The aim of this study was to investigate how unit-managers implement home-care users right to self-determination within home-care services and witch conditions that indicated home-care users self-determination. The empirical material was analysed through qualitative content analysis, which generated two themes: 1) To be the center of the spider web and 2)  To work with implementation plans. The empirical material was also analysed with previous research, implementation theory and street-level bureaucracy.  The result show that unit-managers has a duty to implement and contribute to home-care users self-determination. Unit-managers shall ensure that home-care users has self-determination within the organisational framework, conditions and requirements and also based on home-care users preferences. Methods like IBIC (individual based care) and function preservation work method, are being used to preserve home-care users independency and self-determination throughout the work. Unit-managers implement self-determination using opinion-forms, implementation-plans, contact persons and through dialog with home-care personal creates normes, values and work methods. The conclusion is that self-determination is used by home-care users to influence their aid by leaving complains and opinions to home-care personal, on a opinion form or directly to the unit-manager. Home-care users can decline aid if they are unhappy or feel that they does not have the need for the specific aid. Self-determination has conditions and it exists many obstacles for home-care users desires and right to self-determination.

Bakgrund: Varje år dör omkring 90 000 personer i Sverige och de flesta har behov av palliativ vård. Den enskilde individen skall i största möjliga mån få avgöra om denne vill dö hemma eller inom den slutna vården. Historiskt sett har den palliativa vården behandlat personer med cancersjukdom men har med tiden utvecklats till att behandla flera typer av sjukdomstillstånd. Syfte: Syftet med föreliggande studie var att beskriva hur vuxna patienter upplever den palliativa vården i hemmet, samt att studera de valda artiklarnas datainsamlingsmetod. Metod: Föreliggande studie har en deskriptiv design. Studiens resultat baseras på elva vetenskapliga artiklar, tio med kvalitativ ansats och en med mixad ansats. Samtliga artiklar granskades av båda författarna och färgmarkerades beroende på innehåll. Artiklarna identifierades genom databaserna Cinahl och Pubmed. Huvudresultat: Den palliativa vården i hemmet upplevdes till stor del som positiv av patienterna. Det värderades högt att ha sina närstående nära och att få vistas i sin trygga hemmiljö den sista tiden i livet. Det framkom även att de palliativa patienterna var oroliga över att vara en börda för sina närstående. Genom att ha sjukvårdare i hemmet samt stöd från närstående gavs möjlighet att utföra vardagliga aktiviteter på egen hand, som visade sig generera livskvalitet. Värdighet hos de palliativa patienterna beskrevs genom begreppen integritet, välbefinnande och självbestämmande. God kommunikation och kontinuitet upplevdes som viktiga faktorer för de patienterna. Slutsats: Palliativa patienter som vårdats hemma såg i hög grad positivt på den vård de erhållit. De upplevde att samarbete mellan sjukvården och deras närstående är en förutsättning för trygg vård i hemmet. Hälso- och sjukvård bör prioritera dessa patienters önskan om att få vårdas och dö hemma eftersom detta genererar livskvalitet. Föreliggande studies resultat ger en tydlig indikation på utvecklingsområden inom palliativ vård. / Background: Every year, about 90 000 people in Sweden die and most of them are in need of palliative care. The individual should as far as possible be able to decide if he or she wants to die at home or in hospice care. Historically, palliative care was meant to treat people with cancer but has gradually evolved to treat several types of disorders. Purpose: The purpose of this study was to describe how adults perceive palliative care in their home, as well as to study the selected articles data collection method. Method: The present study has a descriptive design. The study results are based on eleven scientific articles, ten with qualitative approach, and one with a mixed approach. All articles were reviewed by both authors and color marked depending on the content. The articles were identified through databases CINAHL and Pubmed. Main Results: The palliative care at home was perceived largely as positive among patients. It was highly valued having their relatives close and to reside in their familiar home environment at the end of life. It also emerged that the palliative patients were concerned about being a burden to their families. By having paramedics in their home as well as support from relatives they were given the opportunity to be able to handle everyday activities on their own, which turned out to generate quality of life. Dignity of the palliative patients was described by the concepts of integrity, well-being and self-determination. Good communication and continuity was seen as important factors for the patients. Conclusion: Palliative patients who received care at home looked largely positive about the care they received. They felt that the cooperation between health care and their families was essential for safe care in their home. These patients' desire to be cared for and die at home should be a priority as it will lead to increased quality of life. Results of this study gives a clear indication of development areas in palliative care.

<p>Studiens syfte var att undersöka sjuksköterskors upplevelser av att ge stöd till anhöriga till patienter inom palliativ hemsjukvård.</p><p>Designen var deskriptiv med en kvalitativ ansats. Informanterna var strategiskt utvalda och bestod av fem sjuksköterskor som arbetade i ett palliativt hemsjukvårdsteam i Upplands län. Bandinspelade personliga intervjuer analyserades med en kvalitativ innehållsanalys.</p><p>Sjuksköterskorna upplevde att deras arbete kändes meningsfullt och utvecklande. Att arbeta i team var en mycket positiv aspekt. De svårigheter som framkom handlade om att anpassa sig efter olika situationer. Sjuksköterskorna gav stöd till anhöriga främst genom att kommunicera och samtala, samt förmedla trygghet. Det var viktigt att även både verbalt och praktiskt visa anhöriga att det fanns tid även för detta.</p><p>Eftersom det blir allt vanligare med palliativ vård i hemmet och den inte kan ske utan de anhörigas insats är det mycket viktigt att utveckla och optimera sjuksköterskans stöd till dem. Denna studie kan ge en insikt i de problem som finns i anhörigstödet, men även ge en insikt om de organisatoriska och personella insatser som fungerar.</p> / <p>The aim of this study was to investigate nurses' experiences in supporting next of kin to patients in palliative home care.</p><p>The design was descriptive with a qualitative approach. The informants were strategically selected and consisted of five nurses, working in a palliative home care team in Uppland, in Sweden. Tape-recorded personal interviews were analysed with a qualitative content analysis.</p><p>The nurses experienced that their work felt meaningful and developing. To work in a team was a very positive aspect. Difficulties that appeard involved adjusting to different situations. The nurses supported next of kin mainly by communicating and conversing, and mediating safety. It was important to as well both verbally and practically show next of kin that there was also time for this.</p><p>Since palliative care in the home is getting more common, and since it cannot happen without the effort of next of kin, it is very important to develop and optimize the nurses' support to them. This studie can give insight in the problems that exist in this support, but also give insight about the organizational and personal achievements that work.</p>

Studiens syfte var att undersöka sjuksköterskors upplevelser av att ge stöd till anhöriga till patienter inom palliativ hemsjukvård. Designen var deskriptiv med en kvalitativ ansats. Informanterna var strategiskt utvalda och bestod av fem sjuksköterskor som arbetade i ett palliativt hemsjukvårdsteam i Upplands län. Bandinspelade personliga intervjuer analyserades med en kvalitativ innehållsanalys. Sjuksköterskorna upplevde att deras arbete kändes meningsfullt och utvecklande. Att arbeta i team var en mycket positiv aspekt. De svårigheter som framkom handlade om att anpassa sig efter olika situationer. Sjuksköterskorna gav stöd till anhöriga främst genom att kommunicera och samtala, samt förmedla trygghet. Det var viktigt att även både verbalt och praktiskt visa anhöriga att det fanns tid även för detta. Eftersom det blir allt vanligare med palliativ vård i hemmet och den inte kan ske utan de anhörigas insats är det mycket viktigt att utveckla och optimera sjuksköterskans stöd till dem. Denna studie kan ge en insikt i de problem som finns i anhörigstödet, men även ge en insikt om de organisatoriska och personella insatser som fungerar. / The aim of this study was to investigate nurses' experiences in supporting next of kin to patients in palliative home care. The design was descriptive with a qualitative approach. The informants were strategically selected and consisted of five nurses, working in a palliative home care team in Uppland, in Sweden. Tape-recorded personal interviews were analysed with a qualitative content analysis. The nurses experienced that their work felt meaningful and developing. To work in a team was a very positive aspect. Difficulties that appeard involved adjusting to different situations. The nurses supported next of kin mainly by communicating and conversing, and mediating safety. It was important to as well both verbally and practically show next of kin that there was also time for this. Since palliative care in the home is getting more common, and since it cannot happen without the effort of next of kin, it is very important to develop and optimize the nurses' support to them. This studie can give insight in the problems that exist in this support, but also give insight about the organizational and personal achievements that work.

The purpose of this study was to understand how unit managers within communal home care service for older people, convert political policy and guidelines into practical care, and how they within this process govern their personnel. The study was based on a qualitative method with a hermeneutic approach. Former research disclose that the process of converting political policy and guidelines and how unit managers govern personnel are somewhat tenuous. Previous research show structural shifts and reorganisations within public service consequently shaping todays structure of organizations and management. The study draws on eight interviews with unit managers within two municipalities in Sweden. To carry out our interviews we used a semi-structured interview guide followed with an analysis of our main results using Lipskys concept of discretion and Foucaults theory of governmentality. The results indicate that unit managers’ work, converting political policy and guidelines into practical care, are complex. The study shows that unit managers experience difficulties and differ in their ways in the process of adapting political policy and guidelines into practical care. Unit managers therefor find some of the guidelines more difficult to integrate than others. We find it important in this study to highlight the different ways unit managers work in the process of converting political policy and guidelines, and how they in the process govern their personnel.

Syftet med studien var att undersöka hur äldre erfar att livssituationen förändrats när de inte har haft stöd från hemtjänst till att beviljas insatser från hemtjänst. För att undersöka detta genomfördes halvstrukturerade intervjuer på en dagverksamhet med fem äldre personer som har hemtjänst. För att analysera materialet användes innehållsanalys, och teman användes för att kategorisera insamlade data. Dessa teman var livet innan hemtjänst, hälsa, livet efter hemtjänst och känslor kring livsförändring. För att tolka resultatet användes begreppen status passage, divestment passage och coping. Resultatet visar att förändringen av livssituationen börjar med att den fysiska förmågan försämras, antingen med ökande ålder eller genom sjukdom och skador. I och med försämrad fysisk förmåga blir de äldre beroende av stöd från hemtjänst i vardagen, och vardagslivet blir då styrt av hemtjänstens tider och rutiner. Denna förändring som vi har analyserat med hjälp av passage begreppen upplevs av några som negativ, medan den även i ett fall beskrivs som en i övergående positiv erfarenhet. Den sistnämnda erfarenheten föreslår vi ska benämnas som investment passage. För att hantera dessa förändringar av livssituationen används olika strategier, framförallt känslomässiga sådana. / The purpose of this study was to investigate how the elderly experience life changes when they have not received support from formal home care to receive home care services. To investigate this, half-structured interviews were conducted on a day-care facility, with five elderly people who receive formal home care service. In order to analyze the material, content analysis was used, and themes were used to categorize the collected data. These themes were life before home care, health, life after home care and feelings about life change. To interpret the result, the terms status passage, divestment passage and coping was used. The result shows that the change of life situation begins with the physical ability deteriorating, either with increasing age or through illness and injury. With the deterioration of physical ability, the elderly are dependent on home care services in their daily lives, and life is then controlled by the times and routines of the home care service. This change that we have analyzed using passage terms, some experience in a negative way while in one case it is described as a positive experience. We suggest that this positive experience should be called investment passage. To handle these changes of life situation different strategies are used, especially emotional ones.

Introdução: A transmissão ocupacional de patógenos veiculados pelo sangue é uma realidade na área de saúde, expondo os profissionais ao risco de aquisição do HIV, VHC e VHB dentre outros micro-organismos. Objetivo: Avaliar as condutas de profissionais da área da saúde vítimas de acidentes ocupacionais com material biológico que atuam no Serviço de Atenção Domiciliar de Ribeirão Preto. Materiais e Métodos: Trata-se de um estudo de corte transversal aprovado pelo Comitê de Ética em Pesquisa da Escola de Enfermagem de Ribeirão Preto da Universidade de São Paulo. A população elegível do estudo era de 72 profissionais da área da saúde e foi composta por 58 profissionais que preencheram os critérios de inclusão. Os dados foram coletados por meio de entrevistas individuais, no período de maio de 2014 a junho de 2015 e analisados por meio de estatística descritiva utilizando-se o programa Statistical Package for the Social Sciences, version 17.0. para Windows. Resultados: Dos 58 entrevistados, 19 referiram ter sofrido acidentes com material biológico ao longo de sua experiência profissional na instituição. Ressalta-se que 31,6% dos profissionais acidentados realizaram a conduta correta, ou seja, notificaram o acidente por meio da Comunicação de Acidente de Trabalho e procuraram atendimento clínico especializado, porém 52,6% não realizaram nenhuma conduta após o acidente e 15,8% realizaram conduta incompleta. Os motivos mais frequentemente alegados pelos profissionais para não notificarem o acidente e não procurarem por atendimento clínico especializado foi conhecer o paciente fonte e considerar a lesão superficial. Dos 18 profissionais que relataram conhecer as condutas preconizadas para acidentes com material biológico apenas 33,3% realizaram a conduta completa. Conclusões: O presente estudo permitiu identificar as condutas adotadas pelos profissionais que atuavam no Serviço de Atenção Domiciliar, após a ocorrência de acidente com material biológico / Introduction: The occupational transmission of blood borne pathogens is a reality in the health area, exposing professionals to the risk of acquiring HIV, HCV and HBV among other microorganisms. Objective: To evaluate the conducts of health professionals who are victims of occupational accidents with biological material at the Home Care Service in Ribeirao Preto. Materials and Methods: This is a cross- sectional study approved by the Research Ethics Committee in of the University of São Paulo at Ribeirão Preto College of Nursing. The eligible population of the study was 72 professionals of the health area and was composed by 58 professionals who met the inclusion. The data were collected through individual interviews, in the period from May, 2014 to June, 2015 and analyzed through descriptive statistics using the Statistical Package for the Social Sciences, version 17.0.for windows. Results: From the 58 interviewed, 19 reported that already had an accident with biological material throughout its professional experience at the institution. It is noteworthy that 31.6% of the accidented professionals made the correct conduct, that consists in notify the accident through the Work Accident Report, and also looked for specialized clinical care, however 52.6% did not perform any conduct after the accident and 15,8% performed an incomplete conduct. The reasons most frequently alleged by professionals for not notifying the accident and not look for specialized clinical care were to know the source patient and considered that they had a superficial injury. From the 18 professionals who reported knowing the recommended procedures for accidents with biological material, only 33.3% had the complete conduct. Conclusions: This study identified the conduct adopted by professionals working at the Home Care Service, after the occurrence of accidents with biological material

The purpose of this study is to increase the understanding for how home care services interpret and handle situations with and around caretakers alcohol use. Interviews have been conducted with two managers and six basic staff in two different home care service-groups. The interviews were individual with the managers and in group form with the staff. The interviews have been analyzed using Hasenfeld’s theory on Human Service Organizations and moral practice together with Beronius’ interpretation of disciplinary exercise of power. Our result showed that the handling of caretakers alcohol use differed both within and between the home care service-groups and there was a lack of guidelines on how to deal with this. Consequently it seemed to be a lot of individual assessments carried out by the staff, which sometimes led to a moral practice. Another important result was the fact that the interviewees quickly became very fixed on abuse and addiction, even though the interviews had focus on alcohol use in general. It is obvious that when a substance abuse problem exists, difficulties arise in home care services work.

The purpose of this study was to investigate the experiences of the factors demand, control, social support and stress among the staff in home care service and establish how these factors have changed after the introduction of the new working method Vanguardin 2014. The method of the study had a qualitative approach and the data collection was done using semistructured interviews. Four interviews were conducted with staff in a home care service group. The study selection was targeted and the participants were recruited by contacting a manager of a municipal home care service group in a town in central of Sweden.The interviews were recorded, transcribed and analyzed with a manifest thematic content analysis, with a phenomenological element. The results showed that the factors demand, controll, social support and stress have improved since the introduction of the new working method. The results showed that the work-related demands have changed from being a negative factor that caused stress, to instead being something positive that develops staff as individuals. Participation and influence increased in the workplace as staff themselfes began to plan their work. This contributed to an increased sense of control. Social support improved in the workplace since they became smaller groups and thus became better acquainted with each other. Stress is no longer due to high workload but occurs rather if problems arise in the work group. The conclusion is that demands, control, support and stress are important factors in working life that either affect health negatively or positively. Vanguard as aworking method has contributed positively in the investigated group and improved the perceived health of the workers. / Syftet med studien var att undersöka hemtjänstpersonalens upplevelser av krav, kontroll, stöd och stress och utröna hur dessa faktorer förändrats efter införandet av den nya arbetsmetoden Vanguard år 2014. Metoden i studien utgjordes av en kvalitativ ansats och datainsamlingen utfördes genom semi-strukturerade intervjuer. Fyra intervjuer genomfördes med personer som arbetar i hemtjänsten. Studiens deltagare rekryterades till följd av att en chef för en kommunal hemtjänstgrupp i Mellansverige kontaktades. Intervjuerna spelades in, transkriberades och analyserades genom en manifesttematisk innehållsanalys med ett fenomenologiskt inslag. Resultatet visade att faktorerna krav, kontroll, stöd och stress har förbättrats sedan införandet av den nya arbetsmetoden Vanguard. Resultatet visade att de arbetsrelaterade kraven har förändrats från att vara en negativ faktor som orsakade stress, till att istället vara något positivt som personalen utvecklas av som individer. Delaktighet och inflytande ökade på arbetsplatsen i och med att personalen själva började planera sitt arbetet, vilket bidrog till en ökad känsla av kontroll. Socialt stöd förbättrades när de under förändringsarbetet blev mindre grupper och på så vis lärde känna varandra bättre. Stress är inte längre som tidigarerelaterat till hög arbetsbelastning, utan uppkommer snarare om problem uppstår inom arbetsgruppen. Slutsatsen är att krav, kontroll, stöd och stress är viktiga faktorer i arbetslivet som antingen påverkar hälsan negativt eller positivt. Vanguard som arbetsmetod har bidragit med en positiv inverkan på den undersökta arbetsgruppen och förbättrat den upplevda hälsan hos arbetstagarna.

Introdução: A transmissão ocupacional de patógenos veiculados pelo sangue é uma realidade na área de saúde, expondo os profissionais ao risco de aquisição do HIV, VHC e VHB dentre outros micro-organismos. Objetivo: Avaliar as condutas de profissionais da área da saúde vítimas de acidentes ocupacionais com material biológico que atuam no Serviço de Atenção Domiciliar de Ribeirão Preto. Materiais e Métodos: Trata-se de um estudo de corte transversal aprovado pelo Comitê de Ética em Pesquisa da Escola de Enfermagem de Ribeirão Preto da Universidade de São Paulo. A população elegível do estudo era de 72 profissionais da área da saúde e foi composta por 58 profissionais que preencheram os critérios de inclusão. Os dados foram coletados por meio de entrevistas individuais, no período de maio de 2014 a junho de 2015 e analisados por meio de estatística descritiva utilizando-se o programa Statistical Package for the Social Sciences, version 17.0. para Windows. Resultados: Dos 58 entrevistados, 19 referiram ter sofrido acidentes com material biológico ao longo de sua experiência profissional na instituição. Ressalta-se que 31,6% dos profissionais acidentados realizaram a conduta correta, ou seja, notificaram o acidente por meio da Comunicação de Acidente de Trabalho e procuraram atendimento clínico especializado, porém 52,6% não realizaram nenhuma conduta após o acidente e 15,8% realizaram conduta incompleta. Os motivos mais frequentemente alegados pelos profissionais para não notificarem o acidente e não procurarem por atendimento clínico especializado foi conhecer o paciente fonte e considerar a lesão superficial. Dos 18 profissionais que relataram conhecer as condutas preconizadas para acidentes com material biológico apenas 33,3% realizaram a conduta completa. Conclusões: O presente estudo permitiu identificar as condutas adotadas pelos profissionais que atuavam no Serviço de Atenção Domiciliar, após a ocorrência de acidente com material biológico / Introduction: The occupational transmission of blood borne pathogens is a reality in the health area, exposing professionals to the risk of acquiring HIV, HCV and HBV among other microorganisms. Objective: To evaluate the conducts of health professionals who are victims of occupational accidents with biological material at the Home Care Service in Ribeirao Preto. Materials and Methods: This is a cross- sectional study approved by the Research Ethics Committee in of the University of São Paulo at Ribeirão Preto College of Nursing. The eligible population of the study was 72 professionals of the health area and was composed by 58 professionals who met the inclusion. The data were collected through individual interviews, in the period from May, 2014 to June, 2015 and analyzed through descriptive statistics using the Statistical Package for the Social Sciences, version 17.0.for windows. Results: From the 58 interviewed, 19 reported that already had an accident with biological material throughout its professional experience at the institution. It is noteworthy that 31.6% of the accidented professionals made the correct conduct, that consists in notify the accident through the Work Accident Report, and also looked for specialized clinical care, however 52.6% did not perform any conduct after the accident and 15,8% performed an incomplete conduct. The reasons most frequently alleged by professionals for not notifying the accident and not look for specialized clinical care were to know the source patient and considered that they had a superficial injury. From the 18 professionals who reported knowing the recommended procedures for accidents with biological material, only 33.3% had the complete conduct. Conclusions: This study identified the conduct adopted by professionals working at the Home Care Service, after the occurrence of accidents with biological material