Family-Centered Care has been recognized as the best current model for delivering care to all patients, particularly pediatric patients and their families. Although the concepts of family-centered care are accepted in theory, studies show barriers in implementing the model in clinical practice. The major problems reported during pediatric hospitalizations include lack of communication, lack of information and guidance, lack of clearly defined roles and expectations, lack of support for parents' psychosocial needs, disregard for parents' prior experience and concerns, stereotyping of parents by nurses, unfair expectations placed on parents, and the use of parents as unpaid caregivers. This thesis provides a comprehensive review of research literature regarding the barriers associated with implementing family-centered care. Studies included perspectives of parents, nurses, and health care professionals and the themes identified were used to make recommendations for clinical practice, nursing education, and future research

Therapeutic relationships were explored using participatory action research in recreation therapy at Sunnybrook Health Sciences Centre (SHSC). The 22 recreation therapists at SHSC comprised the research team and were actively involved throughout the research process; they determined the research questions, the research process, and engaged in data collection and data analysis. This study explored how recreation therapists understood their therapeutic relationships, how different waves of influences were negotiated and philosophies of care that emerged in their therapeutic relationships. At first glance, therapeutic relationships were understood as meaningful connections and shared experiences that developed over time between a recreation therapist and individual receiving care. Later on, therapeutic relationships emerged as a complex process with welcoming, continuing and closing phases. Positive therapeutic relationships were defined by qualities such as caring, trust, respect, and non-judgment for everyone involved. Therapeutic relationships were also influenced by the organizational context, unit specific cultures, family, and staff members and recreation therapists continually negotiated the expectations, power and boundaries of these influences within their therapeutic relationships. The recreation therapists also discussed the different roles, they and the individuals receiving care could engage in during their therapeutic relationships ranging from the traditional, contemporary or controversial. Findings revealed that recreation therapists’ practices were predominantly influenced by person-centered care philosophies, although the biomedical model and relationship-centred care philosophies were also apparent. The practice of being in the moment emerged as a means of enhancing therapeutic relationships, whereas self-reflective practice assisted the recreation therapists to negotiate different waves of influence on their therapeutic relationships.

Therapeutic relationships were explored using participatory action research in recreation therapy at Sunnybrook Health Sciences Centre (SHSC). The 22 recreation therapists at SHSC comprised the research team and were actively involved throughout the research process; they determined the research questions, the research process, and engaged in data collection and data analysis. This study explored how recreation therapists understood their therapeutic relationships, how different waves of influences were negotiated and philosophies of care that emerged in their therapeutic relationships. At first glance, therapeutic relationships were understood as meaningful connections and shared experiences that developed over time between a recreation therapist and individual receiving care. Later on, therapeutic relationships emerged as a complex process with welcoming, continuing and closing phases. Positive therapeutic relationships were defined by qualities such as caring, trust, respect, and non-judgment for everyone involved. Therapeutic relationships were also influenced by the organizational context, unit specific cultures, family, and staff members and recreation therapists continually negotiated the expectations, power and boundaries of these influences within their therapeutic relationships. The recreation therapists also discussed the different roles, they and the individuals receiving care could engage in during their therapeutic relationships ranging from the traditional, contemporary or controversial. Findings revealed that recreation therapists’ practices were predominantly influenced by person-centered care philosophies, although the biomedical model and relationship-centred care philosophies were also apparent. The practice of being in the moment emerged as a means of enhancing therapeutic relationships, whereas self-reflective practice assisted the recreation therapists to negotiate different waves of influence on their therapeutic relationships.

by Tse Kai Fat, Tsui Ping Tim. / Thesis (M.B.A.)--Chinese University of Hong Kong, 1997. / Includes bibliographical references (leaves 55-56). / ABSTRACT --- p.ii / TABLE OF CONTENT --- p.vi / LIST OF ILLUSTRATIONS --- p.viii / LIST OF TABLES --- p.ix / CHAPTER / Chapter I. --- INTRODUCTION / The Hong Kong Hospital Authority --- p.1 / What is Quality of Health Care Service? / Four Dimensional Approach --- p.3 / Quality -- Standard Medical Practice(A) --- p.4 / Quality -- Good Medical Outcome(B) --- p.5 / Quality -- Customer Satisfaction(C&D) --- p.6 / Quality and Cost Containment / Trade-off between Quality and Cost --- p.9 / Quality Management Reduces Healthcare Cost --- p.10 / Methodology --- p.11 / Malcolm Baldrige National Quality Award(MBNQA) --- p.12 / Chapter II. --- CORPORATE QUALITY MANAGEMENT IN THE HOSPITAL AUTHORITY / Corporate and Hospital Missions --- p.14 / Strategic Quality Management --- p.15 / Continuous Quality Management --- p.17 / Specific Corporate Quality Improvement Programs --- p.20 / Core Value Success Scheme --- p.21 / Dilemma Faced by the Hospital Authority --- p.23 / Chapter III. --- QUALITY MANAGEMENT IN PRINCESS MARGARET HOSPITAL / Hospital Background --- p.24 / Organisational Structure --- p.24 / Quality Management System --- p.25 / Leadership --- p.26 / Information and Analysis --- p.27 / Strategic Planning --- p.29 / Human Resource Development and Management --- p.31 / Process Management --- p.32 / Organisation Performance Results --- p.34 / Patient Satisfaction --- p.35 / Chapter IV --- QUALITY MANAGEMENT IN SHATIN HOSPITAL / Hospital Background --- p.36 / Quality Management System --- p.36 / Leadership --- p.39 / Information and Analysis --- p.39 / Strategic Planning --- p.40 / Human Resource Development and Management --- p.40 / Process Management --- p.41 / Organisation Performance Results --- p.42 / Patient Satisfaction --- p.43 / Chapter V. --- CRITIQUE AND RECOMMENDATIONS / Princess Margaret Hospital versus Shatin Hospital --- p.44 / The Hong Kong Hospital Authority --- p.46 / Corporate Strategy --- p.46 / Measurement of Quality --- p.47 / Staff Motivation --- p.48 / Total Quality Management and Cost Containment --- p.49 / APPENDIX --- p.50 / BIBLIOGRAPHY --- p.55

Sammanfattning Bakgrund Demenssjukdom bidrar ofta till att personerna i senare sjukdomsförlopp behöver flytta till särskilt boende, vilket ställer krav på omvårdnadsperonalen att ha förståelse och kunskap om hur vårdmiljön påverkar personer med kognitiv svikt. Riktlinjer visar att miljön måste uppfylla både fysiska och psykosociala aspekter och omvårdanden ska vara personcentrerad. Metod Artikelsökning gjordes i databaserna CINAHL och PubMed där lämpliga artiklar valts ut, samt via fri- och sekundärsökning som analyserades med integrerad analys. Syfte Syftet med litteraturöversikten är att beskriva hur en personcentrerad vårdmiljö kan påverka personer med demenssjukdom inom särskilt demensboende. Resultat Resultatet visar att personcentrering av vårdmiljön har stor betydelse för personer med demenssjukdom och kan implementeras i alla tillgängliga boendeformer. Att göra miljön så hemlik som möjligt är viktigt och naturen har en positiv inverkan på personer med demens och utomhusmiljön kan också bidra med multisensorisk stimulans. Belysning, buller, och temperatur har också betydelse för exempelvis beteendestörningar. Förbättrad orientering kan erhållas genom användning av symboler och minnesboxar men också genom användning av färger. Slutsats Personcentrering av vårdmiljön har stor betydelse för personer med demenssjukdom när det gäller upplevelse av trygghet, välmående och livskvalitet, och sjuksköterskan kan anpassa miljön med rätt kunskap och engagemang. / Summary Background Dementia often leads to moving into assisted living/ nursing homes, which adds a great responsibility for the staff to understand how the environment affects people with dementia. Guidelines show that the environment must take both physical and psychosocial aspects into consideration and the care should be person-centered. Method Articles were chosen from two databases; CINAHL and PubMed. Free- and secondary references of interest were also found. The chosen articles were analysed with integrated analysis. Aim The aim of this review was to explore how the living environment affect people with dementia in assisted living and nursing homes for people with dementia. Result The result shows that person-centered care environment have great importance for people with dementia, and can be implemented in all available living facilities. Making the home environment as homelike as possible is important, and nature has a positive influence on people with dementia and can provide multisensory stimulance. Light, noise and temperature can induce behavioral changes. Improved orientation can be attained by the use of symbols and memory boxes, and also through the use of colors. Conclusion Person-centered care environment is of great importance for people with dementia to restore the sense of security, wellbeing and quality of life, and with knowledge and commitment the nurse can adjust the environment to fit its purpose.

Bakgrund: Patientrapportering är det informationsutbyte mellan vårdpersonal som handlar om den vårdsökande personens hälsotillstånd. Tidigare forskning visar att kommunikationsbrister kan få allvarliga konsekvenser för den vårdsökande. Vid bedsiderapportering förflyttas rapporteringen till sängkanten. Därmed kan den vårdsökande själv vara delaktig i rapporteringen. Syfte: Att beskriva vårdsökandes och sjuksköterskors upplevelse och uppfattning av bedsiderapportering. Metod: En litteraturöversikt genomfördes utifrån 11 studier som svarade mot syftet. Dessa kvalitetsgranskades och analyserades med hjälp av Fribergs trestegsmodell. Resultat: Från artiklarna med fokus på vårdsökande personer framkom tre teman: 1) Ger ökad trygghet. 2) Integriteten kan påverkas 3) Kommunikation anpassad efter vårdsökande. Från artiklarna med fokus på sjuksköterskor framkom tre teman: 1) Att komma vårdsökande närmare. 2) Vikten av att hantera sekretess och känslig information rätt. 3) Förbättrad kommunikation. Slutsats: Huvudfynden som framkom var ökad säkerhet samt ökad delaktighet. Dessa huvudfynd är begrepp som en personcentrerad omvårdnad bygger på och för den vårdpersonal som ämnar bedriva en personcentrerad omvårdnad skulle bedsiderapportering med fördel kunna implementeras som rapporteringsmodell. / Background: Nurse-to-nurse shift report means the exchange of information about the patient’s state of health between health care professionals. Previous research shows that errors within the communication are common and that it can lead to serious consequences for the patient. Bedside handover means that the shift report is conducted to the patient’s bedside, therefore the patient can also be actively involved in it.  Aim: To describe patients' and nurses’ experience and views of bedside report. Method: A literature review was conducted based on 11 studies that corresponded to the purpose. These were quality checked and analyzed with Friberg's three-stage model. Results: Articles focusing on patients was revealed into three themes: 1) Provides increased safety. 2) The integrity could be affected. 3) Communication adapted to patient. Articles focusing on nurses was revealed into three themes: 1) To get closer to the patient. 2) The importance of dealing with privacy and sensitive information in a correct way. 3) Improved communication. Conclusion: The main findings in this literature review were increased patient safety and increased sense of patient participation. These findings are notions which the person-centered care is based on. Health care professionals who intend to pursue a person-centered care should consider implementing bedside handover as their report model.

This thesis focuses on the role of middle managers in the transfer of a humanistic approach to management, care and services in a physical rehabilitation center.This thesis should interest decision makers and researchers who are paying attention to humanistic approaches to management, care and services. The design of this multi-case qualitative, exploratory and constructivist research includes six cases, representing the six middle managers of the studied organization. The multi-case study allows us to contrast cases of successful middle managers from the ones who were not really able to transfer the humanistic approach in their program. Data production and analysis are done with methods used in grounded theory. Here are the main findings generated by this thesis. Firstly, our analysis reveals that, in spite of top management efforts to disseminate a humanistic approach to management, care and services throughout the organizations the transfer process sometimes clashes against the absorptive capacity of the middle manager within the program. When the middle manager has the capacity to absorb the humanistic approach, often because it is compatible with his profound convictions, this capacity is first expressed through his behavioral exemplarity. In the eyes of his employees, the middle manager primarily represents an embodied example of the humanistic approach through his behavior. Therefore, the behavioral exemplarity of the middle manager came out as a sine qua non condition through which is possible the co-construction of new humanistic care and services practices to be offered to clients of the program. Secondly, our analysis sheds light on the importance, at the beginning of the transfer process, to explain to employees the necessity to adopt a humanistic approach to management, care and services and to recognize existing humanistic practices in the organization. Thirdly, the results bring to the forefront the importance of macro and micro contexts as determinant variables in the transfer of a humanistic approach to management, care and services. Lastly, an intervention model illustrating the key role of middle managers in the transfer of a humanistic approach to management, care and services emerges from the results. The model also includes contextual elements which facilitate the transfer. On a more practical note, the model can guide organizations in the dissemination process of such an approach by providing a rich description of the stages of the dissemination process, the actors involved, the dissemination strategies and the goals of these strategies.

Inledning: Vid en förvärvad hjärnskada är delaktighet i rehabiliteringen en central del för patientens återanpassning till vardagen och eventuellt tillbakabildande av förlorade funktioner. Delaktighet i vårdförloppet leder till en ökad teoretisk förståelse och praktisk insikt hos patienten. Syfte: Syftet med denna studie var att beskriva hur vuxna personer med förvärvad hjärnskada upplever/har upplevt delaktighet under sin vårdtid på en rehabiliteringsavdelning. Metod: Detta är en kvalitativ studie med beskrivande design med semistrukturerade intervjuer som datainsamlingsmetod. Tio patienter som vårdats minst fem arbetsdagar på en rehabiliteringsavdelning intervjuades gällande frågor om delaktighet under vårdtiden på rehabiliteringsavdelningen. En kvalitativ innehållsanalys inspirerad av Graneheim och Lundman (2012) användes för att analysera insamlad data på latentnivå. Resultat: Utifrån temat ”delaktighet” uppstod tre kategorier: kompetent personal, informerad patient, samt självständighet. Temat ”icke-delaktighet” resulterade i två kategorier: bristfällig information och kontrollförlust. Det var flera av informanternas berättelser som liknade varandra i fråga om delaktighet på vårdavdelningen. Samtliga informanter beskrev att de upplevt sig vara delaktiga någon gång under vårdtiden på rehabiliteringsavdelningen. Det handlade bland annat om att de upplevt att de fått tillräcklig information från personalen angående sjukdom och vårdförlopp, att det fanns kompetent personal som anpassade sig efter patienternas individuella behov och önskemål samt möjlighet till självständighet under exempelvis träning. Ett flertal informanter beskrev även upplevelser av att inte vara delaktiga under vårdtiden. Bristfällig information från personalens sida samt en känsla av kontrollförlust var de huvudsakliga anledningarna till detta. Slutsats: Denna studie kan bidra till en ökad förståelse hos vårdpersonal angående delaktighet under rehabiliteringstiden för patienter med förvärvad hjärnskada. Då vårdtiderna kan vara långa på rehabiliteringsavdelningen är det särskilt viktigt med en god kontakt och bra kommunikation med patienterna för delaktighet och en patientcentrerad vård.

Bakgrund: I Sverige insjuknar varje år ungefär 25 000 människor i någon form av demenssjukdom, en sjukdom som ökar världen över och troligtvis kommer att fördubblas inom de närmsta 20 åren. Demenssjukdom drabbar hjärnan vilket påverkar minnet och den kognitiva förmågan och kan ge beteendemässiga och psykiska symtom (BPSD). Studier visar att nio av tio personer någon gång kommer att visa symtom som ångest, oro, vandrande och aggressiva beteenden. Läkemedelsadministrering för att behandla symtom som oro, ångest och agiterande beteenden är inte ovanligt. Dock kan läkemedel ofta orsaka biverkningar hos äldre människor. Att istället använda djurterapi för att behandla symtom som kan uppstå vid demenssjukdomar kan ses som ett positivt alternativ då studier visat att djurterapi har en positiv inverkan på människan med demenssjukdom och andra kognitiva sjukdomar. Syfte: Syftet med denna studie var att beskriva vilken inverkan djurterapi har på människor med demenssjukdom och andra kognitiva sjukdomar. Metod: Studien är en litteraturöversikt baserad på artiklar med kvantitativ och kvalitativ ansats (n=15). Resultat: Resultatet av denna litteraturstudie visar att djurterapi ger minskad stressnivå, minskat uppvisande av aggressiva beteenden, färre vanföreställningar, minskad ångest, nedstämdhet, sorgsenhet, depressiva symtom och apatiska beteenden samt ökning av glädje, lycka, engagemang, vakenhet, medvetenhet, verbala uttryck samt ökat minne. Konklusion: Resultatet tyder på att djurterapi med fördel kan användas som alternativ eller kompletterande behandling för människor med demenssjukdom. Dock ser författarna att utökad forskning behövs för att se långvarig inverkan av djurterapins effekter. / Background: Each year about 25 000 people in Sweden get affected with dementia. The disease increases worldwide and is likely to double within the next 20 years. Dementia affects the brain, which affects memory and cognitive ability and can cause behavioral and psychological symptoms (BPSD). Studies show that nine out of ten people at some time will show symptoms such as anxiety, agitation, wandering and aggressive behaviors. Drug administration to treat symptoms such as agitation, anxiety and agitating behavior is not unusual. Drugs are often likely to cause side effects in older people. If animal-assisted therapy can be used to treat the symptoms that can occur in dementia it can be seen as a positive alternative when studies have shown that animal therapy has a positive effect on people with dementia. Aim: The purpose of this study was to describe the impact of animal-assisted therapy on people with dementia and other cognitive diseases. Method: The study is a literature review based on articles with qualitative and quantitative approach (n = 15). Results: The results of this study show that animal therapy reduces stress levels, decreased production of aggressive behaviors, fewer delusions, decreased anxiety, depression, sadness, depression and apathetic behavior, and increase joy, happiness, commitment, alertness, awareness, verbal and increased memory. Conclusion: The results indicate that animal therapy can be advantageously used as an alternative or complementary therapy for people with dementia. However, the authors think that expanded research is needed to see long-term effects of animal therapy's effects.

Bakgrund    Enligt Sveriges Kommuner och Landsting så ska vårdpersonal inom regioner, kommuner och landsting arbeta för införandet av personcentrerad vård (PCV) som arbetssätt. PCV har tre grundpelare: partnerskap, patientberättelse samt dokumentation. Vårda i samråd med personen som behöver vård är grunden i hela den personcentrerade vården. Syfte                                   Syftet med studien var att beskriva sjuksköterskans tillämpning av personcentrerad vård inom den kommunala hemsjukvården i vården av personer 65 år och äldre. Metod                                 Studien har en beskrivande design med kvalitativ ansats. Huvudresultat                   Ingen av de inkluderade kommunerna tillämpade PCV fullt ut idag. De förutsättningar för en god PCV som sjuksköterskorna beskrev var att de arbetade för att ha personen i fokus. De försökte också skapa en relation till personen och dess anhöriga genom kontinuitet, partnerskap och patientens levnadsberättelse. Hinder för att kunna tillämpa PCV var brist på organisatorisk ledning gällande PCV, bristande kontinuitet, tidsbrist och orealistiska önskemål från personen samt kunskapsbrist om PCV.   Slutsats                              Sjuksköterskorna saknar kunskap om vad PCV innebär inom kommunal hemsjukvård och hur PCV skall tillämpas i det dagliga vårdarbetet. Studien visade på att det är ledningen som präglar vilken vård som ges till dem som vårdades. En ledning som guidar, stöttar och ger förutsättningar till sina sjuksköterskor för att de skall kunna tillämpa PCV är den största förutsättningen för att PCV skall kunna implementeras inom den kommunala hemsjukvården. Det borde vara en rättighet för alla som vårdas att få PCV. / Background                  According to the Swedish Association of Local Authorities and Regions should all healthcare professionals within the regions, municipalities and county council work for an introduction of person-centered care (PCC). PCC has three fundamental pillars: partnership, the patient´s story and documentation. Healthcare should be in agreement with the person needing care, it´s the foundation of PCC. Objective                      The objective of the study was to describe the nurse's application of person-centered care in the municipal home healthcare in the care of people aged 65 years and older. Method                              The study has a descriptive design with a qualitative approach. Main results                      The results showed that none of the participating municipalities applied PCC to full extend currently in daily work. The nurses described good conditions for PCC like having focus on the person. The nurses also tried to create a relationship with the patient and their relatives, through continuity, partnership and patient´s life story. The study identified obstacles in the application of PCC like lack of organizational management, continuity and time, unrealistic requests of care from the person and knowledge deficit regarding PCC. Conclusion                         The nurses within municipal home healthcare lacked knowledge regarding PCC and how to apply PCC in daily work. The study showed that it is the management who characterizes the care given. In the application of PCC a necessity is a management who guides, supports and offers relevant conditions for PCC to the nurses. It should be a right for all people receiving care to obtain PCC.