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<p>Background One of the main demands on Swedish and global health care in general is to meet the patient’s need for safety. By general health care law this also comprises district nurses’ field of responsibility. Although there are numerous studies describing the concept of safety and its different shapes, no research could be found exploring how safety is, or supposed to be, mediated by district nurses’ in a Swedish context. Research about this is therefore needed. Aim The aim of this qualitative study was to explore how district nurses’ mediate safety to their patients. Method Qualitative data were collected from seven district nurses’ by means of semi structured interviews. Thereafter, a concept analysis was carried out. Results Responses revealed that district nurses’ consider themselves mediate safety through a variety of ways. Five major categories emerged: (1) complaisance’s; (2) competence; (3) patient participation; (4) same caregiver; (5) personal characteristics. Conclusion District nurses’ mediate safety through a combination of general attitudes and concrete acts. Preconditions are bound to each district nurse’s individual ability to give a good complaisance, his/her competence and ability to involve patients in treatment and care. Other, less pronounced, are bound to the district nurse’s ability to create continuity in contact with patients’ and his/her personal characteristics.</p>

Background One of the main demands on Swedish and global health care in general is to meet the patient’s need for safety. By general health care law this also comprises district nurses’ field of responsibility. Although there are numerous studies describing the concept of safety and its different shapes, no research could be found exploring how safety is, or supposed to be, mediated by district nurses’ in a Swedish context. Research about this is therefore needed. Aim The aim of this qualitative study was to explore how district nurses’ mediate safety to their patients. Method Qualitative data were collected from seven district nurses’ by means of semi structured interviews. Thereafter, a concept analysis was carried out. Results Responses revealed that district nurses’ consider themselves mediate safety through a variety of ways. Five major categories emerged: (1) complaisance’s; (2) competence; (3) patient participation; (4) same caregiver; (5) personal characteristics. Conclusion District nurses’ mediate safety through a combination of general attitudes and concrete acts. Preconditions are bound to each district nurse’s individual ability to give a good complaisance, his/her competence and ability to involve patients in treatment and care. Other, less pronounced, are bound to the district nurse’s ability to create continuity in contact with patients’ and his/her personal characteristics.

Abstract   Back ground: Home based care is a meaningful activity giving patients and their families a chance to live their lives as close to normal as possible. Advanced palliative care is today provided at home, although geography does play a role in shaping that care. A rural setting can mean that conditions for such care differ from those in urban areas. Purpose: To describe the experiences of district nurses in palliative home care settings in a rural community. Method: Semi structured interviews with seven district nurses. The interviews were recorded digitally and transcribed in a precise fashion. A method of qualitative analysis of the contents, inspired by Burnard, was used to analyze the material. Results: Palliative care places high demands on the competency and experience of district nurses. The conditions of a rural setting contribute to the structure of such care in so far as its organization and prioritization. The work of the district nurses involved was marked by cooperation and peer support. The fact that the care for patients varied between communities was however, seen as unfair. Conclusion: The study expands the body of knowledge of the experiences of district nurses. It also clarifies the conditions that influence palliative care in a rural community. Hopefully this study will contribute to further development of palliative home care, and enable those affected to receive care on more equal terms.

Background: Malnutrition is a nursing issue that causes both physical and psychological suffering of those who are affected. In order to achieve care that is safe and has a good quality, it must be based on the assessment and actions of the state. District nurses play a central role in this work. Aim: The aim of this study was to describe the district nurses' work with identifying and addressing malnutrition in older people in nursing Home Care of the Community. Method: Six interviews with district nurses were conducted. The data were analyzed using qualitative content analysis with an inductive approach Results: From the results of the analysis two categories emerged: observations for finding signs of malnutrition, treatment and following up by malnutrition. Conclusion: Cooperation in the form of communication and information within the care team, together with the patient and their relatives, were found to be important for the patient's nutritional needs and should be identified and addressed in order to avoid the risk of malnutrition. The results that emerge can contribute to new knowledge that can help to identify older persons in order to get early and appropriate interventions and thus reducing the suffering that is caused by malnutrition. / Bakgrund: Malnutrition är ett omvårdnadsproblem som medför både fysiskt och psykiskt lidande för den som drabbas. För att uppnå en vård som är säker och har god kvalitet, måste den baseras på bedömning samt åtgärder av nutritionsproblemet. Distriktssköterskan har en central roll i detta arbete. Syfte: Syftet med studien var att beskriva distriktssköterskors arbete med att identifiera och åtgärda malnutrition hos äldre personer inom kommunal hemsjukvård. Metod: Sex intervjuer med distriktssköterskor genomfördes. Datamaterialet analyserades med kvalitativ innehållsanalys med induktiv ansats. Resultat: Ur analysen av datamaterialet framträdde två kategorier; Observationer för att finna tecken på malnutrition, behandling och uppföljning av malnutrition. Konklusion: Samarbete i form av kommunikation och information inom vårdteamet och tillsammans med patienten och dess anhöriga, visade sig vara av vikt för att patientens nutritionsbehov ska kunna identifieras och tillgodoses för att inte riskera malnutrition. Resultatet som framkom kan bidra med kunskap som kan underlätta att identifiera äldre personer tidigt och med adekvata insatser förmå att minska lidandet som malnutrition medför.

När patienten önskar att få avsluta sitt liv i hemmet krävs det att den avancerade vården också flyttas till hemmet. Distriktssköterskor har övergripande omvårdnadsansvar inom palliativ hemsjukvård och kan uppleva etiska, moraliska och kommunikativa svårigheter. För en god palliativ omvårdnad krävs det att distriktssköterskor är engagerade, har erfarenhet och har avancerad kompetens inom palliativ vård. Syftet med denna studie är att belysa distriktssköterskors erfarenheter av att vårda patienter i livets slutskede inom palliativ hemsjukvård. Nio distriktssköterskor intervjuades. För att analysera data användes en kvalitativ innehållsanalys med induktiv ansats. Analysen resulterade i fyra teman med tillhörande åtta underteman. Teman benämns; Kunna samarbeta och samverka i vården, Kunna vårda anhöriga, Kunna hantera negativa känslor och Skapa en god vårdmiljö. Slutsatsen blev att, ett bra teamarbete är viktigt för distriktssköterskor men att ha olika vårdaktörer kan försvåra vårdarbetet. Det är viktigt för distriktssköterskor att kunna möta anhöriga och ta emot sorg då sorgen kunde komma som missnöje. Detta kan påverka vårdpersonalen negativt. Det är viktigt att distriktssköterskor får stöd vid känsla av otillräcklighet och känslomässiga reaktioner. Fortsatt forskning kan riktas ur anhörigas synvinkel för att kunna förstå anhörigas reaktioner. / When the patient wishes to die at their own home requires that the advanced care also moved to their home. District nurses have primary care responsibilities in palliative home care and may experience ethical, moral and communicative difficulties. For a good palliative care requires that district nurses is involved, have the experience and have advanced skills in palliative care. The purpose of this study is to illuminate district nurses' experiences of caring for patients in the final stage in palliative home care. Nine district nurses were interviewed. To analyze the data, a qualitative content analysis with an inductive approach was applied. The analysis resulted in four main themes with its eight sub- themes. Main themes titled; Being able to collaborate and cooperate in care, Being able to care for relatives, Being able to manage negative emotions and Able to create a good care environment. The conclusion was that, a good teamwork is important for district nurses but having different care providers can complicate caring. It is important for district nurses to meet relatives and receive grief when grief could come as dissatisfaction. This could affect the nursing staff negatively. It is important that district nurses are supported in the sense of inadequacy and emotional reactions. Further research may be aimed at relatives ' point of view in order to understand family members' reactions.

Syfte: Syftet med studien var att beskriva distriktssköterskors upplevelser och erfarenheter av patientundervisning till patienter med diabetes samt att identifiera aspekter som kan relateras till ett personcentrerat förhållningssätt. Metod: Deskriptiv design med kvalitativ ansats med semistrukturerade intervjuer användes vid datainsamlingen. Vid urvalet användes strategiskt urval. Nio intervjuer utfördes med distriktssköterskor på sex olika vårdcentraler i Mellansverige. Vid analysen användes kvalitativ innehållsanalys. Resultat: Distriktssköterskorna önskade mer kunskap om invandrares kost- och motionsvanor. Distriktssköterskorna uttryckte att det var roligt och spännande med patientundervisning och att det var viktigt att de var engagerade. Distriktssköterskorna ville arbeta mer i team och de upplevde att de hade för lite tid avsatt för patientundervisning. De ansåg att de arbetade personcentrerat men det var svårare att arbeta personcentrerat vid gruppundervisning än vid enskild undervisning. Slutsats: Distriktssköterskor bör ha god kunskap om kulturella skillnader hos patienter med diabetes. Distriktssköterskorna upplever brist på tid- och resurser och önskar samarbeta mera i team. Det är viktigt med ett personcentrerat förhållningssätt där distriktssköterskorna utgår från den enskilda individen. En distriktssköterska som är engagerad och trivs med sitt arbete kan lättare klara av det ökade trycket och arbetsbelastningen. / Aim: The aim of the study was to describe district nurses´ perceptions and experiences of patient education for patients with diabetes and to identify aspects that can be related to a person-centered approach. Methods: Descriptive design with qualitative approach with semi structured interviews were used for data collection. In the selection process was strategically selection used. Nine interviews were conducted with district nurses at six different medical centers in central Sweden. In the analysis used qualitative content analysis. Results: District nurses wanted more knowledge about immigrants' eating and exercise habits. District nurses expressed that it was fun and exciting with patient education and that it was important that they were engaged. District nurses wanted to work more in teams and they felt they had too little time set aside for patient education. They felt that they were working person-centered but it was more difficult to work person centered at group education than private education. Conclusion: District nurses should have good knowledge of cultural differences in patients with diabetes. District nurses perceive lack of time and resources and want more cooperate in teams. It is important with a person-centered approach, where district nurses based on the individual person. A district nurse who is engaged and enjoy their work can help dealing with the increased pressure and workload.

The purpose was to elucidate the reactions of formal carers as witnesses and helpers in situations of elder abuse, to illuminate abusive situations and to reflect on the findings from an ethical point of view. Twenty-one district nurses from one county council were interviewed (I, II, III, IV). They described the problems they had when dealing with cases of elder abuse, the uncertainty they felt when they approached the family, identified the abuse and intervened (I). They used no distinct definition of elder abuse but described it as ’overstepping the boundaries of a person’s integrity/autonomy’ (II). In the 44 cases narrated the elderly people were mostly physically and/or psychologically impaired, the person abused could either be the impaired elderly person, the informal carer or both. Abuse was related to the inability of one party to meet the demands made on him/herself, the other person, or to a history of violence (III). The cases narrated were analysed for reliability and were considered reliable (IV). Questionnaires submitted to 163 district nurses revealed 33 cases of elder abuse (V) and to home service assistants 97 cases (VI). The abused elderly people were often very old women, mostly healthy or unhealthy in equal proportions. The perpetrators were mostly close relatives, responsible or not responsible for the caring. The abusive acts often involved a combination of psychological, physical, and financial abuse and neglect. Mental disturbance and alcohol abuse, as well as financial reasons were reported as contributing to the abuse (V, VI). The attitudes of general practitioners, district nurses and home service assistants towards elder abuse and the interventions suggested in hypothetical cases of elder abuse were investigated (VII). All groups were uncertain about their attitudes towards elder abuse. Their suggested interventions were amalgamated into three groups; sparse and of the social type, more specific and of the health care and voluntary type, or overall types of intervention. The situation, profession and organization seemed to result in different interventions (VII). The findings were reflected on using Lögstrup’s ethic as a framework, and the conclusion was that in order to be able to intervene successfully formal carers need to find solutions on a meta-level. Conventions and norms must be developed and public responsibility is needed. / <p>S. 1-82: sammanfattning, s. 85-199: 7 uppsatser</p> / digitalisering@umu

Hälsofrämjande arbete är viktigt inom hela hälso- och sjukvården, där distriktssköterskan har ett stort ansvar. Sedan ädelreformen har de flesta kommuner övertagit ansvaret för att tillhandahålla hälso- och sjukvård, bland annat i hemmiljö. Orems omvårdnadsteori fokuserar på egenvård och menar att människan är en aktiv och fri varelse som kan uppnå välbefinnande genom egenvård. Syftet med studien var att beskriva distriktssköterskors upplevelser av hälsofrämjande arbete inom kommunal hemsjukvård. En kvalitativ metod med induktiv ansats användes och fem intervjuer med distriktssköterskor från två kommuner i nordvästra Skåne genomfördes. Intervjuerna analyserades med kvalitativ innehållsanalys. I studien framkom kategorierna: omvårdnad är hälsofrämjande, hälsofrämjande arbete saknar prioritet samt hemmet som arena. Distriktssköterskorna upplevde att hälsofrämjande arbete bygger på holistiskt synsätt och är grunden för allt omvårdnadsarbete, samtidigt som de lutade sig mot sin medicinska kompetens. Vidare upplevde de att hälsofrämjande arbete saknade prioritet genom bristande kompetens inom hälso- och sjukvårdsteamet, tidsbrist och kortsiktiga interventioner. Det hälsofrämjande arbetet försvårades genom att hemmet är arenan, som är individens revir och dennas villkor styr arbetet. Framtida studier utifrån vårdtagarens perspektiv skulle kunna vidareutveckla resultatet i denna studie och samtidigt vara ett steg i vårdutvecklingen inom kommunal hemsjukvård. / Health promotion is important in all of the health care system, where the district nurse has big responsibility. Since the “ädelreform”, most counties are taking responsibility for providing health care, including the care takers who live at home. Orem´s nursing theory focuses on self-care and believes that man is an active and free being capable of achieving wellness through self-care. The aim of the study was to describe nurses' experiences of health promotion in municipal home care. A qualitative method with inductive approach was used and five interviews were performed, with district nurses from two counties in northwest Skåne. The interviews were analyzed using qualitative content analysis. The study revealed categories: caring is health promotion, health promotion lacks priority and the home as the arena. District nurses felt that health promotion is based on a holistic approach and the foundation for all nursing work, while they leaned towards their medical expertise. Furthermore, they felt that health promotion has low priority by lack of skills in the health care team, lack of time and short-term interventions. Health promotion efforts were affected since the home was the arena, where the individual's terms and conditions governed the work. Future studies based on the resident's perspective could further develop the results of this study while being a step in the healthcare developments in municipal home care.

Bakgrund: Hypertoni är ett folkhälsoproblem och utgör en stor riskfaktor för utveckling av hjärt-kärlsjukdom. Basen för omvårdnaden utgörs av livsstilsförändringar. Distriktssköterskors centrala roll innefattar att i jämlik, ömsesidig kommunikation ge råd, motivera och stödja till förändring av levnadsvanor samt främja patientdelaktighet och autonomi. Syfte: Syftet med studien var att belysa distriktssköterskors erfarenheter av att stödja patienter med hypertoni till livsstilsförändringar. Metod: Datamaterialet analyserades med kvalitativ innehållsanalys med en induktiv ansats. Åtta distriktssköterskor med ansvar för patienter med hypertoni intervjuades. Resultat: Ur analysen av datamaterialet framträdde tre kategorier; Initierar samarbete, Bekräftar individen och Anpassar omvårdnad för patienten, med sex underkategorier. Konklusion: Distriktssköterskorna upplevde sin roll central, viktig och ansvarsfull när det handlade om att ge råd och undervisning. De upplevde sig även vara en viktig länk mellan patient och andra aktörer. De ansåg att lyhördhet för patientens livssammanhang och en samtalsstrategi i kommunikationen vid livsstilsrådgivning var viktigt för främjandet av patientdelaktighet och autonomi. Att individuellt motivera till livsstilsförändring beskrevs som en svårighet och distriktssköterskorna uttryckte en frustration över att det var bristande tid för uppföljning. / Background: Hypertension is a public health problem and a major risk factor for developing cardiovascular disease. The basis for the nursing care is lifestyle changes. District nurses´ role includes to advise, motivate and support life style changes, as well as to promote patient participation and autonomy, through an equal and mutual communication. Aim: The aim of the study was to illuminate experiences of district nurses supporting patients with hypertension to make lifestyle changes. Method: The data were analyzed by qualitative content analysis with an inductive approach. Eight district nurses responsible for hypertensive patients were interviewed. Results: Three categories emerged from the data analysis: Initiates cooperation; Confirms the individual and Adapts nursing for the patient, with six subcategories. Conclusion: The district nurses perceived their role as central, important, and responsible when providing advice and instruction. They also considered themselves as an important link between the patient and other actors. Responsiveness of the patient's life context, as well as using a communication strategy when giving counseling on lifestyle changes were considered important to promote patient participation and autonomy. To motivate lifestyle changes individually was described as a difficulty and district nurses expressed frustration with the lack of time for follow-up.