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21	Beslutstöd i ambulanssjukvården : En enkätstudie om hänvisning av vuxna till egenvård / Decision support in ambulance care : A survey on referral of adults to self-care Söderberg, Nina, Wiesel, Viktoria January 2019 (has links) Abstrakt Bakgrund: Patienter hänvisas idag i större utsträckning till egenvård av sjuksköterskor i ambulanssjukvården och beslutstöd finns för att hjälpa till med hänvisningen. Arbetet innebär att prioritera och bedöma vilken vårdnivå som är optimal för patienterna, vilka patienter som behöver följa med i ambulansen för ytterligare vård på vårdinrättning och vilka som kan hänvisas till egenvård. Att bedöma vad som är optimal vårdnivå ställer krav på att sjuksköterskorna besitter medicinska kunskaper vid olika tillstånd, men också kunskap om helheten i hänvisningsprocessen.Syfte: Syftet var att undersöka sjuksköterskors erfarenheter av ett beslutstöd för hänvisning av patienter från ambulanssjukvård till egenvård. Metod: En kvantitativ tvärsnittsstudie har utförts med hjälp av enkäter. Designen var deskriptiv och explorativ. En totalundersökning av populationen har utförts som innefattade 123 sjuksköterskor i ambulanssjukvården i en region i södra Sverige, fördelat på två länsdelar. Slutligen inkom 95 enkätsvar (77,2 %). Data har analyserats med deskriptiv statistisk och tematisk innehållsanalys. Resultat: Det var 68 (71,5 %) av sjuksköterskorna som höll med om att de alltid använde beslutsstödet och 54 (56,9 %) upplevde att beslutsstödet gav det stöd som behövdes. Det var 84 (88,5 %) som hade uppfattningen att patienter var nöjda med hänvisning till egenvård. Av sjuksköterskorna svarade 77 (81,1 %) att läkare fanns att tillgå vid behov. Dock fanns en önskan om att akutläkare alltid skulle vara tillgängliga vid frågor. Tid på dygnet och geografisk hämtplats påverkade beslutet att lämna patienter hemma. Beslutstödet fokuserade allt för mycket på vitala parametrar och täckte därmed inte andra viktiga aspekter. Konklusion: Resultatet visade att beslutstödet är i behov av förändring. Akutläkare eller läkare med hög kompetens bör finnas tillgängliga vid frågor. Genom att använda sin kliniska blick, hög medicinsk kompetens och erfarenhet, tillsammans med ett väl fungerande beslutsstöd kan sjuksköterskorna i ambulanssjukvården uppleva ökad trygghet när patienter hänvisas till egenvård. / Abstract Background: Today, more and more nurses in the prehospital care are referring patients to self-treatment and there is certain support to help make this decision. The work nurses in the ambulance care do means that assess which level of care that is optimal for the patients. Which patients who need to come along in the ambulance and which patients who can be referred to self-care. To decide what is optimal care requires nurses to possess medical knowledge in different conditions, but also knowledge about the whole process of referring patients. Purpose: The purpose was to examine nurses´ experiences of a decision support for referring patients from ambulance care to self-care. Method: A quantitative study has been made, where the writers used a survey to fulfill the purpose. The design of the survey was descriptive and explorative. A total examination of the population has been done, which was 123 nurses in the Ambulance service in a region in south of Sweden, divided into two counties. Finally, there was 95 replies of the survey (77,2 %). Statistical analysis and thematic analysis of the content were used to present the result. Result: There was 68 (71,5 %) of the nurses who agreed to that they always used the decision support and 54 (56,9 %) experienced that the decision support gave the support that was needed. A bigger part, 84 (88,5 %), had the opinion that patients were satisfied being referred to self-care. Of all nurses, 77 (81,1 %) answered that doctors were available if necessary. However, there was a desire that emergency doctors were always available on questions. Time of day and geographical place of pick up affected the decision to leave the patient in his or her home. There were 84 (88,5%) nurses who had experiences from satisfied patients being referred by the ambulance care to self-care. Decision support focused too much on vital parameters and thus did not cover other important aspects. Conclusion: The result showed that the decision support is in need of change. Emergency doctors or doctors with high competence should be available when needed. By using their clinical eye, with high medical competence and experience, together with a well-functioning decision support - the nurses in the ambulance care can experience increased confidence in referring patients to self-care. nurses in the ambulance service experiences support to make decisions patient safety reference self-treatment appropriate level of care sjuksköterskor i ambulanssjukvården erfarenheter beslutstöd patientsäkerhet hänvisning egenvård optimal vårdnivå Medical and Health Sciences Medicin och hälsovetenskap Nursing Omvårdnad
22	Perceptions et attentes de personnes âgées impliquées dans un processus de relocalisation à partir d’un hôpital Bazelais, Mirlande 12 1900 (has links) Étant donné les limites du système de santé à répondre aux besoins des personnes âgées en perte d’indépendance, la relocalisation vers une ressource d’hébergement à partir de l’hôpital est fréquente. Afin d’optimiser l’accompagnement de ces personnes âgées, les infirmières doivent comprendre leurs perceptions et leurs attentes. Toutefois, les connaissances sur le sujet sont peu nombreuses. Basée sur un cadre de référence composé de l’approche écologique et du modèle des soins humanistes de l’Université de Montréal, une étude qualitative descriptive a été réalisée dans le but d’explorer les perceptions et les attentes de personnes âgées en perte d’indépendance, impliquées dans un processus de relocalisation vers une ressource d’hébergement dans le réseau public à partir de l’hôpital. L’échantillon était composé de six personnes âgées en attente de relocalisation recrutées sur cinq unités de soins. Les données qualitatives recueillies à l’aide d’entrevues semi-dirigées ont été analysées par la méthode d’analyse thématique décrite par Braun et Clarke (2006). Les résultats ont démontré que l’expérience des personnes âgées détermine leurs perceptions par rapport aux soins et aux services. Aussi, l’implication des proches dans leur parcours de vie facilite la transition. Les personnes âgées s’attendent à ce que les professionnels de l’hôpital et de la nouvelle ressource répondent à leurs besoins. De plus, ces perceptions et attentes sont influencées par des croyances et des émotions vécues par les personnes âgées. Les nouvelles connaissances issues de cette étude offrent des pistes pour l’accompagnement holistique par les infirmières des personnes âgées en tenant compte de leurs besoins et préoccupations. / Given the limitations of the health system in meeting the needs of older people losing independence, relocation to a long-term care home from the hospital is common. Nurses need to understand the perceptions and expectations of older people to support them. However, limited knowledge exists on the subject. Based on the ecological approach and the Université de Montréal’s caring model of nursing care, a qualitative descriptive study was conducted to explore the perceptions and expectations of older people, losing independence, involved in a relocation process to a long-term care home in the public sector from the hospital. The sample consisted of six older persons awaiting relocation recruited on five care units. Qualitative data collected through semi-structured interviews were analyzed using the thematic analysis method described by Braun and Clarke (2006). Results showed that the experience of older people determine their perceptions of care and services. Also, the involvement of relatives in their life course facilitates the transition. Older people expect their needs to be met by both the professionals at the hospital and at the new facility. In addition, these perceptions and expectations are influenced by beliefs and emotions experienced by older people. Knowledge developed with this study offer nurses avenues to support globally older people by considering their needs and concerns. Perception Attente Personne âgée Placement Hébergement Soins de longue durée Niveau de soins Hôpital Soins infirmiers Qualitative descriptive Expectation Older people Long term care Level of care Hospital Nursing care Nursing home
23	Ontario’s Home First Approach, Care Transitions, and the Provision of Care: The Perspectives of Home First Clients and Their Family Caregivers English, Christine 23 May 2013 (has links) Home First is an Ontario transition management approach that attempts to reduce the pressure on hospital and Long Term Care (LTC) beds through early discharge planning, the provision of timely and appropriate home care, and the delay of LTC placement. The purpose of this qualitative descriptive study was to obtain descriptions from South Eastern Ontario Home First clients and their family caregivers of their experiences with and thoughts about care transitions, the provision of care, and the Home First approach. The goal was to enable insight into the Home First approach, care transitions, and the provision of care through access to the perspectives of study participants. Nine semi structured interviews (and one or more follow-up calls for each interview) with Home First clients discharged from hospitals in South East Ontario and their family caregivers were conducted and their content analyzed. All participating Home First clients were pleased to be home from hospital and did not consider LTC placement a positive option. All had family involved with their care and used a mix of formal and informal services to meet their care needs. Four general themes were identified: (a) maintaining independence while responding (or not) to risks, (b) constraints on care provision, (c) communication is key, and (d) relationship matters. Although all Home First clients participating in the study were discharged home successfully, a sense of partnership between health care providers, families, and clients was often lacking. The Home First approach may be successfully addressing hospital alternative level of care issues and getting people home where they want to be, but it is also putting increasing demands on formal and informal community caregivers. There is room for improvement in how well their needs and those of care recipients are being met. Health professionals and policy makers must ask caregivers and recipients about their concerns and provide them with appropriate resources and information if they want them to become true partners on the care team. / Thesis (Master, Rehabilitation Science) -- Queen's University, 2013-05-23 16:10:53.323 home support workers home health care community care older home support clients elder care discharge planning relationships family relationships nursing home Ontario health care Canadian health care placement Home First transition management care transitions aging in place maintaining independence caregiving community health and support services community long-term care family carers frail seniors client satisfaction hospital discharge health care older people aged frail elderly aging elderly supportive home care client perspectives long-term care quality of care evaluation of services care planning risk decisions case management communication independence home care constraints on care provision maintaining independence qualitative research family caregivers nursing home placement qualitative description program evaluation alternative level of care patient discharge self-care formal care aged care informal care post-discharge care home support community support services health services research

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