Background and Purpose: Children diagnosed with Type 1 Diabetes face significant challenges in the day to day management of their disease. Parents play an important role in supporting children at every stage of their lives and helping them transition to independence in the management of T1D. The purpose of this study was to learn from parents who have raised their children with T1D to adulthood and identify strategies for parents who are currently raising a child with T1D. Methods: Using a biographical method, a qualitative design, two in-depth interviews with open-ended prompts were completed with purposively selected parents of children with Type 1 Diabetes (T1D) who have grown into adulthood (18 parents, 36 interviews). The first interview invited participants to share their experience raising a child with T1D. The second interview asked specific questions about challenges, things that went well, things that didn't go well and advice for parents currently raising a child with T1D. Qualitative content analysis was used. Results: Analysis of the data identified recommendations for parents currently raising children with T1D. Advice for the parents included, 1) Parental attitude toward diabetes will be reflected in the child – Keep it positive, 2) Learn as much as you can about diabetes, 3) Find a good diabetes provider – Make your endocrinologist your best friend, 4) Don't make diabetes the definition of the child – treat them as normal, 5) Empower self-management – Teach them along the way then step back and let them take over, 6) Be your child's advocate, 7) Find support – Formal or informal, 8) Listen to your child – Don't judge. Conclusions and Implications: Nurses and nurse practitioners can share strategies identified by parents that were helpful in raising their child with Type 1 Diabetes.

Bakgrund: Human immunodeficiency virus (HIV) är en kronisk virussjukdom som drabbat stora delar av världen. Behandling med ART har gett möjlighet för patienter att få en bättre livskvalité. Individer som lever med HIV har sedan upptäckten tillskrivits stereotypiska karaktärsdrag och upplevt stigmatisering, även inom sjukvården. Det är sjuksköterskans ansvar att upprätthålla god yrkeskompetens och arbeta utifrån etiskt förhållningssätt för att bedriva god och jämlik vård oavsett patienters bakgrund och sjukdom. Syfte: Syftet med studien var att belysa HIV-smittade patienters upplevelser av stigmatisering i vårdmöten. Metod: En kvalitativ litteraturöversikt genomfördes med 13 artiklar från 10 länder. Artiklarna granskades och analyserades för att urskilja likheter och sedan sammanställas.  Resultat: Resultatet utmynnade i två huvudteman; upplevelse av bristfälliga vårdhandlingar samt rädsla för att söka vård. Sju underteman; förnekad och fördröjd vård, bruten sekretess, överdrivna försiktighetsåtgärder, fördomar, upplevd okunskap hos vårdpersonal, rädsla för ett dåligt bemötande, att bli kränkt och ignorerad. Konklusion: Patienter upplevde stigmatisering, fördomar och stereotypa föreställningar i vårdmöten, vilket påverkade viljan till fortsatt vård och behandling. Vårdpersonalens bristande kunskap beträffande HIV kan ses som en möjlig orsak till att patienter fortfarande upplever stigmatiserande attityder i mötet med vårdpersonal. För att motverka negativa attityder hos vårdpersonal krävs ökad kunskap och forskning kring stigmatisering i vårdsammanhang. / Background: Human immunodeficiency virus (HIV) is a chronic viral disease that has affected large parts of the world. Treatment with ART has given patients the opportunity to have a better quality of life. Individuals living with HIV have since the discovery been attributed stereotypical traits and experienced stigma, even in healthcare settings. It is the nurse's responsibility to maintain good professional competence and work on the basis of an ethical approach in order to provide good and equal care regardless of patients' background and illness. Aim: The aim of the study was to illustrate patients experiences of stigmatization in healthcare meetings.  Method: A qualitative literature review was conducted with 13 articles from 10 countries. The articles were reviewed and analyzed to identify similarities and then compiled. Findings: The result resulted in two main themes; Experience of inadequate care documents and fear of seeking care. Seven sub-themes; denied and delayed care, broken confidentiality, excessive precautions, prejudice, perceived ignorance by healthcare professionals, fear of bad treatment, being offended and ignored. Conclusion: Patients experienced stigma, prejudice and stereotypical perceptions in care meetings that affect the willingness to continue care and treatment. The care staff's lack of knowledge regarding HIV can be seen as a possible reason why patients still experience stigmatizing attitudes in the meeting with care staff. To counteract negative attitudes among care staff, increased knowledge and research on stigma in care contexts is required.

The aim of the diploma thesis is to define presumptions of the criminal liability of healthcare providers and answer the question in which circumstances and under what conditions can healthcare providers can be criminal liable. The diploma thesis is divided into nine chapters. The first chapter deals with legal entities, particularly their history and definition in Czech legal order. In second chapter I envisage with the basic medical law terms importing in relation with the subject of the diploma thesis, especially I mentioned health related services, healthcare, services to promote and maintain health, healthcare provider and patient. In the third chapter I define in general the fundamental types of legal liability in the health care sector and in the subchapter I analyse the institute of the informed consent, which is in my opinion an important aspect in defining legal liability in healthcare. Further in the fourth chapter I focus specifically on criminal liability, which I first define as such, including the individual circumstances that exclude unlawfulness, then I deal with the criminal liability of legal entity and its possible criminal conduct in relation with the provision of healthcare. I also analyze the terms of lege artis and vitium artis procedure, which are usually the necessary...

Cancer-related fatigue (CRF) as a distressing, persistent, subjective sense of physical, emotional, and/or cognitive tiredness or exhaustion related to cancer and cancer treatment that is not proportional to recent activity, such as physical activity, that interferes with usual functioning (Howell et al., 2015; National Comprehensive Cancer Network, 2020). CRF is one of the most common symptoms experienced by cancer patients at all stages of the cancer trajectory which significantly impacts patient’s quality of life, return to work, mental health, and can lead to disability (Bower, 2014b; Jones et al., 2016). Much research has focused on the development of CRF assessment and intervention strategies which have promoted the development of comprehensive evidence-based guidelines (Howell et al., 2015; National Comprehensive Cancer Network, 2020). However, previous research has identified many practice gaps in their implementation (Berger et al., 2015; Borneman et al., 2007; Pearson et al., 2015a, 2017b). This thesis’ objectives were to gain a deeper understanding of potential barriers to CRF clinical guideline implementation to identify potential knowledge translation strategies of CRF guidelines into practice following a Knowledge-To-Action (KTA) framework perspective (Graham et al., 2006; Straus et al., 2013). In Study 1, a qualitative research design was used to recruit a total of 62 participants—16 patients, 32 healthcare providers (HCPs), and 15 community support providers (CSPs). Drawing on the KTA model, the goal of the study was to explore key stakeholders’ (patients, HCPs, CSPs) experiences and opinions on CRF assessment and management and to explore underlying causes of CRF treatment gaps. No specific hypothesis were determined given the exploratory nature of the study. The results of this study highlight CRF guideline implementation gaps, patient dissatisfaction with CRF care, and challenges contributing to CRF assessment and management gaps. The results also suggested the presence of two underlying mechanisms contributing to treatment gaps: A Perfect Storm and Patient-Provider Communication Gaps. Understanding these mechanisms provides clarity on the potential causes maintaining CRF treatment gaps and can help direct targeted knowledge translation strategies to improve the implementation of CAPO CRF guidelines into practice. Consistent with a recent Delphi study (Pearson et al., 2017b), the results supported the need for professionals’ training on CRF guidelines to fill knowledge gaps. In Study 2, a mixed-methods pilot study with 18 HCPs and CSPs was used to develop and evaluate the acceptability and feasibility of a one-time training session for HCPs and CSPs on CAPO CRF guidelines, once again flowing the KTA framework (Graham et al., 2006; Straus, 2011). A secondary objective was to evaluate the learning outcomes of the training session including CAPO CRF guidelines knowledge, self-efficacy, and intent to apply CAPO CRF guidelines in practice. Overall, results suggest that offering a brief one-time training for HCPs and CSPs on CRF guidelines may be effective in increasing knowledge, self-efficacy, and intent to apply guidelines into practice. Similarly, that KT tools are appreciated by HCPs/CSPs and may be used in practice to supplement and sustain the knowledge and skills gained in training.

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Background: Obesity affects over 1 billion individuals across the world. In Canada, nearly 1 in 7 children and adolescents are obese. The risk of obesity is heightened for newcomer children due to their adoption of the Western diet and a sedentary lifestyle. While healthcare providers (HCPs) are the first point of contact upon health concerns, little is known about how HCPs approach HAL communication with newcomer families, with the goal of preventing childhood obesity. Objectives: This study aims to understand HCPs’ experiences with newcomer families relating to (1) HAL communication, (2) HAL promotion strategies, and (3) challenges with HAL promotion. Methods: 12 HCPs currently practicing in Hamilton and experienced in working with newcomer families completed 30–60-minute semi-structured interviews. Thematic analysis was used to identify key themes relating to HAL communication approaches, HAL promotion strategies, and challenges with promoting HAL among newcomer families. Results: Three themes emerged for HAL communication: 1) reactive approach, 2) patient-centered and culturally sensitive communication, 3) holistic health discussions. Four themes emerged for HAL promotion strategies: 1) tailored resource recommendations, 2) facilitating connections among newcomers, 3) family-centered approach, 4) referrals to additional support. Five themes emerged for challenges with HAL promotion: 1) time constraints, 2) difficulty to obtain buy-in, 3) limited resources awareness & availability, 4) navigating sensitivity and empathy, 5) ambiguity in role responsibilities. Conclusion: HCPs emphasized the influence of time limitations, limited resource awareness, and newcomer families’ competing priorities on limiting their ability to proactively promote HAL. Analyzing the data through the Commission on Social Determinants of Health (CSDH) framework revealed the various intersecting determinants of health that make HAL promotion an intricate task. With HCPs expressing reservations about their efficacy in promoting HAL proactively, investigation into collaborative approaches for proactive HAL promotion should be explored. / Thesis / Master of Science (MSc) / Obesity affects over 1 billion individuals across the world. In Canada, nearly 1 in 7 children and adolescents are obese. The risk of obesity is heightened for newcomer children due to their adoption of the Western diet and a sedentary lifestyle. While healthcare providers (HCPs) are the first point of contact upon health concerns, little is known about how HCPs communicate and promote the importance of healthy eating and daily physical activity to newcomer families, with the goal of preventing childhood obesity. Using a qualitative thematic analysis approach, semi-structured interviews were conducted with 12 HCPs. Their responses revealed that HCPs commonly only discuss health behaviours in response to evident weight concerns, tailor their recommendations to address newcomers’ circumstances, and are hindered by time constraints to discuss health behaviours. Acknowledging the limitations of their role capacity, HCPs advocated for collaborative approaches to proactively promote healthy active living to newcomer children.

Bakgrund: Ljumskbråck är den vanligaste operationen inom allmänkirurgin, varje år utförs nästan 20 000 operationer i Sverige. I Östergötland utförs ljumskbråcksoperationer på tre ställen inom ramen för dagkirurgi; vid Aleris Specialistvård i Motala (ASM), Närsjukvården i Finspång (NiF) samt Medicinskt Centrum i Linköping (MCL). Det finns en teori om att privata vårdgivare är mer tidseffektiva än offentliga vårdgivare. De privata anses kunna utföra fler operationer under en given tid, men ingen studie har gjorts på tidseffektiviteten kring operationerna hos respektive vårdgivare. Denna studie har genomförts för att detektera om det finns en skillnad i hur lång tid olika moment tar att utföra och vad denna skillnad i sådana fall beror på, samt om patientunderlaget skiljer sig mellan klinikerna. Metod: Studien omfattade 70 patienter fördelade på tre kliniker; ASM, MCL och NiF. Ljumskbråcksoperationerna delades upp i flertalet moment som mättes med digital klocka. Dessutom samlades uppgifter in om patientens ålder, ASA-klass, BMI samt information om vilka som närvarade i operationssalen. Statistisk analys gjordes enligt Kruskal-Wallis. Programvaran som användes var SPSS version 22. Resultat: Studien fann ingen signifikant skillnad i BMI, ASA-klass eller ålder mellan klinikernas patienter (p > 0,05 för samtliga). Däremot fanns stora skillnader vad gäller hur lång tid ett flertal av momenten under ljumskbråcksoperationen tog. Slutsats: Studien påvisar att det finns stora skillnader i olika moment vid ljumskbråcksoperationer. De privata klinikerna var alltid snabbare än den offentliga kliniken. Då det saknas studier inom området vore det intressant att se om det finns liknande skillnader vid andra ingrepp som utförs av olika aktörer. / Background: Inguinal hernia surgery is one of the most common surgeries within general surgery, with approximately 20 000 surgeries per year in Sweden. There are three places in Östergötland County where inguinal hernias are executed within outpatient surgery; at Aleris Specialistvård in Motala (ASM), Närsjukvården in Finspång (NiF) and at Medicinskt Centrum in Linköping (MCL). There is a theory that private health care providers are more time-efficient than public health care providers. The private health care providers are considered to perform more operations over a given time though no studies has been done on time efficiency. This study was performed to detect if there is a difference in time in the various steps during the surgery between the clinics, what causes these differences and if the patients differ. Methods: The study includes 70 patients distributed on three outpatient surgery clinics; ASM, MCL and NiF. The inguinal hernia operations were divided into shorter steps measured with a digital watch.  Furthermore, data were noted about the patients’ age, ASA-score, BMI and who were present in the operating room. Statistical analyses were performed with the Kruskal-Wallis one-way analysis of variance. The software used was SPSS version 22. Results: The study found no significant difference in BMI, ASA-score and age between the health care providers (p > 0,05). However, regarding the time efficiency, there were significant differences between the clinics. Conclusions: The study concludes that there are big differences in time, within the various steps in the inguinal hernia surgeries, between the clinics. The private health care providers were always faster than the public health care provider. Since no earlier studies have been made in this area, it would be interesting to see if there are similar differences in other types of surgeries.

To understand the impact of recurrent pandemics such as MERS-CoV on Respiratory Therapists (RTs) behavior and commitment has become an extremely important and relevant exercise because of the unprecedented MERS-CoV occurrences in Saudi Arabia. The purpose of this study was to assess RTs knowledge, attitudes, and skills, in order to examine the differences in RTs readiness level, training status, and the association and during MERS-CoV disasters. Method used Cross-sectional survey. A web-link survey was emailed to Saudi Society for Respiratory Care (SSRC) members, (N 750). The survey consisted of two parts: knowledge, skills, and attitudes, and the readiness to come to work. Data was collected and analyzed using SPSS 23.0. Findings showed a significant difference between the different levels of work positions (p = 0.027), a gender and work position (p = 0.012). There was a significant moderate correlation between readiness to work and knowledge (r = .407, p < 0.05), a significant low correlation between readiness to work and skills (r = 0.261, p = .05). There was a significant substantial correlation between skills and knowledge (r = .521, p < 0.05). In conclusion, this study showed the importance of establishes effective disaster health bureaucracy by performs periodic health policy analysis for epidemic and pandemic influenza. It called for planning, preparedness to respond effectively using all hazard-approach for potential influenza disasters. It revealed the significance of capability building for first line responders in term of HCWs Check-list education and training programs. Moreover, it supported the establishment of independent local CDC and Disaster Management panel. It recommended flexible bureaucracy and leadership enhancement for HCWs strike teams to increase likelihood success in response for unconventional scenarios.

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