Diss. (sammanfattning) Umeå : Univ., 2007. / Härtill 4 uppsatser.

Current situation: Educated and qualified nurse can fully do her job, give a patient bio-psycho-social-spiritual needs and satisfy them. This can happen only if optimal conditions are given to her, which means the optimal number of nursing staff. The aim of the study was to set the optimal number of nursing staff at surgical department in the Hospital of the Vysočina region, which was chosen. A standardized methodology of Pochylá and Pochylý (1999 and 2008) was used. Methodology and the research complex: Quantitative-qualitative method was used in the research. Detailed interviews were used in the first part of the study while talking to nurses of the surgical department of the Hospital of the Vysočina region. In phase two, 26 special nursing procedures were selected and divided into four thematic parts. 520 measurements were made in total, average time of making each special nursing procedure was set. In phase three, average values of nursing one patient in 12 hours at surgical department were set. Daily shots of the procedures were being taken for 14 days (Monday-Sunday). Optimal numbers of nursing staff and their qualified substitution in the Hospital of the Vysočina region were set in the last stage of the research. Results: The research question and three hypotheses were answered by performing and processing the research. The result is that there are statistically major differences in average value of basic and special nursing. 21 patients in average were treated in the hospital in the first week of research. The average nursing time for this number of patients in 12 hours was 3585 minutes 1027 minutes of basic nursing care and 1718 minutes of special nursing procedures. In the second week of research, 24 patients were treated at the department in average. The average nursing time for this number of patients was 3647 minutes in 12 hours 1036 minutes of basic nursing care and 1675 minutes of special nursing procedures. Statistically major differences were confirmed even during special nursing procedures. The longest average time was measured while incoming of patients, transferring, discharging (14,31 minutes) and the shortest average time was measure while applicating medicine into body cavities (0,5 minutes). Based on the research we can say that the number of staff at selected department is for a 12-hour shift optimal. Recommended number of full-time employees is 5, the real number is 5,4. Conclusion and recommendation: The output of this thesis is recommendation for management of nursing care regarding the issue of getting and maintaining the optimal number of nursing staff.

Com a finalidade de analisar os indicadores intervenientes do dimensionamento de profissionais de enfermagem, para assistência no período transoperatório do Centro Cirúrgico (CC), especializado em oncologia, foi realizada esta investigação de abordagem quantitativa, tipo estudo de caso, observacional, transversal e descritiva. A metodologia empregada compreendeu: identificação das atividades, por meio do registro no prontuário e da observação das atividades executadas pela equipe de enfermagem; mapeamento das atividades em linguagem padronizada de intervenções de enfermagem, segundo a Nursing Interventions Classification (NIC); validação das intervenções/atividades de enfermagem, utilizando a técnica de oficina de trabalho; mensuração do tempo despendido nas intervenções/atividades de enfermagem, adotando-se a técnica de amostragem do trabalho e identificação dos indicadores para o cálculo de profissionais de enfermagem. Foram identificadas e validadas 49 intervenções de enfermagem, sete domínios e 20 classes, segundo a taxonomia da NIC. Obteve-se 4831 mensurações de intervenções/atividades realizadas pela equipe de enfermagem, no transoperatório do CC. Os profissionais despenderam: enfermeiros 42,79% do seu tempo em intervenções de cuidados diretos e 42,00% em indiretos, 8,00% em atividades pessoais e 7,21% em associadas ao trabalho; técnicos de enfermagem (Circulação de Sala de Operação - CSO) 64,27% em intervenções de cuidados diretos e 30,46% em indiretos, 0,45% em atividades associadas e 4,82% em pessoais; técnicos de enfermagem (Instrumentação Cirúrgica - IC) 94,85% em intervenções de cuidados diretos e 2,20% em indiretos e 2,95% em atividades pessoais; técnicos de enfermagem (Recepção de Pacientes - RP) 57,08% em intervenções de cuidados diretos e 28,75% em indiretos, 7,92% em atividades associadas e 6,25% em pessoais e a equipe de enfermagem 70,91% em intervenções de cuidados diretos e 22,38% em indiretos, 2,05% em atividades associadas e 4,66% em pessoais ao trabalho. O domínio da taxonomia da NIC, de maior representatividade para a equipe de enfermagem, foi o Fisiológico Complexo (61,68%), com a intervenção Assistência Cirúrgica (30,62%), a mais frequente. No período de estudo, foram realizadas 85 cirurgias, com o maior movimento cirúrgico de porte I (34,12%); tempo médio do intraoperatório de 218,10min; tempo médio para o intervalo de substituição de cirurgia de 48,12min, correspondendo ao tempo médio de limpeza e reabastecimento da SO de 33,81min e ao tempo médio de espera de 14,31min. A taxa de ocupação do CC foi de 78,57% e a quantidade de SO foi adequada para o atendimento de cirurgias eletivas e urgência/emergência e encaixes. O enfermeiro participa 18,38% e os técnicos de enfermagem 81,62% da carga de trabalho. A produtividade da equipe de enfermagem atingiu 95,34%, considerada alta, com base nos dados preconizados na literatura. A análise dos indicadores intervenientes no dimensionamento de profissionais de enfermagem do CC possibilitou reformular a equação proposta por Possari (2001) e obter valores mais próximos à realidade do CC. O conhecimento da carga de trabalho, no que se refere à identificação das intervenções/atividades realizadas pela equipe de enfermagem, poderá contribuir na argumentação efetiva de um quadro de profissionais adequado às necessidades de cuidado, no período transoperatório, que proporcione segurança ao paciente e à equipe de enfermagem que o assiste. / In order to analyze indicators involved in nursing staff for assistance during the perioperative period of a Specialized Oncology Surgical Center (SC), this observational, transverse and descriptive case study was carried out in a quantitative method. The methodology included: identification of activities by means of written records and observation of activities performed by nursing staff; mapping activities in standardized language of nursing interventions according to Nursing Interventions Classification (NIC), validation of interventions / nursing activities using the workshop technique , measuring time spent on interventions / nursing activities adopting the work-sampling technique and identifying indicators for the calculation of nursing staff. Forty-nine nursing interventions, seven domains and 20 classes were identified and validated, according to NIC taxonomy. We obtained 4831 measurements of interventions / activities performed by nursing staff, in the perioperative period, at the SC. Time spent by the professionals were as follows: nurses 42.79% of their time in direct care interventions and 42.00% in indirect, 8.00% on personal activities and 7.21% in work-related activities; nursing technicians (Room Operating Circulation - ROC) 64.27% in direct care interventions and 30.46% in indirect activities, 0.45% in associated activities and 4.82% on personal activities; nursing technicians (Instrumented surgery - IS) 94.85% in direct care interventions and 2.20% indirect and 2.95% on personal activities; nursing technicians (Patient Reception area- PR) 57.08% in direct care interventions and 28.75% indirect, 7.92 % in associated activities and 6.25% on personal activities and nursing staff 70.91% in direct care interventions and 22.38% indirect , 2.05% in associated activities and 4.66% on personal related-work. The most representative NIC taxonomy domain for the nursing staff was the Physiological Complex (61.68%), being the Surgical Assistance intervention (30.62%) the most frequent. During the study 85 surgeries were performed, with predominance of surgeries of major size procedures (34.12%), mean time of intraoperative 218.10 min, mean time interval for replacement surgery of 48.12 min, corresponding to the mean time for cleaning and refilling the OR of 33.81 min and the mean time of waiting 14.31 min. The occupancy rate of SC was 78.57% and the number of OR was adequate for the assistance of elective and urgent/emergency and optional surgeries. The nurse participates 18.38% of the workload and nursing technicians 81.62%. The nursing staff productivity reached 95.34%, considered high when compared to data recommended in the literature. The analysis of the intervenient indicators involved in nursing staff on SC allowed to reformulate the equation proposed by Possari (2001) and to obtain values closer to the reality of SC. Knowledge of the workload with regard to identification of interventions / activities performed by nursing staff may help in effective reasoning about a professional staff appropriate to the needs of care during perioperative period, providing safety for patient and nursing staff.

Com a finalidade de analisar os indicadores intervenientes do dimensionamento de profissionais de enfermagem, para assistência no período transoperatório do Centro Cirúrgico (CC), especializado em oncologia, foi realizada esta investigação de abordagem quantitativa, tipo estudo de caso, observacional, transversal e descritiva. A metodologia empregada compreendeu: identificação das atividades, por meio do registro no prontuário e da observação das atividades executadas pela equipe de enfermagem; mapeamento das atividades em linguagem padronizada de intervenções de enfermagem, segundo a Nursing Interventions Classification (NIC); validação das intervenções/atividades de enfermagem, utilizando a técnica de oficina de trabalho; mensuração do tempo despendido nas intervenções/atividades de enfermagem, adotando-se a técnica de amostragem do trabalho e identificação dos indicadores para o cálculo de profissionais de enfermagem. Foram identificadas e validadas 49 intervenções de enfermagem, sete domínios e 20 classes, segundo a taxonomia da NIC. Obteve-se 4831 mensurações de intervenções/atividades realizadas pela equipe de enfermagem, no transoperatório do CC. Os profissionais despenderam: enfermeiros 42,79% do seu tempo em intervenções de cuidados diretos e 42,00% em indiretos, 8,00% em atividades pessoais e 7,21% em associadas ao trabalho; técnicos de enfermagem (Circulação de Sala de Operação - CSO) 64,27% em intervenções de cuidados diretos e 30,46% em indiretos, 0,45% em atividades associadas e 4,82% em pessoais; técnicos de enfermagem (Instrumentação Cirúrgica - IC) 94,85% em intervenções de cuidados diretos e 2,20% em indiretos e 2,95% em atividades pessoais; técnicos de enfermagem (Recepção de Pacientes - RP) 57,08% em intervenções de cuidados diretos e 28,75% em indiretos, 7,92% em atividades associadas e 6,25% em pessoais e a equipe de enfermagem 70,91% em intervenções de cuidados diretos e 22,38% em indiretos, 2,05% em atividades associadas e 4,66% em pessoais ao trabalho. O domínio da taxonomia da NIC, de maior representatividade para a equipe de enfermagem, foi o Fisiológico Complexo (61,68%), com a intervenção Assistência Cirúrgica (30,62%), a mais frequente. No período de estudo, foram realizadas 85 cirurgias, com o maior movimento cirúrgico de porte I (34,12%); tempo médio do intraoperatório de 218,10min; tempo médio para o intervalo de substituição de cirurgia de 48,12min, correspondendo ao tempo médio de limpeza e reabastecimento da SO de 33,81min e ao tempo médio de espera de 14,31min. A taxa de ocupação do CC foi de 78,57% e a quantidade de SO foi adequada para o atendimento de cirurgias eletivas e urgência/emergência e encaixes. O enfermeiro participa 18,38% e os técnicos de enfermagem 81,62% da carga de trabalho. A produtividade da equipe de enfermagem atingiu 95,34%, considerada alta, com base nos dados preconizados na literatura. A análise dos indicadores intervenientes no dimensionamento de profissionais de enfermagem do CC possibilitou reformular a equação proposta por Possari (2001) e obter valores mais próximos à realidade do CC. O conhecimento da carga de trabalho, no que se refere à identificação das intervenções/atividades realizadas pela equipe de enfermagem, poderá contribuir na argumentação efetiva de um quadro de profissionais adequado às necessidades de cuidado, no período transoperatório, que proporcione segurança ao paciente e à equipe de enfermagem que o assiste. / In order to analyze indicators involved in nursing staff for assistance during the perioperative period of a Specialized Oncology Surgical Center (SC), this observational, transverse and descriptive case study was carried out in a quantitative method. The methodology included: identification of activities by means of written records and observation of activities performed by nursing staff; mapping activities in standardized language of nursing interventions according to Nursing Interventions Classification (NIC), validation of interventions / nursing activities using the workshop technique , measuring time spent on interventions / nursing activities adopting the work-sampling technique and identifying indicators for the calculation of nursing staff. Forty-nine nursing interventions, seven domains and 20 classes were identified and validated, according to NIC taxonomy. We obtained 4831 measurements of interventions / activities performed by nursing staff, in the perioperative period, at the SC. Time spent by the professionals were as follows: nurses 42.79% of their time in direct care interventions and 42.00% in indirect, 8.00% on personal activities and 7.21% in work-related activities; nursing technicians (Room Operating Circulation - ROC) 64.27% in direct care interventions and 30.46% in indirect activities, 0.45% in associated activities and 4.82% on personal activities; nursing technicians (Instrumented surgery - IS) 94.85% in direct care interventions and 2.20% indirect and 2.95% on personal activities; nursing technicians (Patient Reception area- PR) 57.08% in direct care interventions and 28.75% indirect, 7.92 % in associated activities and 6.25% on personal activities and nursing staff 70.91% in direct care interventions and 22.38% indirect , 2.05% in associated activities and 4.66% on personal related-work. The most representative NIC taxonomy domain for the nursing staff was the Physiological Complex (61.68%), being the Surgical Assistance intervention (30.62%) the most frequent. During the study 85 surgeries were performed, with predominance of surgeries of major size procedures (34.12%), mean time of intraoperative 218.10 min, mean time interval for replacement surgery of 48.12 min, corresponding to the mean time for cleaning and refilling the OR of 33.81 min and the mean time of waiting 14.31 min. The occupancy rate of SC was 78.57% and the number of OR was adequate for the assistance of elective and urgent/emergency and optional surgeries. The nurse participates 18.38% of the workload and nursing technicians 81.62%. The nursing staff productivity reached 95.34%, considered high when compared to data recommended in the literature. The analysis of the intervenient indicators involved in nursing staff on SC allowed to reformulate the equation proposed by Possari (2001) and to obtain values closer to the reality of SC. Knowledge of the workload with regard to identification of interventions / activities performed by nursing staff may help in effective reasoning about a professional staff appropriate to the needs of care during perioperative period, providing safety for patient and nursing staff.

Sammanfattning Ett hälsofrämjande ledarskap bidrar till att främja hälsan hos sina medarbetare. Året 2020 blev ett speciellt år på många sätt, men speciellt inom vård och omsorg. Syftet med denna studie var att öka kunskapen om olika synsätt som finns på ett hälsofrämjande ledarskap hos vård och omsorgspersonal. En kvalitativ metod valdes och datainsamlingsmetod var semistrukturerade intervjuer. Fem informanter deltog i studien varav alla jobbar inom kommunal vård och omsorg i Göteborgs Stad. Informanterna intervjuades med hjälp av en intervjuguide och materialet analyserades enligt en innehållsanalys. De framkom tre teman ur materialet ledarskap, hälsofrämjande insatser och arbetsplatsen. Resultatet visar centrala delar inom ledarskap var närvarande, information, kommunikation och återhämtning. Hälsofrämjande insatserbeskrevs som friskvård och planeringsdagar. Under arbetsplats framkom sjukfrånvaro och vikarier samt skyddsutrustning. Slutsatsen är att ledarskapet varit positivt om än literörigt under pandemin. Under året 2020 har störst skillnader varit skyddsutrustningen och frånvaro eller anpassningar kring planeringsdagar.

Sammanfattning Titel: I mötet med depressiv ohälsa på äldreboenden Handledare: Anna Siverskog Examinator: Klas Borell Forskning pekar på en betydande omfattning av depressiv ohälsa bland äldre på äldreboende, något som medför mänskligt lidande och hög belastning på samhället. Mot den bakgrunden ämnar följande studie undersöka förekomst och symtombild av denna ohälsa utifrån vård-och omsorgspersonals erfarenheter. Studien syftar även till att utforska de bemötande- och arbetsstrategier som medarbetarna använder i sina yrkesroller samt om olika yrkesbakgrund förefaller utgöra grund för skillnader i arbetet med depressiva äldre på äldreboenden. I syfte att besvara frågeställningarna har semistrukturerade intervjuer gjorts med elva yrkesverksamma personer. Bearbetning av empirin har skett utifrån en tematisk ansats och med stöd av teorierna kring ålderism och livslopp.  Den upplevda förekomsten av depressiv ohälsa varierar utifrån intervjupersonernas erfarenheter, men flertalet upplever att problematiken är omfattande bland de äldre på boenden. Symtomen för depressiv ohälsa skiftar, men det råder samstämmighet bland de intervjuade att symtomen ofta är diffusa och sällan uttrycks med konkreta ord. Personalen beskriver att de utifrån sin kompetens och i nära samarbete inom arbetsgruppen använder sig av olika övergripande bemötandestrategier som anpassas utifrån de individuella behoven och förutsättningarna med ambitionen att bedriva en god vård. Mindre skillnader mellan yrkesgrupperna har iakttagits i det att sjuksköterskorna förefaller ge uttryck för en starkare tilltro till kliniskt medicinsk vård medan omvårdnadspersonalen i större utsträckning lyfter dess risker och i stället framhåller vikten av nära relationer för att skapa god vård och omsorg.  Begränsade förutsättningar i tid och kompetens utgör dock hinder och belyser behovet av att förhålla sig till ålderistiska föreställningar och tillskapa resurser för att leva upp till samhällets ambitioner för en äldreomsorg som möter allt fler äldre med komplex problematik. Det är av vikt att rikta forskning mot hur vård-och omsorgspersonalens uttryckta behov av ökad individuell kompetens avseende depressiv ohälsa bland äldre kan understödjas på ett optimalt sätt. / Abstract Title: Dealing with depressive illness in nursing homes Tutor: Anna Siverskog Examinator: Klas Borell Research indicates a significant extent of depressive illness among the elderly in nursing homes, something that causes human suffering and a high burden on society. The following study intends to investigate the prevalence and symptoms based on the experiences of health and care professionals. The study also aims to explore the treatment and work strategies that employees use in their professional roles and whether different professional backgrounds seem to form differences in working with depressed elderly people in nursing homes. Eleven semi-structured interviews were conducted with professionals in the specified field of work in order to answer the questions. The empirical data was processed using a thematic approach supported by theories of ageism and life course.   The perceived incidence of depressive illness varies based on the interviewees' experiences, but the majority experience this to be extensive among the elderly in nursing homes. The symptoms of depressive illness vary, but there is a consensus among the interviewees that the symptoms are often diffuse and rarely expressed in specific words. Care and nursing staff describe that, based on their competence and in close collaboration within the team, they use various overall treatment strategies based on the individual needs and conditions with the ambition of conducting good care. Minor differences between professional groups have been observed, nurses seem to express a stronger reliance on clinical medical care, while other nursing staff are more likely to highlight its risks and instead emphasize the importance of close relationships in providing good care and support. However, the study points towards that limited time and individual skills obstruct as well as highlight the need to address ageist notions and provide resources to meet society's ambitions for elderly care, which is facing an increasing number of older people with complex problems. It is important to focus research on how to optimally support the expressed needs of health and social care professionals, for increased individual competence in relation to depressive illness in older people.

Vård- och omsorgspersonal påverkas i dagsläget av hög stressrelaterad ohälsa, samtidigt som få interventioner implementeras för att hantera det. Studiens syfte var att utforska vård- och omsorgspersonals upplevelse av en internetbaserad stresshanteringskurs utifrån compassionfokuserad terapi med fokus på kursens genomförbarhet och hur den påverkat hantering av arbete och vardagligt liv. Flertalet regioner i Sverige representerades av elva deltagare som arbetade med direkt patientkontakt inom vård- och omsorg. Deltagarna besvarade frågeformulären Treatment Credibility Scale och “Utvärdering av stresshanteringskursen”. Sju deltagare deltog även i en semistrukturerad intervju som syftade till att utforska upplevelsen av kursen. Det insamlade materialet analyserades med kvalitativ innehållsanalys samt deskriptiv sammanställning av frågeformulären. Resultatet påvisade att kursen hade hög genomförbarhet som ökade deltagarnas upplevda stresshantering. Alla deltagarna beskrev nya förhållningssätt utifrån bland annat ökade insikter och nya färdigheter. Studiens resultat indikerar att en liknande kurs kan implementeras i större skala för att öka vård- och omsorgspersonals hantering av stress samt öka välmående. / Care and nursing staff are currently affected by high-stress-related health issues, while few interventions are implemented to handle it. The purpose of the study was to explore care and nursing staff´s experiences of an internet-based stress management course based on compassion-focused therapy with a focus on the course's feasibility and how it affected coping of work and everyday life stress. Some regions in Sweden were represented by eleven participants who worked with direct patient contact in healthcare. Participants answered the questionnaires Treatment Credibility Scale and “Evaluation of the stress management course”. Seven participants also participated in a semi-structured interview which aimed to explore the experience of the course. The material was analyzed with qualitative content analysis and a descriptive compilation of the questionnaires. The results showed that the course had high feasibility that increased the participants' stress management. All participants described new approaches based on, for instance, increased insights and new skills. The results of the study indicate that a similar course can be implemented to a greater extent to increase care and nursing staff's coping of stress and well-being. / ICOP

Det förekommer stora brister och utmaningar gällande utbildad vård- och omsorgspersonal, ekonomi, besparingar och dålig kommunikation inom vård- och omsorgssektorn i Sverige. Denna problematik skapar problem för det förebyggande arbetet inom smittskydd och vårdhygien. Genom att lyssna och lära av vård- och omsorgspersonalens berättelser och på detta sätt arbeta fram en mer hållbar plan för framtida pandemier och förhindra smittspridning av virus på särskilda boenden. Syfte-Syftet med studien är att granska om vård- och omsorgspersonal på särskilda boenden i en kommun i Västra Götaland upplevde att de hade tillgång tillkorrekt skyddsutrustning, grundläggande kunskap samt aktuell information inom smittskydd och vårdhygien för att stoppa smittspridning under covid-19 pandemin. Metod-Studien är en kvantitativ tvärsnittsstudie med vård- och omsorgspersonal i en liten kommun i Västra Götaland. Datainsamlingen har genomförts genom en online enkätundersökning med totalt 21 deltagare. Vård- och omsorgspersonalen arbetade på fyra särskilda boenden och ett korttidsboende i kommunen. Resultat- Av vård- och omsorgspersonalen upplevde 9,5 av 10 att de innan covid-19 pandemins start hade förkunskaper inom smittskydd och vårdhygien. Resultatet påvisar att majoriteten av studiepopulationen upplevde att tillfällena för utbildning inom smittskydd och vårdhygien ökade efter covid-19 pandemins början i kommunens verksamheter. Slutsats-Majoriteten av vård- och omsorgspersonalen upplevde att de hade till gång till grundläggande kunskap samt aktuell information inom smittskydd och vårdhygien. Det är viktigt att vård- och omsorgspersonalen förstår vikten i deras roll att arbeta smittförebyggande och främja ett hälsosamt åldrande i Sveriges äldrevård. / There appears to be big flaws and challenges regarding educated care staff, economy, savings and bad communication within health and care sector in Sweden, and this creates a problem in prevention work within infection control and care hygiene. By listening and learning of care staffs report and, on this way, working towards a more durable plan for future pandemics and prevent spread of virus in retirement homes. Aim- The purpose of the study is to examine whether care and nursing staff in retirement homes in a county in Västra Götaland felt that they had access to correct protective equipment, basic knowledge and current information within infection control and care hygiene in order to stop the spread of the infection during ongoing covid-19 pandemic.Methods- The study is a quantitative cross- sectional study with care staff from a county in Västra Götaland. The data collection has conducted through an online survey with a total of 21 participants. The care staff worked in four different retirement homes and one short-term accommodation. Results- By the care staff experienced 9,5 out of 10 that they before covid-19 pandemic start had previous knowledge within infection control and care hygiene. The result demonstrates that most of the study population experienced that the occasions for education within infection control and care hygiene increased after covid-19 pandemics start in the county operations. Conclusion- The majority of the health and care workes in the county in Västra Götaland felt that they had access to basic knowledge and information in infection controll and care hygiene, to stop the spread during the beginning and during the pandemic of covid-19.