No description available.

INTRODUCTION: La collaboration interprofessionnelle a émergé comme étant l’un des aspects essentiels à consolider pour améliorer l’organisation de la première ligne de soins et assurer un accès adéquat aux ressources disponibles. Pour favoriser l’accroissement de la collaboration interprofessionnelle, il est suggéré que les professionnels des sciences de la santé soient formés en interdisciplinarité, particulièrement à l’occasion des stages cliniques. OBJECTIFS: Ce projet vise à mesurer le degré d’implantation du programme de formation interprofessionnelle (PFI) du Centre de santé et de services sociaux (CSSS) à l’étude comparativement au modèle proposé initialement. De plus, ce projet vise à comprendre comment les facteurs systémiques, les facteurs organisationnels et les caractéristiques du programme de formation mis en place influencent l’implantation du PFI. MÉTHODOLOGIE : Il s’agit d’une étude de cas unique effectuée au sein d’un CSSS situé dans la grande région de Montréal au Québec, Canada. Les données ont été recueillies à l’aide de 11 entrevues semi-dirigées qui ont été réalisées auprès de professionnels et administrateurs responsables de l’implantation du PFI et d’un étudiant en stage ayant participé au PFI. Une analyse des documents administratifs et cliniques écrits concernant l’implantation du PFI a également été effectuée. RÉSULTATS : L’implantation du PFI est toujours en évolution comme le traduit la présence des différentes composantes définissant la mise en œuvre du PFI qui est de moyenne à élevée et l’intensité des différentes composantes qui est généralement faible. Les facteurs systémiques, les facteurs organisationnels et les caractéristiques du programme de formation mis en place influencent l’implantation du PFI en milieu clinique et il existe des interrelations entre ces différents facteurs. L’analyse des facteurs influençant l’implantation d’un PFI en milieu clinique doit également s'attarder aux différents facteurs influençant le développement des pratiques collaboratives dans ce milieu. / INTRODUCTION: Interprofessional collaboration emerged as one of the key aspects that have to be consolidated to improve the organization of primary care and to ensure an appropriate access to available resources. In order to increase interprofessional collaboration, it has been suggested that health sciences professionals should be trained in an interdisciplinary fashion, especially during clinical training. OBJECTIVES: The aim of this research is to measure the degree of implementation of an initiative in interprofessional education (IPE) which takes place in the Health and social service centre (HSSC) studied, as compared to the initially proposed model. Furthermore, the objective of this research is to understand how systemic factors, organizational factors and the training program’s attributes influence the IPE initiative’s implementation. METHODS: This is a case study based on an HSSC located in the greater Montreal region in Quebec, Canada. Data was collected through 11 semi-structured interviews performed with professionals and administrators responsible for the IPE initiative’s implementation, together with one student who participated in the IPE initiative during his clinical training. An analysis of administrative and clinical documents regarding the IPE initiative’s implementation was also performed. RESULTS: The implementation of the IPE initiative is still an ongoing process as it is showed by the medium-high presence of the different elements which define the IPE implementation and the generally low intensity of these elements. Systemic factors, organizational factors and the training program’s attributes influence the implementation of the IPE initiative in a clinical setting and there is an interaction between all of these factors. An analysis of the different factors influencing the implementation of an IPE initiative in a clinical setting should also consider the different factors influencing the development of collaborative practice in this environment.

Problématique : Au Québec, les troubles anxieux et dépressifs touchent près d’une personne sur cinq au cours de leur vie. Elles consultent majoritairement dans les services de première ligne (SPL) qui sont souvent dispensés en collaboration interprofessionnelle, mais qui ne semblent pas répondre efficacement à leurs besoins. Le rôle optimal (RO) infirmier permet d’intervenir lors du continuum de services. Un écart entre les rôles réels (RR) et le RO des infirmières semble s’observer dans les SPL. But : Décrire et analyser le RR de l’infirmière lors de la prestation des soins aux personnes atteintes de troubles dépressifs et anxieux dans les équipes multiprofessionnelles de première ligne. Méthodologie : 15 professionnels de la santé (infirmières [n=9], autres [n=6]) dans deux milieux de SPL ont participé à cette étude de cas multiples qualitative. Résultats : Trois catégories de facteurs influencent l’écart entre les RR et le RO des infirmières, soit les facteurs liés : 1) à l’équipe, 2) à la clientèle et 3) aux infirmières. La formation du RO des infirmières influence également l’écart. L’approche typiquement holistique et non stigmatisante des infirmières ainsi que la réduction de l’écart entre les RR et le RO semblent optimiser la prise en charge des TMC dans les SPL. Conclusion : Cette recherche met en lumière les facteurs pour réduire l’écart entre les RR et le RO. La formation des professionnels et l’organisation du travail dans le milieu clinique devrait mettre l’accent sur la collaboration interprofessionnelle, maximisant ainsi la pratique des professionnels selon leurs RO. / Problematic: In Québec, anxiety and depressive disorders affect nearly one in five people in their lives. They mainly consult in primary care services which are often provided in interprofessional collaboration but does not seem to succeed to effectively meet their needs. The optimal role allows nurses to intervene throughout the care plan. A difference between the nurse’s actual and optimal roles seems to be observed in the primary care services. Purpose: To describe and analyze the nurse’s actual roles in primary care multiprofessional teams during the delivery of care to people with depressive and anxiety disorders. Methods: 15 healthcare professionals (nurses [n=9], others [n=6]) in two primary care service environments participated in this qualitative multiple case study. Results: Three categories of factors influence the difference between the nurses’ actual and optimal roles: 1) the team, 2) the customer and 3) the nurses. Nurse’s training on the optimal role also influences the gap. The typical nurse’s holistic approach and the nurse’s actual role approaching the optimal role seem to contribute to primary care services in mental health. Conclusion: University training for health professionals and the organization of work in the clinical setting should focus on interprofessional collaboration, maximizing the contribution of optimal role. This research highlights the factors to reduce the gap between the nurse’s actual and optimal roles.

No description available.

The thesis investigates team talk and team collaboration from a dialogical perspec­tive, and is based on video recordings of 15 multi­professional team conferences involving a pain rehabilitation team. The analyses also draw upon a vast material of interviews, field notes and documents collected during almost a year of fieldwork at the clinic. The main purpose of the thesis is to shed light on some of the distinguish­ing linguistic features of such team confe­ren­ces and on the pragmatic strategies deployed by the team members in order to bring into play the variety of professional perspectives represented in the team. Ana­lyses of their lexical choices and interaction show three areas of responsibility: professional, overlapping and shared. Analyses of phases, activities and participant structures show how the team conferences can be understood as a specific type of institutional interaction, a communicative activity type that makes it possible both to share information and to reach a shared understanding of the patients’ problems. A deeper interactional analysis reveals pragmatic strategies enhancing the team’s multiprofessional com­munication: the identification and sorting of information, in-depth discussions of specific problems and decision-making procedures. The results illustrate central aspects of what is often called interprofessional competence within the field of health care, i.e. the ability to make the most of multiprofessional collabo­ration. The thesis adds to our understanding of team conferences as a communi­ca­tive activity type and increases our understanding of how participants can offer their perspec­tive through conversation, thereby making it possible for the others to adopt this perspective – in short, to achieve what is often referred to as a democratic dialogue. / Med utgångspunkt i ett dialogiskt perspektiv analyseras samtalen under teamkon­ferenserna i ett smärtrehabiliteringsteam för att beskriva språkliga strategier som stödjer samarbetet mellan företrädare för olika professioner. Analyserna baseras på videoinspelningar av 15 teamkonferenser (motsv. c:a 40 tim) samt fältanteck­ningar, intervjuer och dokument insamlade under ett knappt års fäl­tarbete. Analys­erna av ordförråd och interaktion visar att teammedlemmarnas ansvars­områden består av tre typer: professionsspecifika, delade och gemen­samma ansvarsom­råden. Analyser av faser, delaktiviteter och deltagarstruktur visar hur samtalen kan beskrivas som en form av inominstitutionella arbetsmöten, en verksamhetstyp som både ger möjlighet för teammedlemmarna att dela med sig av information till varandra och att nå en delad förståelse av patienternas situation och möjliga lös­ningar. Vidare har en mer omfattande interaktionsanalys resulterat i en beskriv­ning av språkliga strategier som stödjer samarbetet i teamet: inventering och sortering av information, fördjupande diskussioner av specifika problem samt för­handling och förankring av beslut. Analyserna visar också hur teammedlemmarna tillsammans definierar vilket förklaringsdjup som krävs i dis­kussionen av en viss aspekt av ett problem för att en delad förståelse av prob­lem och potentiella lös­ningar ska kunna uppnås. Tillsammans tydliggör resultaten några centrala aspek­ter av det som brukar kallas interprofessionell kompetens – förmågan att på ett socialt smidigt och interaktionellt effektivt sätt förhålla sig till och överskrida gränserna mellan olika professioners kompetens- och ansvarsområden. Avhandlingen bidrar till för­ståelsen av team­konferenser som verksamhetstyp och fördjupar förståelsen av hur samtalsdel­tagare kan göra sina respektive perspektiv tillgängliga för varandra – en grundläggande förutsättning för att uppnå det vi brukar kalla det goda samtalet.

INTRODUCTION: La collaboration interprofessionnelle a émergé comme étant l’un des aspects essentiels à consolider pour améliorer l’organisation de la première ligne de soins et assurer un accès adéquat aux ressources disponibles. Pour favoriser l’accroissement de la collaboration interprofessionnelle, il est suggéré que les professionnels des sciences de la santé soient formés en interdisciplinarité, particulièrement à l’occasion des stages cliniques. OBJECTIFS: Ce projet vise à mesurer le degré d’implantation du programme de formation interprofessionnelle (PFI) du Centre de santé et de services sociaux (CSSS) à l’étude comparativement au modèle proposé initialement. De plus, ce projet vise à comprendre comment les facteurs systémiques, les facteurs organisationnels et les caractéristiques du programme de formation mis en place influencent l’implantation du PFI. MÉTHODOLOGIE : Il s’agit d’une étude de cas unique effectuée au sein d’un CSSS situé dans la grande région de Montréal au Québec, Canada. Les données ont été recueillies à l’aide de 11 entrevues semi-dirigées qui ont été réalisées auprès de professionnels et administrateurs responsables de l’implantation du PFI et d’un étudiant en stage ayant participé au PFI. Une analyse des documents administratifs et cliniques écrits concernant l’implantation du PFI a également été effectuée. RÉSULTATS : L’implantation du PFI est toujours en évolution comme le traduit la présence des différentes composantes définissant la mise en œuvre du PFI qui est de moyenne à élevée et l’intensité des différentes composantes qui est généralement faible. Les facteurs systémiques, les facteurs organisationnels et les caractéristiques du programme de formation mis en place influencent l’implantation du PFI en milieu clinique et il existe des interrelations entre ces différents facteurs. L’analyse des facteurs influençant l’implantation d’un PFI en milieu clinique doit également s'attarder aux différents facteurs influençant le développement des pratiques collaboratives dans ce milieu. / INTRODUCTION: Interprofessional collaboration emerged as one of the key aspects that have to be consolidated to improve the organization of primary care and to ensure an appropriate access to available resources. In order to increase interprofessional collaboration, it has been suggested that health sciences professionals should be trained in an interdisciplinary fashion, especially during clinical training. OBJECTIVES: The aim of this research is to measure the degree of implementation of an initiative in interprofessional education (IPE) which takes place in the Health and social service centre (HSSC) studied, as compared to the initially proposed model. Furthermore, the objective of this research is to understand how systemic factors, organizational factors and the training program’s attributes influence the IPE initiative’s implementation. METHODS: This is a case study based on an HSSC located in the greater Montreal region in Quebec, Canada. Data was collected through 11 semi-structured interviews performed with professionals and administrators responsible for the IPE initiative’s implementation, together with one student who participated in the IPE initiative during his clinical training. An analysis of administrative and clinical documents regarding the IPE initiative’s implementation was also performed. RESULTS: The implementation of the IPE initiative is still an ongoing process as it is showed by the medium-high presence of the different elements which define the IPE implementation and the generally low intensity of these elements. Systemic factors, organizational factors and the training program’s attributes influence the implementation of the IPE initiative in a clinical setting and there is an interaction between all of these factors. An analysis of the different factors influencing the implementation of an IPE initiative in a clinical setting should also consider the different factors influencing the development of collaborative practice in this environment.

Aim: The aim of this comprehensive thesis is to explore different perceptions of public health nursing practice. The intention being to contribute to developing the service, theoretically and practically, in throe with current and future public health needs. Methods: The thesis comprises five studies. Public health nurses, young people, parents and decision makers are interviewed and share their perceptions of public health nursing practice (studies I, II, III and IV). Consultations at local child health clinics, clinics for young people and at school health services are observed (study III). A cross sectional study amongst a sample of doctors, public health nurses, midwives and child protection workers is carried out (study V). The first four studies have an explorative, descriptive design. Study V, with its focus on interprofessional collaboration, is based on the results of studies I, II, and IV. Findings: Study I, a case study, provides a backdrop for the remaining four studies. It focuses on changes the nurses have faced during the period 1984-2005. The results point to issues of visibility and that respect is more important for the nurses than authority or status. Study II is a philosophical study based on interviews with public health nurses. It gives an introduction to the philosophy of Emmanuel Levinas and develops a novel theoretical and practical understanding of aspects of responsibility in public health nursing. Study III shows the importance of relationships with service users in public health nursing practice; and that not only pleasantness but also honesty and openness are important. This study has contributed to further developing models of public health nursing interventions. Decision makers in study IV point to the challenges public health nurses face regarding collaboration, visibility and boundaries. Study V is a cross sectional questionnaire study that focuses on interprofessional collaboration. The results show that size of municipality can influence frequency of meeting points and views on issues relating to collaboration; and that mental health services are those most missed in collaborative relationships. The findings warrant further research and should be of interest when organising municipal health- and social services in Norway. Conclusions: The thesis concludes that service users and decision makers are satisfied with public health nursing services, but that public health nurses face challenges related to collaboration, to boundaries for knowledge and involvement, and in making their health promotive function visible / Denne doktorgradsavhandling: Perceptions of public health nursing practice - on borders and boundaries, visibility and voice, fokuserer på ulike oppfatninger av helsesøsters praksis. Helsesøstre, ungdom, foreldre, samt lokale politikere og administratorer er intervjuet om deres syn på helsesøstertjenesten. Konsultasjoner på helsestasjon for barn, ungdom og i skolehelsetjenesten er observert. Et utvalg av samarbeidspartnere har svart på et spørreskjema om samarbeidsforhold. Avhandlingen består av fem studier. De første fire studier har eksplorativ, deskriptiv design. Studie V er en tverrsnittsstudie som bygger på resultatene fra studiene I,II, og IV. Avhandlingen har til hensikt å løfte frem områder som respondentene mener fortjener oppmerksomhet og som kan ha praktiske og teoretiske implikasjoner for utvikling av tjenesten. Studie I, en case studie danner et bakteppe for de andre studiene. Den fokuserer på endringer i helsesøstertjenesten i perioden 1984-2005. Resultatene fra denne studien peker på helsesøstrenes opplevelse av usynlighet og at respekt er mer viktig for helsesøstrene i studien enn autoritet og status. Studie II er en filosofisk studie basert på intervjuer med helsesøstre. Den gir en introduksjon til Levinas’ filosofi og utvikler en dypere forståelse for teoretiske og praktiske aspekter av etisk ansvar i helsesøsters praksis. Studie III peker på betydningen av relasjoner i helsesøsters praksis. Det var viktig at konsultasjonene var hyggelige for helsesøstrene og brukerne, men ærlighet og åpenhet var også vesentlig for gode relasjoner. Beslutningstakere i studie IV peker på utfordringer helsesøstre har når det gjelder samarbeid, usynlighet, samt grenser for deres kunnskap og involvering. Studie V er en spørreskjemaundersøkelse som fokuserer på samarbeid. Resultatene viser at kommunestørrelse har betydning for hyppighet av møtepunkter og syn på samarbeid og at psykiske helsetjenester er savnet mest i samarbeidsrelasjoner. Disse funn burde være av interesse i fremtidig organisering av helse- og sosialtjenester. Avhandlingen konkluderer med at foreldre, ungdom og beslutningstakere er fornøyde med helsesøstertjenesten, men at helsesøstre står overfor viktige utfordringer i samarbeidsrelasjoner, i forhold til grenser for involvering og i å synliggjøre deres helsefremmende funksjon

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Global health organizations attend to populations around the world applying an evidence-based model of care that often does not correspond with local realities on the ground. My thesis provides an in-depth anthropological study of how this occurs within practices in and around World Spine Care's (WSC) clinics in Shoshong and Mahalapye, Botswana. More specifically I explore how knowledge is negotiated and improvised on the ground, paying particular attention to the ways WSC volunteers are (un)able to work with local health workers as they desire. I show the flows and counter-flows implicated in the difficult task of reconciling skills with standards. The study is based on a total of 15 months of participation with WSC's organization through attending meetings, activities and shadowing practitioners both in Ottawa and in Botswana. Expanding the scope of their creative improvisational skills beyond the closed settings of WSC clinics is proposed as a way to move forward.

I dagens samhälle vill människor bli delaktiga och få medbestämmande. Personcentrerad vård medför att sjukvårdens strävar efter att patienten involveras och vården anpassas efter dennes behov och förutsättningar. På så sätt blir vården mer jämlik och kan utföras på ett kostnadseffektivt sätt. Vid utgångsläget på studerat sjukhus utfördes mindre gynekologiska interventioner på operationsavdelningen. Processen var resurskrävande och hade låg patientdelaktighet. Patientkontrollerad sedering (PCS) betyder att patienten styr sederingen själv. På så sätt kan både patientens delaktighet och värdet i mikrosystemet öka. Förbättringsarbetet innebar att utbilda sjuksköterskor från kvinnoklinikens mottagning att erbjuda PCS självständigt utan att anestesisjuksköterskan deltar. Då skapas möjlighet att utföra vissa interventioner på mottagningen istället för på operation. Syftet med förbättringsarbetet var att öka patientens delaktighet genom att införa patientkontrollerad sedering vid gynekologiska interventioner på kvinnoklinikens mottagning, Värnamo sjukhus. Eftersom detta arbetssätt inte är vedertaget var studiens syfte var att undersöka medarbetarnas erfarenheter av att erbjuda patientkontrollerad sedering. Förbättringsarbetet utgick från Nolans förbättringsmodell och strukturen i förbättringsrampen. Värdekompassens perspektiv och mätetal användes för att belysa effekten av förändringen, både för patienten, medarbetarna och verksamheten. Studien genomfördes med kvalitativ metod med hjälp av semistrukturerad fokusgruppintervju av medarbetare på kvinnoklinikens mottagning, Värnamo Sjukhus. Förbättringsarbetet resulterade i en funktionell sederingsmetod och ett förändrat mikrosystem för kvinnor som ska genomgå gynekologiska interventioner. Förbättringsarbetet stärkte patientens delaktighet och ökade möjligheten att bli en aktiv medspelare i sin egen vård. Samtliga värdekompassens balanserade mått påvisade att arbetssättet var välfungerande, patientsäkert och uppskattat både av patienter och medarbetare. Ytterligare effekt var att medarbetarnas kompetens ökade och att samverkan mellan klinikerna förbättrades. Studien påvisade att medarbetarna upplevde att det nya arbetssättet stärkte den personcentrerade vården. Införandet av PCS upplevdes både relationsskapande, engagerande och resurskrävande. / In modern society people prefer participation and co-determination. Person-centred care leads health care to involve the patient and the care adapts to the patient´s needs and conditions. This way the care will be more equal and can be performed in a more cost-effective way. Originally gynaecological interventions were costly performed in the operating room (OR) with lack of participation. Patient- controlled sedation (PCS) means that the patient controls the sedation itself. With this the patient's participation grows and increases value in the microsystem. The Quality improvement (QI) involved to teach nurses at the out-patient clinic (OPC) to handle PCS by themselves, without an anaesthetic nurse attending. In this way some interventions could be performed in the OPC instead of in the OR. The purpose of QI was to increase patient-participation by introducing PCS during interventions at the gynaecological OPC at Värnamo hospital. The study aimed at determining the co-worker's experiences when introducing PCS. The QI started from Nolans improvement model and the structure in the improvement ramp. The value-compass and measurements were used to evaluate the effects of the changes. The study was performed in a qualitative method with inductive approach using focus-group interview with co-workers at the gynaecological OPC. By introducing PCS in the QI women became participants in the gynaecological OPC. The QI resulted in that more interventions could safely be performed in the OPC. The new procedure makes the patient an active co-player, the competence of the co-workers rises, the collaboration between the clinics grows and the care is performed at the right level of care.  The study showed that the co-workers experienced increased patient-centered care. The QI built relationships, was engaging and demanding resources.