviews. Twenty-two older people participated voluntarily. In study (II) interviews with fourteen next of kin were conducted. In both studies Constant comparative analysis, the core foundation of grounded theory was used. Five categories; Being addressed, receiving respect, desiring to participate, increasing self-determination and gaining self-confidence formed the basis for the core category in study (I): Approaching. Approaching concerns the way people become closer to each other in a physical space .It also includes how people become closer to each other in a dialogue, which involves verbal or bodily communication. Approaching indicates the ethical values that guide nurses in their caring encounters with older people. This ethical value is noted by the older person and has an individual value, as well as leading to improved quality of their care. The older person will be confident and satisfied with the caring encounter if the desired components in the nurse’s approaching are exhibited. Four categories were identified in study (II): Receiving, showing respect, facilitating participation and showing professionalism. These categories formed the basis of the core category: “Being amenable”, a concept identified in the next of kin’s description of the ethical values that they and the elderly patients perceive in the caring encounter. Being amenable means that the nurses are guided by ethical values; taking into account the elderly patient and next of kin. Nurses who focus on elderly patients’ well-being as a final principle will affect next of kin and their experience of this fundamental situation.

Enligt läroplanen (Lgr11) och skollagen (SFS 2010:800) är det lärarens uppdrag att individanpassa sin undervisning. Dessa styrdokument är tydligare kring den individanpassade undervisningen än vad tidigare styrdokument har varit. Min erfarenhet var att detta inte gjordes fullt ut som det förväntades. Med detta som bakgrund ville jag undersöka lärares förståelse av individanpassad undervisning. Därmed blev mitt syfte att undersöka och studera lärares skilda uppfattningar av individanpassad undervisning. Detta valde jag att göra genom en kvalitativ metod med intervju som datainsamlingsteknik. Studien har sin utgångspunkt i fenomenografin. I studien har fyra verksamma lärare intervjuats. Resultatet visade två skilda uppfattningar av individanpassad undervisning: Individanpassad undervisning som generell princip för undervisning och Individanpassad undervisning som utopi. Det som blev tydligt i resultatet är att kategorin Individanpassad undervisning som generell princip för undervisning är den kategori som var mest frekvent förekommande i det empiriska materialet, det vill säga lärarna uppehöll sig i intervjuerna kring resonemang som kan hänföras till innehållet i den beskrivningskategorin. Lärarna ger alltså uttryck för att de använder sig mycket av individanpassad undervisning. Innan studien antog jag att lärarna i större utsträckning skulle se den individanpassade undervisningen som något som de ville jobba med, men inte ansåg sig ha tid, resurser eller möjligheter till. Vid en analys av relationen mellan de skilda uppfattningarna kunde det konstateras att kategorin Individanpassad undervisning som generell princip för undervisning kan betraktas i ett elevperspektiv som mer utvecklande än kategorin Individanpassad undervisning som utopi. / According to the curriculum (Lgr11) and Education Act (SFS 2010:800) is the teacher's assignment to individualize their education. These policy documents are clearer about the individualized education than previous policy documents have been. My experience was that this wasn´t done fully as it should. With this as background, I wanted to investigate teachers' understanding of individualized education. This made my purpose to examine and study the teachers' different conceptions of individualized education. This, I chose to do through a qualitative approach to interview data collection techniques. The study was based on phenomenography. The study has four active teachers interviewed. The results showed two different conceptions of individualized education: Individually tailored teaching as a general principles of teaching and individualized education as a utopia. What became clear in the results is that the category Individually tailored teaching as a general principle of teaching is the category most frequently occurring in the empirical material. The teachers expressed that they use a lot of individualized education as a general principle of teaching. Before the study, I assumed that teachers in the greater would see the personalized education as a utopia, as something they wanted to work with, but felt they had time, resources or opportunities. When analyzing the relationship between the different positions, was it clear that the category Individually tailored teaching as a general principle of teaching can be seen in a student perspective as more developed than the category Individually tailored teaching as a utopia.

Background During pregnancy, a healthy diet is beneficial for the expecting mother and her fetus. Midwives in antenatal care have an ideal position for promoting a healthy diet and thereby help women to not only lower the risks of pregnancy complications and adverse birth outcomes, but improve maternal health. The overall aim of this thesis was to describe diet and dietary changes during pregnancy from the women’s and the midwives’ perspectives with a focus on dietary counseling. The thesis comprises four studies. The specific aims in the respective studies were to: I) Describe pregnant women’s attitudes to and experiences of dietary information and advice, as well as dietary management during pregnancy. II) Explore midwives’ strategies in challenging dietary counseling situations. III) Describe how midwives’ perceive their role and their significance in dietary counseling of pregnant women.  IV) Describe women’s food habits during pregnancy and up to six months postpartum. Methods Studies I-III were qualitative. Study I included focus group interviews with 23 pregnant women. Study II included telephone interviews with 17 experienced midwives working in Swedish antenatal health care. Study III included the same 17 interviews from study II and supplemented them with four face-to-face-interviews. Qualitative content analysis was performed in all three studies. Study IV was a longitudinal study including a quantitative analysis of a questionnaire, which was given to women at five occasions during and after pregnancy. It concerned their food habits and it was answered by 163 women. The quantitative data was analyzed using comparative and descriptive statistics. Results The overall findings of the thesis were summarized as the main theme “Pregnant women and midwives are not in tune with each other about dietary counseling”. The main theme included the two themes ‘Pregnant women are concerned about risks for their child but fail to change to healthier dietary habits over time’, and ‘Midwives view themselves as authorities, though questioned ones’. In subthemes it was highlighted that pregnant women are well informed and interested in risk reduction for their child’s best and that they try to do their best to improve their diet during pregnancy. However, their diet did not reach levels of healthy eating recommendations and became even unhealthier after pregnancy. It was also highlighted that midwives experienced insufficient knowledge in dietary issues and related risks and that they had difficulties to give dietary support to pregnant women. Midwives were found to mainly focus on giving information and they lacked sufficient competence for challenging counseling. Conclusion Pregnant women, on the one hand, experience a lack of support from the midwives when dealing with dietary changes. The midwives, on the other hand, feel exposed and express a need for both further education in dietary issues and training in counseling. Women’s food habits during, but in particular after pregnancy need improvement, and dietary counseling could be more focused on healthy eating in a long-term perspective. / <p>Felaktigt ISSN angivet i avhandlingen och på spikbladet.</p>