Tyrimas atliktas, siekiant ištirti elektroninės vertinimo sistemos, kaip naujos grįžtamojo ryšio priemonės veiksmingumą. Tirta, kaip dažnai ir kokiu tikslu mokytojai, mokiniai ir jų tėvai (globėjai) naudojasi elektronine pažymių knygele, kokią įtaką elektroninė vertinimo sistema daro grįžtamosios informacijos kokybei, ko trūksta, kad elektroninės vertinimo sistemos pildymas bei tikrinimas būtų efektyvesnis. Tyrime dalyvavo tik tų mokyklų respondentai, kuriose įdiegta elektroninė ryšio sistema. Tyrimas parodė, kad elektroninė pažymių knygelė yra dažniau naudojama mokytojų, nei mokinių ir jų tėvų (globėjų). Jos pildymas yra skatinamas ugdymo įstaigų vadovų. Vertinant atsakymus pastebėta, kad mokytojams vis dar trūksta patirties ir žinių, kaip efektyviai elektroninę vertinimo sistemą panaudoti ugdymo procese. Tyrimo rezultatai parodė, kad elektroninė mokinių pasiekimų vertinimo sistema turi reikšmės grįžtamosios informacijos kokybei: palengvina ugdymo subjektų tarpusavio bendravimą, pagerina mokinių lankomumą ir pažangumą, skatina naudotis informacinėmis technologijomis, suteikia savalaikę informaciją apie mokinius: jų pažangumą ir lankomumą. Išryškintos techninės elektroninės vertinimo apskaitos tobulinimo kryptys: sistemos administratoriai turi suteikti galimybę bet kuriuo metu ištaisyti padarytą klaidą, turi būti skiriamos papildomos apmokamos darbo valandos elektroninių vertinimo priemonių pildymui, mokytojų darbo vietos turi būti aprūpintos kompiuteriais. Atskleistos... [toliau žr. visą tekstą] / The research was aimed at the analysis of the efficiency of the electronic assessment system as a new means of feedback. The analysis focuses on the frequency and aim of teachers, students and their parents (foster-parents) using the electronic record book and on the influence electronic assessment system has on the quality of the feedback as well as on the shortcomings of the system that prevent a more efficient input and testing in the electronic assessment system. Respondents exclusively from schools that have electronic connection system were involved in the research. The research revealed that electronic record book is more frequently used by teachers than by students and their parents (foster-parents). Its constant updating is incited by heads of educational institutions. Analyzing the questionnaires it became obvious that teachers still lack experience and skills to effectively use electronic assessment system in the process of education. The results of the research revealed that electronic student achievement assessment system has an impact on the quality of feedback: it facilitates the intercommunication between educational subjects, increases student attendance and level of achievement, encourages the usage of informational technologies, provides up to date information on students, their achievements and attendance. The following technical directions for the development of electronic record of assessment have been pointed out: system administrators should provide... [to full text]

Den elektroniska journalen är en del av distrikts- och sjuksköterskors dagliga arbete och ökar förutsättningen för ett patientsäkert arbete. Distrikts- och sjuksköterskor arbetar efter kärnkompetenserna informatik och säker vård, men brister i den elektroniska journalen kan påverka dessa negativt. Syftet var att undersöka sjuksköterskors och distriktssköterskors kunskap om och förståelse av att använda elektronisk journal i kommunal hemsjukvård. Metod: kvantitativ tvärsnittsstudie. Urvalet bestod av sjuksköterskor och distriktssköterskor från fem kommuner i Kronobergs län (n 67). Datainsamlingen skedde med frågeformulär som analyserades med beskrivande statistik. Resultat: elektroniska journalen ansågs i hög grad vara ett bra stöd i det dagliga arbetet, och bidrog till en god och säker vård. Navigeringen i journalen och informationsöverföring mellan olika vårdgivare innebar oftast inte några större problem. Dubbeldokumentation mellan olika system förekom ofta och kunskap om journalens funktioner saknades. Det var i de flesta fall inte möjligt att använda journalen mobilt i hemsjukvården, trots att behov fanns. Över 80 % uppgav att läkemedelslistan ibland eller sällan var uppdaterad. Dessa brister kan påverka patientsäkerheten negativt eftersom förutsättningen för att bedriva en säker vård är att informationen i journalen är tydlig och korrekt. Studiens resultat kan ligga till grund för fortsatt forskning inom patientsäkerhet och utveckling av journalens användarvänlighet. / The electronic patient record is a part of nurses´ daily work, and increases the premise of patient safety. Nurses work by the core competencies informatics and safety, but flaws in the electronic patient record can affect these adversely. The aim of the study was to investigate the nurses' knowledge and understanding of using electronic patient records in municipal home care. Method: quantitative cross-sectional study. The sample consisted of nurses and district nurses from five municipalities in the county of Kronoberg (n 67). The data collection was done using questionnaires, which were analyzed with descriptive statistics. Results: the electronic patient record was to a high degree considered to be a good support in the daily work, and to contribute to a good and safe care. Navigation in the patient record and transfer of information between different health care providers, was usually not regarded as a major problem. Double documentation between various systems were common. There was a lack of knowledge of the patient record´s functions. It was in most cases not possible to use wireless connections for the patient record in the patient´s home, although the need existed. Over 80 % stated that the medication list was updated sometimes or rarely. These shortcomings can affect patient safety in a negative way, because the prerequisite for providing a safe care is that the information in the patient record is clear and accurate. The results of the study could be the basis for further research in safety, and for the development of the electronic patient record´s usability.

Aim: The overall aim of this thesis is to explore School health nursing through school nurses’ descriptions of schoolchildren’s health and to analyse factors influencing the recording of school-children’s health in the School Health Record (SHR). An additional aim is to evaluate fam-ily nursing interventions as a tool for the school nurses in the School Health Service (SHS). Methods: The thesis comprises four papers. A combination of qualitative and quantita-tive methods was used through individual interviews with a strategic sample of school nurses (n=12) (PI), a national survey to a representative sample of school nurses (n=129) (PII, III) and the implementation of family nursing models developed in Canada with girls in their early ad-olescence with recurrent health complaints and their families (n=4) in co-operation with their school nurses (n=2) (PIV). The Strengths and Difficulties Questionnaire (SDQ) was used as pre and post test. Evaluation interviews were conducted with the families and the nurses separate-ly. Qualitative content analyses were used to analyze the interview text with the school nurs-es and the families. Manifest content analysis was used to analyze the free text answers of the survey and the evaluation interview with the school nurses. Descriptive statistical analyses were used to describe demographic data in all four papers. The SDQ was hand-scored statistically. Findings: The findings showed that nurses judged the schoolchildren’s mental health as dete-riorated, especially in socially disadvantaged areas and more generally among girls expressed as psychosomatic symptoms. Individual factors related to lifestyle affected the schoolchildren’s physical health, and the mental health was, to a large extent, affected by the school environ-ment and family relations. The latter seemed to be the most important factor affecting school-children’s mental health. The basis for the school nurses judgement of the physical health was health check-ups and the health dialogues. Spontaneous visits were more commonly used to judge the mental health. Recording schoolchildren’s mental health was a challenge for school nurses. Difficulties were related to ethical considerations, tradition, lack of time and the im-proper structure of the SHR. Fears of marking the schoolchild for life related to the schoolchild itself, the parents or to other authorities/successive caregivers were brought up as hinders for recording mental and social health. Family sessions may be useful within the profession when handling recurrent health complaints among adolescence girls. The girls and their families ex-perienced relief, they felt confirmed and that their feelings and reactions were normal in that situation. The families became aware of their own strengths and possibilities and this was sup-ported by the SDQ which showed an increased well-being. The school nurses valued this way of working and meant that the sessions seemed to start a changing process within the families. Conclusions: The results indicate that school nurses have a deep knowledge about schoolchil-dren’s health which is not used to its full potential in a public health perspective. However, the experienced difficulties recording schoolchildren’s mental health seem obvious, which would de-mand developing the SHR for the needs of today. Family sessions in SHS with the school nurse as a collaborator with the family seemed useful and may be transferable to other health problems expressed by the schoolchildren. Bronfenbrenner’s ecological systems theory and other models for health determinants are used to illustrate the school nurse as a mediator working on the bridge over different health streams with schoolchildren’s health on an individual and a population level.

The use of technology in primary care settings is not a new concept; the benefits of implementing electronic medical records are stated throughout the literature related to gains in productivity, patient safety, and adherence to clinical guidelines. Yet, despite these benefits, the adoption of electronic medical records in primary care settings, in Canada remains low. This thesis research, a descriptive case study, is an in-depth look at the process of electronic medical record implementation for a family practice group in an attempt to understand the process, technology, and the challenges associated with such as transition. This research uses two well-known models as its framework: the Delone and McLean IS Success Model and John Kotter’s Eight Stages of Organizational Change. The use of the two models together is unique; their use together provides a broader look at the aspects of implementation including the environment in which it is being conducted.

Forskning har vist at dårlig kommunikasjon og mangelfull kontinuitet kan føre til dårlig kvalitet på tjenestene til barn. I noen tilfeller har dette ført til uriktige diagnoser og behandling, samt til mangelfull informasjon til foreldrene. Statens Helsetilsyn opprettet en arbeidsgruppe som utformet et forslag til egen journal til bruk for barn og foreldre. Gruppen foreslo å prøve ut egenjournalen til enutvalgt populasjon, og evaluere denne før den ble tatt i bruk i resten av landet. Mål/ hensikt: Endepunktsmål var foreldrenes opplevde kvalitet på kommunikasjon med helsepersonell, informasjonens relevans, følelse av likeverd og invitasjon til egen delaktighet. En ønsket å finne ut ihvilken grad foreldrene ville bruke egenjournalen i møte med helsetjenesten, om foreldrene opplevde at bruk av egenjournal ville føre til en bedre og mer delaktig kommunikasjon, om egenjournalen ville påvirke bruken av helsetjenester, og om foreldrene fikk tilført mer kunnskap om barns helse gjennom egenjournalen. Setting: Helsestasjoner i ti kommuner på nordvestlandet i Norge Metode: Et utvalgpå 309 barn født mellom 1. august 2000 og1. oktober 2001, ble rekruttert gjennom helsestasjonsbesøk og randomisert i en intervensjonsgruppe eller en kontrollgruppe. Førstefødte ble ekskludert. Vi brukte selvutfyllende spørreskjema, som var standardiserte og lukkede. Begge gruppene besvarte del 1 både før og etter intervensjonen. Intervensjonsgruppen besvarte i tillegg del 2 etter intervensjonen. Det var 289 (94%) foreldre som besvarte spørreskjemaet før intervensjonenog 260 (84%) etter. Helsesøstrene introduserte både egenjournalen ogspørreskjemaene. Helsepersonell ble også intervjuet for å validere resultatene. Resultat: Ca ¾ av foreldrene benyttetegenjournalen ved besøk på helsestasjonen, og en tilsvarende andel mente den var nyttig og haddeselv skrevet i den. Halvparten av foreldre oppgav at egenjournal førte til bedre oversikt over barnets helse og utvikling og at de ble mer involvert i bestemmelser. Den ble mindre brukt ved andre typerkontakter med helsetjenesten. Brukav egenjournalen påvirket ikke bruken av helsetjenester, kunnskaper om barns helse eller tilfredshet med informasjon og kommunikasjon med helsepersonell. Konklusjoner: Egenjournalen ble godtmottatt og hyppig benyttet i denne randomiserte og kontrollerte undersøkelsen, men undersøkelsen støttet imidlertid ikke de positive resultatene egenjournalen hadde på kommunikasjon og informasjon, som er blitt vist i tidligere deskriptive oppfølgingsstudier. Foreldre og helsesøstre som deltok i studien, trodde imidlertid at resultatene ville blitt bedre dersom egenjournalen ble introdusert ved første hjemmebesøk etter fødsel, og dersom det ble gitt mer opplæring i bruken av egenjournalen. Det vil være behov for videre forskning for åkunne bestemme hva som videre skal skje med egenjournalen i det helsefremmende arbeidet / Background:Research has shown that insufficient communication skills and lacking continuity has led to poor quality of the children's health services. In some cases this has caused incorrect diagnosis and treatment and insufficient information to the parents. The Norwegian Board of Health appointed a working group that created a parent-held child health record. The group proposed the record to betried out in a selected population and evaluated before introducing it for the whole country. Aim: Tostudy parents use of the PHCHR, and to evaluate participation in decisionmaking and communication with the professionals. We also wanted to determine the PHCHR’s influence on health care utilisation, knowledge about child health and self-care. Setting: Maternal child health centres in ten municipalities in the North-west of Norway between October 2001 and January2003. Method: A sample of 309 children born between Jan 8. 2000 (00.08.01) and Oct 1. 2001 (01.10.01) was recruited successively at routine health surveillance visits and randomised into an intervention ora control group. First-born children were excluded. We used self-completed questionnaires, which had standardised, specific and closed questions. Both groups answered part one before and after the intervention, and the intervention group also answered part two after the intervention. It was 289(94%) parents who answered the questionnaires before the intervention, and 260 (84%) after. Public health nurses introduced both the PHCHR and the questionnaires. The nurses were interviewed to validate the interpretation of the results. Results: 3/4 of the parents used the PHCHR when visiting the maternal child health centres, 3/4 reported that the record had been helpful to them and 3/4 had entered information in the PHCHR themselves. Half of the parents claimed that the PHCHR led to better view of the child's health and development, and that they got more involved in decisions. The PHCHR was less used visiting other health professionals. The use of PHCHR did not influence the utilisation of health care services, parents’ knowledge of child's health, or the parents' satisfaction of information and communication with professionals. Conclusions: The PHCHR was well acceptedand frequentlyused in this randomised controlled trial, but the survey does not support the positive results using PHCHR shown in earlier descriptive follow up studies. Still, the public health nurses taking part in the study believe that an earlier introduction of the parent-held child record – at the first home visit, and more training would alter the results. Further studies are needed before one is to decide what to do about PHCHR in health promotion in children / <p>ISBN 91-7997-092-3</p>

The two longitudinal case studies that make up this dissertation sought to explain and predict the relationship between usability and clinician acceptance of a health information system. The overall aim of the research study was to determine what role usability plays in the acceptance or rejection of systems used by clinicians in a healthcare context. The focus was on the end users (the clinicians) rather than the views of the system designers and managers responsible for implementation and the clients of the clinicians. A mixed methods approach was adopted that drew on both qualitative and quantitative research methods. This study followed the implementation of a community health information system from early beginnings to its established practice. Users were drawn from different health service departments with distinctly different organisational cultures and attitudes to information and communication technology used in this context. This study provided evidence that a usability analysis in this context would not necessarily be valid when the users have prior reservations on acceptance. Investigation was made on the initial training and post-implementation support together with a study on the nature of the clinicians to determine factors that may influence their attitude. This research identified that acceptance of a system is not necessarily a measure of its quality, capability and usability, is influenced by the user’s attitude which is determined by outside factors, and the nature and quality of training. The need to recognise the limitations of the current methodologies for analysing usability and acceptance was explored to lay the foundations for further research.

Diss. (sammanfattning) Linköping : Univ., 2003. / Härtill 5 uppsatser.

Texte remanié de: Th. 3e cycle, 1984. / Bibliogr. p. 169-177.

Cette thèse étudie la notion de sceau authentique au Moyen Âge. Elle aspire à proposer une définition du sceau à travers la lecture des lois et commentaires médiévaux. Ce travail nous permet de considérer qu’un acte scellé d’un sceau authentique était avant toute autre chose un instrument au service du pouvoir et des justiciables. Pour être reconnu comme authentique, le sceau devait répondre à un ensemble de conditions. Il devait donc : respecter un ensemble de formalités ; avoir été reçu, rédigé et vérifié par des agents compétents et avoir donné lieu au paiement d’une taxe sans laquelle l’acte n’aurait pu être authentique puisque d’une part il n’aurait pas été scellé et d’autre part il n’aurait pas été conservé. Une telle analyse met en lumière l’idée selon laquelle l’authenticité n’existe pas en soi mais se présente comme le résultat d’un processus de contrôle et de vérification créé par l’autorité publique et mis en œuvre par des agents spécialement habilités par elle. Cette étude nous donne également l’occasion d’observer que l’écrit n’était pas aussi déprécié dans la société médiévale que ne le pensait traditionnellement la doctrine en histoire du droit. Elle nous a enfin offert l’opportunité de reconsidérer le rapport entre la preuve scripturale et la preuve testimoniale. / This thesis puts forward the notion of the sigillum authenticum at the Medieval time. It proposes a definition of such a concept through the analysis of medieval legal material. The aim is to show that a deed with a sigilum authenticum was used as a tool for power and any persons subject to Community laws. To be recognised as authentic, the seal required a few conditions. It had to respect a set of formalities, to be received, written and verified by officials and to prove a tax payment. Without all these requirements, the seal could not be considered as authentic since it would neither have been sealed nor been. Such an analysis puts forward the idea that authenticity could not exist on its own but was the result of a dynamic process of controls and checkings. Such a process was created by the competent public authority and set up by assermented officials. This study also shows the importance of written proof by the medieval society. It underlines the relationship between the written proof and the oral testimonies.

In this study health information seeking behaviour among young adults is investigated and attitudes toward available health information examined. Further, the electronic health record(EHR), ‘Journalen’, is investigated among young adults that use the health services in Sweden. The aim of this study is to gain insight in young adults’ health information seeking behaviour on the Internet.   A survey of health information seeking behaviour among young adults, 18-29 years old, reports that as well as searching for information for their own use, searching for information to help family and friends is also their practice. 95.4% say that they search for health information on the Web.   Overall, the top five categories of information searched are Personal Health, Symptoms, Healthy Diet, Mental Health and Treatment. For the Top five Information searches for themselves(’Self’), Mental Health is displaced by Disease Prevention. Health information categories sought the least by the young adults are information about Illegal Drugs, Allied Health, Alternative medicine and Support Groups. Respondents mostly report a high regard for the information they retrieve in their searches.   The majority rate the quality of health information as ‘Good’ or ‘Very Good’. Broadly speaking the young adults trust the health information found online but say that the quality of health information varies from source to source. 1177.se is often referred to as a trustworthy source among the respondents and according to them good quality information can be found there. The respondents use of support groups for themselves is reported, as well an altruistic motivation to support others. While the motivation for many searches is to avoid attending a health professional, approximately one-third report searching after their visit.   This study demonstrates that young adults are active consumers of health information on the Internet and their attitudes toward the available health information are generally positive. Of the respondents who are Swedish residents, 42% are unaware of the availability of their electronic health record in Sweden, Journalen, and of those 56.7% who know of it, 18% have never accessed their EHRs.  More research is needed to investigate the reason for the relatively low numbers of the young adults’ awareness and use of the Journelen. The aim of the study is discussed in the Introduction chapter and research questions identified. The research design is described in the methodology chapter and how data is collected through a survey. Results are presented in Tables and Figures and further analysed in the Analysis chapter in context of earlier research. Finally, the researcher concludes on the study and what could be learned from the findings.