Vårdprogram för höftfraktur har tidigare använts vid Akademiska sjukhuset i Uppsala.  Höftspår är en ny process och målet är att underlätta flödet genom hela vårdkedjan. Syfte: Syftet är att studera hur Höftspår har påverkat omvårdnaden inom områdena; smärtskattning, smärtbehandling, vårdtid, förekomst av hudinspektion samt förekomst av trycksår hos patienter med höftfraktur, i jämförelse med Vårdprogram för höftfraktur. Metod: Journalgranskning utfördes med en retrospektiv, deskriptiv och komparativ design. Urvalet utgjordes av 30 patientjournaler i grupp I, före införandet av Höftspår, och 30 patientjournaler i grupp II, från införandestart för Höftspår. Inkluderade patientjournaler var diagnosgrupp höftfraktur, >60 år, ankomst till akutmottagning med ambulans, bedömas av läkare som operationsfall med inläggning på samma sjukhus. Av de 30 granskade patientjournalerna i grupp II var inklusionskriteriet även fascia-iliaca blockad. Resultat: Resultat som framkom var kortare vårdtid på akutmottagning och en minskning i administrerad opiat. En förbättrad dokumentation av hudinspektion och smärtskattning sågs på akutmottagningen. Prehospitalt mättes ingen större skillnad i antal milligram administrerad opiat. På vårdavdelning minskade vårdtiden något och smärtskattning gjordes sällan. Hudinspektion utfördes överlag ofta på vårdavdelning men minskade något efter införandet av Höftspår. Slutsats: Vi ser en kvalitetshöjning för patienten med höftfraktur, i och med kortare vårdtider och bättre smärtbehandling. / Care-programmes for hip-fracture were previously employed at Akademiska hospital in Uppsala. Hip-track is a new process and the objective is to facilitate the flow through the entire chain of care. Objective: The aim of this study was to investigate how the care-programme Hip-track has affected nursing within the areas: pain-assessment, pain-treatment, care-time, skin-inspection and pressure-ulcer of patients with hip-fracture compared with previous care-program. Method: A review of health-records was carried out with a retrospective, descriptive and comparative design. The sample consisted of 30 health-records, before the introduction and 30 health-records after the introduction of Hip-track. Included health-records: diagnosis-group hip-fracture, > 60 years of age, arrival to the emergency-departement with ambulance, assessed by doctors as a surgical-case and admitted to the hospital. After the introduction was fascia-iliaca-block a criteria for inclusion.  Results: The results that emerged were shorter care-time at the emergency-department and a reduction in administered opioid. Improved documentation of skin-inspection and  pain-assessment were seen at the emergency-departement. In prehospital-care, there were no notable differences observed of opioid administered. Care-time decreased at the ward and pain-assessment. Skin-inspection was in general often done but decreased with introduction of Höftspår. Conclusion: Hip-track is quality-improvement, shorter care time and better pain-treatment.

Discharge planning is an integral part of patient care, which involves the transfer of patients from the hospital to the community, taking into account the patient’s unique and complex needs. However, this process is often fraught with complexities. This study was designed to explore challenges of current practices in discharge planning and to establish factors and effective strategies for future management. A qualitative and descriptive study was undertaken to understand the views of health care professionals on discharge planning within a tertiary hospital setting in KwaZulu-Natal. A comprehensive, rather than a disease-specific approach was used. Systems theory and the bio-psycho-social model formed the appropriate theoretical framework for the current study, which considered a holistic approach, taking into account systemic factors, relationships, physical, psychological and social aspects of patient care. Purposive sampling was used to identify 26 members of the multidisciplinary team with the relevant knowledge and experience. Semi-structured interviews, that were audio-recorded, were undertaken as the primary method of data collection, from which transcripts were thematically analysed. The study identified the key themes in terms of major challenges that included inter-hospital transport and referrals, resource constraints, patient compliance, and caregiver preparedness. The poor socio-economic circumstances of patients and their families formed a grim background. A documentation analysis of discharge summaries, utilized as a secondary method for the purposes of triangulation, revealed inconsistencies in the discharge summary system that varied between incomplete or well written reports. Based on the study findings, recommendations are made in respect of practice, policy and further research in the designated area of study. Some of the strategies recommended include collaboration with the multidisciplinary team, improving patient and caregiver education and establishing a formalized system of discharge planning, policies and discharge summaries. / M.A. University of KwaZulu-Natal, Durban, 2014.

Community participation is a key feature of major global health declarations and a fundamental principle of health strategies in Aotearoa New Zealand. However, the frequency with which it is espoused belies the complexities associated with its practical application. Engaging communities in primary health care programmes designed to improve their health has been identified as a major challenge. This study’s objective was to explore community members’ perspectives of participation within a health development programme. The programme chosen aimed to increase the fruit and vegetable intake of targeted population groups, including M ori, Pacific peoples, and low income earners. A qualitative instrumental case study approach was adopted to examine the programme and investigate what influenced, constrained, and sustained community participation. Data collection included fieldwork over an eighteen-month period. Two programme projects were selected as the study foci: a communityled project involving distributions of thousands of free heritage variety plants; and, instigated by health services, a project establishing community gardens. These projects provided markedly different pictures of participation occurring within the same programme. The plant distributions had widespread appeal, while the community garden faltered. Community participation fitted within a description of ‘focused social action’. Participation was motivated by needs, values, and interests. While some were personal and family based, the programme also became an imagined vehicle for addressing wider health, social justice, and environmental sustainability goals. Ongoing challenges related to defining targeted communities and groups, varying degrees and types of participation, and different perspectives of participation, especially as health sector staff worked from an equity mandate and community members spoke of equality. Programme groups established as mechanisms to foster community participation had contradictory effects, engaging some as advisors, while failing to reach communities targeted for the programme. The complexities of health sector bureaucracy both enabled and constrained the programme and community participation. This thesis provides an in-depth examination of the complexities of community participation in action, the contradictory effects of contexts enveloping programmes, and the resolve of community members. It increases our understandings of how community members perceive health programmes and community participation, which are critical factors in improving population health.

Community participation is a key feature of major global health declarations and a fundamental principle of health strategies in Aotearoa New Zealand. However, the frequency with which it is espoused belies the complexities associated with its practical application. Engaging communities in primary health care programmes designed to improve their health has been identified as a major challenge. This study’s objective was to explore community members’ perspectives of participation within a health development programme. The programme chosen aimed to increase the fruit and vegetable intake of targeted population groups, including M ori, Pacific peoples, and low income earners. A qualitative instrumental case study approach was adopted to examine the programme and investigate what influenced, constrained, and sustained community participation. Data collection included fieldwork over an eighteen-month period. Two programme projects were selected as the study foci: a communityled project involving distributions of thousands of free heritage variety plants; and, instigated by health services, a project establishing community gardens. These projects provided markedly different pictures of participation occurring within the same programme. The plant distributions had widespread appeal, while the community garden faltered. Community participation fitted within a description of ‘focused social action’. Participation was motivated by needs, values, and interests. While some were personal and family based, the programme also became an imagined vehicle for addressing wider health, social justice, and environmental sustainability goals. Ongoing challenges related to defining targeted communities and groups, varying degrees and types of participation, and different perspectives of participation, especially as health sector staff worked from an equity mandate and community members spoke of equality. Programme groups established as mechanisms to foster community participation had contradictory effects, engaging some as advisors, while failing to reach communities targeted for the programme. The complexities of health sector bureaucracy both enabled and constrained the programme and community participation. This thesis provides an in-depth examination of the complexities of community participation in action, the contradictory effects of contexts enveloping programmes, and the resolve of community members. It increases our understandings of how community members perceive health programmes and community participation, which are critical factors in improving population health.

Community participation is a key feature of major global health declarations and a fundamental principle of health strategies in Aotearoa New Zealand. However, the frequency with which it is espoused belies the complexities associated with its practical application. Engaging communities in primary health care programmes designed to improve their health has been identified as a major challenge. This study’s objective was to explore community members’ perspectives of participation within a health development programme. The programme chosen aimed to increase the fruit and vegetable intake of targeted population groups, including M ori, Pacific peoples, and low income earners. A qualitative instrumental case study approach was adopted to examine the programme and investigate what influenced, constrained, and sustained community participation. Data collection included fieldwork over an eighteen-month period. Two programme projects were selected as the study foci: a communityled project involving distributions of thousands of free heritage variety plants; and, instigated by health services, a project establishing community gardens. These projects provided markedly different pictures of participation occurring within the same programme. The plant distributions had widespread appeal, while the community garden faltered. Community participation fitted within a description of ‘focused social action’. Participation was motivated by needs, values, and interests. While some were personal and family based, the programme also became an imagined vehicle for addressing wider health, social justice, and environmental sustainability goals. Ongoing challenges related to defining targeted communities and groups, varying degrees and types of participation, and different perspectives of participation, especially as health sector staff worked from an equity mandate and community members spoke of equality. Programme groups established as mechanisms to foster community participation had contradictory effects, engaging some as advisors, while failing to reach communities targeted for the programme. The complexities of health sector bureaucracy both enabled and constrained the programme and community participation. This thesis provides an in-depth examination of the complexities of community participation in action, the contradictory effects of contexts enveloping programmes, and the resolve of community members. It increases our understandings of how community members perceive health programmes and community participation, which are critical factors in improving population health.