Bakgrund: Kronisk obstruktiv lungsjukdom (KOL) är en folksjukdom och många miljoner personer lever med sjukdomen globalt. För att patienter med KOL ska uppnå en god livskvalité genom minskade sjukhusinläggningar krävs en god palliativ vårdinsats som ska ges i hemmet. Distriktssköterskor inom kommunal hemsjukvård har en central roll inom palliativ vård. Syfte: Syftet med studien var att beskriva hinder för distriktssköterskans palliativa vårdinsatser till patienter med KOL i hemmet. Metod: Studien var en systematisk litteraturstudie baserat på tio artiklar. Sökningen, granskningen och analysen av samtliga artiklarna gjordes enligt Bettany-Saltikov & McSherrys modell. Resultat: I resultatet framkom fyra kategorier: bristande kunskap och kompetens, kommunikationsproblem och teamsamarbete, initiering av palliativ vård och brister i organisationen inom hemsjukvård. Slutsats: Ökad kompetens genom kunskapsutveckling, välstrukturerad organisation inom hemsjukvård såsom personalbemanning, och multidisciplinär teamssamverkan ger distriktssköterskor goda förutsättningar att klara av palliativa vårdinsatser till KOL-patienter i hemsjukvården. I resultatet framkommer att dessa viktiga faktorer brister, vilket förhindrar distriktssköterskor att ge en god palliativ vård till patienter med KOL. Förslag på vidare forskning är en intervjustudie med distriktssköterskor inom hemsjukvården samt med deras chefer med frågor kring kunskap, kompetens, utbildning och organisation. / Background: Chronic Obstructive Pulmonary Disease (COPD) is a public health disease that affects millions of people globally. To improve quality of life with reduced hospital admissions, palliative care at home are important for patients with COPD. District nurses in municipal home care have a central role in palliative care. Aim: The purpose of this study was to describe obstacles to the district nurse’s palliative care efforts to patients with COPD at home. Method: The study was a systematic literature review based on ten articles. The search, review and analysis of all the articles was done according to Bettany-Saltikov & McSherry’s model. Results: The results revealed four categories: lack of knowledge and competence, communication problems and team collaboration, initiation of palliative care and shortcomings in the organization in home care. Conclusion: Increased competence through knowledge development, well-structured organization in home care such as staffing, and multidisciplinary team collaboration give district nurses good conditions to cope with palliative care efforts to COPD patients in home care. The results show that these important factors are lacking, which prevents district nurses from providing good palliative care to patients with COPD at home. Suggestion for further research explore district nurse´s knowledge and understanding through an interview method.

Ofrivillig ensamhet hos äldre är ett problem som kan orsaka ohälsa, lidande och öka risken att dö i förtid. I hemsjukvården möter distriktssköterskan ofta patienter som erfar ofrivillig ensamhet. Vårdpersonal kan genom sitt bemötande orsaka känslor av ensamhet hos dem de vårdar. Genom att beskriva fenomenet ur distriktssköterskans perspektiv förväntas kunskapen öka, vilket i sin tur kan leda till att patienterna får en bättre vård. Syftet med studien var att beskriva distriktssköterskans upplevelse av mötet med äldre patienter inom hemsjukvård som erfar ofrivillig ensamhet. Studien genomfördes genom semistrukturerade intervjuer med sex distriktssköterskor i hemsjukvården. Materialet tolkades med hjälp av kvalitativ innehållsanalys med ett induktivt tillvägagångssätt. Resultatet presenteras utifrån kategorierna: Det ofrivilliga lidandet, Känslors betydelse och Nycklar till det vårdande mötet. Distriktssköterskornas möte med ofrivilligt ensamma patienter väcker känslor som får dem att vilja hjälpa den äldre människan bakom ensamheten. Samtalet har stor betydelse i mötet med ofrivilligt ensamma äldre och kan lindra deras lidande. Öppenhet, kunskap och att se hela människan är viktigt i uppbyggnaden av relationen. Distriktssköterskorna upplever svårigheter i mötet med äldre ofrivilligt ensamma patienter och att dessa människor får för lite hjälp och behöver mer stöd. Slutsatserna är att avsaknad av egenskaper som lyhördhet, öppenhet och respekt hindrar vårdaren att få tillgång till patientens livsvärld och kunna vara vårdande. För att hjälpa ofrivilligt ensamma patienter är tiden, samtalet och kunskap avgörande i det vårdande mötet. / Involuntary loneliness in elderly people is a problem that can cause ill health, suffering and increase the risk of premature death. In home health care, the district nurse often encounters patients who experience involuntary loneliness. Nursing staff can, through their treatment, cause feelings of loneliness in those they care for. By describing the phenomenon from the district nurse's perspective, knowledge is expected to increase, which in turn can lead to patients receiving better care. The purpose of the study was to describe the district nurse's experience of the meeting with elderly patients in home health care who experience involuntary loneliness. The study was conducted through semi-structured interviews with six district nurses in home health care. The material was interpreted using qualitative content analysis with an inductive approach. The results are presented based on the categories: Involuntary suffering, The importance of feelings and Keys to the caring encounter. The district nurses' meeting with involuntarily lonely patients arouses emotions that make them want to help the elderly person behind the loneliness. The conversation is of great importance in the meeting with involuntarily lonely elderly people and can alleviate their suffering. Openness, knowledge and seeing the whole person are important in building the relationship. The district nurses experience difficulties in meeting elderly patients who are involuntarily alone and that these people receive too little help and need more support. The conclusions are that a lack of qualities such as responsiveness, openness and respect prevents the carer from gaining access to the patient's life world and being able to care. To help involuntarily lonely patients, time, conversation and knowledge are crucial in the caring encounter.nsamma patienter är tiden, samtalet och kunskap avgörande i det vårdande mötet.

Bakgrund: Alltmer vård bedrivs i patienternas egna hem och den kommunala vården är omfattande och expanderar. Samtidigt beskriver tidigare studier hemsjukvården som en komplex vårdkontext med delat patientansvar på många professioner och huvudmän. I Sverige pågår det en nationell satsning mot en ‘god och nära vård’ med personcentrerad vård som fokus. Den personcentrerade vården är ett beforskat område, men fokus ligger då oftast på slutenvårdskontexten. Hur erfarenheterna av personcentrerad vård i hemsjukvården ser ut är ej tydligt beforskat. Syfte: Syftet med studien var att belysa sjuksköterskors erfarenheter av att arbeta personcentrerat i hemsjukvården. Metod: En kvalitativ studie genomfördes med 14 semistrukturerade intervjuer av sjuksköterskor i hemsjukvården. Intervjuerna analyserades med manifest innehållsanalys. Resultat: Studien mynnade ut i 4 kategorier som beskrev sjuksköterskornas erfarenheter av att arbeta personcentrerat i hemsjukvården. Dels hade hemmet som vårdkontext en påverkan på den personcentrerade vården, även en tidsaspekt togs upp. Vidare beskrevs utmaningar i samverkan med andra vårdaktörer och i teamarbetet. Dessutom framkom att den personcentrerade vården tolkades olika av de olika sjuksköterskorna i studien. Slutsats: Sjuksköterskor i hemsjukvården har goda möjligheter att arbeta personcentrerat samtidigt som det är svårt att få hela vårdkedjan att arbeta personcentrerat. Det behövs ytterligare studier för att kartlägga hur samarbetet mellan kommunal och regional vård kan förbättras för att trygga upp den personcentrerade vården. / Background: More and more care are provided in the patients' own homes and municipal care is extensive and expanding. At the same time, previous studies describe home health care as a complex care context with shared patient responsibility among many professionals and caregivers. In Sweden, there is a national investment towards 'good and close care' with person-centred care as the focus. Person-centred care is a researched area, but the focus is usually on the inpatient care context. How the experiences of person-centred care in home health care are perceived is not well researched. Aim: The purpose of the study was to elucidate nurses' experiences of working person-centred in home health careMethod: A qualitative study was conducted with 14 semi structured interviews with nurses in home health care. The interviews were analyzed using manifest content analysis. Result: The study resulted in four categories that described the nurses' experiences of working person-centred in home health care. The home as a care context had an impact on the person-centred care, a time aspect also influenced the care. Furthermore, challenges were described when collaborating with other health care providers and in teamwork. In addition, it emerged that the person-centred care was interpreted differently by the different nurses in the study. Conclusion: Nurses in home health care have good opportunities to work person-centred, while it is difficult to get the entire health care organization to work person-centred. Further studies are needed to investigate how the cooperation between municipal and regional care can be improved in order to secure a person-centred care.

Bakgrund: Palliativ vård i sen palliativ var central del av distriktssköterskans arbete inom hemsjukvården. Behandlingen har vid sen palliativ fas skiftat fokus till att symtomlindra lidande i stället för att bota sjukdom.  Distriktssköterskan bör i sin profession ha ett helhetsperspektiv vilket bland annat innefattar att kunna samverka med patient, närstående samt andra professioner. Syfte: Syftet var att undersöka distriktssköterskans erfarenheter av att vårda patienter i sen palliativ fas inom hemsjukvården.  Metod: En kvalitativ intervjustudie med semistrukturerade frågor utfördes med 18 distriktssköterskor inom hemsjukvård i Södra och Mellansverige. Resultatet analyserades med ett induktivt förhållningssätt enligt Elo & Kyngäs kvalitativa innehållsanalys. Resultat: Resultatet ledde till tre huvudkategorier: Förutsättningar för att vårda i den sena palliativa fasen, samarbete med patient och närstående samt betydelsen av symtomlindring i den sena palliativa fasen.  Huvudkategorierna delades sedan in i 10 underliggande subkategorier.  Slutsats: Studien framhävde distriktssköterskans viktiga roll i samband med vårdandet av patienter i den sena palliativa fasen. Det var avgörande att distriktsköterskan fick rätt förutsättningar från ledningen, möjligheten till samverkan med andra professioner, närstående och patienter. Vid goda förutsättningar minimerades risken för ojämlik vård, onödigt lidande genom symtomlindring samt gav en värdig död för patienten. / Background: Palliative care in the late palliative phase was a central part of the district nurse's work in home health care. In the late palliative phase, the treatment has shifted focus to alleviating suffering rather than curing the disease. The district nurse should have a holistic perspective in her profession, which includes, among other things, being able to cooperate with patients, relatives, and other professions. Aim: The aim of the study was to examine the district nurse's experiences of caring for patients in the late palliative phase within home health care Method: A qualitative interview study with semi-structured questions conducted with 18 district nurses in home health care in Southern and Central Sweden. The result was analyzed with an inductive approach according to Elo & Kyngäs qualitative content analysis. Results: The results led to three main categories: Prerequisites for care in the late palliative phase, collaboration with the patient and relatives and the importance of symptom relief in the late palliative phase. The main categories then divided into 10 underlying subcategories. Conclusion: The study highlighted the important role of the district nurse in connection with the care of patients in the late palliative phase. It was crucial that the district nurse received the right conditions from management, the opportunity for collaboration with other professionals, relatives, and patients. Under good conditions, the risk of unequal care, unnecessary suffering through symptom relief was minimized and a dignified death was provided for the patient.

No description available.

Bakgrund: De patienter som har hemsjukvård har ofta flera samtidiga medicinska sjukdomar och är vanligen äldre personer. Eftersom alkoholkonsumtionen i den äldre befolkningen ökar är sannolikheten hög att i hemsjukvård möta patienter som konsumerar alkohol. Att ge vård och omvårdnad i patientens hem skiljer sig från andra vårdkontexter på grund av hemmet som vårdmiljö, patientens integritet, vårdrelationen samt även utifrån samverkan med andra vårdgivare. Tidigare forskning visar på olika svårigheter för sjuksköterskor att samtala med patienter om alkoholkonsumtion och olika förhållningssätt i vårdandet av patienter som konsumerar alkohol.  Syfte: Syftet med studien var att belysa sjuksköterskors erfarenheter av att samtala om alkohol i vården med och kring patienten i hemsjukvården.  Metod: En kvalitativ studie genomfördes med semistrukturerade intervjuer av 12 sjuksköterskor i hemsjukvården. Intervjuerna analyserades med manifest innehållsanalys.  Resultat: Sjuksköterskors erfarenheter av att samtala om alkohol i vården med och kring patienten i hemsjukvården belystes från olika aspekter. Studiens resultat mynnade ut i fyra kategorier: Hinder för att samtala med patienten om alkoholkonsumtion, Ökad samverkan efter samtal om patientens alkoholkonsumtion, Varierande förutsättningar för sjuksköterskan att samtala med patienten om alkohol samt Konsekvenser av samtal om alkohol med patienten.  Slutsats: Vård och omvårdnad av patienter som konsumerar alkohol i hemsjukvården påverkades på olika sätt utifrån sjuksköterskans erfarenheter av att samtala eller inte samtala om alkohol med patienten. Kunskaper, riktlinjer och rutiner för stöd samt bedömning av patientens alkoholkonsumtion behöver förstärkas och implementeras för att en säker vård och omvårdnad ska kunna ges av sjuksköterskor i hemsjukvården. / Background: The patients within home health care often have several different diagnoses of medical illnesses and are usually older people. As alcohol consumption in the elderly population increases, the probability of encountering patients who consume alcohol within home health care is high. Providing care and nursing in the patient’s home differs from other contexts of care because of the home as a care environment, the patient’s integrity, the relationship of care and because of the cooperation with other providers of care. Previous research shows varying difficulties for nurses in talking to patients about alcohol consumption and different approaches in caring for patients who consume alcohol.  Aim: The aim of the study was to illuminate nurses’ experiences of talking about alcohol with the patient and with other providers of care in home health care.  Method: A qualitative study was conducted through semi-structured interviews with 12 nurses in home health care. The interviews were analysed using manifest content analysis.  Result: Nurses’ experiences of talking about alcohol in home health care with the patient and with other providers of care around the patient were highlighted from different aspects. The results of the study unfolded in four categories: Obstacles in talking with the patient about alcohol consumption, Increased cooperation after talking about the patient’s alcohol consumption, Varying conditions for the nurse to talk to the patient about alcohol, and Consequences of talking about alcohol with the patient. Conclusion: Care and nursing of patients who consume alcohol within home health care was affected in different ways based on the nurse’s experiences of talking or not talking about alcohol with the patient. Knowledge, guidelines and routines for support and assessment of the patient’s alcohol consumption need to be strengthened and implemented so that safe care and nursing can be provided by the nurses in home health care.

This thesis deals with the security system care services and other related services, including informal care for seniors in the Czech Republic. The aim of the work is to evaluate, describe and offer a closer understanding of nursing as a basic social care service in connection with the principle of shared care in a natural home environment for seniors as the ideal form of care for the elderly at present and due to the demographic development in the future. The thesis is divided into a theoretical and a practical part. The theoretical part covers three main topics: day care service system in the Czech Republic, seniors as a target group of caring and sharing and municipalities and their role in caring for the elderly. The practical part is devoted to the research, which focuses on the relationship of care services and communities from the perspective of potential service users, ie. the elderly. A combination of qualitative and quantitative research methods is used in the research and interprets the results of the survey conducted among the elderly in three senior clubs in Prague 17. The research complements the findings mentioned in the theoretical part.

Résumé indisponible. / A healthcare network or health system consists of all organizations, actions and people who participate to promote, restore or maintain people’s health. The health care systems in many developed countries are facing increasing costs. The major reason is the changing age distribution of the population with more elderly people in need of support. Increasing healthcare costs has created new alternatives to traditional hospitalization in which one is Home Health Care (HHC). Home health care or domiciliary care is the provision of health care and assistance to people in their own homes, according to a formal assessment of their needs. HHC has attained a specific place in healthcare network. HHC programs have now been successfully implemented in many countries. The purpose of HHC is to provide the care and support needed to assist patients to live independently in their own homes. HHC is primarily performed by means of personal visitations of healthcare workers to patients in their homes, where they provide care assistance according to patients’ needs. In this thesis we have considered different aspects of planning problems for home health care services. The efficient use of resources is necessary in continuous healthcare services. To meet the increased demand of HHC, operation research specialist can play an important role by solving the various combinatorial optimization problems arising in HHC. These problems can be tactical, strategic or operational with respect to planning horizon. Strategic problems are those which help in attaining long term goals or objectives, e.g. higher level of quality for HHC patients and efficient use of resources. These strategic objectives can be achieved through tactical i.e. medium term panning and operational planning i.e. short term planning. The main purpose of our thesis is to identify these potential optimization problems and solve them via recent metaheuristics. HHC is an alternative to traditional hospitalization and has got a significant share in the organization of healthcare in developed countries. The change in aging demographics, recent development in technology and the increase in the demand of healthcare services are major reasons for this rapid growth. Some studies show HHC as a tool to reduce costs of care, which is a major preoccupation in developed countries. Some others reveal that it leads to the improvement of patients’ satisfaction without increasing the resources. Home health care, i.e. visiting and nursing patients in their homes, is a flourishing realm in the medical industry. The number of companies has grown largely both in public and private sectors. The staffing needs for HHC companies have been expanded as well. Also they face the problem of assigning geographically dispersed patients to home healthcare workers and preparing daily schedules for these workers. The challenge of this problem is to combine aspects of vehicle routing and staff rostering. Both of them are well known NP- hard combinatorial optimization problems, it means the amount of computational time required to find solution increases exponentially with problem size. Home healthcare workers scheduling problem is difficult to solve optimally due to presence of large number of constraints. These are two types of constraints: hard constraints and soft constraints. The hard constraints are the restrictions to be fulfilled for the schedules to be applicable and soft constraints are preferences to improve the quality of these schedules. (...)

Bakgrund: Allt fler svårt sjuka patienter får vård i hemmet. Områdesansvarig distriktssköterska i kommunal hemsjukvård ansvarar ensam för både omvårdnad och medicinska insatser kring patienten. En hög arbetsbelastning ökar risken för att göra fel när distriktssköterskan har ansvar för många patienter. Syfte: Syftet med studien var att beskriva distriktssköterskornas upplevelser av arbete inom kommunal hemsjukvård med omvårdnadsansvar för patienter i ordinärt boende. Metod: Kvalitativ metod med induktiv ansats användes i studien. Genom ett strategiskt urval har 14 distriktssköterskor från fyra kommuner intervjuats. Resultat: I resultatet framkom tre kategorier: ”Arbetsglädje”, ”Stödjande resurser” och ” Upplevelser av svåra situationer”. Distriktssköterskornas upplevelse av arbetsglädje kunde relateras till patientkontakten, användandet av sin kompetens, allmänhetens förtroende, variation i arbetet, trivseln på arbetsplatsen och samarbetet med andra i vården.  Distriktssköterskornas kompetens, relation med patienten och anhöriga, teamarbete och arbete i grupp, samarbete med andra vårdenheter, stöd från ledningen, arbetsmiljö och hjälpmedel och administrativt arbete är stödjande resurs i distriktssköterskans arbete. Distriktssköterskor i studien hade individuellt olika belastning i arbetet och förutsättningar till stödjande resurser i sitt arbete, därför upplevde de olika mycket arbetsglädje och upplevelser av svåra situationer såsom etiska dilemman, oförutsägbarhet, otillräcklighet, frustration och irritation. Slutsats: Fungerande stödjande resurs i distriktssköterskans arbete kan öka distriktssköterskornas upplevelse av arbetsglädje. Tillsammans med resurser och kontinuerlig kompetensutveckling finns förutsättningar för att uppleva arbetsglädje, vilket behövs för att uppfylla distriktssköterskornas skyldighet att ge bra vård till patienterna. Ytterligare forskning behövs inom området eftersom kommunal hemsjukvård är i ständig utveckling i alla kommuner och det är oklart vilket sätt som är bäst att bedriva den. / Background: An increasing number of severe ill patients receive care at home. Area manager district nurse in municipal home care alone is responsible for both nursing and medical interventions regarding the patient. A high workload increases the risk of making mistakes when district nurse have the responsibility for many patients. Objective: The aim of this study was to describe district nurses' experiences of working in municipal home care with nursing responsibilities for patients in regular housing. Methods: Qualitative methods with inductive approach used in the study. Through the strategic selection 14 district nurses from four municipalities had been interviewed. Results: The results revealed three categories: "Job satisfaction", "Supporting Resources" and” Experiences of difficult situations". District nurses experience of job satisfaction could be related to patient contact, use of their skills, public trust, variation of work, being at work and cooperation with others in care. District nurses skills, relationship with the patient and family, team work and group work, collaboration with other health care units, management support, work environment and facilities and administrative work is supportive resource in the district nurse work. District nurses in the study had individually different workloads and prerequisites for supporting resource in their work because they experienced different amounts of job satisfaction and perceptions of difficult situations such as ethical dilemmas, unpredictability, inadequacy, frustration and irritation. Conclusion: Functional supportive resource in the district nurse work can increase district nurses experience of job satisfaction. Along with resources and continuous professional development are prerequisites for experiencing job satisfaction, which is needed to fulfill the district nurses obligation to provide good care to patients. Further research is needed in the area since the municipal home care is in constant development in all communities and it is unclear how best to pursue it.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The World Health Organization estimates that the diseases caused by contaminated food constitute one of the most widespread sanitary problems. Currently, the food prepared at home have had great influence on the ocurrence of outbreaks of Diseases Transmitted by Food (DTFs), as a result of hygienic failures in the manipulation of foods. Taking this situation into account, this work aimed to develop and apply an education program on good practice for the manipulation of foods at home. The present study was conducted in 615 houses distributed in the 8 Administrative Regions (AR) of the city of Santa Maria RS, between March and November 2011. In order to make the diagnosis, the person in charge of the manipulation of foods at home was asked to complete a form covering personal data, knowledge and practice of food safety. Also, a List of Evaluation of Good Practice at Home (LEGPH) was applied to identify the level of hygienic and sanitary conditions in home kitchens. After the diagnosis, an education program was developed using the most popular means of communication reported by the population for a further reapplication of the LEGPH in a third of the sample of homes with the aim of evaluating the efficiency of this program. Through the application of the form, it was found that the urban central region differed in most cases from the north, south, central-west and western regions. The level of education of the interviewees influenced on the classification of the houses, that is, the higher the level of education, the higher the level of adequacy. After the education program, it was verified that there was no significant difference in the level of adequacy of the houses when compared to the first application, however, an enhancement was observed in almost all of the items of the LEGPH. Since it is difficult to modify practices and habits of the population with only three months of educational actions, it is suggested the need to continue with programs on the consciousness-raising process of the population due to the risks related to food manipulation, seeking a food safety perspective and an improvement of the quality of life of the population. / A Organização Mundial de Saúde estima que as enfermidades causadas por alimentos contaminados constituem um dos problemas sanitários mais difundidos no mundo. Atualmente, os alimentos preparados nos domicílios têm grande influência na ocorrência de surtos de Doenças Transmitidas por Alimentos (DTAs), como resultado de falhas higiênicas na manipulação dos alimentos. Tendo em vista o exposto, objetivou-se desenvolver e aplicar um programa educativo sobre boas práticas na manipulação de alimentos nos domicílios. O presente estudo foi realizado em 615 domicílios distribuídos nas 8 Regiões Administrativas (RA) da cidade de Santa Maria RS, nos meses de março a novembro de 2011. Para a realização do diagnóstico, aplicou-se um formulário com o responsável pela manipulação de alimentos nos domicílios, abrangendo dados pessoais, conhecimentos e práticas em segurança dos alimentos, assim como foi aplicada uma Lista de Avaliação das Boas Práticas nos Domicílios (LABPD) para identificar o nível higiênico-sanitário das cozinhas domiciliares. Após o diagnóstico, foi desenvolvido um programa educativo utilizando os meios de comunicação de maior acesso relatados pela população para, posteriormente, reaplicação da LABPD em um terço da amostra de domicílios com o intuito de avaliar a eficácia desse programa. Constatou-se, através da aplicação do formulário, que a região centro urbano diferiu-se, na maioria das vezes, da região norte, sul, centro-oeste e oeste. O nível de escolaridade dos entrevistados influenciou na classificação dos domicílios, ou seja, quanto maior o nível de escolaridade, maior o nível de adequação. Após o programa educativo, verificou-se que não houve uma diferença significativa no nível de adequação dos domicílios quando comparada com a primeira aplicação; no entanto, observou-se uma melhora em quase todos os itens da LABPD. Por ser difícil modificar práticas e hábitos da população com apenas três meses de ações educativas, sugere-se a necessidade de continuidade de programas no processo de conscientização da população, em virtude dos riscos relacionados à manipulação dos alimentos, buscando uma perspectiva de segurança alimentar e melhoria da qualidade de vida da coletividade.