Höftkirurgi är ett vanligt ingrepp både som elektivt och akut. Sjuksköterskans arbete inkluderar preoperativ information vilken oftast ges muntligt. Studier visar att smärta ofta är ett problem postoperativt. Tidigare forskning har även kommit fram till att patienter önskar vara välinformerade om det postoperativa förloppet för att kunna vara delaktiga i sin egen vård. Syfte : Syftet var att utifrån aktuell forskning undersöka betydelsen av olika sätt att informera patienter preoperativt avseende smärta och smärtbehandling för patientens postoperativa smärtupplevelse vid höftkirurgi. Metod : En litteraturöversikt gjordes genom att söka artiklar på databaserna CINAHL och PubMed. En granskningsmall användes där valda artiklar kvalitetsgranskades och endast artiklar av minst medelhög kvalitet användes. Arbetet grundas på 17 artiklar som delades in i huvudkategorierna elektiv, akut, information och smärta. Resultat : Ett samband mellan preoperativ information och postoperativ smärta hittades i 13 artiklar. Sambandet visar att den givna informationen skapade förutsättningar för patienterna att hantera den postoperativa smärtan. Vid elektiv kirurgi fanns bättre förutsättningar för patientaktiverande preoperativa utbildningar. Preoperativa individuella strategier identifierades. Slutsats : Merparten av studierna syftar till att preoperativ information används för att kunna minska postoperativ smärta genom att öka patienternas delaktighet och copingförmåga. Då samband hittats hos de flesta av artiklarna i denna litteraturstudie stärker detta sannolikheten att det finns ett samband mellan sjuksköterskans preoperativa information och patientens postoperativa smärtupplevelse. / Hip surgery is a common operation, for both elective and acute approach. Nurses’ duties includes pain prevention and information to the patient. This with the patient always in focus. Studies have shown that it is most common to give the information verbally, and that patients want to know more preoperative about the postoperative phase to be more involved. Aim : The purpose of this literature review was to investigate the importance of nurses’ preoperative information for postoperative pain management. Methods : For the research the database CINAHL and PubMed was used. A review template was used, and only the articles with a medium high score has been used. This work is based on 17 articles which has been divided in main categories that was elective, acute, information and pain. Results : A relationship between preoperative information and postoperative pain was found in 13 of the articles. This connection indicate that the given information provided the patients to manage their postoperative pain. Patients undergoing elective surgery was better prepared and was given more patient activated education preoperative than acute surgery. Preoperative individual strategies was identified. Conclusion: Most of the studies showed that preoperative information is used to reduce postoperative pain by increasing patients’ participation and their ability to cope better. Since a connection was found between most of the articles in this work it increases the likelihood that there is a relationship between nurses’ preoperative information and patients’ postoperative pain experience.

Background: Primary care faces the challenge of developing an easily accessible and effective health care system to meet the needs of the population and to fulfill the care guarantee. Teamwork with satisfactory communication can provide more efficient work and good results for patients. In Gävleborg County, three healthcare centers have started a joint emergency care, where collaboration in teams should optimize resources. Aim: The aim of the this study was to describe district nurses and nurses' experiences of working in the emergency care of primary care. Method: The study had a qualitative approach and a descriptive design. Data were collected using semi-structured interviews and was analyzed with qualitative content analysis. Main result: The interviews resulted in three categories: The teamwork in the emergency care, Changes with a new way of working and Challenges in working with the emergency care. The categories describe district nurses 'and nurses' experiences of a team-based approach where collaboration and accessibility facilitate work and make it effective. The categories also describe challenges in working with the emergency care that led to difficulties in work and shortcomings for the patient. Conclusion: District nurses and nurses in the present study described that the work in primary emergency care was an effective teamwork with satisfactory cooperation and communication between professions. Advantages of the method were accessibility to get advice and support from others and not to be alone. Challenges and difficulties emerged in the work that affected both the working group and the patients. The result in the study give an insight into a common approach of emergency care in the primary care based on the experience of district nurses and nurses. The result in the study can hopefully lead to development and improvement of working methods within emergency care in the primary care.

The capacity for online learning environments to provide quality learning experiences for students has been the focus of much speculation and debate in the higher education sector from the late 1990s to the present day. In this area, 'quality' has become synonymous with engaging students in a learning community. This study reports on a qualitative research project designed to explore the significance of community for students when they study in online learning environments. This project used three case studies to explore tertiary students' thoughts and expectations about community in the online environment. The research was constructed iteratively. Data from the initial case suggested the need to explore the relationship between the constructed online learning environment and the development of learning communities or what I have termed Social Learning Support Networks (SLSN). To explore this issue further, the project was expanded and subsequent cases were chosen that included fundamentally different types of online learning environments. The project had two significant results. Firstly, students not only confirmed popular educational theories on the value of learning communities, but also described how this form of social connection might practically benefit their learning. Secondly, the project found that certain forms of synchronous online environments provided enhanced opportunities for students to form social connections that supported their learning. This project provides new evidence of the benefit of community for students studying online and argues that future online learning environments should be shaped by five key principles designed to foster a sense of social connection between students.

Researchers have approached the problem of designing context-aware systems, computer systems that can react intelligently to the context in which they are used, from both software engineering and human-centred perspectives. While engineered context-aware systems have found successful application in optimising technical settings without requiring mundane and explicit interaction from humans, challenges remain in furthering their application to more complex environments. In particular, when technical decisions and human actions are intertwined in sophisticated work environments (rather than, for example, the simple act of transferring a mobile phone call to receive a signal from the nearest tower), the problem of designing context-aware systems demands further examination and calls for a new approach. A natural extension of the software engineering approach in more challenging environments is to try to implement increasingly sophisticated algorithms for managing context in the hope that this will lead to autonomous application behaviour. In contrast, research from a human-centred perspective, grounded in the social sciences and philosophy, demonstrates that context is not entirely objective and measurable but rather is dynamic and created through human action. It may not be easily detected through technical sensing systems, and therefore simply employing more sophisticated algorithms within the technical sphere may not be effective. While engineering approaches have continued to evolve, the problem of how to design interfaces to context-aware applications still remains. The research reported in this dissertation investigated the problem of designing context-aware systems for the complex environment of a dental surgery. I undertook, though a participatory design approach (a) to better characterise the problem of designing context-aware systems, and (b) to understand how design methods could be employed to bridge the human and software engineering approaches. The gap in existing research on context-aware systems is evident in the way that the methods applied to designing systems don't provide an insight into how people actively create the context in which they work (in a practical rather than theoretical sense) they don‘t closely examine the behaviours of people, the role and arrangement of artefacts, and the dynamic relationships between people and artefacts. I found that an understanding of how these features of work and human behaviour are realised in practice in a given environment is fundamental to being able to design an effective context-aware system for that environment. The challenge is to design at the boundary between the technical and the social. The contribution of this thesis is an approach that explores context-aware design through synthesis. The synthetic approach leads to design opportunities and guidelines based on an understanding of the processes through which people actively co-create the context in which they work. I have applied and built upon a number of existing user-centred design and participatory design methods, in addition to creating some new methods in order to develop an understanding of how designers can examine the human aspects surrounding the co-creation of context and apply these in a way that progressively informs the design process. The methods collectively represent a novel approach to designing context-aware applications and differ from the more traditional technical approaches of developing software frameworks and infrastructures, and formal models of context, tasks, users, and systems. The techniques presented have focused primarily on developing an understanding of how humans find meaning in their actions along with their interaction with other people and technology. Participatory design methods help participants to reveal potential implicit technical resources that can be presented explicitly in technologies in order to assist humans in managing their interactions with and amidst technical systems gracefully. The methods introduced and the design approach proposed complement existing research on context-awareness from both a human-centred and software engineering perspective. This research builds on the notion of providing resources which allow users to manage their own context and also manage shifts in control while interacting with other people and with a variety of technical artefacts. It does this by examining a complex work environment, in particular looking at the kinds of resources people use and expect to use (and the constraints around these), the form(s) it is appropriate for them to take, and the patterns of interaction they will ultimately be used within.

This thesis evaluates the rehabilitation process with respect to client participation. The Swedish version of a client-centred structure, the Canadian Occupational Performance Measure (COPM), is evaluated from the perspectives of the clients, the occupational therapists and the members of a rehabilitation team. Data have been collected through diaries, the COPM, assessments of ability to perform activities of daily living, mobility, self-assessments of pain and health, interviews with clients, interviews with staff, and focus groups interviews. The results show that a structured method is needed in order to improve clients’ active participation in goal formulation. The Swedish version of the COPM has high responsiveness to change over time. The use of the COPM improved client participation in the goal-formulation process, according to the results from a study with experiment and control groups. The clients perceived that treatment goals were identified, they were able to recall the goals and felt that they were active participants. They also perceived they had a higher ability to manage after the rehabilitation period was completed compared to clients in the control group. The clinical utility of the Swedish version of the COPM was confirmed in focus-group interviews with occupational therapists. The occupational therapists perceived the COPM as helpful in the goal-setting process and planning of treatment interventions. Even though problems are identified, they are directly related to, and formulated as, goals. Clients receive feedback on improvement over time. The COPM ensures a client-centred approach, facilitates communication within the rehabilitation team, and encourages therapists in their professional role. Therapists need knowledge about the theoretical foundation of the instrument and have to develop a personal interview technique. When the COPM is used in a team setting, it provides the team with broader information on what is purposeful occupation to the client. The focus is on occupational performance rather than function. According to team members the use of the COPM as a team tool increased client participation, was a good outcome measure, resulted in distinct goals, and focused on goals that were meaningful to the client. Implementation of a client-centred approach is facilitated when a structured method is used, but this is not enough. Involvement and motivation from all team members are required, as well as support during the introduction and implementation period. Support from management, knowledge about the underlying theory, time for discussions and reflections as well as opportunities to develop a personal interview technique are pointed out as important factors for a successful implementation. / On the day of the defence date the status on article V was Submitted.

In this thesis, the aim was to attain a deeper understanding according to the students meaning of learning related to their own responsibility and independence within a framework of an educa¬tional programme. An empirical study with an ethnographic approach was carried out during one term of a nursing programme that uses the PBL-approach. Based on observations, conversations, inter¬views and documents, three narratives were formulated. One describes the phases students experience in the planned curricula. Periods characterised of chaos, uncertainty and a heavy workload, alternate with periods of ‘cosmos’, optimism, curiosity and satisfaction. The second narrative is about students' learning objectives while realising that they have to make choices and decisions on their own to succeed. A dialectic driving force emerging from frustration and stimulation, chaos and cosmos, results in questions about what to learn and how to act. The third narrative describes how students handle these questions. The narratives reveal two dimensions. One concerns how the students form attitudes about the relevance of learning objectives and how they go about learning a knowledge base necessary for their future profession. The other dimension takes as its starting point the fact that students try to manage their learning situation taking into consideration the framework of the educa¬tional programme. These dimensions were further analysed using theoretical references. The first dimension was analysed from the perspective of teacher/learner control and a didactic analysis of the meaning of an educational setting. The second dimension was analysed on the basis of phenomenographic learning theory. As regards responsibility and independence there seems to be a point in abandoning the concept of self-directed learning. Instead of emphasising self, the interaction between people, the individual and the educational framework and the interaction with content, are found to be fundamental. This interaction includes communication, dialogue and active participation in all the parts of a learning situation. Based on the results of this study, I claim that the driving force in student-centred learning is the dialectic relation between frustration and stimulation, chaos and cosmos. This stimulates the students to engage in the teachers' traditional didactic ques¬tions concerning an educational programme: what are we going to study, how and why, and what are the objectives? The students' conduct as regards independence, vis à vis dependence, are related to a dialectic relationship between the prerequisites provided by the educational frame¬work and the students' interpretation and ability to use them. Expressions of responsibility and independence emerge as choices and decisions concerning the didactic questions, initiative, activity, search for opportunities to reflect and co-operate and self-confidence. The opposite, dependence, is characterised by strategies for “survival”. The students plan their learning situa¬tion so that the examinations and assignments can be successfully tackled, and the learning situation takes on features of a surface approach. I believe that further insights into learning in student-centred education can be found in the two dialectic relationships described above.

This qualitative study explored and described the lived experience of people with brain injuries with regard to resuming their worker roles. Based on the results, an occupational therapy practice model to facilitate return to work was developed. The theoretical framework of occupational science with emphasis on occupational risk factors informed the study. The research design was a theory generative design based on a qualitative, phenomenological, explorative and descriptive research approach utilizing the methods of theory generation as advocated by Chinn and Kramer (1999), Walker and Avant (2005) and Dickoff, James and Wiedenbach (1968).

In the light of an ageing society with shrinking economic resources, deinstitutionalization of elderly care is a general trend. As a result, homecare is increasing, and increasingly shared between different health and social care organizations. To provide a holistic overview about the patient care process, i.e. to be patient-centred, shared homecare needs to be integrated. This requires improved support for information sharing and cooperation between different actors, such as care professionals, patients and their relatives. The research objectives of this thesis are therefore to study information and communication needs for patient-centered shared homecare, to explore how integrated information and communication technology (ICT) can support information sharing, and to analyze how current standards for continuity of care and semantic interoperability meet requirements of patient-centered shared homecare. An action research approach, characterized by an iterative cycle, an emphasis on change and close collaboration with practitioners, patients and their relatives, was used. Studying one specific homecare setting closely, intersection points between involved actors and specific needs for information sharing were identified and described as shared information objects. An integration architecture making shared information objects available through integration of existing systems was designed and implemented. Mobile virtual health record (VHR) applications thereby enable a seamless flow of information between involved actors. These applications were tested and validated in the OLD@HOME-project. Moreover, the underlying information model for a shared care plan was mapped against current standards. Some important discrepancies were identified between these results and current standards for continuity of care, stressing the importance of evaluating standardized models against requirements of evolving healthcare contexts. In conclusion, this thesis gives important insights into the needs and requirements of shared homecare, enabling a shift towards patient-centered homecare through mobile access to aggregated information from current feeder systems and documentation at the point of need.

A comprehensive understanding is lacking of the experiences persons with acquired physical disabilities have of changes in their engagement in occupations and of the conditions influencing these experiences Furthermore, little is known about the experiences these people have of the rehabilitation process and whether the rehabilitation services satisfy their needs. Access to such knowledge would significantly add to the ability to design rehabilitation services intended to enhance participation in everyday life. The overall aim of this thesis was, therefore, to illuminate and enhance the understanding of how persons with acquired physical disabilities experienced their rehabilitation process and their possibilities to engage in occupations in everyday life. The thesis is comprised of five studies. The planning of the clients’ rehabilitation at hospital was explored through interviews with the clients (n=57) and the professionals (n=50). Interviews exploring how persons with physical disabilities experienced their rehabilitation process (n=15), their occupational lives in their homes (n=13) and the use of assistive devices (n =17) were analysed qualitatively. Data was also collected from persons with spinal cord injury (n =161) by the Impact on Participation and Autonomy questionnaire. The findings showed that the professionals used different strategies to encourage the clients to participate in the planning of the rehabilitation and that the strategies were based on traditions rather than on the individual clients’ desires to participate. The informants’ experiences reflected three parallel chains of rehabilitation over a period of time, a medical, a psychological and a social one. The influence of the different rehabilitation chains on how the clients’ lives turned out varied over time, and the professionals were predominantly involved in the medical rehabilitation chain. The informants’ experiences showed that their engagement in occupations in the home differed profoundly. Access to social support, which was provided under different conditions, was of decisive importance for their occupational engagement. The findings also showed that changes in the informants’ occupations in the home setting transformed the meaning of the home in general. The meaning of using assistive devices was experienced as manifold and double-edged. The incorporation of or resistance to assistive devices was understood as different approaches to adaptation with the same intention: to achieve desired occupational self-images. The majority of the informants perceived their participation in the life situation as sufficient but more than half reported one or more severe problems with participation. Access to social support in everyday occupations had a greater impact on predicting severe problems with participation than certain traditional health related factors or aspects related to the individual. To conclude, the findings indicate that the rehabilitation services need to be better able to adapt to clients’ desires to participate in the planning of their rehabilitation, and designed to satisfy the various needs the clients experience throughout the rehabilitation process. It was revealed that the societal and social environment, as manifested through social interactions, are of central importance in understanding the consequences of and possibilities to engage in occupations supporting participation in everyday life.

Have you ever been frustrated with that IT system at work that does not behave the way you expect it to? Or had problems with using the features on your new mobile phone? When systems and appliances do not support us in what we are doing, and do not behave the way we expect them to, then usability is neglected. Poor usability may be frustrating and irritating when trying out your mobile phone, but in a critical work situation poor usability may be disastrous. In this thesis, user-centred systems design (UCSD) is advocated as an approach for facilitating the development of usable interactive systems. Systems that suit their intended use and users do not just “emerge”. They are the result of a UCSD process and a user-centred attitude during the development. This means in short that the real users and their needs, goals, context of use, abilities and limitations, drive the development – in contrast to technology-driven development. We define UCSD as: a process focusing on usability throughout the entire development process and further throughout the system life cycle. I argue that this definition along with a set of key principles do help organisations and individual projects in the process of developing usable interactive systems. The key principles include the necessity of having an explicit focus on users and making sure that users are actively involved in the process. The thesis provides knowledge and insights gained from real-life situations about what UCSD is and how it can be put into practice. The most significant results are: the proposal of a clear definition of UCSD and a set of key principles encompassing UCSD; a process for usability design and the usability designer role. Furthermore, design cases from different domains are provided as examples and illustrations.