<p>With government pressure to cut healthcare costs, the hospital sector in Ontario has directed increased attention to moving patients out of the hospital as soon as they are deemed not to require acute care. Discharge planning has become a highly measured and managed process facilitated by social workers and Community Care Case Managers. The purpose of this thesis is to look at the experiences of hospital social workers and CCAC case managers and the common (and distinct) ways they experience their discharge planning roles and responsibilities. Information was obtained from two focus groups: one with hospital social workers and the other, with hospital CCAC case managers. Themes from the focus group of social workers emerged that illustrated the ‘heat’ in discharge planning and the implications this pressure had on patients and families, and the role of social work. Two dominant sources of pressure on discharge planning were the provincial focus on reducing wait times and organizational performance markers related to patients’ length of stay. Social workers voiced their concerns about government rhetoric and the inadequacies in community resources for ‘aging at home’, constrained choices and coerced caregiving that had implications for patients and families. CCAC case managers experienced similar pressures to discharge patients quickly while wanting more time to spend with them so that they could arrange the most appropriate services and care plans. CCAC case managers described the unique experience of working in an organization that is not their employer and having to facilitate ‘their’ discharge planning policies. This study looked at the inter-professional relations between social workers and CCAC case managers and how professional identity impacts the role of discharge planning. Social workers associated a certain “character” as needed to stand up against a system that is not always working in the best interests of patients and families.</p> / Master of Social Work (MSW)

No description available.

There has been inadequate attention to the aftercare of psychiatric patients, resulting in an increase in readmission rates plus longer hospital stays. There is a gap in the aftercare for psychiatric patients; The purpose of this qualitative retrospective study is to explore what may have contributed to readmission for psychiatric patients. The biopsychosocial model was used as the theoretical framework to support the direction of the research. The health belief model and transtheoretical model of change were used to further support for biopsychosocial model. The research questions were created to determine the influences on readmission, psychological well-being, explore the adaptation to aftercare and narrative of aftercare from the caregiver. This study used a content analysis to identify patterns and themes with a total of 10 participants. The data used had been previously collected by the behavioral transition team at Houston Methodist Hospital which consists of case notes, mental health diagnoses, hospital history and reasons for readmission. The findings include reports of psychiatric patients not adhering to their prescribed medication due to its side effects or cost, caregivers feeling overwhelmed, and the importance of psychoeducation. Once adjustments were made to the dosage or a prescription for less expensive medication, adherence improved, regular attendance to therapy sessions occurred, and the increase in the level of frustration from the caregiver. Psychiatric patients can benefit in post-discharge care if there is more focus on the reasons for hospital readmission by developing a treatment plan for the prevention of a relapse. This study may improve patient vulnerability to mental health issues and to assist psychiatric patients in establishing balance in their lives.

<p> </p><p><strong>Bakgrund:</strong> Allt fler vårdas av en nära anhörig i sitt hem. En vårdplanering ska utföras för att tydliggöra vårdtagarens behov av fortsatt vård i hemmet. De uppgifter som anhörigvårdaren och vårdtagaren utför efter utskrivning beskrivs som icke sjukvård; egenvård. Omvårdnadsteoretikern Dorothea Orem beskriver egenvården och dess betydelse för att uppnå en god hälsa. Kraven på anhörigvårdare ökar och behov finns för stöd, eftersom de ofta står ensamma i vårdsituationen. <strong>Syfte:</strong> Syftet var att belysa vårdtagare och deras anhörigvårdares upplevelser efter vårdtid inom slutenvård, med särskilt fokus på vårdplaneringens centrala roll. <strong>Metod:</strong> En allmän litteraturstudie har utförts. Nio stycken vetenskapliga artiklar har genom en kvalitativ innehållsanalys analyserats. <strong>Resultat:</strong> Följande teman framkom från analysen: Bristande kommunikation/information, Behov av trygghet och stöd, Ökad ansvarsbörda samt Känslomässig påverkan. Huvudrubrikerna i resultatet innefattar både positiva och negativa upplevelser kring vårdsituationen i hemmet. Upplevelserna skiljer sig mellan anhörigvårdare och vårdtagare beroende på hur de uppfattar situationerna i omvårdnaden. <strong>Konklusion:</strong> Anhörigvårdarna står ensamma med ansvarbördan och de har en betydande roll för sin anhöriges välbefinnande. Vårdplaneringen har en väsentlig funktion för en väl förberedd hemgång och en fungerande eftervård för vårdtagaren och dennes anhörige.</p><p> </p> / <p><strong>Background:</strong> Many patients receive care in their home by relatives. The needs of the patient for continued care at home can be addressed with discharge planning. Tasks that carers and patients performs after discharge are described as non-care, self-care. Nursing theorist Dorothea Orem describes self-care and its importance for achieving good health. Increasing demands on carers requires additional assistance and support as they are alone in the care situation. <strong>Aim:</strong> Was to highlight the patients and carers experiences of care after hospitalization and the significant roll of discharge planning. <strong>Method:</strong> A general literature review was conducted. Nine scientific articles provided the base. A qualitative content analysis has been used to analyze the articles. <strong>Findings:</strong> Lack of communication /information, The need for safety and support, Increasing responsibility and Emotional impact are the main headings in the results and includes positive and negative experiences regarding the care situation at home. Experiences differ between carers and patients due to, different understandings of the situations in the nursing care. <strong>Conclusion:</strong> Carers are alone with the burden of caring and they have a significant role for their families´ welfare. A discharge plan has an essential function after discharge and in the aftercare for the patient and relatives.</p>

Bakgrund: Allt fler vårdas av en nära anhörig i sitt hem. En vårdplanering ska utföras för att tydliggöra vårdtagarens behov av fortsatt vård i hemmet. De uppgifter som anhörigvårdaren och vårdtagaren utför efter utskrivning beskrivs som icke sjukvård; egenvård. Omvårdnadsteoretikern Dorothea Orem beskriver egenvården och dess betydelse för att uppnå en god hälsa. Kraven på anhörigvårdare ökar och behov finns för stöd, eftersom de ofta står ensamma i vårdsituationen. Syfte: Syftet var att belysa vårdtagare och deras anhörigvårdares upplevelser efter vårdtid inom slutenvård, med särskilt fokus på vårdplaneringens centrala roll. Metod: En allmän litteraturstudie har utförts. Nio stycken vetenskapliga artiklar har genom en kvalitativ innehållsanalys analyserats. Resultat: Följande teman framkom från analysen: Bristande kommunikation/information, Behov av trygghet och stöd, Ökad ansvarsbörda samt Känslomässig påverkan. Huvudrubrikerna i resultatet innefattar både positiva och negativa upplevelser kring vårdsituationen i hemmet. Upplevelserna skiljer sig mellan anhörigvårdare och vårdtagare beroende på hur de uppfattar situationerna i omvårdnaden. Konklusion: Anhörigvårdarna står ensamma med ansvarbördan och de har en betydande roll för sin anhöriges välbefinnande. Vårdplaneringen har en väsentlig funktion för en väl förberedd hemgång och en fungerande eftervård för vårdtagaren och dennes anhörige. / Background: Many patients receive care in their home by relatives. The needs of the patient for continued care at home can be addressed with discharge planning. Tasks that carers and patients performs after discharge are described as non-care, self-care. Nursing theorist Dorothea Orem describes self-care and its importance for achieving good health. Increasing demands on carers requires additional assistance and support as they are alone in the care situation. Aim: Was to highlight the patients and carers experiences of care after hospitalization and the significant roll of discharge planning. Method: A general literature review was conducted. Nine scientific articles provided the base. A qualitative content analysis has been used to analyze the articles. Findings: Lack of communication /information, The need for safety and support, Increasing responsibility and Emotional impact are the main headings in the results and includes positive and negative experiences regarding the care situation at home. Experiences differ between carers and patients due to, different understandings of the situations in the nursing care. Conclusion: Carers are alone with the burden of caring and they have a significant role for their families´ welfare. A discharge plan has an essential function after discharge and in the aftercare for the patient and relatives.

The overall aim of this thesis was to investigate the patients’ and their relatives’ perceived participation in discharge planning after stroke and the patients’ health-related quality of life, depressive symptoms, performance of personal daily activities and social activities in connection with discharge. Another aim was to evaluate the psychometric assumptions of the SF-36 for Swedish stroke patients. Prospective, descriptive and cross-sectional designs were used to study all patients with stroke admitted to the stroke unit at a hospital in southern Sweden from October 1, 2003 to November 30, 2005 each with one close relative. The total sample consisted of 188 patients (mean age=74.0 years) and 152 relatives (mean age=60.1 years). Data were collected during interviews, 2-3 weeks after discharge. The results showed that less depressive symptoms, more outdoor activities and performance of interests are important variables that related to higher HRQoL. SF-36 functions well as a measure of health related quality of life in Swedish stroke patients, but the two summary scales have shortcomings. Compared to a Swedish normal population, scores on all scales/components of the SF-36 were lower among stroke patients especially in the middle-aged group. Most of the patients perceived that they received information, but fewer perceived participation in the planning of medical treatment and needs of care/service/rehabilitation and goal setting. The relatives perceived that they need more information and they perceived low participation in goal setting and needs assessment. The professionals seem to lack effective practices for involving patients and their relatives to perceive participation in discharge planning. It is essential to develop and to implement methods for discharge planning, including sharing information, needs assessment with goal setting that facilitate patients’ and relatives’ perceived participation. The results suggest that ICF can be used in goal setting and needs assessment in discharge planning after acute stroke.

såväl vårdens lagstiftning som i utveckling av vården får patienten allt mer central ställning och roll. Ur ett patientperspektiv pekar dock uppföljningar av lagstiftning som reglerar samverkan vid utskrivning från sluten hälso- och sjukvård på bristande kunskapsläge på nationell nivå. Syftet med denna studie var att genom patientens egen berättelse söka insikter om upplevelser av utskrivningsprocessen från somatisk sluten hälso- och sjukvård och tiden efter, där behov funnits av fortsatt vård och omsorg efter utskrivning. Syftet var också att söka förståelse för huruvida Appreciative Inquiry kan bidra till insikter till ständiga förbättringar ur ett patientperspektiv. Med kvalitativ design och narrativ ansats genomfördes nio värdeskapande intervjuer med vuxna personer som vårdats på sjukhus 1 januari 2018. Dessa personer hade även behov av vård och/eller omsorg efter utskrivning. Intervjuguiden innehöll två huvudfrågor; “Berätta din berättelse om när du senast låg inne på sjukhus och tiden efter när du kom hem” och “Kan du berätta om en situation eller händelse som sticker ut som fungerade riktigt bra?”. Släktskapsdiagram grupperade och sorterade intervjuernas innehåll varvid fem indikatorer identifierades som viktiga i utskrivningsprocessen; Bemötande, att bli Lyssnad på, vara Informerad, uppleva att det Klaffar och upplevelse av Delaktighet. Ålder, allvarlighetsgrad på sjukdom eller behovsnivå av kommunal vård och omsorg efter utskrivning verkar inte vara faktorer som påverkar vad som är viktigt i samband med utskrivning från sluten vård. Befintlig lagstiftad process harmoniserar delvis med patientens uttryckta behov av vad som är viktigt. Patientens egen berättelse ingår i personcentrerat förhållningssätt där Appreciative Inquirys grundfilosofi såväl som värdeskapande verktyg kan bidra till processutveckling. / In both healthcare legislation and in the development of healthcare, the role of the patient is obtaining an increasingly central position. However, from a patient perspective, there appears to be a lack of knowledge at the national level about what is important during the discharge process from the hospital. The study aimed to gain insights through the patient's own story about experiences of the discharge process from closed somatic health care, including the time following discharge when additional care was needed. The purpose was also to develop understanding about in what ways the Appreciative Inquiry method can contribute to insights about the patients perspective that could serve continuous improvements. With qualitative design, and a narrative approach based on appreciative inquiry, nine interviews were conducted with adults who had been hospitalized after January 1th 2018. These individuals were also in need for care after discharge. The interview guide contained two main questions; “Tell me your story of when you were last hospitalized and the time after when you came home” and “ Can you tell me about a certain situation or event which stands out, that worked really well?”. The content from the interviews was sorted and categorized using a relationship diagram that identified five indicators as important to the discharge process; Empathetic response, being listened to, being informed, experiencing flow and experience of participation. Age, severity of illness or level of need for municipal care after discharge does not appear to be factors of importance in context of the discharge process from hospitalized care. Existing legislative process are partially in harmony with the needs expressed by patients about what is important. The patient’s own story is part of the person-centered approach where Appreciative Inquiry’s philosophy, as well as its value-creating tools, can contribute to process development. / <p>2020-06-26</p>

Bakgrund: Informationsöverföring från slutenvården är viktigt för att kunna säkerställa patientsäkerheten i kommunal hälso- och sjukvård. Det används olika journalsystem i regionen och i kommunerna och därför är det av stor vikt att informationsöverföringen dem emellan fungerar optimalt för att distriktssköterskan ska få fullständig rapport om patienten när denne skrivs ut från slutenvården. Syftet var att belysa distriktssköterskans erfarenhet av informationsöverföring vid utskrivning av vuxen patient från slutenvård till kommunal hälso- och sjukvård. Metod: Kvalitativ metod med induktiv ansats. 12 semistrukturerade intervjuer med distriktssköterskor i kommunal hälso- och sjukvård genomfördes. Data analyserades med kvalitativ innehållsanalys (Graneheim &amp; Lundman). Resultat: Resultatet mynnade ut i tre kategorier; Vikten av att följa överenskomna rutiner, Samverkan och Patientsäkerhet. Det framkom att rapportering via befintliga system måste fungera och att framförhållning är viktigt. Samverkan mellan de olika verksamheterna var en nyckelfaktor och när patienter krävde mer avancerade insatser efter utskrivning var det viktigt med samordnad individuell planering. Olika modeller för utskrivning förekom, vilket upplevdes både positivt och negativt. Patientsäkerheten riskerades när kommunikationen mellan verksamheterna var bristfällig. Slutsats: Det finns flera brister i informationsöverföringen mellan verksamheter idag där patientsäkerheten äventyras. Resultatet i studien skulle kunna vara aktuell för vidare forskning inom ämnet, där förbättring kring informationsöverföringen skulle behöva ses över. Utbildning till personalen i digitala kommunikationshjälpmedel skulle gynna informationsöverföringen liksom att ge tid för patientansvarig sjuksköterska inom slutenvården att kunna ge en fullständig och patientsäker utskrivning. / Background: Information transfer from inpatient care is important to be able to ensure patient safety in municipal health care. Different record systems are used in the region and in the municipalities, therefore it is of great importance that the information transfer between them works optimally for the district nurse to receive a complete report on the patient when he is discharged from inpatient care. The purpose was to highlight the district nurse's experience of information transfer when discharging an adult patient from inpatient care to municipal health care. Method: Qualitative method with an inductive approach. 12 semi-structured interviews with district nurses in municipal health care were conducted. Data were analyzed with qualitative content analysis (Graneheim &amp; Lundman). Results: The results resulted in three categories; The importance of following agreed procedures, Collaboration and Patient Safety. It emerged that reporting via existing systems must work and that foresight is important. Collaboration between the different operations was a key factor and when patients required more advanced interventions after discharge, coordinated individual planning was important. Different models for discharge occurred, which were perceived both positively and negatively. Patient safety was put at risk when communication between the operations was deficient. Conclusion: There are several shortcomings in the transfer of information between businesses today where patient safety is compromised. The results of the study could be relevant for further research in the subject, where improvement in the information transfer would need to be reviewed. Training the staff in digital communication aids would benefit the transfer of information as well as giving time for the inpatient nurse responsible for the patient to be able to provide a complete and patient-safe discharge.

No description available.

<p>Alternate Level of Care, or ALC, is a designation assigned to a patient during an acute care hospital stay when that patient is occupying a bed but no longer requires that intensity of service. A high proportion of beds occupied by patients requiring ALC results in problems in the healthcare system related to patient flow, access, and efficiency. The purpose of this study was to better understand the experience of older patients and family caregivers while the patient is designated as requiring ALC. This study employed the Three-Dimensional Narrative Inquiry Space method of Clandinin and Connelly (2000) to examine the experiences of five patients and four family caregivers. The primary data source for this study was a series of semi-structured interviews with individual participants over time while they were in the midst of the experience of ALC. Data analysis involved a twofold process of restorying all interview transcriptions for a given participant into a single story summarizing his or her experience, and analyzing the content across stories to identify common themes. The major finding of this study was that uncertainty was a significant part of the experience of ALC. This uncertainty was manifest in relation to self-concept, waiting for placement, not knowing about information, not being included in planning, lack of mobility, and lack of meaningful activity. The study findings have implications for strategies to manage uncertainty in the areas of practice, policy, education, and research in order to improve the experience of older patients and their family caregivers.</p> / Master of Science (MSc)