Det övergripande syftet med denna uppsats var att undersöka hur kuratorer upplever sina möjligheter att bedriva psykosocialt arbete inom en medicinsk kontext. Upplever kuratorerna att de har handlingsutrymme att utföra psykosocialt arbete samt har förutsättningarna ändrats sedan införandet av en legitimation för hälso- och sjukvårdskuratorer? Studien har genomförts som en kvalitativ intervjustudie där semistrukturerade intervjuer genomförts med sex kuratorer på olika mottagningar på en klinik på ett medelstort sjukhus i Sverige. För att bearbeta materialet har tematisk analys använts, där fyra huvudteman och fjorton underteman växte fram. Kuratorerna på kliniken gör ett gediget psykosocialt arbete men utrymmet det får i kontrast till det medicinska är begränsat. Hierarkier och statusskillnader framkommer på olika sätt i materialet. Uppsatsen visar på att det upplevda handlingsutrymmet är stort men att det faktiska handlingsutrymmet till viss del är begränsat. Gällande hälso-och sjukvårdskuratorslegitimationen ges en bild av att legitimationen inte hade haft någon inverkan på kuratorernas arbete på kliniken, varken gällande arbetsuppgifter, arbetsförhållanden eller status. En förhoppning fanns hos dock alla informanter men främst hos de med kortast tid på kliniken gällande att legitimationen framledes skulle stärka deras ställning samt förbättra deras arbetsvillkor. / The overall aim of this essay was to examine how healthcare social workers experienced their opportunities to conduct social work within a medical context. Do they feel that they have room for action to carry out social work, and have the conditions changed since the introduction of a license for health care social workers? The study was conducted as a qualitative interview study where semi-structured interviews were held with six healthcare social workers at a clinic in a medium-sized hospital in Sweden. To analyze the material, thematic analysis was used, where four main themes and fourteen sub-themes emerged. The healthcare social workers at the clinic do solid social work, but the space it gets in contrast to the medical perspective is limited. Hierarchies emerge in different ways in the material. The essay shows that the perceived room for action is large, but that the actual room for action is to some extent limited. The healthcare social workers didn´t experienced any improvement regarding duties, working conditions or position at the clinic since the introduction of a license for health care social workers. However, there was a hope among all the informants, but mainly among those with the shortest time at the clinic that the license in the future would strengthen their position and improve their working conditions.

Society's view of addiction problems and their treatment is constantly evolving. This study highlights the experience of counselors, nurses and others with social worker education of the structure of the activities, the practical work and the social work in a medical context. Based on previous research and theoretical concepts, this qualitative study is conducted to gain a more in-depth insight into the practical work of the professions and to create an understanding of the structure of the organization. The reason for conducting this study is also to see similarities and differences in how the employees of the syringe exchange activities experience what social work looks like in a medically permeated workplace. To obtain the empirical data, semi-structured interviews were conducted with seven different active professions at different needle exchange facilities in Sweden. The results of the study highlight, among other things, the professions' flexibility and broad scope of action, the importance of collegial collaboration for knowledge exchange and support, and the laws and regulations that the activities need to relate to. Conclusions that could be drawn were that the social work at the syringe exchange facilities is also a pervasive part of the work of the professionals and the interventions offered. Similarly, laws and regulations are perceived to be somewhat flexible according to the interviewees and many times solutions are found to ensure the best interests of the patient. Another conclusion is that large parts of the professionals' experiences of the activities support the goal and purpose of the syringe exchange activities in Sweden, i.e. to motivate people to receive care and treatment.

Einleitung In einem größeren Universitätsklinikum wie in der Charité sind EDV-gestützte Verfahren in verschiedenen Einrichtungen und für verschiedene Aufgaben im Einsatz: Verwaltung, Krankenversorgung, Forschung und Lehre. Diese Subsysteme sind in der Regel nicht in der Lage, Daten untereinander so auszutauschen, daß die in den Daten enthaltene Semantik nicht verlorengeht. Die Ursache liegt im wesentlichen in der Komplexität und in der Unschärfe der medizinischen Informationen. Medizinische Standards (HL7, DICOM, SNOMED, ICD, ICPM, ...) lassen sich für den Austausch von Daten verwenden, die gut formalisierbar und mit einer klaren Bedeutung behaftet sind. Nicht formalisierbare Daten, die z. B. in einem Befund oft vorkommen, lassen sich nicht ohne weiteres mit diesen Standards darstellen. Ziel Entwicklung eines Konzeptes für den Austausch medizinischer Daten, das die o. g. Probleme vermeidet. Material und Methoden Die Analyse der vorhandenen Subsysteme, Standards und Konzepte zeigt, daß das Konzept einerseits eine sehr einfache Syntax und eine simple Struktur aufweisen muß. Andererseits muß die medizinische Semantik voll erhalten bleiben. Als Vorbild kann die relationale Datenbank dienen, die mit einem Datentyp (Relation bzw. Tabelle) und einem einzigen Operator (SELECT) auf diesen Datentyp auskommt. Ergebnisse Das Konzept ist objektorientiert. Es enthält nur einen Datentyp. Das ist das AMICI-Objekt (AMICI: Architecture for Medical Information Exchange and Communication Interface). Über dieses AMICI-Objekt wird der gesamte Datenaustausch vorgenommen. Kann das Empfängersystem ein Objekt nicht oder nicht korrekt interpretieren, so wird die Interpretation vom Sendesystem übernommen. Ein Subsystem wird im Netzwerk über einen medizinischen Kontext angeschlossen, der das Interessengebiet und die Fähigkeit des Subsystems beschreibt. Das Subsystem kann an Hand der im Netz bekannten medizinischen Kontexte feststellen, welche weiteren Subsysteme für den eigenen Zweck interessant sein könnten. Alle AMICI-Objekte erhalten eine weltweit eindeutige Identifikation, so daß die Daten aus verschiedenen Institutionen, auch international, miteinander gemischt werden können. Diskussion Das Konzept kann als Basis für weitere Dienstleitungen in einem Klinikum bzw. einem Krankenhaus dienen. Namentlich zu nennen sind telemedizinische Anwendungen, bei denen nicht nur die Kommunikation zwischen Ärzten, sondern auch zwischen Patienten und Arzt möglich ist. Weiterhin betrifft dies den Einsatz von Software-Agenten, die sich um den Informationsbedarf eines Arztes individuell kümmern. / Introduction Large hospitals like the University hospital Charité use in different units different information systems for recording patient and medical data. There are also different tasks: administration, healthcare, research and education. These medical information systems are often called subsystems. They are usually not able to exchange data without lost of semantic. The complexity and the variability of medical terminology cause this problem. Existing medical standards (e. g. HL7, DICOM, SNOMED, ICD, ICPM, ...) are helpful for well formalised terms. Non-formalised terms that are often used in diagnostic reports can not be represented by existing standards. Aims Development of a concept for medical information exchange which fulfills the requirements mentioned above. Material and Methods The system analysis that is performed based on existing subsystems, medical standards and concepts provides two essential requirements. On the one hand the syntax of such standard must be extremely simple. On the other hand the standard must be able to transfer extremely complex semantics. As an example relational databases (RDB) provide a good idea of such simple syntax and complex semantics. RDB's include only one data type. It is called relation or table. To manipulate tables one needs only one operation. That is the SELECT command in SQL. Result The concept is object oriented. It includes only one object called AMICI-object like RDB's (AMICI: Architecture for Medical Information Exchange and Communication Interface). Data exchange is completely performed by these AMICI-objects. If the receiving subsystem is not able to interpret and represent an object, the sending subsystem will take over this task. Within a network a subsystem uses a special AMICI-object called medical context to describe its features and its area of interest. A subsystem can inquire medical contexts to explore installed and running subsystems in the network. An international unique identifier identifies every AMICI object so that you can mix objects provided by different international institutions, e. g. to use them in multi-center-studies. Discussion This concept can also be used as a basic service for higher level applications in a hospital. Two of them are telemedicine and software agents. Telemedicine is not only a tool for physicians. It should be also a tool for communication and interaction between patient and physician. Physicians can use personal software agents for information acquisition, which meets exactly his specific requirements.