Meeting the heath care needs of patients is becoming more complex as individuals are living longer and often with multiple chronic health conditions. In Canada, the majority of patients will die in hospitals (Statistics Canada, 2009), many on medical units. Studies of hospital care have shown that end-of-life care (EOLC) could be improved. Qualitative nursing research studies on EOLC in hospital medical units have been few. More needs to be known about nurses’ experience of providing EOLC within the medical unit environment. The purpose of this study was to seek to understand the lived experience of nurses on a medical unit providing EOLC to patients. Interpretive phenomenology using van Manen’s (1990) approach guided the methodology and analysis of the findings. Face to face interviews with 10 nurses on two hospital medical units were audio-recorded, transcribed and analyzed. The underlying essence of these nurses’ experience was that of “battling a tangled web”. Battling a tangled web represented the nurses’ struggles in attempting to provide EOLC in an environment which was not always conducive to it. Seven themes were generated from the analysis of the data: caring in complexity, caught in a tangled web, bearing witness to suffering, weaving a way to get there: struggling through the process, creating comfort for the patient, working through the dying process with the family, and finding a way through the web. These findings add to our growing knowledge of nurses’ roles and actions as part of EOLC. It also highlights nurses’ perceived facilitators and barriers to EOLC within the medical environment.

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Professional nurses and their patients are directly influenced by insufficient medication, causing a decrease in the quality of care, delays in hospitalisation and it might lead to resistance. In some cases professional nurses have to leave the unit in search of medicine. Amoxicillin-clavulanic acid 1.2 gram for intravenous administration is prescribed to the majority of patients in the medical units in public South African hospitals. Yet there are intermitted insufficient stock levels and challenged inventory systems for amoxicillin-clavulanic acid 1.2 gram in some public hospitals. This fact is positioned against the background of a South African health system that has undergone major changes since the fall of Apartheid in 1994 and amidst major positive changes, is still challenged by overburdened hospital admissions and a quadruple disease burden. The aim of this research was to enhance optimal levels of amoxicillin-clavulanic acid 1.2 gram in medical units in public hospitals to ensure sufficient stock levels and timeous administration. The aim was achieved by identifying and describing the current supply chain of intravenous amoxicillin-clavulanic acid 1.2 gram in two medical units in a district (level 2) public hospital in the North West Province (from here referred only as North West) by identifying inefficiencies in the current supply chain and to formulate recommendations for management to enhance the supply chain of intravenous amoxicillin-clavulanic acid 1.2 gram to medical units in public hospitals. An exploratory case study approach was followed to explain the supply chain of amoxicillin-clavulanic acid 1.2 gram by utilising a qualitative, descriptive, explorative and contextual design. A case study approach was chosen as it examined single units within the context of real life as environment, which in this case were medical units in a level two public hospital, North West. The case selection was motivated and described, followed by case records of policies and standard operational procedures. Field participants included all levels of nurses (professional, enrolled and auxiliary) in medical male and female units on day and night duty, and the head of pharmacy [n=8]. Non-probable, purposive sampling was conducted according to inclusion criteria after all levels of ethical clearance and consent were granted. Three semi-structured individual interviews followed, after which two focus groups were conducted. Thematic analysis of transcriptions was done, followed by an analysis of case records regarding where after all results were integrated. Results indicated complex organisational, unit-specific and behavioural challenges that impact on the supply chain management of amoxicillin-clavulanic acid 1.2 gram and insufficient stock levels are predominantly positioned within retailer and customer aspects of the supply chain. Despite well-formulated standard operational procedures, the realisation thereof lacks, implicating a greater need for managerial control. Recommendations were formulated for management to enhance the supply chain of amoxicillin-clavulanic acid 1.2 gram in medical units in public South African hospitals integrated with good pharmacy practices. The close collaboration, mutual respect and effective communication between health professionals in the multi-professional team are reiterated. / MCur, North-West University, Potchefstroom Campus, 2015

Professional nurses and their patients are directly influenced by insufficient medication, causing a decrease in the quality of care, delays in hospitalisation and it might lead to resistance. In some cases professional nurses have to leave the unit in search of medicine. Amoxicillin-clavulanic acid 1.2 gram for intravenous administration is prescribed to the majority of patients in the medical units in public South African hospitals. Yet there are intermitted insufficient stock levels and challenged inventory systems for amoxicillin-clavulanic acid 1.2 gram in some public hospitals. This fact is positioned against the background of a South African health system that has undergone major changes since the fall of Apartheid in 1994 and amidst major positive changes, is still challenged by overburdened hospital admissions and a quadruple disease burden. The aim of this research was to enhance optimal levels of amoxicillin-clavulanic acid 1.2 gram in medical units in public hospitals to ensure sufficient stock levels and timeous administration. The aim was achieved by identifying and describing the current supply chain of intravenous amoxicillin-clavulanic acid 1.2 gram in two medical units in a district (level 2) public hospital in the North West Province (from here referred only as North West) by identifying inefficiencies in the current supply chain and to formulate recommendations for management to enhance the supply chain of intravenous amoxicillin-clavulanic acid 1.2 gram to medical units in public hospitals. An exploratory case study approach was followed to explain the supply chain of amoxicillin-clavulanic acid 1.2 gram by utilising a qualitative, descriptive, explorative and contextual design. A case study approach was chosen as it examined single units within the context of real life as environment, which in this case were medical units in a level two public hospital, North West. The case selection was motivated and described, followed by case records of policies and standard operational procedures. Field participants included all levels of nurses (professional, enrolled and auxiliary) in medical male and female units on day and night duty, and the head of pharmacy [n=8]. Non-probable, purposive sampling was conducted according to inclusion criteria after all levels of ethical clearance and consent were granted. Three semi-structured individual interviews followed, after which two focus groups were conducted. Thematic analysis of transcriptions was done, followed by an analysis of case records regarding where after all results were integrated. Results indicated complex organisational, unit-specific and behavioural challenges that impact on the supply chain management of amoxicillin-clavulanic acid 1.2 gram and insufficient stock levels are predominantly positioned within retailer and customer aspects of the supply chain. Despite well-formulated standard operational procedures, the realisation thereof lacks, implicating a greater need for managerial control. Recommendations were formulated for management to enhance the supply chain of amoxicillin-clavulanic acid 1.2 gram in medical units in public South African hospitals integrated with good pharmacy practices. The close collaboration, mutual respect and effective communication between health professionals in the multi-professional team are reiterated. / MCur, North-West University, Potchefstroom Campus, 2015

This thesis is called "Working conditions of nurses at acute medical units." The intensive care medicine was chosen as the main focus of research. It pervades all branches and it became a very interesting multidisciplinary part of medicine. Another subject is non-medical staff, as demands made on them are really high. First, the thesis deals with intensive care medicine and relates it with nursing. Then it describes the role of nurses, mentions their system of education, changes which has happened and the peculiarities for intensive medicine. The operation of second internal clinic of General University Hospital in Prague from the nursing point of view including related internal and legal regulations is described in more detail in the empirical part, for better understanding wider context. Out of consideration for the fact that a coronary unit (whose staff are the research sample) is on the verge of offering resuscitation and higher intensive care, it is also aimed at and its specifications too. Individual factors making working execution harder can be influenced, although partly they are determined by a human factor and have their limits whose exceeding or change can become a problem. The diploma project investigates the working conditions of nurses at acute medical units because that is what can be both positively and negatively affected and it is measurable. A qualitative enquiry in the form of non-standard interview was used for collecting the data. Overall fifteen nurses working at acute medical units of General University Hospital in Prague were addressed. Their personal situation is briefly outlined, but the main focus follows the aims in the thesis, i.e. findings of the nurses' opinions at acute medical units on their working conditions; findings of which factors make their working conditions difficult; ways of eliminating these factors and how to improve the quality of nursing. Altogether ten research questions were formulated so that interviews with respondents could be categorized and analyzed. The thesis came to the conclusion that improvement in the area of working conditions while providing nursing at acute medical units is possible. Most suggested solutions are not able without the help of management, or are dependent on it fully. However, even today the provided nursing care is at an excellent level.

This thesis engage in design of outdoor multifunctional madical box for vaccination. It´s a mobile rear specified firstly for humanitarian missions and for resolution of current inconvenient conditions. Its multifunctionality consist in a transport of necessary supply, in a possibility of siting of medics and pacients, in satisfactory stacking area and in possibility of networking. Many things are compact in this project. mobility with sufficiency of space, simplicity with variability, weight with stability as well as shaping with acceptable financial expenses.

Sjukvårdstaktiken idag grundar sig idag i reglementen och handböcker där sjukvårdsgrupper bär det Röda Korset för att kunna få de skydd som den internationella humanitära rätten ger. Dessa lagar gäller i väpnade konflikter och ska respekteras av alla parter i en konflikt. Trots dessa lagar sker attacker riktade mot sjukvårdsenheter medvetet. Senast i Rysslands invasion av Ukraina har det enligt WHO skett 859 attacker mot sjukvårdsenheter.  När sjukvårdsgrupper ses som legitima mål för en motståndare skapas ett problem och ett dilemma om svenska sjukvårdsgrupper bör bära det Röda Korset för att få de skydd som den internationella humanitära rätten ger, eller om gruppen i stället bör skyddas genom att inte utmärka dem med det Röda Korset. Syftet med arbetet är att utforska, om en sjukvårdsgrupp bör bära det Röda Korset eller inte, genom att besvara frågeställningen: Vad händer med en sjukvårdsgrupps skydd när de inte bär det Röda Korset, utifrån skyddslökens lager? Slutsatsen är att skyddet kommer att öka på sjukvårdsgruppen om de inte bär det Röda Korset, men att det då måste beslutas på högre nivåer och alla i Försvarsmakten måste göra likadant. De reglementen som finns för dagens sjukvårdtaktik behöver ses över och revideras då den tänkta motståndaren inte följer krigets lagar som de är tänkta att göra. Sjukvårdsgruppers uppträdande behöver också ändras för att deras egna skydd ska kunna öka ytterligare. / Medical tactics today are based on the regulations and manuals where medical units wear the Red Cross to get the protection that international humanitarian law gives. These laws apply in armed conflicts and must be respected by all parts in a conflict. Despite these laws, attacks targeting healthcare facilities still occur. Most recently in Russia's invasion of Ukraine, according to the WHO, there have been 859 attacks on medical units. When medical units are seen as legitimate targets for an adversary, it creates a problem and a dilemma as to how Swedish medical units should wear the red cross to receive the protections that international humanitarian law provides, or whether one should instead protect medical units by not using the Red Cross.  The aim of this essay is to explore, if a medical unit should wear the Red Cross or not by answering the question: What happens to a medical unit’s protection when they don't wear the Red Cross, based on the layer of system survivability? The conclusion is that protection will increase for the health care group if not wearing the Red Cross, but it must be joint decisions within the Armed Forces, and everyone must do the same.  The regulations that exist for today's medical unit tactics need to be reviewed and revised as the adversaries that exist today do not follow the laws of war as they are supposed to. Medical units’ tactics need to be changed so that their own protection can increase.