No description available.

<p><b>Aim:</b><b> </b>The overall aim of the present thesis was to describe and evaluate IT support in dementia care from the perspectives of staff and relatives. More specifically, it was to examine staff members’ satisfaction with work, life satisfaction and sense of coherence before and after increased IT support, to describe staff members’ opinions and perceptions of IT support during the process of implementation, to describe relatives’ opinions of IT support and to compare relatives’ perceptions of their irritations with care and life satisfaction before and after increased IT support. In addition, three questionnaires were further developed and tested among staff working in elderly care, and then used in the staff evaluation. <b>Methods:</b> A quasi-experimental design with baseline assessments and follow-ups and experimental and control groups was used in two studies to investigate the outcomes of IT support. A descriptive design was used to study staff views on IT support, and a correlative design was used in the methodological study. Participants were 33 staff members and 22 relatives in the evaluation, 14 staff members in the descriptive study and 299 staff members in the methodological study. Data collection methods were questionnaires and group interviews. The IT support consisted of passive passage alarms, fall detectors, sensor-activated night-time illumination of the lavatory, movement detectors, email communication, an Internet website and additional computers. <b>Findings and conclusions:</b> Staff job satisfaction and perceived quality of care increased in the experimental group. The relatives were generally positive about the IT support, and the experimental group showed a decrease in practical/logistical irritations. Staff described ‘moving from fear of losing control to perceived increase in control and security’ and ‘constant struggling with insufficient/deficient systems’. Conclusions are that IT support can be a resource in dementia care as perceived by caregivers if IT support is incorporated into the care system.</p>

L'évolution des soins médicaux en milieu hospitalier se caractérise par une intensité accrue des soins et de l'utilisation des médicaments, ces derniers étant de plus en plus nombreux et souvent onéreux. De plus, les personnes âgées, en nombre croissant dans notre société, souffrent fréquemment de pathologies concomitantes et nécessitent donc une polythérapie. Il devient dès lors de plus en plus complexe d'assurer un usage optimal (efficace, non toxique, et économique) des médicaments, et également d'assurer un suivi adéquat du traitement lorsque ces patients sont transférés entre milieux de soins aigus et chroniques. De nombreuses publications ont mis en évidence, à l'étranger, une prévalence élevée d'utilisation inappropriée des médicaments en gériatrie (sous forme d'overuse, de misuse, et d'underuse). Les facteurs explicatifs d'une utilisation inappropriée n'ont cependant jamais été étudiés dans cette population. Or, cette étape d'identification est indispensable pour le développement d'interventions appropriées. Elle a donc constitué la première partie du travail de recherche (1). Ensuite, certaines études ont tenté d'évaluer l'impact de diverses approches permettant d'améliorer la prescription (y compris la pharmacie clinique), mais peu ont utilisé une méthodologie robuste. De plus, l'intérêt de cette approche de pharmacie clinique n'a jamais été évaluée en Belgique, alors qu'il existe un potentiel certain pour la développer. C'est dans ce cadre que s'est effectuée la deuxième partie du travail (2). (1) Pour répondre au premier objectif, une étude qualitative combinant des données issues d'entretiens et d'observations avec des professionnels et patients au sein de services de gériatrie a été réalisée. Trois grandes catégories de facteurs sous-jacents à une utilisation inappropriée des médicaments ont été identifiés : référence au modèle de soins de santé aigus pour des adultes en général ; attitude d'apprentissage passive; prise de décisions paternaliste. A l'inverse la prise en charge par un gériatre et la communication multidisciplinaire permettent une meilleure utilisation des médicaments. Les mesures d'optimisation potentielles devraient donc entre autres concerner les compétences individuelles, les relations médecin-patient et médecin-médecin, et les systèmes de transfert d'informations entre milieux de soins. (2) Afin de quantifier la qualité de prescription, et l'impact d'une collaboration avec un pharmacien clinicien, une étude randomisée contrôlée a été réalisé, et a inclus 200 patients hospitalisés au sein d'un service de gériatrie. Les résultats montrent que l'intervention d'un pharmacien clinicien permet de réduire de façon significative l'overuse, l'underuse et le misuse des médicaments. L'acceptation des interventions est excellente, et leur pertinence clinique élevée.Enfin, l'intervention s'accompagne d'une tendance à une diminution de la mortalité et de la morbidité des patients, un an après leur sortie de l'hôpital. Ce travail démontre donc l'intérêt de la pharmacie clinique dans le contexte belge, et ouvre plusieurs perspectives, dont une évaluation de la généralisation à d'autres services cliniques, et une évaluation de son rapport coût-efficacité.

Residential care in nursing homes continues to be necessary for those individuals who are no longer able to live safely and comfortably at home. The demographic change with increasing number of persons over 65 years in the next 20 years also means that the percentage of those who will require care in a nursing home some time before the end of their lives will increase. Therefore, anticipating this pressure to expand nursing home availability, it is critical that these services are developed from a profound understanding of what creates the best value. Nursing homes in developed countries have evolved over the past half-century from being places of mainly custodial care to facilities responsible for the management of an ever increasing range of complex nursing and medical conditions. Nursing home residents are frail older adults with complex needs, dependent on advanced nursing care.  Determining what aspect of nursing homes should and can be measured is the current work of many national health care systems. However, uncovering what the nursing home residents perceive as the most important aspects of quality and how they experience living in a nursing home is necessary to develop effective person-centred care.  The overall aim of the present thesis was to contribute to a deeper understanding of quality of care in nursing homes, integrating the professionals’, residents’ and family’s perspectives. The research design is a qualitative approach to explore the concept quality of care and its domains. The thesis comprises a review of internationally used nursing sensitive quality indicators for nursing homes. The indicators are evaluated for their validity as described in the literature. The thesis further describes the residents’ experiences with the interpersonal factors of nursing care quality, as well as the residents’ experiences of living in a nursing home. The thesis also explores the understanding and belief about nursing home quality held by family members of residents. The thesis is based on in-depth interviews of residents in four different nursing homes, and focus group interviews of family members of residents in two different nursing homes. The findings are that quality of care in long-term care in nursing homes encompasses at least four domains: quality of the living conditions, quality of the nursing staff, quality of direct nursing care, and quality of the social environment. Moreover, care quality is influenced by a range of external factors such as the national policy, laws and regulations, management of the organization and the physical building. The local community provides a context in which the nursing home is more or less integrated into. The review of internationally used quality indicators indicate that some factors of care processes and health outcomes for nursing home residents could be measured and give valid and reliable evaluation of the nursing home care quality. In the explorative qualitative study, residents and family placed more emphasis on physical and psychological well-being, interpersonal relationships and the social environment if quality of care is to result. Objective indicators of essential areas of resident-experienced quality need to be developed. This should be done in collaboration with the residents and their next-of-kin, in addition to professional expertise. Methodological and practical implications of the results are discussed. / Sykehjem er en helsetjeneste som vil være nødvendig for eldre som ikke føler seg trygge eller kan få tilstrekkelig behandling, pleie og omsorg i eget hjem. Antall eldre over 65 år er økende i Norge, noe som innebærer et økt press på sykehjem i framtiden. Det er derfor av stor betydning at sykehjemstjenesten utvikles med tanke på å skape best mulig nytteverdi ut fra behov. Sykehjemmene har utviklet seg de siste 50 årene fra hovedsakelig et botilbud til helseinstitusjoner som gir avansert helsehjelp. Sykehjemsbeboere er skrøpelige eldre med komplekse problemstillinger, avhengig av avansert sykepleie. Kvalitetsindikatorer er kvantitative mål som reflekterer en profesjonell standard for pleie og omsorg, og slike mål benyttes i økende grad for å vurdere kvalitet i sykehjem. Imidlertid er det nødvendig å inkludere det som har størst betydning for sykehjemsbeboere i slike mål for å kunne gi god pasientsentrert sykepleie.   Hovedmålsettingen med studien var å bidra til en dypere forståelse av sykehjemskvalitet, ut fra helsepersonellets, beboernes og pårørendes ståsted. Avhandlingen omfatter en oversikt over kvalitetsindikatorer som er i bruk internasjonalt. Videre beskriver avhandlingen beboernes erfaringer med mellommenneskelige faktorer ved sykehjemskvalitet, samt hvordan de erfarer å bo i et sykehjem og opplever kvaliteten på “hjemmet” sitt. I avhandlingen blir også pårørendes forståelse av og meninger om sykehjemskvalitet utforsket. Avhandlingen er basert på dybdeintervju av beboere ved fire ulike sykehjem, og fokusgruppeintervjuer med pårørende ved to av sykehjemmene.   Funnene viser at kvalitet på pleie og omsorg i sykehjem omfatter minst fire hovedområder: Bokvalitet, personellkvalitet, helsetjenestekvalitet og sosial kvalitet. Videre er pleie- og omsorgskvaliteten påvirket av en rekke eksterne faktorer som nasjonale føringer, lovverk, ledelsesstruktur, bygningskonstruksjon og lokale forhold. Den internasjonale oversikten over kvalitetsindikatorer gir indikasjoner på at noen av dem kan brukes som pålitelige og gyldige evalueringer av kvaliteten på pleie og omsorg, samt helserelaterte resultater for beboerne. I den kvalitative intervjuundersøkelsen med beboere og pårørende, ble fysisk og psykisk velvære, mellommenneskelige forhold og det sosiale miljøet tillagt større betydning for kvaliteten. Objektive indikatorer for disse beboererfarte områdene for kvalitet må utvikles. For å sikre at disse er pasientsentrerte, bør utviklingen av kvalitetsindikatorer gjøres i tett samarbeid med sykehjemsbeboerne og pårørende, i tillegg til helsepersonell.

The period of pregnancy and childbirth is an important and sensitive time for men’s upcoming parenthood. Research into fathers’ experiences of childbearing has received less attention compared to maternal experiences. The purpose of this thesis was to study the sources fathers use to obtain information about pregnancy and childbirth, fathers’ preference for the mode of birth of their baby, and fathers’ childbirth experience and their perception of postnatal care quality.In 2007, 1105 expectant fathers were enrolled in the study when their partner had reached the middle of pregnancy. The fathers were followed until one year after the birth of their baby. The fathers were living in the county of Västernorrland in Sweden and their babies were born in one of the three hospitals in the county. Data was analysed using descriptive and inferential statistics, and content analysis. An index was created from a combination of fathers’ experiences of postnatal care quality.iiiCommon sources of information about pregnancy and childbirth used by prospective fathers were the Internet, their partners and the midwife. Fathers who were expecting their first baby (OR 1.4; 1.2-1.7), had a high level of education (OR 1.3; 1.2-1.5) and fathers with previous experience of caesarean section (OR 1.3; 1.1-1.6) were the greatest users of the Internet. Of the prospective fathers 71 (6.4%) desired caesarean section for the birth of their baby. Previous negative birth experience (PR 8.6; 2.6-28.3) and the experience of caesarean section (PR 5.7; 2.8-11.9) were factors associated with the wish that the baby would be born by caesarean section. A desire to plan the day of the baby’s birth (PR 6.0; 1.5-24.1) was associated with a preference for caesarean section for the men who were expecting their first baby. Two months after the birth of the baby 604 (74%) of the fathers in this group had had a positive birth experience. A correlation with a less-positive birth experience was with emergency caesarean section (OR 7.5; 4.1-13.6), instrumental vaginal birth (OR 4.2; 2.3-8.0) and if the man was unhappy with the medical care which the partner received (OR; 4.6; 2.7-7.8). Positive experience of healthcare professionals’ knowledge and attitudes was related to a satisfactory birth experience. The deficiencies in the postnatal care were mainly related to deficiencies in the information on the baby’s care and needs, and fathers’ experiences of their partners’ inadequate check-ups and medical care. A year after the birth 488 (79%) of the fathers were satisfied with the overall postnatal care, although they had pointed to deficiencies in the provision. Deficiencies in the attitude of the staff (OR 5.01; 2.80-8.98) and the medical care and check-ups their partner received were associated with fathers’ dissatisfaction with the overall postnatal care (OR 2.13; 1.25-3.62).ivMost fathers in this study had a positive birth experience and were happy with the postnatal care. The thesis highlights, however, opportunities for improvements in intrapartum and postnatal care. Healthcare professionals should be informed regarding the information provided via the web and to discuss the information that expectant fathers receive about pregnancy and childbirth. Prospective fathers should be given the opportunity to discuss their preferences and attitudes to the mode of birth. In addition, professionals should provide supportive information and be present in the delivery room. The information about the newborn baby’s care and needs can be strengthened, both before and after birth.

No description available.

Problem: Yrken inom Hälso- och sjukvården är högt fysiskt och framför allt psykiskt påfrestande arbeten där tidspress och arbetstempo fortsätter att öka. Syfte: Syftet med litteraturstudien var att belysa stressorer som kan påverka sjuksköterskans omvårdnadsarbete. Metod: Studien var en litteraturstudie, 17 artiklar (3 kvali- tativa och 14 kvantitativa) och en avhandling som svarade mot studiens syfte har granskats och analyserats. Resultat och konklusion: Många faktorer och orsaker till nutidens ohälsa kan sökas i arbetsmiljön och dess alltmer ökade krav på individen. Varje individ är unik och påverkas därmed olika av samma situationer. Upplevelsen och hur varje person hanterar en situation är beroende av hela dennes livsvärld och vilka faktorer som finns där. Att människan inte mår bra av långvarig stress, oberoende av situation, framkommer tydligt. De faktorer som anses bidra till försämrad vårdkvalitet är bland annat tidsbrist, hög arbetsbelastning, personalbrist, bristande arbetsmiljö och omorganisationer. Dessa faktorer tillsammans och även var för sig, gör att sjuksköterskor upplever stress och missnöjdhet med sitt arbete, vilket kan påverka patienternas omvårdnad och dess kvalitet. Implikation: Vidare forskning bör fokusera på hur sjuksköterskan kan påverka de faktorer som leder till stress samt försämrad arbetsmiljö och vårdkvalitet. / Problem: The professions in health care are highly physically and especially mentally stressful jobs where time pressure and work rate continues to increase. Purpose: The purpose of this study was to illuminate stressors that may affect nursing outcomes. Method: The study was a literature review, 17 articles (3 qualitative and 14 quantitative) and a thesis which met the study's purpose was reviewed and analysed. Results and conclusion: Many factors and causes of ill health can today be found in the work environment and its increasingly greater demands on the individual. Each individual is unique and therefor affected differently by the same situations. The stressful experience and how each person handles the situation depends on all the factors in her/his whole life-world. It becomes clear that regardless of the situation, no one is doing well during long-term stress. The factors considered to contribute to the deterioration of quality of care includes lack of time, heavy workload, staff shortages, poor working conditions and reorganizations. These together and also separately, result in that nurses´ experiences of stress and dissatisfaction with their work, which may affect quality of patient care. Implication: Further research should focus on how nurses can influence the factors which leads to stress and a poor work environment and decrased quality of care.

Background: Type 1 diabetes is a chronic disease for which there is currently no cure, and high quality care is essential if acute and long-term complications are to be avoided. Many children and adolescents have inadequate metabolic control with increased risk for complications later in life, and adolescent girls have reported low quality of life. Differences in metabolic control between treatment centres have been found but the reasons for this are unclear. Diabetes is a largely self-managed disease. Patient education is central to successful self-management but little is known about how to make best use of diabetes communities on the Internet and integrate them into a practitioner-driven service. Aim: The main objective of this thesis was to gain better understanding of how to improve the quality of diabetes care for children and adolescents, aiming to have near-normal blood glucose, to prevent both acute and late complications and to have good quality of life. Methods: The geographic populations of two paediatric centres (n=400) received validated questionnaires on perceived quality of care and Health-Related Quality of Life (HRQOL). An intervention with a web portal containing diabetes-related information and social networking functions was carried out within the same population. Clinical variables from 18 651 outpatient visits registered in the Swedish paediatric diabetes quality registry, SWEDIABKIDS were analysed. Using data from SWEDIABKIDS, five centres with the lowest mean HbA1c, five with the highest, and five with the largest decrease in centre mean HbA1c between 2003 and 2007 were identified. Team members (n=128) were asked about structure, process, policy, and the messages given to patients about important diabetes issues. Results: Specific areas that were identified as needing improvement included information about self-care, waiting time at outpatient clinics and for treatment, and access to care. Diabetes seemed to reduce HRQOL. Subjects with better metabolic control and with higher frequency of injections reported slightly higher HRQOL, as did those living with both parents compared to those with separated parents. Only 35% of children and adolescents with diabetes in Sweden had an HbA1c level below the treatment target value. Mean HbA1c showed a correlation with mean insulin dose, diabetes duration, and age. A difference between centres was found, but this could not be explained by differences in insulin dose, diabetes duration, or age. Adolescent girls reported lower HRQOL, as did parents of girls aged &lt; 8 years. Girls also had poorer metabolic control, especially during adolescence. In teams with the lowest and the most decreased mean HbA1c, members gave a clear message to patients and parents and had a lower HbA1c target value. Members of these teams appeared more engaged, with a more positive attitude and a greater sense of working as a team. Members of teams with the highest mean HbA1c gave a vaguer message, felt they needed clearer guidelines, and had a perception of poor collaboration within the team. High insulin dose, large centre population, and larger teams also seemed to characterize diabetes centres with low mean HbA1c. The most frequently visited pages on the web portal were the social networking pages, such as blogs, stories and discussions, followed by the diabetes team pages. Those who used the portal most actively were younger, had shorter diabetes duration, and lower HbA1c, and were more often girls. The web portal was not found to have any significant beneficial or adverse effects on HRQOL, empowerment or metabolic control. Conclusions: The quality of diabetes care for children and adolescents in Sweden is not sufficiently good and needs to improve further if complications in later life are to be avoided. Psychosocial support for children and adolescents with diabetes should be appropriate for age and gender. The attitudes of the members in the diabetes care team and the message they give to patients and their parents seem to influence metabolic control in children and adolescents. A clear and consistent message from a unified team appears to have beneficial effects on metabolic control. A web portal that includes comprehensive information about diabetes, and the opportunity to communicate with other people with diabetes and with healthcare professionals may be a useful complement to traditional patient education tools. Members of the diabetes team should encourage its use.

Sammanfattning  Syftet med studien var att värdera närståendes skattning av vårdkvaliteten på en  intensivvårdsavdelning med hjälp av frågeformuläret KUPP (Kvalitet Ur Patientens  Perspektiv). Antalet respondenter uppgick till 33 personer (10 män och 23 kvinnor) som  valdes konsekutivt. Designen var en deskriptiv och komparativ studie med kvantitativ ansats.  Den före detta intensivvårdspatienten vårdades på avdelningen 24 timmar eller mer.  Resultatet visade att närstående skattade balans i vårdkvaliteten inom frågor som belyste  vilken vårdutrustning som fanns tillgänglig, patientens medicinska vård, sjuksköterskors och  undersköterskors engagemang, sjuksköterskors och undersköterskors empatiska och  personliga förhållningssätt samt hela personalgruppens respekt i bemötandet av patienten.  Bemötandet av släkt och vänner värderades också högt. Bristande vårdkvalitet skattades inom  frågor som belyste information efter åtgärder, information om patientens vårdförlopp och  vilken person som var ansvarig för patientens vård. Vissa intensivvårdsspecifika frågor som  belyste möjligheten att få diskutera med personalen om otrygghet, mardrömmar och slem i  luftvägar skattades som bristande vårdkvalitet. Slutsatsen blev att närstående var generellt  nöjda med vårdkvaliteten men att det fanns faktorer som behövde förbättras t.ex. information  om resultat efter undersökningar.

Vid ortopedavdelning 3A och 3B inom länsverksamhet ortopedi Landstinget i Värmland har ett projekt startats för att förändra organisation och arbetssätt utifrån så kallade patientnärmre vård. Detta är en arbetsmodell som bygger på att vården skall ske i nära anslutning till patienterna och en förutsättning är att selektera bort så mycket vårdadministration som möjligt från sjuksköterskornas praktiska arbete. Syftet med studien, som är en del i ett större projekt, var att beskriva nuläget vid ortopedavdelningarna 3A och 3B före införandet av arbetsmodellen patientnärmre vård. Enkäter delades ut till patienter och medarbetare där de viktigaste frågeområdena var vårdkvalitet, hälsoindex, arbetsklimat och delaktighet. Undersökningsgruppen bestod av 130 patienter (96% svarsfrekvens) och 64 medarbetare (94% svarsfrekvens). Resultatet visade på en högt skattad vårdkvalitet i patientgruppen och en något lägre skattad vårdkvalitet i medarbetargruppen. Patientgruppens lägsta skattningar handlade om ”delaktighet i beslut”, ”egna önskemål” och ”information om ansvarig sjuksköterska”. Patienterna skattade genomgående de olika kartlagda vårdaspekterna som mer betydelsefulla än vad medarbetarna gjorde. Patienterna upplevde sitt hälsotillstånd som relativt gott, det psykiska välbefinnandet skattades dock som bättre än den fysiska hälsan. Medarbetarna upplevde stor delaktighet i det egna teamet och närhet till patienterna. Lägre värden framkom dock på möjligheter att observera patienterna och att påverka arbetet. Arbetsklimatet upplevdes som stagnerat inom dimensionerna konflikt, utmaning och frihet. I dimensionerna idé-stöd och risktagande närmade sig organisationen ett innovativt klimat, vilket kan ha positiv betydelse vid ett förändringsarbete. / At the Clinic of Ortopedic Surgery, wards 3A and 3B, in the County Board of Health Care in Värmland, a project has been initiated with the purpose of changing the workprocess in accordance with so called Patient-Focused Care. This is a working model built on the principle that care should take place in a close relationship with the patient with the prerequisite of reducing as much care administration as possible from the nurses’ work. The aim of the study, which is a part of a larger project, was to describe the current status at the wards, before the implementation of the Patient - Focused Care work model. Questionnaires containing questions on quality of care, a health index, organizational climate, and opportunities for participation were distributed among patients and staff. The study group consisted of 130 patients (96 % response rate) and 64 staff members (94 % response rate). The results showed that the patients rated the quality of care as high, while the staff members give somewhat lower ratings. The least favourable ratings in the patient group were noted on questions designed to measure “participation in decision making”, “own preferences,” and “information on the responsible nurse.” Compared to the staff members, the patients ascribed higher subjective importance to all mapped aspects of care. The patients experienced their health status as relatively good, however, the subjective well-being was rated as more favourable than the physical health. The staff members experienced a high participation in their team and a sense of being close to the patients. Less favourable ratings were noted on the possibilities to observe the patients and to have an influence on their own work. The organizational climate was perceived as declined in the dimensions of conflict, challenge and freedom. In the dimensions of idea-support and risk taking the organization approached an innovative climate, which might have a positive impact in an organizational change process.