This thesis addresses the hypothesis that a single, waist-mounted triaxial accelerometer (TA) can be used to monitor human movement patterns in unsupervised, freeliving subjects over extended periods, and that it can be used to quantitatively measure parameters that can provide clinical insight into the health status of the subject. A rigorous theoretical and experimental understanding of the signals obtained from a TA is developed. The effect of the placement of the TA device on the waist is explored and a model relating device position to TA signal is developed for a range of postures and activities. A classification framework for movement identification using the signals from a waist-mounted TA is presented. This framework is based on a hierarchical binary processing tree and is designed for real time use. An implementation of this framework for monitoring housebound patients is presented. Algorithms for detecting falls, distinguishing between activity and rest, classifiying transitions between different postural orientations, and for identifying periods of standing, sitting, lying and walking are developed. In evaluation studies performed in controlled laboratory conditions, every algorithm performed with better than 90% accuracy. Once movements are identified, movement-specific parameters sensitive to changes in functional status are extracted from the signal. A two stage methodology for employing the accelerometry system in monitoring free-living subjects is introduced. The first stage involved monitoring specific movements through a directed routine. The second stage involved monitoring of free movement. Signals obtained from the directed routine are used to extract clinically relevant, movement-specific parameters. Signals obtained from the period of free movement are monitored for falls and other abnormal events. General parameters of movement, including energy expenditure, are also measured. The system was evaluated in a series of field studies in laboratory and home environments, in supervised and unsupervised settings, using cohorts of healthy subjects. A pilot trial was conducted in which six healthy elderly subjects wore the TA device for a period of up to three months. The technical performance and useability of the system were evaluated. Clinically significant parameters were measured and the effects of age and health status on the measured parameters were evaluated.

Idag erbjuds familjer som fått ett prematurfött barn att gå hem med neonatal hemsjukvårddetta gör att vårdtiden på sjukhuset blir kortare och familjen får komma hem och vårdabarnet i hemmet. Fler sjukhus i Sverige ansluter sig till den neonatala hemsjukvården ochkan i och med det erbjuda föräldrarna denna form av vård. Faderskapet har utvecklats frånatt ha haft rollen som familjeförsörjare till att vara mer aktiv i föräldraskapet. Papporna tarmer plats i familjen. Syftet med denna studie var att beskriva pappors upplevelser avneonatal hemsjukvård. Som datainsamlingsmetod utfördes intervjuer. För att genomförastudien och bearbeta materialet, användes en kvalitativ innehållsanalys. Resultatetutmynnade i två teman, en tillfredsställelse i att få komma hem och en känsla av att bliomhändertagen av vårdpersonalen. Det första temat innebar att papporna upplevdefrihetskänsla, enkelhelhet och att det var ett naturligt steg. Det andra temat innebar attpapporna upplevde tillmötesgående vårdpersonal, lättillgängligheten och attvårdpersonalen var återkommande i hemmet. En av studiens konklusioner var att pappornaupplevde den neonatala hemsjukvården som en positiv upplevelse. Livet blev enklare ochsmidigare. I en eventuell kommande studie skulle det vara intressant att studera hurvårdpersonalen upplever stödet till papporna i den neonatala hemsjukvården. / Families of today who have a child born prematurely often go home from the hospital withneonatal homecare, this implies a reduced duration in the hospital. The parents can takecare of their child at home and they can stay in an familiar environment. Several hospitalsin Sweden can offer families neonatal homecare. The fatherhood has developed from beingan economic family support to a father who now is more active in parenting and take moreresponsibility in the family. The purpose with this study was to describe father’sexperiences of neonatal homecare. Interviews were performed with seven fathers. and thecontent of the interviews were analysed with a qualitative method. The result concludedtwo themes, one was the satisfaction of coming home and the other one was the feeling ofbeen taken care of by the staff. The first theme involved feelings of freedom, simplicityand a natural step. The second theme involved accommodating staff, easily accessible andreturned in the home. The fathers experienced the neonatal homecare very positive. Thelife became easier and more convenient. A future study focusing on how the staff workingwith neonatal homecare experience given support to fathers could give importantknowledge to improve the support of fathers.

Sjuksköterskor har idag en arbetsledande roll framförallt inom den kommunala hälso- och sjukvården. Syfte: Att belysa sjuksköterskors upplevelse av teamarbete kring patienten i hemvården. Bakgrund: Sedan Ädelreformen 1992 har sjuksköterskor blivit mer framträdande medarbetare i den kommunala sjukvården. Att arbeta inom kommunal hemvård är en utmaning då det krävs en stor kunskapsbredd för sjuksköterskor. Sjuksköterskors arbete regleras av lagar och författningar som betonar att hon bör ha en arbetsledande förmåga och att hon bör arbeta för teamsamverkan. Tidigare forskning tyder på att teamarbete främjar både arbetskamraters trivsel med varandra och kvalitén på vården. Metod: Kvalitativ ansats. 10 berättelser från sjuksköterskor verksamma i kommunal hemvård analyserades. Analysen gjordes med inspiration av Dahlbergs tre analysfaser.Resultat: Sex kategorier framkom under analysen: Samarbete, Kommunikation, Relation, Ansvar, Tidsbrist, Patient. Kommunikation framstår som en viktig del som både hindrar och möjliggör gott samarbete. Att se varandras kompetens och att lita på den framgick också som viktigt. Att brister i samarbetet kunde leda till att patienten ej fick den vård han/hon bör få framkom också i studien. Studien antyder att det kan vara av vikt att i framtiden belysa teamarbete inom hemvården då det tycks finnas brister i samarbetet mellan sjuksköterskor och undersköterskor, vilket kan påverka omvårdnaden. / Nurses today have a supervising role primarily in the community health services. Aim: To illuminate nurse’s experience of team work around the patient in home care. Background: Since Ädelreformen 1992, nurses have become a more prominent employee in the community health care. Working within the community homecare is a challenge because it requires a wide knowledgebase for nurses. Nurses are regulated by laws and constitutions that stresses her role as supervisor and her work for the team interaction. Previous research suggests that teamwork promotes both work colleagues' comfort with each other and the quality of care. Method: Qualitative approach. 10 stories from nurses working in homecare were analyzed with inspiration from Dahlberg`s three analysis phases Results: Six categories emerged in the analysis: Cooperation, Communication, Relation, Responsibility, Shortage of time, Patient. Communication appears to play an important role both as obstacles and as possibilities for teamwork. To see each other's competence and to trust it is important. Lack of cooperation could lead to patients not receiving the care he/she should get emerged in the study. The study suggests that it may be important in the future to highlight teamwork in homecare because there seems to be lack of co-operation between nurses and assistant nurses, which may affect the nursing care.

Hospital stays have grown increasingly shorter with a corresponding increase in the use of homecare services. However, we have a limited understanding of how homecare services are allocated in Ontario, particularly homecare rehabilitation services. The primary objective of this research is to explore the current decision-making processes for the allocation of occupational and physical therapy services in homecare for the long stay clients. To address this objective a exploratory study using key informant interviews was conducted. The results indicate that the process of decision making for the allocation of therapy services is comprised of a series of stages called intake, assessment, referral to service provider and reassessment. Amongst these the process of determining the volume of therapy services varies widely across different region. These variations are primarily due to the regional contextual (e.g. financial constraints) factors of the individual CCACs.

Hospital stays have grown increasingly shorter with a corresponding increase in the use of homecare services. However, we have a limited understanding of how homecare services are allocated in Ontario, particularly homecare rehabilitation services. The primary objective of this research is to explore the current decision-making processes for the allocation of occupational and physical therapy services in homecare for the long stay clients. To address this objective a exploratory study using key informant interviews was conducted. The results indicate that the process of decision making for the allocation of therapy services is comprised of a series of stages called intake, assessment, referral to service provider and reassessment. Amongst these the process of determining the volume of therapy services varies widely across different region. These variations are primarily due to the regional contextual (e.g. financial constraints) factors of the individual CCACs.

Idag ökar den palliativa omvårdnaden i hemmet. För att den sjuke ofta har en önskan om att få dö hemma. Det ställer krav på anhörigvårdarna som är dem som kommer att bli dem primära vårdarna. Syftet med studien var att undersöka anhörigvårdarnas upplevelser av att vårda hemma, i livets slutskede, med hjälp av det palliativa teamet. Studien genomfördes som en systematisk litteraturstudie. Genom litteraturstudien fick man fram de positiva och negativa upplevelserna från anhörigvårdarna som vårdat den sjuke i hemmet. Studien visade att anhörigvårdarna skulle välja att vårda den sjuke i hemmet igen med hjälp av det palliativa teamet. Detta trots att flera negativa upplevelser kom fram. Anhörigvårdarna ville vara mer delaktiga i omvårdnadsarbetet och detta gjorde att anhörigvårdarna upplevde en större tillfredställelse av själv, genom att kunna ge något tillbaka till den sjuke. Anhörigvårdarna önskade mer stöd från vårdpersonalen eftersom de ansåg sig ha bristande kompetens om medicinteknik, kroppens hälsa, sjukdomen, dess symptom, behandling, och prognos etc.

In this study, the factors affecting the acceptance of mobile homecare system were examined. These factors were assessed by taking Unified Theory of Acceptance and Use of Technology (UTAUT) as a theoretical model. The main feature of this thesis (differing from the other studies in the literature) is that the user acceptance study model is analyzed on a system that is not realized yet. So, this study has two dfferent perspectives. The first one is the examination the results of UTAUT for a system in the design phase. The other one is the investigation of the relations of factors that affect the acceptance of mobile homecare by patients with chronic diseases. For these purposes, a homecare system model was formulated based on similar studies in the literature. A quantitative research was conducted on this formulated system. The results were evaluated by Structural Equation Model. According to the results of structural model, all hypotheses were supported and consistent with the earlier study results, which were based on completed and in-use systems. Therefore, this study shows that, for systems in the design level, the acceptance models can also be applicable and may give similar results. The results also show that performance expectance was the most significant predictor for patients

<p>Idag erbjuds familjer som fått ett prematurfött barn att gå hem med neonatal hemsjukvårddetta gör att vårdtiden på sjukhuset blir kortare och familjen får komma hem och vårdabarnet i hemmet. Fler sjukhus i Sverige ansluter sig till den neonatala hemsjukvården ochkan i och med det erbjuda föräldrarna denna form av vård. Faderskapet har utvecklats frånatt ha haft rollen som familjeförsörjare till att vara mer aktiv i föräldraskapet. Papporna tarmer plats i familjen. Syftet med denna studie var att beskriva pappors upplevelser avneonatal hemsjukvård. Som datainsamlingsmetod utfördes intervjuer. För att genomförastudien och bearbeta materialet, användes en kvalitativ innehållsanalys. Resultatetutmynnade i två teman, en tillfredsställelse i att få komma hem och en känsla av att bliomhändertagen av vårdpersonalen. Det första temat innebar att papporna upplevdefrihetskänsla, enkelhelhet och att det var ett naturligt steg. Det andra temat innebar attpapporna upplevde tillmötesgående vårdpersonal, lättillgängligheten och attvårdpersonalen var återkommande i hemmet. En av studiens konklusioner var att pappornaupplevde den neonatala hemsjukvården som en positiv upplevelse. Livet blev enklare ochsmidigare. I en eventuell kommande studie skulle det vara intressant att studera hurvårdpersonalen upplever stödet till papporna i den neonatala hemsjukvården.</p> / <p>Families of today who have a child born prematurely often go home from the hospital withneonatal homecare, this implies a reduced duration in the hospital. The parents can takecare of their child at home and they can stay in an familiar environment. Several hospitalsin Sweden can offer families neonatal homecare. The fatherhood has developed from beingan economic family support to a father who now is more active in parenting and take moreresponsibility in the family. The purpose with this study was to describe father’sexperiences of neonatal homecare. Interviews were performed with seven fathers. and thecontent of the interviews were analysed with a qualitative method. The result concludedtwo themes, one was the satisfaction of coming home and the other one was the feeling ofbeen taken care of by the staff. The first theme involved feelings of freedom, simplicityand a natural step. The second theme involved accommodating staff, easily accessible andreturned in the home. The fathers experienced the neonatal homecare very positive. Thelife became easier and more convenient. A future study focusing on how the staff workingwith neonatal homecare experience given support to fathers could give importantknowledge to improve the support of fathers.</p>

Bakgrund: Enligt World Health Organization's (WHO) definition är palliativ vård en helhetsvård av patienten och dennes närstående genom ett professionellt sammansatt vårdteam. Palliativ vård är ett område där närståendes roll blir speciellt viktigt och hela familjen drabbas när en i familjen får en svår sjukdom. Många med svår sjukdom önskar att få vård i hemmet vid livets slutskede. När en person vårdas i hemmet är det ofta den närstående som tar vårdarrollen i hemmet och tar ansvaret över sin anhöriges vård. Närståendes engagemang i vården av deras anhörig kan påverka dem fysisk och psykiskt. Syfte: Syftet var att beskriva närståendes upplevelser av att vårda en anhörig i livets slutskede i hemmet. Metod: Metoden var en litteraturöversikt som baserades på elva vetenskapliga artiklar med kvalitativ ansats. Artiklarna togs fram via databaserna CINAHL complete with full text och Medline. Resultat: Resultatet visade att närstående kände ett ansvar att vårda sin anhörige. Ansvarstagandet påverkade närståendes egen hälsa och deras dagliga liv. Jobb och hobby begränsades då fokus lades på den anhöriges behov. Att se sin anhörig bli försämrade i livets slutskede upplevdes särskilt svårt. Stöd från familj, vänner och sjukvårdpersonal underlättade att hantera vårdandet. Dock upplevde närstående otillräckligt stöd av hälso- och sjukvården när det gäller information, vägledning och förberedelse för vårdarrollen. Diskussion: Resultatet diskuterades mot Meleis transitons teori, relaterad till att de närstående genomgår en transition när de vårdar en sjuk anhörig. Vidare diskuterades vilken roll sjuksköterskan har för att hjälpa närstående att genomgå en hälsosam transition. / Background: The World Health Organization (WHO) defines palliative care as a total care of the patient and their relatives, provided by a multi professional healthcare team. Palliative care is an area where the next of kin's role is particularly important because when a family member suffers from an illness it affects the whole family. Many people with serious illness wish to be cared for at home at the end of life. When a person is cared for at home, often the next of kins take the caring role and the responsibility over their relative's care. The next of kins involvement in the care of their loved one can affect them physically and mentally. Aim: To describe the next-of-kin's experiences of caring for a loved one at the end of life at home. Method: The literature review was based on eleven scholarly articles with a qualitative approach. Articles were gathered through database search in CINAHL complete with full text and Medline. Results: The result showed that the next of kins experienced a responsibility to care for their loved one. Taking responsibility influenced the caregivers own health and social activities. Work and hobbies were limited since focus was on their loved one's needs. To witness the deterioration of their loved one at the end of life was perceived particularly difficult. Support from the family, friends and health care professionals facilitated them to manage the care giving. However, the next of kin experienced insufficient support by healthcare when it came to information, guidance and preparedness for the caregiver role. Discussions: The result was discussed in relation to Meleis transition theory, because the next of kins were seen to go through a transition when they were caring for an ill loved one. Furthermore, the nurse's role was discussed with a focus on how to help the next of kin to undergo a healthy transition.

Detta examensarbete i socialt arbete belyser hur äldre personer upplever övergången till en beviljad hemtjänstinsats. Genom kvalitativa intervjuer med fyra äldre män på landsbygden har det empiriska materialet samlats in. För att analysera resultatet har vi använt oss av KASAM och aktivitetsteorin. Resultatet visade att de äldre männen har haft en lyckad övergång. De ansåg att hjälpen som de fick av hemtjänsten bidrog till att de kunde känna meningsfullhet och självständighet i sin tillvaro. Den sociala samvaron och den kontakt de fick med hemtjänstpersonalen betydde mycket för dem. En viktig aspekt som bidragit till att övergången varit positiv är den dagverksamhet männen deltog i. Slutsatser man kan dra från studien är att männens accepterande inställning till övergången, gemenskap med hemtjänstpersonalen och deltagande i dagverksamheten har bidragit till de positiva erfarenheterna. / This Bachelor’s thesis in social work highlights how older people experience the transition to a committed home care effort. The empirical material has been gathered through qualitative interviews with four older men in a rural area. The interviews have been analyzed with regard to the activity theory and KASAM. The results showed that the older men had a successful transition. They felt that the help they received from home care services contributed to a meaningful and independent life. The social interaction and the contact they got from the home help staff, meant a lot to them. One important aspect that contributed to a positive transition is the daytime activities the men attended. Conclusions that can be drawn from the study is that their own accepting attitude to the transition, and the social interaction they received from home care staff and the daytime activities have contributed to the positive experiences