In this paper the authors are focusing on people that work in psychiatric acute care. How do they identify the individual that is in most need of acute care? How do they judge in this kind of cases?    The foundation in this study is in the qualitative method. The material to this study has been collected by doing qualitative interviews with six people in different professions and positions in psychiatric acute care.    The material that we collected from these six qualitative interviews has been analysed with help from Sherif’s and Hovland’s (1961) Social judgement theory. The theory describes people’s judgement based on certain criterions and how it affects them.     It has been noticed that the individuals who asses first acute care are usually the ones that has a suicidal behavior. The resources are decreasing while the need for psychiatric acute care is increasing. The personell have to make decisions about which individual that are in most need of acute care. Their judgments are very important for the indiviuals in need of immediate care. This judgement can be depending on which individual who is doing the judgemet. This paper has given us comprehension for the immortance of good individual properties for doing judgements, and that they are made in several positions.

The purpose of this study was to explore the referrals that were generated from one hospital emergency room to a community outreach team. This study used a specific geriatric program assessment team in Winnipeg, Manitoba, Canada as the community outreach team. Malcolm Payne’s description of Task Centered Casework and Crisis Intervention and Irene Pollin’s Medical Crisis Counseling served as the theoretical structure and design to gain an understanding of the reasons geriatric patients were referred to the GPAT on discharge. This study aimed to answer three research questions: 1) What is the emergency room medical team’s main reason for referral to a geriatric outreach team? 2) Are the referrals received from the emergency room medical team clearly identifying psychosocial issues as areas for examination by an outreach team? 3) Are psychosocial issues identified only after an outreach team clinician completed a comprehensive assessment? This study revealed that out of the 209 referrals to geriatric program assessment team, the highest number of times referred was for functional decline. It revealed that the emergency room medical team saw functional decline as a valid reason to have the geriatric program assessment team assess the individual in their home settings to ensure that any functional issue be addressed and possible adaptations made in a timely manner to avoid the reverberation that one ailment can set off. The second most common reason for referring to the geriatric program assessment team was for social issues. Forty percent of the referrals identified that there were concerns in relation to social issues which clearly identifies that the emergency room medical team identified psychosocial issues as an area for further examination. And finally, the findings show psychosocial issues were not identified only after an outreach team clinician completed a comprehensive assessment, but that both appear cognizant of the interplay between medical issues and social issues.

The purpose of this study was to explore the referrals that were generated from one hospital emergency room to a community outreach team. This study used a specific geriatric program assessment team in Winnipeg, Manitoba, Canada as the community outreach team. Malcolm Payne’s description of Task Centered Casework and Crisis Intervention and Irene Pollin’s Medical Crisis Counseling served as the theoretical structure and design to gain an understanding of the reasons geriatric patients were referred to the GPAT on discharge. This study aimed to answer three research questions: 1) What is the emergency room medical team’s main reason for referral to a geriatric outreach team? 2) Are the referrals received from the emergency room medical team clearly identifying psychosocial issues as areas for examination by an outreach team? 3) Are psychosocial issues identified only after an outreach team clinician completed a comprehensive assessment? This study revealed that out of the 209 referrals to geriatric program assessment team, the highest number of times referred was for functional decline. It revealed that the emergency room medical team saw functional decline as a valid reason to have the geriatric program assessment team assess the individual in their home settings to ensure that any functional issue be addressed and possible adaptations made in a timely manner to avoid the reverberation that one ailment can set off. The second most common reason for referring to the geriatric program assessment team was for social issues. Forty percent of the referrals identified that there were concerns in relation to social issues which clearly identifies that the emergency room medical team identified psychosocial issues as an area for further examination. And finally, the findings show psychosocial issues were not identified only after an outreach team clinician completed a comprehensive assessment, but that both appear cognizant of the interplay between medical issues and social issues.

<p>In this paper the authors are focusing on people that work in psychiatric acute care. How do they identify the individual that is in most need of acute care? How do they judge in this kind of cases? <strong></strong></p><p>   The foundation in this study is in the qualitative method. The material to this study has been collected by doing qualitative interviews with six people in different professions and positions in psychiatric acute care.</p><p>   The material that we collected from these six qualitative interviews has been analysed with help from Sherif’s and Hovland’s (1961) Social judgement theory. The theory describes people’s judgement based on certain criterions and how it affects them. </p><p>   It has been noticed that the individuals who asses first acute care are usually the ones that has a suicidal behavior. The resources are decreasing while the need for psychiatric acute care is increasing. The personell have to make decisions about which individual that are in most need of acute care<strong>. </strong>Their judgments are very important for the indiviuals in need of immediate care. This judgement can be depending on which individual who is doing the judgemet. This paper has given us comprehension for the immortance of good individual properties for doing judgements, and that they are made in several positions.</p>

Abstract The purpose of this study was to describe and explain the care of older people with dementia in surgical wards from the viewpoints of the patients and their close relatives, nursing staff and physicians. The study was conducted in two stages. The first stage of the study was conducted with a qualitative approach, collecting the data from older people with dementia (n=7), their close relatives (n=5), nursing staff (n=19) and physicians (n=9) using individual and group interviews. The data were analysed using inductive content analysis. The approach in the second stage was quantitative: data were collected with a questionnaire from the nursing staff (n=191). The data were analysed using descriptive statistics as well as explorative factor analysis. The nursing staff stated that responding to the physical, psychological and social needs of patients with dementia requires more effort and time than usual. The nursing staff pointed out that they did not have all the required know-how to provide good care for older people with dementia. The nursing staff with longer work experience indicated doing nothing more often than other nursing staff when encountering challenge behaviour of a patient with dementia. Concerns about well-being of a patient and feeling shame about patient’s behavioural symptoms were causing exhaustion among close relatives. Relatives expected some time for personal dialogue and support from the nursing staff. The patients experienced that they did not get enough information about their own care. The study provides new information that can be used to develop the care of older people with dementia in hospital environment. The results can be utilized in basic, further and updating education in the field of health care. / Tiivistelmä Tutkimuksen tarkoituksena oli kuvata ja selittää ikääntyvän muistisairaan potilaan hoitotyötä kirurgisella vuodeosastolla muistisairaiden potilaiden, omaisten, hoitohenkilökunnan ja lääkäreiden näkökulmasta. Tutkimus toteutettiin kahdessa vaiheessa. Ensimmäisen vaiheen lähestymistapa oli kvalitatiivinen eli laadullinen, ja aineisto kerättiin kirurgisilla vuodeosastoilla olevilta muistisairailta potilailta (n=7), omaisilta (n=5), hoitohenkilökunnalta (n=19) ja lääkäreiltä (n=9) yksilö-, pari- ja ryhmähaastatteluina. Aineisto analysoitiin induktiivisella sisällön analyysilla. Tutkimuksen toisen vaiheen lähestymistapa oli kvantitatiivinen eli määrällinen, ja aineisto kerättiin kyselylomakkeella kirurgisilla vuodeosastoilla työskentelevältä hoitohenkilökunnalta (n=191). Aineisto analysoitiin käyttäen kuvailevan tilastotieteen menetelmiä sekä eksploratiivista faktorianalyysia. Ikääntyvän muistisairaan potilaan hoitotyössä korostui fyysiseen, psyykkiseen ja sosiaaliseen avuntarpeeseen vastaaminen, joka vaati keskimääräistä enemmän aika- ja henkilöstöresursseja. Hoitohenkilökunta toi esille, ettei heillä ollut tarvittavaa tieto-taitoa muistisairaiden potilaiden hoitamiseen. Hoitajat, joilla oli pitkä työkokemus reagoivat muistisairaan potilaan käytösoireisiin muita hoitajia välinpitämättömämmin. Huoli potilaan voinnista ja häpeän tunne potilaan käytösoireista aiheuttivat puolestaan omaisen uupumista. Omaiset kaipasivatkin henkilökunnalta keskusteluapua ja tukea. Potilaat taas kokivat, etteivät he saaneet tarpeeksi tietoa hoitoaan koskevista asioita. Tutkimuksella tuotetaan uutta tietoa, jonka avulla voidaan kehittää ikääntyvän muistisairaan potilaan hoitotyötä sairaalaympäristössä. Tuloksia voidaan hyödyntää terveydenhuoltoalan perus-, jatko- ja täydennyskoulutuksessa.

Background: The diagnoses of dementia increases in line with the aging population of the earth. Symptoms vary between different dementia diagnoses and for some, a diagnosis might be a relief and confirmation of what’s really going on for both the patient and their relatives. Person centered care aims to empower a person's self-esteem and involvement in their own care. It urges healthcare professionals to look beyond the diagnosis of the patient, which makes this the form of care advocated for patients with dementia. Despite the fact that long waiting times is an acknowledged problem, nurses are still obliged to pursue nursing on equal standardse. Aim: The aim was to acknowledge nurses' experiences of caring for patients with dementia in acute care settings Method: A literature-based study with nine qualitative articles were chosen. Results: The analysis identified three main categories; lack of knowledge, structural deficiencies and relatives as a co-actor of the caring process, and eight subcategories. Conclusion: Dedication and education are central aspects regarding the care of patients with dementia. It becomes apparent that regardless of context, caring for patients with dementia is often mired in complexity. Nurses claim that lack of time and education combined with structural deficiencies constitutes an obstacle for nurses providing what they would consider sufficient care. These deficiencies may also negatively affect attitudes and perceptions and consequently the care of patients with dementia can be stigmatized. / Bakgrund: Diagnostik av demens ökar i takt med världens åldrande befolkning. Symtom skiljer sig mellan olika diagnostyper och en diagnos kan innebära en lättnad och bekräftelse för både patient och anhöriga. Den vårdform som förespråkas för patienter med demens är personcentrerad vård som syftar till att stärka en persons självkänsla och delaktighet i vården och se bortom diagnoser. Även om väntetiderna på landets akutmottagningar är erkänt långa för äldre patienter har sjuksköterskor en skyldighet att ge omvårdnad på en likvärdig grund. Syfte: Syftet med studien var att belysa sjuksköterskors erfarenheter av att vårda patienter med demens på akutvårdsavdelningar. Metod: En litteraturbaserad studie valdes där nio kvalitativa artiklar analyserats Resultat: Ur analysen framträdde tre kategorier; bristande kunskap, strukturella brister och anhöriga en medaktör i vårdandet med åtta underkategorier. Konklusion: Vårdandet av patienter med demens kräver engagemang och utbildning och det visar sig att det oavsett kontext är komplext att vårda patienter med demens. Sjuksköterskors erfarenheter visar att tid, utbildning och strukturella brister utgör ett hinder i vårdandet. Dessa brister kan även påverka attityder i negativ riktning och vårdandet av patienter med demens kan stigmatiseras.

BACKGROUND: A comprehensive Primary Health Care approach includes clear referral and continuity of care pathways. South Africa lacks data that describe Intermediate Care (IC) services and its role in the health system. This study aimed to describe the model of service provision at an IC facility and the role it plays in the continuity of care in Cape Town. METHODS: Sixty-eight patients (65% Response Rate) were recruited in a prospective cohort design over a one-month period in mid-2011. Patient data were collected from a clinical record review and an interviewer-administered questionnaire, administered at a median interval between admission and interview of 11 days to assess primary and second ary diagnosis, knowledge of and previous use of Home Based Care (HBC) services, reason for admission, demographics and information on referring institution. A telephonic interviewer-administered questionnaire to patients or their family members post-discharge recorded their vital status, use of HBC post-discharge and their level of satisfaction with care received at the IC facility. A Cox regression model was run to identify predictors of survival and the effect of a Care-plan on survival. Seventy staff members (82%) were recruited in a cross-sectional study using a self-administered questionnaire to describe demographics, level of education and skills in relation to what they did for patients and what they thought patients needed. RESULTS: Of the 68 participants, 38 % and 24% were referred from a secondary and tertiary hospital, respectively, and 78% were resident of a higher income community. Stroke (35%) was the most common single reason for admission at acute hospital. The three most common reasons reported by patients why care was better at the IC facility than the referring institution was the caring and friendly staff, the presence of physiotherapy and the wound care. Even though a large proportion of the IC inpatients had been admitted in a health facility on the year preceding the study, only 13 patients (21%) had used a Community Health Worker (CHW) ever before and only 25% (n=15) of the discharged patients had a confirmed CHW visit post-discharge. The presence of a Care-plan was significantly associated with a 62% lower risk of death (Hazard Ratio: 0.380; CI 0.149-0.972). Notably, 46% of staff members reported performing roles that were outside their scope of practice and there was a mismatch between what staff reported doing and their actual tasks. In addition, of the 57 patients that could be traced on follow-up 21(37%) had died. CONCLUSION: Patients and family understood this service as a caring environment that is primarily responsible for rehabilitation services. Furthermore, a Care-plan which extends beyond admission could have a significant impact on reducing mortality. IC services should therefore be recognised as an integral part of the health system and it should be accessed by all who need it.

Bakgrund Studier visar att nyexaminerade sjuksköterskor som kommer ut till arbetslivet beskriver det som en ”verklighetschock” då det kan vara stressfullt och de är inte beredda på det. Akuta vårdsituationer är något man ställs inför som sjuksköterska och det förväntas av dem att kunna hantera detta. Studier visar även att det finns svårigheter för de nyexaminerade sjuksköterskorna som kommer ut i arbetslivet. Syfte Syftet var att beskriva nyexaminerade sjuksköterskors upplevelse av att ställas inför akuta vårdsituationer. Metod Examensarbetet har genomförts som en strukturerad litteraturstudie med inslag av den metodologi som används vid systematiska översikter. Databaserna CINAHL och PubMed har använts och elva artiklar hittades. En integrerad analys användes för att ta fram resultatet. Resultat Resultatet landade i tre kategorier: emotionella reaktioner, olika aspekter av kompetens och organisatorisk påverkan. Inom varje kategori formulerades två underkategorier. Underkategorierna är tvivel på sig själv, hantering av svår sjukdom och död, teoretisk kompetens, handlingsberedskap, brist på stöd samt brist på tid. Slutsats Resultatet visar att nyexaminerade sjuksköterskor upplever den första tiden som utmanande. Utmaningar som upplevdes var brist på resurser som exempelvis tid och stöd från övriga kollegor. Otillräcklig erfarenhet var något som hindrade handlingsberedskapen i akuta vårdsituationer. En tänkbar lösning till detta skulle kunna vara ett introduktionsprogram med mentorskap för de nyexaminerade sjuksköterskorna. / Background Studies show that newly graduated nurses who come out to workforce describes it as a“reality shock” because it can be stressful, and the newly graduated nurses is not preparedfor that. Acute care situations are something that a RN face and is expected to manage. Studies also shows that there are difficulties for newly graduated nurses entering the workforce, therefore this bachelor ́s thesis was accomplished. Aim The aim was to describe newly graduated nurses’ experiences of managing acute care situations. Method This bachelor ́s thesis has been accomplished as a structured literature study with elements of the methodology used in systematic reviews. The databases CINAHL and PubMed have been used and eleven articles was found. An integrated analysis was used to find the result. Results The results resulted in three categories: emotional reactions, different aspects of competence and organizational impact. Within each category, two subcategories were formulated. The subcategories are self-doubt, management of serious illness and death, theoretical competence, preparedness of action, lack of support and lack of time. Conclusions The results show that newly graduated nurses experience the first period as challenging. Challenges that were experienced were a lack of resources such as time and support from other colleagues. Insufficient experience was something that hindered readiness for action in acute care situations. A possible solution to this could be an introductory program with mentoring for the newly graduated nurses.

Bakgrund: Ett personcentrerat förhållningssätt innebär en holistisk syn på patienten där det etableras ett partnerskap mellan patient och sjuksköterska. Ett personcentrerat förhållningssätt upplevs svårt att implementera i det dagliga arbetet inom vården. Akutsjukvårdsmiljöer präglas av att medicinska åtgärder i första hand måste prioriteras och det finns kort om tid i kritiska situationer. Det kan uppstå en konflikt mellan personcentrerad vård och de medicinska insatserna. Syfte: Syftet var att belysa sjuksköterskans upplevelse av ett personcentrerat förhållningssätt i akutsjukvårdsmiljöer. Metod: En allmän litteraturstudie där tio artiklar granskades och bearbetades med hjälp av innehållsanalys. Resultat: Sjuksköterskan upplever att det finns hinder och främjande faktorer för ett personcentrerat förhållningssätt inom akutsjukvårdsmiljöer. Hindrande faktorer är relaterade till: tidsbrist och hög arbetsbelastning, brist på organisatoriskt stöd, begränsade rutiner, sjuksköterskans brist på intresse och emotionell stress. Främjande faktorer är relaterade till: patientrelation, kommunikation, kunskap och kompetens, samverkan i team, organisationens stöd och arbetsglädje. Konklusion: Sjuksköterskorna upplever att ett personcentrerat förhållningssätt inom akutsjukvårdsmiljöer skulle kunna förbättra vårdkvalitén och öka arbetsglädjen. / Background: A person-centred approach means a holistic view of the patient where a partnership is established between the patient and the nurse. Personcentred care is perceived as difficult to implement in the daily work in health care. Emergency care environments are characterized by the fact that medical interventions must be prioritized in the first place and there is little time available in critical situations. A conflict between person-centred care and medical interventions might occur. Aim: The aim was to illustrate the nurse’s experience of a person-centred approach in emergency care environments. Method: A general literature study in which ten articles were reviewed and processed using content analysis. Results: The nurse experienced barriers and promoting factors a person-centred approach in emergency care environments Hindering factors are related to lack of time and high workload, lack of organizational support, limiting routines, the nurse’s lack of interest and emotional stress. Promoting factors are related to patient relationship, communication, knowledge and competence, collaboration in teams, organizational support and job satisfaction. Conclusion: The nurses experience that a person-centred approach in emergency care environments could improve the quality of care and increase job satisfaction.

The adoption of healthcare information technology (HIT) has been advocated by various groups as critical in addressing the growing crisis in the healthcare industry. Despite the plethora of evidence on the benefits of HIT, however, the healthcare industry lags behind many other economic sectors in the adoption of information technology. A significant number of healthcare providers still keep patient information on paper. With the recent trends of reimbursement reduction and rapid technological advances, therefore, it would be critical to understand differences in structural characteristics and healthcare performance between providers that do and that do not adopt HIT. This is accomplished in this research, first by identifying organizational and contextual factors associated with the adoption of HIT in US acute care hospitals and second by examining the relationships between the adoption of HIT and two important healthcare outcomes: patient safety and quality of care. After conducting literature a review, the structure-process-outcome model and diffusion of innovations theory were used to develop a conceptual framework. Hypotheses were developed and variables were selected based on the conceptual framework. Publicly available secondary data were obtained from the American Hospital Association (AHA), the Health Information and Management Systems Society (HIMSS), and the Healthcare Cost and Utilization Project (HCUP) databases. The information technologies were grouped into three clusters: clinical, administrative, and strategic decision making ITs. After the data from the three sources were cleaned and merged, regression models were built to identify organizational and contextual factors that affect HIT adoption and to determine the effects of HIT adoption on patient safety and quality of care. Most prior studies on HIT were restricted in scope as they primarily focused on a limited number of technologies, single healthcare outcomes, individual healthcare institutions, limited geographic locations, and/or small market segments. This limits the generalizability of the findings and makes it difficult to draw definitive conclusions. The new contribution of the present study lies in the fact that it uses nationally representative latest available data and it incorporates a large number of technologies and two risk adjusted healthcare outcomes. Large size and urban location were found to be the most influential hospital characteristics that positively affect information technology adoption. However, the adoption of HIT was not found to significantly affect hospitals' performance in terms of patient safety and quality of care measures. Perhaps a remarkable finding of this study is the better quality of care performance of hospitals in the Midwest, South, and West compared to hospitals in the Northeast despite the fact that the latter reported higher HIT adoption rates. In terms of theoretical implications, this study confirms that organizational and contextual factors (structure) affect adoption of information technology (process) which in turn affects healthcare outcomes (outcome), though not consistently, validating Avedis Donabedian's structure-process-outcome model. In addition, diffusion of innovations theory links factors associated with resource abundance, access to information, and prestige with adoption of information technology. The present findings also confirm that hospitals with these attributes adopted more technologies. The methodological implication of this study is that the lack of a single common variable and uniformity of data among the data sources imply the need for standardization in data collection and preparation. In terms of policy implication, the findings in this study indicate that a significant number of hospitals are still reluctant to use clinical HIT. Thus, even though the passage of the American Recovery and Reinvestment Act (ARRA) of 2009 was a good stimulus, a more aggressive policy intervention from the government is warranted in order to direct the healthcare industry towards a better adoption of clinical HIT.