This descriptive correlational study describes the relationships among 30 home care clients' perceptions of nursing invasiveness, territorial control, and satisfaction with nursing care. The self-report data were collected using a Nursing Invasiveness Scale (NIS), Index of Patient Territorial Control Perceptions (IPTCP), and Patient Satisfaction Instrument (PSI). The subjects were males and females, aged 23 to 93 years, who were receiving home care nursing. Analysis of the data suggests that the subjects perceived a low level of invasiveness by home care nurses, "much control" within their homes (their primary territories), and were highly satisfied with their nursing care. There was a significant negative correlation (r = -0.79) between perceptions of nursing invasiveness and satisfaction with nursing care. The relationships between perceptions of nursing invasiveness and territorial control (r = -0.02) and between perceived territorial control and satisfaction with nursing care (r = 0.14) were not significant.

The purpose of this study was to retrospectively identify risk factors of elderly nursing home residents that may predict the hospitalization of recently admitted elderly nursing home residents. Two groups of randomly chosen residents were studied. The non-hospitalized group (n = 100) were admitted to a nursing home and remained in the facility for at least 90 days. The hospitalized group (n = 100) were discharged to a hospital within 30 days of admission to the nursing home. The presence of HCFA irregularities increased the odds for hospitalization of an elderly nursing home resident by 1.67. Regular medication orders on discharge increased the odds of hospitalization by 1.25. This study showed that the use of the 33 HCFA indicators are useful in identifying elderly nursing home residents that may be at an increased risk of hospitalization.

A descriptive design was used to describe five client outcome scales as potential measures of quality care in home health care: discharge status, client satisfaction, medication adherence, general symptom distress and caregiver strain. The conceptual model used necessitated three separate samples: a discharged sample of 20 clients, an active client sample of 14 subjects and a caregiver sample of three subjects for a total of 37 subjects. Structured interviews and questionnaires were used; descriptive statistics were applied to scores. The most notable indicator of quality of care, the medication adherence scale, showed all clients taking medications as prescribed. The primary reason for discharge showed that the client could manage without further services. Clients reported that they were somewhat satisfied or very satisfied with services. Caregivers reported a low perceived level of stress. The scales measuring discharge status and symptom distress need further investigation to determine if they are true indicators of the concept of quality care.

Proponents of Canadian health reform in the 1990s argued for regional structures, which enables budget silos to be broken down and integrated budgets to be formed. Although regionalization has been justified on the basis of its potential to increase home care resources, political science draws upon the scope of conflict theory, which instead suggests marginalized actors, such as home care, may be at risk of being cannibalized in order to safeguard the interests of more powerful actors, such as hospitals. Prince Edward Island, Nova Scotia, and New Brunswick, constitute a natural policy experiment. Each has made different decisions about the regionalization model implemented to restructure health care delivery. The policy question underpinning this research is: What are the implications of the different regional models chosen on the allocation of resources to home care? Provincial governments are at liberty to fund home care within the limits of their fiscal capacity and there are no federal terms and conditions which must be complied with. This policy analysis used a case comparison research design with mixed methods to collect quantitative and qualitative data. Two financial outcomes were measured: 1) per capita provincial government home care expenditures and 2) the home care share of provincial government health expenditures. Hospital data was used as a comparator. Qualitative data collected from face-to-face, semi-structured interviews with regional elite key informants supplemented the expenditure data. The findings align with the scope of conflict theory. The trade-off between central control and local autonomy has implications for these findings: 1) home care in Prince Edward Island increased it share from 1.6% to 2.2% of provincial government health spending; 2) maintaining central control over home care in Nova Scotia resulted in an increase in its share from 1.4% to 5.4%, and 3) in New Brunswick, home care share grew from 4.1% to 7.6%. Inertia and entrenchment of spending patterns was strong. Health regions did not appear to undertake resource reallocation to any great extent in either Prince Edward Island or New Brunswick. Resource reallocation did occur in Nova Scotia where the hospital share of government spending went down and was reallocated to home care and nursing homes. But, Nova Scotia is the only province of the three in which home care was not regionalized. Regional interests in maintaining existing levels of in-patient hospital beds was clearly a source of tension between the overarching policy goals formulated for health reform by the provincial governments and the local health regions.

The home should represent safety and security for the person who lives there, and this is an important factor for independence and autonomy in very old age. With aging populations, the needs for long-term care increase, care provided by spouses and/or from the growing home care sector. Injuries among these groups are common. In this study, an ergonomics perspective was applied in the analysis of some basic daily activities performed by old persons and by home care workers, assisting. The postures and movements of home care staff assisting at toilet visits, and transferring persons from wheelchair to toilet, were measured and analysed. Some daily activities related to making food and washing clothes, performed by a group of persons between the age of 75 and 100, were measured and analysed. The task of getting up from the floor – on your own and with the help of a walker equipped with a lifting device – was analysed with the help of older persons and nursing staff. The design was built on the knowledge gained from analysing how older people get up from floor. Requirements for access with a four-wheeled walker in the local built environment were investigated. Observations were made with the help of video recording. Postures were recorded with the CUELA measurement system. The VIDAR ergonomics evaluation instrument was used to register the participants’ experiences of discomfort and pain during getting up from the floor with or without the walker with a lifting device. Structured interviews were used to find out about older peoples’ experience of using the four-wheel walker. It is concluded that ageing at home requires improved architectural and technical bathroom design and improved access in the local built environment. / <p>QC 20140124</p>

När befolkningen blir allt äldre, samhället förväntas bli effektivare, hemtjänstens ansvarsområde breddas och konkurrensen från privata aktörer växer; så behöver hemtjänsten anpassa sig, vilket kräver fler resurser. Frågan är dock hur det fungerar och hur effektiv vår hemtjänst är? Syftet med denna uppsats är att få en förståelse för effektiviteten inom hemtjänsten i området Örnsberg/Aspudden i stadsdelsförvaltningen i  Hägersten/Liljeholmen i Stockholms stad. Detta har undersökts utifrån ett personal- respektive brukarperspektiv, genom en enkätundersökning för personalen och en semistrukturerad intervju med en brukare. Uppsatsen har främst en kvalitativ ansats och grundar sig på teorier kring effektivitet och kvalitet. Studien har visat att både personalen och brukaren känner en hög nöjdhet till hemtjänsten i Hägersten/Liljeholmen. De känner båda att arbetet som ska göras hinns med och personalen upplever ingen stress. Dock anser alla parter att det i allmänhet investeras för lite ekonomiska resurser i hemtjänsten, vilket får oss att undra vad dessa ytterligare resurser skulle användas till, då båda parter anser sig nöjda med sitt jobb respektive sin hjälp. Det är även svårt att fastställa att effektiviteten i Hägersten/Liljeholmens hemtjänst är hög, då endast en brukare intervjuats vilket ger en subjektiv bild av effektiviteten, detta även om vår studie påvisar en hög effektivitet. / As the population ages, the community is expected to become more effective; home-care's responsibilities increase and competition from private home-care givers is growing; the need for public home-care to adapt increases, requiring more resources. The question is how effective is our public home-care service? The purpose of this thesis is to gain an understanding of the effectiveness of home-care services in the area Örnsberg/Aspudden in the municipal district administration office of Hägersten/Liljeholmen in Stockholm. This has been examined from a personnel and user perspective, through a survey for the personnel and a semi-structured interview with the user. The thesis has primarily a qualitative approach and is based on theories about efficiency and quality. The study has shown that both the personnel and the user feel a high level of satisfaction for home-care in Hägersten/Liljeholmen. They both feel that there is enough time for the planed work and the personnel feels no stress during their average workday. However, all parties consider that there is a general under-investment of financial resources in home-care; which leads us to wonder what these additional resources would be used for, when both parties are satisfied with their job and the help they receive. It is also difficult to determine that the effectiveness of Hägersten/Liljeholmen’s home-care service is high, when only one user has been interviewed. Which gives us a subjective view of efficiency, even though our study shows a high efficiency.

Bakgrund: Antalet patienter med hjärtsvikt kommer att öka i framtiden då fler äldre överlever en hjärtinfarkt vilket är en vanlig orsak till hjärtsvikt. Många patienter med hjärtsvikt väljer att vårdas i sitt hem vilket innebär en utmaning för distriktssköterskor i den kommunala hälso- och sjukvården. Syfte: Syftet med denna studie är att belysa distriktssköterskors stöd till patienter med svår hjärtsvikt som vårdas i hemmet inom kommunal hälso- och sjukvård. Metod: Genom intervjuer samlades data in från sex distriktssköterskor. Data analyserades med kvalitativ innehållsanalys med induktiv ansats. Resultat: Ur analysen framträdde fem kategorier: samordna och utföra vårdinsatser, bygga upp nära samspel med anhöriga, följas åt från ett palliativt skede till slutet, bristande läkarmedverkan samt brister i organisationen. Konklusion: I resultatet framkommer att det är viktigt att distriktssköterskan känner sina patienter väl för att kunna ge rätt stöd. Det framträder också att anhöriga har behov av stöd för att orka och känna trygghet vilket kan vara avgörande om patienten kan vårdas i hemmet. Brister finns både internt och externt som kan ge konsekvenser. Fortsatta studier kan vara inom en kommun med läkarunderstödda team tillsammans med kommunal hälso- och sjukvård. / Background: The number of patients with heart failure will increase in the future as more older people survive a heart attack, which is a common cause of heart failure. Many heart failure patients choosing to receive care in their home which poses a challange for district nurses in the community health-care.  Aim: The aim of this study is to illuminate districtnurse´s support for patients with grave heart failure at home in community home care Method: Six interviews were conducted with districtnurse´s. The data from these interviews were analyzed with an inductive content analysis.  Results: From the analysis, five major categories were found; coordinate care efforts, build close interactions with relatives, follow each other from a palliative stage to the end, lack of physician involvement and deficiencies in the organization. Conclusion: The result shows that it is important that the district nurse know their patient´s well in order to provide the proper support. It also appears that relatives need support to cope and feel secure, which can be crucial if the patient can be cared for at home. Deficiencies are both internally and externally that can have consequenses. Further studies may be within a municipality with a physician-sponsored team together with community health-care.

There is the desire amongst elderly Canadians to remain living at home, maintaining their independence. As the population ages, the health care system is faced with the challenge of allocating limited resources. Home care in Ontario is provided through Community Care Access Centres (CCAC) or Community Support Agencies (CSA). This study made comparisons among CSA clients (using the interRAI-Community Health Assessment, n=796), a sub-population of CCAC clients with lighter-care needs (n=8163) and all other CCAC clients (n=31,078), both using the Minimum Data Set-Home Care (MDS HC). The majority of clients in all groups were female, widowed, and spoke English as their primary language. CCAC clients had more health conditions than did CSA clients. Light-care CCAC clients received less hours of formal support than other CCAC clients and were less likely to have informal support caregivers who reported caregiver burden. Between 1998 and 2005, Ontario provided services to an increasingly impaired home care population, although overall impairment among home care client remained low. For the purposes of benchmarking, MDS HC data from Ontario was compared with MDS HC data from 11 European countries and was found to fall within the range of the other countries in terms of average impairment level of home care clients. Logistic regression was used to predict the likelihood of receiving CCAC services. Not being self-reliant, having decline in activities of daily living, having experienced falls, self-reporting one's health to be poor and reporting less loneliness were all correlates for CCAC service use. Implications and direction for future research were discussed.

SAMMANFATTNING Bakgrund Medelåldern i Sverige ökar, och så även behovet av avancerad hemsjukvård då många är sjuka eller svårt sjuka sista tiden i livet. Tillgång till avancerad hemsjukvård kommer främja palliativa patienters rätt till autonomi, varför en ständig utveckling är nödvändig. Syfte Att observera PICC-lineinläggning i två olika vårdmiljöer i syfte att upptäcka eventuella likheter och skillnader vad gäller vårdmiljön och patientens upplevelser. Metod Strukturerad icke-deltagande observationsstudie med en deskriptiv design. I de fall det var möjligt utfördes kortare intervjuer med patienten efter PICC-lineinläggningens slutförande. Den insamlade datan analyserades kvalitativt. Resultat Båda observationstillfällen resulterade i en lyckad PICC-lineinläggning. När tekniska svårigheter uppstod vid inläggningen, var det i sjukhusmiljö enkelt att tippa sjukhussängen bakåt för att underlätta införandet, medan det var svårare att utföra samma åtgärd i hemmet. Där fick sjuksköterskorna nöja sig med att ta bort kuddar och lägga patienten helt plant i sängen. Patienten som mottog PICC-line på sjukhuset uttryckte missnöje och besvikelse över bristen på assistans från sjuktransporten till sjukhuset, medan patienten i hemmet uttryckte tacksamhet över att inte behöva åka in till sjukhuset för att få en PICC-line. Det fanns ingen skillnad i teknik eller grad av sterilt utförande. Slutsats Båda patienter genomgick en PICC-lineinläggning med lyckat resultat, och inläggningen kunde utföras enligt samma rutin både i hemmet och på sjukhus. Oförutsedda händelser och komplikationer löstes således, men det är värt att notera att förutsättningarna för att lösa dem skiljde sig i patientens hem jämfört med på sjukhus, främst på grund av skillnader i utbud av extramaterial. Medtagandet av ytterligare material så som en extra PICC-line skulle ytterligare eliminera risken för en misslyckad PICC-lineinläggning i hemmet. Tacksamheten över att inte behöva komma in till sjukhuset var överväldigande hos patienten som fick PICC-line i hemmet, vilket går helt i linje med den svenska vårdens strävan att hjälpa patienter uppnå autonomi. Fortsatt forskning och utveckling skulle kunna innebära att PICC-line inläggning i hemmet kan erbjudas även till patienter som är svårt sjuka men som ännu inte trätt in i ett palliativt skede. Nyckelord PICC-line, hemsjukvård, palliativ vård, autonomi / ABSTRACT Background The average age of Swedish people is rising, and so is the need for advance health care since a lot of people are poorly or very poorly during the last period of their lives. Access to advanced health care will support dying patients right to autonomy. Therefore it is necessary to constantly develop this area. Aim To observe PICC-line insertion in two different environments of care with the aim to discover any possible similarities or differences with regards to the environment of care and experiences of the patient. Method Structured Non-Participant Observational study with a descriptive design. When possible, short interviews were conducted with the patient after the PICC-lineinsertion. The collected data was analysed qualitatively. Results Both observations resulted in a successful PICC-lineinsertion. When technical difficulties occurred during the insertion, it was easy to tip the hospital bed backwards to make the insertion easier, while it was more difficult to perform the same action in the home environment. There the possible measures were reduced to removing pillows and placing the patient completely flat on the bed. The patient who received a PICC-line in the hospital expressed discontent and disappointment over the lack of assistance during the transport to the hospital, while the patient in the home expressed gratitude over not having to go to the hospital to have the PICC-line inserted. Conclusion Both patients went through a PICC-lineinsertion with a successful result, and the insertion could be performed according to the same routine both in the home and the hospital. Unforeseen events and complications were solved, but it’s worth noting that the conditions for solving them differs between the home and hospital environment, mainly due to differences in availability to extra material. To bring extra material, such as an extra PICC- line, would further eliminate risks of an unsuccessful PICC-lineinsertion in the home. The gratitude shown towards not having to come in to the hospital was overwhelming from the patient who received a PICC-line in the home, something that resonates well with the swedish health care systems desire to help patients uphold their autonomy. Continued research and development could mean that PICC-lineinsertion in the home can also be offered to patients who are very sick but have not yet entered the palliative phase. Keywords PICC-line, home care, palliative care, autonomy

Bakgrund: Den tekniska utvecklingen har möjliggjort för många, om än inte alla, med obotliga sjukdomar, att kunna tillbringa sin sista tid i hemmet. Hemmiljön ger förutsättningar för gemensamhet och jämlikhet där både patienter och närstående kan utföra vardagliga aktiviteter tillsammans som förut.  Närstående tar där ett stort ansvar med varierande arbetsuppgifter. Tidigare studier har visat att närstående lider av både fysisk och psykisk ohälsa. Sjuksköterskans roll inom palliativ vård är att arbeta utifrån de fyra hörnstenarna för att förbättra livskvalitet hos patienten och även kunna erbjuda stöd till närstående. Syfte:Att beskriva närståendes upplevelser av att vårda en familjemedlem i hemmet vid livets slutskede. Metod:En litteraturöversikt har genomförts med tio kvalitativa vetenskapliga artiklar. Artiklarna hämtades från databaserna CINAHL Complete, PubMed och Nursing &amp; Allied Health och publicerades mellan 2006–2016. Analysen av artiklarna har skett genom att söka likheter och skillnader enligt Fribergs (2012) metod. Resultat: Resultaten framställdes i tre huvudteman: närståendes upplevelser av att ta ansvar i omvårdnaden, närståendes upplevelser av sin tillvaro och närståendes upplevelser av stöd från hälso- och sjukvårdpersonalen. En del närstående beskrev att det kändes naturligt att vårda sin familjemedlem. Andra upplevde att det förväntades av dem att kliva in och ta ansvar i vårdarrollen både från den sjuke familjemedlemmen och från vårdpersonalen. De beskrev att de upplevde detta som ett stort ansvar och en börda. Närståendes tillvaro speglades av maktlöshet, osäkerhet och rädsla. De använde sig av olika strategier för att hantera sin situation och för att finna mening i det som skedde. En del närstående uppskattade hjälp och stöd från vårdspersonalen medan andra såg brister i hjälpinsatser och bemötande. Diskussion:Författarna diskuterade metodens styrkor och svagheter. Med Antonovskys modell för känsla av sammanhang (KASAM) som teoretisk referensram och Katie Erikssons konsensusbegrepp ”människan” diskuterades resultatet mot bakgrund av litteraturöversikten. Författarna fann att närstående behövde information och kunskap för att uppfatta och begripa sin situation. Stöd och resurser var av stor betydelse för att kunna hantera sin situation och finna mening i sin tillvaro. Därutöver diskuterades närståendes meningsskapande i vårdarrollen. / Background: The technological development has made it possible for many people with incurable diseases to spend their last days at home. The home creates solidarity and equality where both patients and relatives can perform everyday activities together as before. Relatives take a great responsibility with varied tasks in the care for their ill family member at home. The role of the nurses working at the palliative care unit, based on the four cornerstones, is to be able to improve the quality of life of the patient, but also to offer support to the relatives. Aim: To describe the relatives’ experiences of caring for a family member at home at the end of life. Method: A literature review was performed with ten qualitative research articles. The articles retrieved from databases CINAHL Complete, PubMed and Nursing &amp; Allied Health, and published between 2006 and 2016. The analysis of the articles has been done by searching the similarities and differences according to Friberg`s (2012) method. Results: The result is presented in three main themes: The relatives’ experiences of taking responsibility of the care, the relatives’ experiences of their own life situations and the relatives’ experiences of the support they get from health care professionals. Many relatives described that it is natural to provide care for their family members. Some felt that they were expected to step in and take responsibility over the caregiving role both by the patient and the nursing staff. They expressed that they felt a huge responsibility and burden. The feelings of the relatives were characterised by powerlessness, insecurity, incompetence and apprehension. They used different strategies to deal with and to find a meaning in their situations. Many of them appreciated the help and support they got from the health care professionals, while others perceived that there was a lack of help and supportive approach. Discussion: The authors discussed the strengths and weaknesses of the method. The results were discussed with the help of Antonovsky's model of sense of coherence (SOC) and Katie Eriksson’s “human” consensus concept. Relatives need information and knowledge in order to grasp and comprehend their situations. Support and resources are of a great importance for the relatives to be able to deal with their situations and find a meaning to understand the situation that they are involved in. Additionally, relatives´ creations of meaning in their caring roles were discussed.