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Syftet med studien var att undersöka kommunsjuksköterskan omvårdnadsdokumentation om bensår i hemsjukvård. Som metod valdes journalgranskning. Resultatet visade att omvårdnadsdokumentationen brister på många sätt. / Background: In Sweden, approximately 50 000 people suffers from slow-healing leg ulcers. The number of municipal registered nurses ́ has decreased in recent years. The municipal registered nurses ́ often hold function as an advisory consultant for the nursing staff and without participating in nursing care. This documentation is based on second-hand information from the nursing staff. Purpose: The aim was to investigate how municipal registered nurse care documents about leg ulcers in patients in home care practice. Method: An audit of patient journals was chosen to investigate how municipal registered nurse ́ care documents about leg ulcers in patients in home care practice. Results: The results are presented in five themes: contact cause, health and medical history, skin functions alternatively skin / tissue, skin action alternatively action / prescription skin / tissue and Ulcer case record. Beneath these themes the assessment of documentation was into incomplete, partially complete and complete. The result shows that the municipal registered nurse often documents in chronological order and not applying to the nursing process. The results also showed that the old documentation was not completed in the journal, which meant that it was difficult to follow a course of treatment. Discussion: The result shows that documentation in home care failures in many ways. Municipal registered nurse works as a consultant and is not involved in daily care. The documentation is based on second-hand information from the nursing staff and resulting in the documentation of leg ulcers is poor. Patient journals documentation was divided into different keyword, which means that it was difficult to follow the nursing process.

Cluster randomized trials (CRT) are comparative studies designed to evaluate interventions where the unit of analysis and randomization is the cluster but the unit of observation is individuals within clusters. Typically such designs involve a limited number of clusters and thus the variation between clusters is left uncontrolled. Experimental designs and analysis strategies that minimize this variance are required. In this work we focus on the CRT with pre-post intervention measures. By incorporating the baseline measure into the analysis, we can effectively reduce the variance of the treatment effect. Well known methods such as adjustment for baseline as a covariate and analysis of differences of pre and post measures are two ways to accomplish this. An alternate way of incorporating baseline measures in the data analysis is to order the clusters on baseline means and pairmatch the two clusters with the smallest means, pair-match the next two, and so on. Our results show that matching on baseline helps to control the between cluster variation when there is a high correlation between the pre-post measures. Six cases of designs and analysis are evaluated by comparing the variance of the treatment effect and the power of related hypothesis tests. We observed that - given our assumptions - the adjusted analysis for baseline as a covariate without pair-matching is the best choice in terms of variance. Future work may reveal that other matching schemes that reflect the natural clustering of experimental units could reduce the variance and increase the power over the standard methods.

Managed clinical and care networks (MCNs) have emerged in Scotland as a collaborative form of organising within health and between health and social services. Bringing together disparate disciplines and professions their aim has been to allow work across service and sector boundaries to improve care for patients. Whilst MCN prevalence has increased and policy has moved to centralise this method of organising, many research questions remain. These include: how can we understand the form, function and impact of MCNs, and further, what are the underlying motivations for practitioners and managers to organise in this way? Focussing in on the work of 3 voluntary MCNs operating in Scotland, the centrality of practice emerges. Practice is defined broadly to encompass both the interactions between practitioner-patient and practitioner-population. From this, the MCN becomes conceptualised as a set of activities focussed around ground-level clinical MCN service issues and top-level policy direction. Through considering work the interplay between ethics and scientific evidence emerges. The inherent uncertainty and suffering of daily practice comes to the fore, these concepts are brought together within a framework, morals-in-practice. Further, using the hermeneutic dynamics of alterity, openness and transcendence, MCNs can be understood as providing a space to foster creative responses to the wicked problems created by health and social service design and delivery. The organising opportunities provided by MCNs thus arguably serve several organisational and social functions, providing a forum to: mutually support and respond to the intrinsically challenging nature of practice understood; debate morals-in-practice helping to ensuring collective clinical governance; sharing of organisational knowledge; planning, delivery and audit of services; and creatively respond to wicked problems. By focussing in on the work, the practice particularities of each individual MCN are resultantly emphasised, whilst still maintaining recognition that much of the NHS operational context is more widely shared. Through this these voluntary MCNs, at least, can be viewed as an organising form which has emerged in response to the complexities of modern health and social service, care, design and delivery.

A imigração boliviana para São Paulo remonta ao início do ano 1950, quando Brasil e Bolívia estabeleceram um programa de intercâmbio cultural. Os bolivianos migram para o Brasil em busca de melhores condições de vida e, quando chegam, geralmente, vão trabalhar em indústrias de confecções têxteis, em condições de trabalho muito precárias, quase sob o regime de escravidão. Não se sabe ao certo a quantidade de bolivianos imigrantes, contudo as pesquisas chegam a um consenso que, atualmente, São Paulo é o destino mais procurado e que a maioria dos imigrantes que tem chegado ao Brasil são bolivianos. Os imigrantes bolivianos muitas vezes são marginalizados e excluídos do campo social, no sentido de não ter garantia dos direitos universais, e o seu acesso aos serviços de saúde muitas vezes ser dificultado pelas questões culturais. Nota-se que a estrutura social é extremamente importante na relação com o sofrimento social, entendido como a humilhação, vergonha e falta de reconhecimento, este não tem visibilidade visto que é inscrito no interior das subjetividades e não há um compartilhamento coletivo. Esta forma de sofrimento é mais comum na contemporaneidade, já que há uma veneração excessiva ao individualismo, um crescimento de um ideal pseudo meritocrático, onde há a ilusão de que todos têm oportunidades para ter êxito social - exceder sua classe social, ter uma liberdade econômica para suprir seu consumo - quando o sistema social não suporta que todos tenham essa ascensão. Propõe-se compreender sobre as práticas de cuidado à saúde dos imigrantes bolivianos relacionando isto ao acesso ao serviço de saúde, a partir do que eles entendem por saúde e o que, para eles, está relacionado a ela: medicação, bem estar, processo saúde-doença, equipamentos e profissionais de saúde. Trata-se de uma etnografia realizada com os usuários bolivianos da Unidade Básica de Saúde Jd. Japão, localizada na Vila Maria, município de São Paulo. Um estudo qualitativo que lançou mão da observação participante e de entrevistas semiestruturadas para ser concretizado. Constatou que o trabalho na vida do imigrante boliviano sustenta e baliza todos os outros eventos da vida é o eixo central. Durante a maior parte do tempo estão trabalhando e isso é um empecilho para se divertir ou para cuidar da própria saúde. Eles entendem que saúde é estar bem para poder trabalhar é poder resistir ao que pode te destruir. Sentem-se respeitados pelos profissionais de saúde, mas não cuidados. Quando estavam na Bolívia não iam ao médico ou a serviços de saúde, o cuidado era feito com ervas, folhas, medicamentos alopáticos. Suas práticas de cuidado à saúde não são muitas, são principalmente relacionadas à alimentação. Evidenciou-se forte a questão de gênero nas relações familiares e violência contra mulher por parceiro íntimo sugerindo como possibilidade, estas questões, serem mais aprofundadas em novos estudos. Bem como às condições das crianças nascidas no Brasil e filhos de bolivianos. / The Bolivian immigration to São Paulo started in the beginning of 1950s, when Brazil and Bolivia placed a cultural interchange program. Bolivians migrate to Brazil looking for better conditions of life and, when arriving, they usually end up working in textile manufacturing companies under considerably precarious work conditions, almost under slavery regime. It is not known the exact amount of Bolivian immigrants, however researches agree that, currently, São Paulo is the most common destiny and that the majority of the immigrants that has been arriving in Brazil are Bolivians. Bolivian immigrants are, many times, made apart of the society and excluded of social life, in terms of having no guarantee of universal rights, and their access to health services are frequently more difficult due to cultural issues. It is remarkable that the social structure is extremely important on the relation with the social suffering - understood as humiliation, shame and lack of recognition -, which has no visibility once it is inscribed inside the subjectivity and there is no collective sharing. Such kind of suffering is more frequent on the contemporaneity, once there is an excessive veneration to the individualism, an increase of a pseudo meritocratic ideal, where there is the illusion that everyone has opportunities to succeed in the society to overcome their social level, to have an economical freedom to fulfill their consumption - while the social system do not stand that everyone ascend like this. The proposal is to understand about the Bolivian immigrants health care practices relating with the access to health service, starting on their understanding on health and what, for them, is related to it: medication, welfare, process health-sickness, equipments and health care professionals. The present study is an ethnography developed with Bolivian users of Health Primary Unit Jd. Japão, in Vila Maria, São Paulo district. A qualitative study that drew on participant observation and semi-structured interviews to be developed. Found out that the work on Bolivian immigrants life sustains and marks all other events in life, it is the central axle. During the most part of the time, they are working and it is an obstacle to have fun or take care of their own health. They understand that health is being fine to be able to work, it is being able to resist to what could destroy them. They feel respected by the health professionals, but not taken care. When in Bolivia they did not go to the doctor or to health services, the care was taken with herbs, leaves, allopathic medicines. They do not have too many health care practices, just some related to food. It became strongly evident the matter of gender in familiar relationships and the violence towards woman by intimate partner, suggesting as possibility in future studies to get deeper in this matters. As well the conditions of Bolivians Brazilian born children.

A imigração boliviana para São Paulo remonta ao início do ano 1950, quando Brasil e Bolívia estabeleceram um programa de intercâmbio cultural. Os bolivianos migram para o Brasil em busca de melhores condições de vida e, quando chegam, geralmente, vão trabalhar em indústrias de confecções têxteis, em condições de trabalho muito precárias, quase sob o regime de escravidão. Não se sabe ao certo a quantidade de bolivianos imigrantes, contudo as pesquisas chegam a um consenso que, atualmente, São Paulo é o destino mais procurado e que a maioria dos imigrantes que tem chegado ao Brasil são bolivianos. Os imigrantes bolivianos muitas vezes são marginalizados e excluídos do campo social, no sentido de não ter garantia dos direitos universais, e o seu acesso aos serviços de saúde muitas vezes ser dificultado pelas questões culturais. Nota-se que a estrutura social é extremamente importante na relação com o sofrimento social, entendido como a humilhação, vergonha e falta de reconhecimento, este não tem visibilidade visto que é inscrito no interior das subjetividades e não há um compartilhamento coletivo. Esta forma de sofrimento é mais comum na contemporaneidade, já que há uma veneração excessiva ao individualismo, um crescimento de um ideal pseudo meritocrático, onde há a ilusão de que todos têm oportunidades para ter êxito social - exceder sua classe social, ter uma liberdade econômica para suprir seu consumo - quando o sistema social não suporta que todos tenham essa ascensão. Propõe-se compreender sobre as práticas de cuidado à saúde dos imigrantes bolivianos relacionando isto ao acesso ao serviço de saúde, a partir do que eles entendem por saúde e o que, para eles, está relacionado a ela: medicação, bem estar, processo saúde-doença, equipamentos e profissionais de saúde. Trata-se de uma etnografia realizada com os usuários bolivianos da Unidade Básica de Saúde Jd. Japão, localizada na Vila Maria, município de São Paulo. Um estudo qualitativo que lançou mão da observação participante e de entrevistas semiestruturadas para ser concretizado. Constatou que o trabalho na vida do imigrante boliviano sustenta e baliza todos os outros eventos da vida é o eixo central. Durante a maior parte do tempo estão trabalhando e isso é um empecilho para se divertir ou para cuidar da própria saúde. Eles entendem que saúde é estar bem para poder trabalhar é poder resistir ao que pode te destruir. Sentem-se respeitados pelos profissionais de saúde, mas não cuidados. Quando estavam na Bolívia não iam ao médico ou a serviços de saúde, o cuidado era feito com ervas, folhas, medicamentos alopáticos. Suas práticas de cuidado à saúde não são muitas, são principalmente relacionadas à alimentação. Evidenciou-se forte a questão de gênero nas relações familiares e violência contra mulher por parceiro íntimo sugerindo como possibilidade, estas questões, serem mais aprofundadas em novos estudos. Bem como às condições das crianças nascidas no Brasil e filhos de bolivianos. / The Bolivian immigration to São Paulo started in the beginning of 1950s, when Brazil and Bolivia placed a cultural interchange program. Bolivians migrate to Brazil looking for better conditions of life and, when arriving, they usually end up working in textile manufacturing companies under considerably precarious work conditions, almost under slavery regime. It is not known the exact amount of Bolivian immigrants, however researches agree that, currently, São Paulo is the most common destiny and that the majority of the immigrants that has been arriving in Brazil are Bolivians. Bolivian immigrants are, many times, made apart of the society and excluded of social life, in terms of having no guarantee of universal rights, and their access to health services are frequently more difficult due to cultural issues. It is remarkable that the social structure is extremely important on the relation with the social suffering - understood as humiliation, shame and lack of recognition -, which has no visibility once it is inscribed inside the subjectivity and there is no collective sharing. Such kind of suffering is more frequent on the contemporaneity, once there is an excessive veneration to the individualism, an increase of a pseudo meritocratic ideal, where there is the illusion that everyone has opportunities to succeed in the society to overcome their social level, to have an economical freedom to fulfill their consumption - while the social system do not stand that everyone ascend like this. The proposal is to understand about the Bolivian immigrants health care practices relating with the access to health service, starting on their understanding on health and what, for them, is related to it: medication, welfare, process health-sickness, equipments and health care professionals. The present study is an ethnography developed with Bolivian users of Health Primary Unit Jd. Japão, in Vila Maria, São Paulo district. A qualitative study that drew on participant observation and semi-structured interviews to be developed. Found out that the work on Bolivian immigrants life sustains and marks all other events in life, it is the central axle. During the most part of the time, they are working and it is an obstacle to have fun or take care of their own health. They understand that health is being fine to be able to work, it is being able to resist to what could destroy them. They feel respected by the health professionals, but not taken care. When in Bolivia they did not go to the doctor or to health services, the care was taken with herbs, leaves, allopathic medicines. They do not have too many health care practices, just some related to food. It became strongly evident the matter of gender in familiar relationships and the violence towards woman by intimate partner, suggesting as possibility in future studies to get deeper in this matters. As well the conditions of Bolivians Brazilian born children.

In this autoethnographic inquiry, the author examines the complexities of international practicum placements by exploring past and present-day reflections written in response to her undergraduate practicum experience in South Africa. Using intersectional analysis, the author reflexively writes about personal desire and the intent to offer care in Majority World contexts by describing how these themes are deeply implicated by larger social, political, and historical systems and structures. In an attempt to benefit the nature of international practicum placements within the context of CYC practice, five key topics are outlined to better prepare students who might be considering practice across cultures in Majority World contexts. / Graduate / 0727 / 0700 / 0631 / lljones@uvic.ca

Since 2008, physician-led primary care practices have decreased as physician's encounter sustainability challenges because of government regulations and the requirements of the Affordable Care Act. The problem is that some physician-led primary care practice leaders lack strategies to sustain a medical practice longer than 5 years. The purpose of this study was to explore strategies primary-care practice leaders use to sustain a practice longer than 5 years. This study followed a case study design, including a purposeful sampling of 3 physician-led primary care practice leaders in southern Indiana. Open-ended semistructured interviews were conducted and triangulated with company policies and procedures as well as government statistics. Coded data and themes were identified using the complex adaptive systems theory. Three sustainability themes emerged: (1) patient engagement, (2) relationship development and retention, and (3) adaptation and innovation. The recommended action is for physician leaders to apply the strategies to develop their primary care medical practices. Results from the study may contribute a positive social change by presenting strategies to develop and sustain physician-led primary care practices, which could lead to an increase of primary care medical practices, resulting in more patients having access to primary care physicians.

No description available.

The term care has been part of the CYC title since the University of Victoria School of Child and Youth Care (CYC) opened in the 1970’s, making care a central aspect of CYC’s public and professional identity. The purpose of this research is to explore how care is conceptualized in Foundations of Child and Youth Care Practice; a Canadian textbook widely used in CYC postsecondary education programs. This text introduces future CYC practitioners to important aspects of CYC praxis, such as care. In this research I use the Trace method developed by Selma Sevenhuijsen (2004) to analyze the text. In this analysis, feminist ethics of care acts both as a lens for analyzing care and as a framework for renewing ways of thinking about and doing care in CYC. Key findings show that conceptualizations of care in the text are deeply influenced by neoliberal ‘justice’ frameworks leading to care being framed as always ‘good’ and understood as apolitical, simple and instrumental. This reveals a lack of theorizing about care in the text and suggests that understandings of care are taken for granted and devalued. These conceptualizations of care cannot account for the complexities of the care relationship and do not adequately reflect the lived experience of young people and families. This research advocates for engagement with feminist ethics of care as a starting point for re-imagining care in CYC and offers suggestions for what this might look like. / Graduate