Bakgrund: Användandet av substanser är ett ökande problem såväl globalt som i Sverige. Förekomsten av samsjuklighet anses vanligt förekommande då individer lider av både psykisk ohälsa och ett substansbrukssyndrom. Patienter med substansbrukssyndrom är i stort behov av att samverkan mellan olika instanser är välfungerande för att få adekvat hjälp i sin situation. Trots lagstiftning kring samverkan har brister uppmärksammats. Syfte: Syftet var att belysa specialistsjuksköterskans erfarenheter av samverkan mellan psykiatrisk vård och andra aktörer när patienter har substansbrukssyndrom. Metod: En intervjustudie med specialistsjuksköterskor som arbetade inom öppen- och sluten psykiatrisk vård. Studien hade en induktiv ansats och grundade sig i Graneheim och Lundmans kvalitativa innehållsanalys. Resultat: I resultatet framkom det erfarenheter av utmaningar i samverkan som delats in bristfällig kunskap, resursbrister, bristande uppföljning efter LVM kopplat till otillräcklig kommunikation samt utmaningar i samsynen kring patientgruppen. Erfarenheter av att främja god samverkan lyfts även i resultatet genom positiva erfarenheter av samverkan samt vikten av att samverka med närstående. Konklusion: Att belysa specialistsjuksköterskans erfarenheter av samverkan kan leda till att specialistsjuksköterskan når en fördjupning och medvetandegör sin kunskap. Detta kan bidra till en säkrare och mer personcentrerad vård för patientgruppen samt att specialistsjuksköterskan synliggör de främjande komponenterna och utmaningarna i samverkan. / Background: Substance abuse is an increasing problem both globally and in Sweden. The occurrence of co-morbidity is considered common when individuals suffer from both mental illness and substance abuse syndrome. Patients with substance abuse syndrome are in great need of well-functioning cooperation between different agencies in order to receive adequate help with their situation. Despite legislation regarding cooperation, shortcomings have been noticed. Purpose: The purpose was to illustrate the specialist nurse's experiences of collaboration between psychiatric care and other actors when patients have substance abuse syndrome. Method: An interview study with specialist nurses who worked in outpatient and inpatient psychiatric care. The study had an inductive approach and was based on Graneheim and Lundman's qualitative content analysis. Results: The results revealed experiences of challenges in cooperation divided into insufficient knowledge, resource shortages, lack of follow-up after LVM linked to insufficient communication and challenges in consensus around the patient group. Experiences in encouraging good collaboration is also highlighted in the results through positive experiences of collaboration and the importance of collaborating with close relatives. Conclusion: Highlighting the specialist nurse's experiences of collaboration can lead to the specialist nurse reaching greater depth in and raising awareness of their knowledge. This can contribute to a safer and more person-centered care for the patient group and that the specialist nurse makes visible the promoting components and the challenges in the collaboration.

Bakgrund: Inom vården av äldre ska det finnas ett anhörigperspektiv. Anhöriga uttrycker en önskan om att få vara delaktiga i vården av sin äldre närstående men trots det så visar tidigare forskning att anhöriga många gånger inte upplever delaktighet. Syfte: Syftet var att öka kunskapen om hur anhöriga kan uppleva delaktighet i vården av den äldre personen. Metod: En systematisk litteraturöversikt där artiklar analyserades med tematisk syntes. Resultat: Tre olika teman om anhörigas upplevelser av delaktighet i vården av sina äldre närstående framkom i resultatet. Känsla av utanförskap: där anhöriga beskrev hur de önskade ett samarbete med den formella vården och där de värdesattes för sina expertkunskaper. Att känna kontroll: Anhöriga beskrev att de önskade känna att de hade insyn och möjlighet att påverka vården av sin närstående samt ha bra informationsutbyte och en god tvåvägskommunikation med vårdpersonalen. Maktlöshet vid bristande tillgänglighet hos vårdpersonal: Anhöriga lade mycket tid på att leta efter sjuksköterskan för att ställa sina frågor. Många anhöriga försökte hitta rätt tillfälle när vårdpersonalen inte var upptagna men uppgav att tillfället aldrig kom och att de kände som att de avbröt vårdpersonalen för att få information och kommunicera.Slutsats: Denna studie ökar förståelsen för de upplevelser som anhöriga känner i vården av sina äldre närstående. Anhöriga önskar bättre samarbete och kommunikation med vårdpersonalen för att minska de negativa känslor som de upplever när de inte är delaktiga. Tillgängligheten hos vårdpersonalen hindrar anhöriga att kunna påverka vården av sin närstående och minskar möjligheten till kommunikation och informationsutbyte som anhöriga upplever är en viktig del i upplevelsen av delaktighet.

Bakgrund: Akutsjuksköterskan är specialiserad inom akutsjukvård och jobbar företrädesvis på en akutmottagning och bedriver där högkvalificerad akutsjukvård. Akutsjuksköterska som specialistutbildning är i sammanhanget en förhållandevis ny utbildning och adekvat forskning kring just akutsjuksköterskans inverkan på den utförda vården saknas således. Syfte: Syftet var att studera akutsjuksköterskors upplevelser av hur specialistkompetensen påverkar vårdandet på en akutmottagning. Metod: En kvalitativ intervjustudie med induktiv ansats. Tio specialistsjuksköterskor inom akutsjukvård intervjuades från tre olika akutmottagningar i södra Sverige. Det insamlade materialet analyserades med Graneheim och Lundmans beskrivning av manifest innehållsanalys. Resultat: Tre kategorier identifierades och beskriver akutsjuksköterskans upplevelse av hur specialistkompetensen påverkar vårdandet: Reell eller formell kunskap, förändrad syn på vårdandet och trygg i sin yrkesroll. Slutsats: Akutsjuksköterskans specialistkompetens skapar trygghet i yrkesrollen samt leder till att akutsjuksköterskan ser helheten, både sett ur ett patientperspektiv och ett organisatoriskt perspektiv. Erfarenhet kan i viss mån kompensera för specialistutbildning. Dock behövs mer forskning gällande hur akutsjuksköterskans kompetens påverkar vårdandet. / Background: Emergency nurse is a nurse who is specialized in emergency healthcare and preferably work in a emergency room and conduct highly qualified healthcare. Emergency nurse is in context a relatively new training and therefor there is a lack of research regarding how emergency nursing impact the health care. Aim: The aim was to study emergency nurses’ experience of how their specialist competence affects care in an emergency department. Methods: A qualitative interview study with an inductive approach. Ten specialist nurses in emergency care were interviewed from three different emergency departments in southern Sweden. The material that were colleceted were analyzed with Graneheim och Lundmans description of manifest content analysis. Findings: Three different categories were identified and describes how emergency nursing impact the health care: Real or formal competence, a changed view on the overall health care and confident in his role. Conclusions: Emergency nurses has an overall positive impact on the emergency nurse and creates comfort in the professional role. The emergency nurse sees the whole patient both from a patient perspectiv and from an organizational perspective. Experience can in some extent make up the lack of specialist training.  However more research is needed on how emergency nurses impact the overall health care.

Aim To determine the impact on clinical outcomes of specialist diabetes clinics compared with routine primary care clinics. Methods Observational study measuring clinical performance (process/outcome measures) in the primary care sector. A cohort of patients attending specialist diabetes clinics was compared with a control cohort of patients attending routine primary care clinics. Results Patients seen in specialist diabetes clinics had a significantly higher HbA1c than patients in routine primary care clinics (mean difference 0.58%; P < 0.001) but there was no significant difference in rate of improvement with visits compared with primary care clinics. In contrast, patients seen in the routine primary care clinics had significantly higher cholesterol levels (mean difference 0.24 mmol/l; P < 0.001) compared with patients in specialist diabetes clinics and their improvement was significantly greater over time (mean difference 0.14 mmol/l per visit compared with 0.10 mmol/l; P < 0.006). Patients in routine primary care clinics also had significantly higher diastolic blood pressure (mean difference 1.6 mmHg; P < 0.007) but there was no difference in improvement with time compared with specialist diabetes clinics. Uptake of podiatry and retinal screening was significantly lower in patients attending routine primary care clinics, but this difference disappeared with time, with significant increases in uptake in the primary care clinic group. Weight increased in both groups significantly with time, but more so in the specialist clinic patients (mean increase 0.18 kg per visit more compared with routine clinic primary care patients; P < 0.001). Conclusions This study provides evidence that the provision of primary care services for patients with diabetes, whether traditional general practitioner clinics or diabetes clinics run by general practitioners with special interests, is effective in reducing HbA1c, cholesterol and blood pressure. However, the same provision of care was unable to prevent increasing weight or creatinine over time. No evidence was found that patients in specialist clinics do better than patients in routine primary care clinics.

Yes / Heel pressure ulcers can cause pain, reduce mobility, lead to longer hospital stays and in severe cases can lead to sepsis, amputation, and death. Offloading boots are marketed as heel pressure ulcer prevention devices, working by removing pressure to the heel, yet there is little good quality evidence about their clinical effectiveness. Given that evidence is not guiding use of these devices, this study aims to explore, how, when, and why these devices are used in hospital settings. To explore how offloading devices are used to prevent heel pressure ulcers, for whom and in what circumstances. A realist evaluation was undertaken to explore the contexts, mechanisms, and outcomes that might influence how offloading devices are implemented and used in clinical practice for the prevention of heel pressure ulcers in hospitals. Eight Tissue Viability Nurse Specialists from across the UK (England, Wales, and Northern Ireland) were interviewed. Questions sought to elicit whether, and in what ways, initial theories about the use of heel pressure ulcers fitted with interviewee's experiences. Thirteen initial theories were refined into three programme theories about how offloading devices are used by nurses 'proactively' to prevent heel pressure ulcers, 'reactively' to treat and minimise deterioration of early-stage pressure ulcers, and patient factors that influence how these devices are used. Offloading devices were used in clinical practice by all the interviewees. It was viewed that they were not suitable to be used by every patient, at every point in their inpatient journey, nor was it financially viable. However, the interviewees thought that identifying suitable 'at risk' patient groups that can maintain use of the devices could lead to proactive and cost-effective use of the devices. This understanding of the contexts and mechanisms that influence the effective use of offloading devices has implications for clinical practice and design of clinical trials of offloading devices. How, for whom, and in what circumstances do offloading devices work to prevent heel pressure ulcers? Tissue viability nurses' perspectives. / CG conducted this review as part of her PhD at the University of Leeds which was funded by a Charitable Grant from https://leedscares.org/LeedsHospitalsCharity (https://www.leedshospitalscharity. org.uk/) and Smith and Nephew Foundation.

Bakgrund: Specialistsjuksköterskor som jobbar prehospitalt möter många patienter med många olika sjukdomar och livssituationer. En patientkategori som specialistsjuksköterskan träffar och vårdar är de patienter som är påverkade av droger eller alkohol, och denna grupp upplevs många gånger som svår att handlägga. Denna patientgrupp utsätts även för diskriminering av samhället och vården. Syfte: Syftet med studien var att inom den prehospitala sjukvården undersöka specialistsjuksköterskors upplevelse av att vårda narkotikapåverkade patienter. Metod: En kvalitativ studie med induktiv ansats. Datainsamlingen utfördes genom individuella semistrukturerade intervjuer med åtta specialistsjuksköterskor inom prehospital sjukvård. Intervjuerna genomfördes på ambulansstationer i Norrbotten samt Skåne län. Intervjuerna analyserades med latent kvalitativ innehållsanalys. Resultat: I resultatet framkom fem huvudkategorier: Att känna känslor av utsatthet och otillräcklighet, att värdera kunskapsläget, att reflektera över tankar och risker, att bedöma och handlägga samt att finna hjälp i vårdandet. Majoriteten av deltagarna ansåg att ett ökat säkerhetstänkande var något av de viktigaste vid larm där narkotikapåverkan förekom. De ansåg att bristande kunskap och svårigheter att få tillräckligt med information gällande patienten, drogen och miljön starkt påverkade handläggningen av dessa patienter. Brist på resurser från samhällets andra aktörer skapade frustration. Slutsats: Det finns ett ökat behov av kunskap, utbildning och samverkan för att specialistsjuksköterskor ska kunna handlägga denna patientgrupp optimalt och minimera säkerhetsrisker.

Magistro baigiamajame darbe išanalizuota į veiklos audito specialistų veiklą nukreipta kompetencija, jos turinys ir pripažinimas Europos AAI, įvertintas Europos AAI atstovų požiūris į veiklos audito specialistų sertifikavimo galimybę. Pirmoje darbo dalyje atskleista veiklos audito samprata, vieta ir reikšmė audito sistemoje, Europos AAI veiklos audito raida bei esminiai veiklos audito bruožai. Antroje dalyje atskleista veiklos audito specialistų samprata, kompetencija ir strateginiai individo kompetencijos tobulinimo būdai. Trečioje dalyje nustatomi į veiklos audito specialistus nukreiptos kompetencijos elementai: asmeninės savybės, žinios ir įgūdžiai, išsilavinimas, darbo patirtis, audito patirtis, auditorių mokymai. Ketvirtoje dalyje įvertinami į veiklos audito specialistų veiklą nukreipti kompetencijos elementai bei palyginamas šių kompetencijos elementų pripažinimas Europos AAI, nustatomi Europos AAI atstovų požiūriai į veiklos audito specialistų sertifikavimo galimybę. / The goal of master’s thesis is to analyse performance audit specialists competence, its content which is pointed to their activity, appreciation by Europe’s SAI and evaluate Europe’s SAI representatives attitude towards the possibility to certificate the performance audit specialists. In the first part of master’s thesis performance audit conception, its place and significance in the audit system, Europe’s SAI evolution of performance audit and fundamental performance audit features are revealed. In the second part of master’s thesis author unclosed the conception of performance audit specialists, competence and strategic individual competence development methods. In the third part of master’s thesis it is determined the performance audit specialists competence elements of content: personal features, knowledge, skills, background, work experience, audit work experience, auditor’s education. In the fourth part of master’s thesis the author evaluated performance audit specialists elements of competence and compared appreciation of these competence elements by different Europe’s SAI, defined Europe’s SAI attitudes towards the possibility to certificate performance audit specialists.

The focus of this thesis is on describing and analysing recently graduated physicians’ and engineers’ experiences of the relationship between the professional education programs and the respective professional practices. The aim is to explore the professionals’ reasons for their educational and career choices, what they learn in professional education, the demands they encounter in the workplace, and the perceived needs and opportunities for learning and further development in their professional practices. This study is based on a comparative design and the empirical data have been collected in interviews with physicians and master’s level engineers in information technology. The theoretical framework is structured around three parts, consisting of theories of professionalisation, theories concerned with the functions of higher education, and theories concerned with the concepts of knowledge, competence and qualifications. There is a close relationship between the process of professionalisation, the authority of the professions, the legitimacy of professional knowledge, and the higher education institutions. The results indicate that theory and practice are intimately integrated in the physicians’ professional education, whereas the engineers’ experiences of the educational program are characterised by little overlap between theory and practice. Furthermore, the physicians emphasise the importance of theoretical specialist knowledge and socio-communicative competence while the engineers instead stress the importance of generalist competence. The educational knowledge base is relatively static for both physicians and engineers. However, whereas there is a correspondence between the educational and the professional knowledge base in the case of the physicians they are only a loosely coupled in the case of the engineers. This can be attributed to the changing nature of the engineers’ professional knowledge base, which is characterised by constant change. The physicians regard their professional education as a rational preparation for the world of work. Although education does provide a general foundation for further professional development and learning, the engineers associate their professional education more with a symbolic ritual. For physicians, the formal credentials are a legal requirement to practise the profession. Education is regarded as constituting an important credential also for the engineers as it increases individual employability. The physicians tend to emphasise the use value of the educational program, while the engineers instead stress the exchange value of their educational program.

Submitted by isabela.moljf@hotmail.com (isabela.moljf@hotmail.com) on 2017-08-25T14:33:45Z No. of bitstreams: 0 / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2017-08-30T14:34:13Z (GMT) No. of bitstreams: 0 / Made available in DSpace on 2017-08-30T14:34:13Z (GMT). No. of bitstreams: 0 Previous issue date: 2016-03-31 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / A Floresta Atlântica é considerada um hotspot de biodiversidade mundial por apresentar altas taxas de endemismos, grande riqueza e abundância de espécies vegetais, incluindo de briófitas (antóceros, hepáticas, musgos). A Floresta Atlântica apresenta heterogeneidade de paisagens incluindo diferentes fitofisionomias. No Parque Estadual do Ibitipoca, a heterogeneidade da Floresta Atlântica se revela em um complexo mosaico de fitofisionomias florestais, arbustivas, campestres e savânicas, que são contínuas umas as outras formando regiões de borda. As bordas podem ser naturais, constituídas pela dinâmica natural de formação do ambiente ou formadas pelo homen que causa impacto ao estabelecer suas atividades. As bordas apresentam modificações na riqueza florística, abundância, densidade e diversidade, processo conhecido como efeito de borda. As hepáticas (Marchantiophyta) são importantes na composição e riqueza da Floresta Atlântica e em estudos sobre a influência da borda por serem organismos bioindicadores. Estudos sobre efeito de borda na composição de especies na Floresta Atlântica Mineira são importantes para a sua conservação. Deste modo, o trabalho foi desenvolvido na área que compreende a Floresta Latifoliada Nebular Perenifólia Tropical Superomontana (Floresta Nebular) do Parque Estadual de Ibitipoca (Minas Gerais, Brasil), também conhecida como Mata Grande, com o objetivo de estudar as hepáticas (Marchantiophyta), através de coletas sistemáticas, identificação das espécies e avaliações ecológicas (agrupamento, One-way ANOSIM, riqueza, abundância, freqüência e tolerância à luz). As coletas foram realizadas nos anos de 2013 e 2014, distribuindo-se 20 parcelas de 5x5m2; a partir da borda em direção ao interior da Floresta Nebular. Os resultados indicam abundância de 1220 espécimes e riqueza de 90 espécies, distribuídas em 29 gêneros e nove famílias. Do total de espécies identificadas, nove são endêmicas do Brasil e oito representam novos registros para o estado de Minas Gerais. A família Lejeuneaceae é a mais rica e abundante. A análise de agrupamento mostra a formação de dois grupos distintos (borda e interior florestal) e a análise One-way ANOSIM atesta que tal diferença é significativa. A riqueza da borda foi de 64 espécies (22 exclusivas). Já no interior florestal, a riqueza foi de 68 espécies (26 exclusivas). A distribuição das classes de frequência, na região da borda apresentou predominância de espécies consideradas raras, seguidas das pouco frequentes, assíduas, muito freqüentes e frequentes. Enquanto as parcelas do interior florestal inverteram a classe pouco frequente por assídua. As espécies foram classificadas em especialistas de sol, de sombra e generalistas e quando comparadas, a distribuição do grupo ecológico de tolerância à luz não mostrou diferenças estatísticas significativas entre a borda e o interior florestal. Ressalta-se o tamanho da floresta estudada (64 ha) como importante para a conservação das briófitas, devido à sua elevada riqueza específica associada à ocorrência de táxons endêmicos para o Brasil. / The Atlantic Forest is considered a global biodiversity hotspot by presenting high rates of endemism, great richness and plant abundance, including bryophytes (hornworts, liverworts, mosses). Liverworts are important organisms in the composition and richness of Atlantic Forest and they belong to Marchantiophyta. The Atlantic Forest is composed by heterogeneous landscapes including different phytophysiognomies. In Parque Estadual de Ibitipoca such heterogeneity forms a complex mosaic of forest vegetation types, shrub, countryside and savannas, which are continuous to each other forming regions of edge. The edges can be natural created by the natural dynamics of environmental formation, and caused by mankind in order to establish their activities. The edges support community with different characteristics from continuing communities, showing changes in species richness, abundance, density and diversity, a process known as edge effect. The liverworts are bioindicators organisms and then they are important in studies on edge influence. Studies on edge effect on species composition in Minas Gerais Atlantic Forest are essential for their conservation. Therefore, this study was developed in Broadleaved Cloud Evergreen Upper Highlands Tropical Forest (Broadleaved Forest) from Parque Estadual de Ibitipoca (Minas Gerais, Brazil), also known as “Mata Grande”, and with a goal of studying the liverworts species (Marchantiophyta) through systematic collections, identification of species and ecological assessments (cluster analysis, One-way ANOSIM, richness, abundance, frequency and tolerance to light). Samples were collected in 2013 and 2014 distributing 20 plots of 5x5m2 each from the edge through the interior of Broadleaved Forest. The results indicate abundance 1220 specimens and richness of 90 species distributed in 29 genera and nine families. From the total species identified nine are endemic to Brazil and eight represent new records for Minas Gerais State. The Lejeuneaceae family is the most rich and abundant in the forest studied. The cluster analysis showed the formation of two distinct groups (edge and forest interior), and One-way ANOSIM analysis confirms that this difference is significant. The edge richness was 64 species (22 exclusive) and in the forest interior the richness was 68 species (26 exclusive). The frequency classes distribution in the edge area presented predominance of species considered rare, followed by infrequent, assiduous, very common and common. However, the forest interior plots reversed infrequent class by assiduous. The species were classified as generalist, sun specialist and/or shade specialist and when they were compared the difference were not statistically significative between the edge and forest interior. It is important to highligh this forest for bryophytes conservation because of its size (64 ha) and its high species richness associated with the occurrence of endemic taxa to Brazil.

Die Tätigkeiten im Notarzt- und Rettungsdienst sind häufig mit persönlichen Gefährdungen verbunden. Im Raum steht aber auch immer die Problematik von Gefährdungssituationen, die durch den Notarzt "nur" als solche wahrgenommen, sozusagen "empfunden" werden. In dieser Arbeit wird v. a. vor dem Hintergrund der Erforderlichkeit und Zumutbarkeit die Frage prinzipiell diskutiert, ob und inwieweit ein Notarzt zum Handeln verpflichtet ist. Im Ergebnis ist objektiv-typisierend auf den Facharztstandard bzw. den Indikationskatalog für den Notarzteinsatz in Kombination mit arzt-/berufsrechtlichen Gesichtspunkten im engeren Sinne (z. B. Freiberuflichkeit) abzustellen. Es wird sich jedenfalls immer um eine Einzelfallbetrachtung und um eine individuelle, fallbezogene Entscheidung handeln. Bei seltenen, sehr unwahrscheinlichen Situationen mit relativer Ermangelung von objektiv-typisierbaren Gesichtspunkten werden die Anforderungen, aber auch die Chancen, an die "höchstpersönliche" Berufsausübung, an die Persönlichkeit des Arztes (v. a. in der Entscheidungsfindung) umso größer werden.