Bakgrund: En akutmottagning är en plats där snabba beslut ofta måste tas. Tidigare studier visar att faktorer som påverkar sjuksköterskans arbete med att vårda patienter i livet slut inom akutmottagning är hög arbetsbelastning, svårigheter att stötta närstående och dålig utformning av akuten där möjligheten för avskildhet är liten för döende patienter och deras sörjande närstående. Att påbörja palliativ vård i ett tidigare skede kan minska akuta sjukhusbesök och inläggningar den sista tiden i livet. Vissa diagnoser har ett ojämnt sjukdomsförlopp, det kan då vara svårt att veta när övergången till palliativ vård bör ske, vilket kan leda till att vården kommer i ett sent skede av sjukdomen. Vid upprepade vårdtillfällen på akutsjukhus bör dessa patienter fångas upp och den palliativa vården sättas in.  Syfte: Syftet var att beskriva metoder för att identifiera och bedöma palliativa vårdbehov hos patienter på akutmottagning.  Metod: Litteraturöversikt med 15 inkluderade artiklar. Sökning utfördes i databaserna PubMed och CINAHL. Studierna är av både kvalitativ och kvantitativ ansats. Utvalda artiklar granskades, analyserades och sammanställdes till nytt resultat.  Resultat: Genom analysen framkom tre kategorier: Bedömningsverktyg, Bedömning av palliativt vårdbehov utifrån individuell vårdplan och Samarbete mellan enheter. Förslag på olika bedömningsverktyg lyfts fram men även vikten av ett gott samarbete mellan olika enheter, här mellan akutmottagning och palliativ vård. Behov av tidiga samtal med patienter med livsbegränsande sjukdom framkommer.  Slutsats: För att identifiera och bedöma palliativa vårdbehov behövs ett specifikt bedömningsinstrument, kunskap och ett bra teamsamarbete mellan olika enheter. Tillgängliga vårdplaner och patientfullmakter skulle kunna underlätta bedömning och beslut om vidare vård. Sjuksköterskan har en nyckelroll både vid triagering och som länk mellan teamen, men även som förmedlare av kunskap och genom att leda utbildning på avdelningen. / Background: At the emergency room immediate decisions often have to be made. Prior studies show that some of the factors that affect a nurse’s ability to care for patients at the end of their lives in the emergency room include a heavy workload, challenges in supporting and offering seclusion to dying patients and their grieving families due to inefficient design of the emergency facility. Beginning palliative care at an earlier stage can reduce acute hospital visits and hospitalizations in the last period of life. Some diagnoses reveal an uneven course of disease, leading to challenges in knowing when the transition to palliative care should take place. Patients that require repeated visits to emergency rooms should be identified and palliative care should be administered.  Aim: The aim was to describe methods for identifying and assessing palliative care needs in patients in the emergency department.  Method: Literature review with 15 included articles. Search was performed in the databases PubMed and CINAHL. The studies are of both qualitative and quantitative approach. Selected articles were reviewed, analyzed and compiled into new results.  Results: The analysis revealed three categories: Tools for Assessment, Assessment of palliative care needs based on individual care plan and Cooperation between hospital units. Proposals for different assessment tools are emphasized, as well as the importance of sustained cooperation between different units. The need for early consultations with patients experiencing life-limiting illness emerges.  Conclusion: To identify palliative care needs requires specific assessment tools, knowledge and teamwork across different departments. Available care plans and patient authorizations could facilitate assessment and decisions about further care. The nurse plays a key role in triage and as a link between teams, as well as a leader of education and training within the departments.

Bakgrund: Närståendestöd är en av de fyra hörnstenarna för god palliativ vård. Sjuksköterskor inom palliativ vård ska identifiera och bedöma behov hos närstående. Specialistsjuksköterskor inom palliativ vård ska arbeta för utveckling, kvalitetssäkring och implementering av validerade metoder för bedömning av behov. Studier har visat att närstående har behov som sällan bedöms med strukturerade metoder. Enligt de befintliga riktlinjer som finns i Sverige för palliativ vård ska närståendes behov bedömas, men det finns inga rekommenderade metoder.  Syfte: Syftet var att beskriva metoder som sjuksköterskor kan använda för identifiering av närståendes behov.  Metod: En litteraturöversikt har genomförts där både kvantitativa och kvalitativa artiklar har använts i resultatet. Narrativ syntes har använts för att analysera resultaten från artiklarna, med inspiration från guiden av Popay et al. (2006).  Resultat: Fyra instrument för bedömning av närståendes behov har identifierats. Carer Support Needs Assessment Tool (CSNAT), Needs Assessment Tool (NAT), Carer Alert Tool (CAT) och Family Inventory of Needs (FIN). Fyra teman framkom i syntetiseringen: bedömningsinstrumentens användbarhet, bekräftar närstående, öppnar upp för kommunikation samt lyhördhet har betydelse.  Slutsats: Denna litteraturöversikt tillför en översikt över befintliga metoder för att bedöma närståendes behov. Av de fyra instrumenten som identifierades bedömdes CSNAT ha starkast evidens. Regelbunden användning av CSNAT kan bidra till en mer jämlik vård för närstående. Bedömningen med CSNAT skulle även medföra att aktuella riktlinjer för närståendestöd inom palliativ vård följs. / Background: In palliative care there are four cornerstones, one of them is support of the next of kin. Nurses in palliative care should identify and assess the needs of next of kin. Specialized nurses in palliative care should work for the development, quality assurance and implementation of validated methods for assessing needs. Studies have shown that next of kin have needs that are rarely assessed with structured methods. According to the existing guidelines in Sweden for palliative care, the needs of next of kin must be assessed, but there are no recommended methods.  Aim: The aim was to describe methods that nurses can use to identify the needs of next of kin.  Method: A literature review has been carried out where both quantitative and qualitative articles have been used in the result. Narrative synthesis has been used to analyze the results from the articles, with inspiration from the guide by Popay et al. (2006). Results: Four instruments for assessing the needs of next of kin have been identified. Carer Support Needs Assessment Tool (CSNAT), Needs Assessment Tool (NAT), Carer Alert Tool (CAT) and Family Inventory of Needs (FIN). Four themes emerged in the synthesis: The usefulness of the assessment instruments, confirms next of kin, opens up for communication and sensitivity matters.  Conclusion: This literature review provides an overview of existing methods for assessing the needs of next of kin. Of the four instruments identified, CSNAT was estimated to have the strongest evidence. Regular use of CSNAT can contribute to a more equal care for next of kin. The assessment with CSNAT would also mean that current guidelines for support of next of kin in palliative care are followed.

Purpose - This dissertation in practice is an evaluation study conducted at Iowa State University, entitled, Learning Ecosystem Assessment Review of Needs (LEARN). The evaluation posed these questions: (a) What educational technologies are currently used and what technologies will be needed in the future? (b) What are the attitudes and practices of faculty and students toward online and blended learning? (c) What academic technology support services are used? What are the perceptions of the support provided for the application of academic technologies? Methodology/design - The study was a mixed-methods design employing interviews with deans and focus groups and surveys of faculty and students. Findings - Iowa State University faculty and students use a wide array of academic technologies both in physical and virtual classrooms. The prevailing sentiment regarding the need for future academic technologies is not for new offerings and new features but for easier to use, more reliable technologies, and more timely support. Although Iowa State University has formally adopted online learning by offering numerous programs and courses, the university is in the early stages of adopting blended learning. Implications - The results and implications of the study inform the university on next steps to ready the institution for leveraging technology and preparing for the transformation toward strategic adoption of online and blended learning. The author outlines an organizational learning approach to manage change and promote adoption of blended learning.

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Modular housing is an important segment of the factory-built housing industry, in the Mid-Atlantic. In 1998, a study was conducted to assess the structural needs and requirements of this industry. This study addressed three questions. (1) What is the current and future state of the industry? (2) What structural material trends are present between 1992 - 2000? (3) What opportunities exist for product substitution and development of new structural materials? This study found that the modular housing industry in the Mid-Atlantic region is growing. The greatest barrier to market expansion is transportation costs. Expansion is expected in the South and Midwest regions of the US. Most competition comes from site-built and manufactured homebuilders. To stay competitive, respondents plan to increase customization options and home size. The need for cost effective, quality structural materials is a growing concern. Softwood dimensional lumber has been decreasing since 1992 and is expected continue to decrease through 2000. Decreases are due to design changes and quality concerns. The use of engineered lumber has increased in order to compensate for decreases in dimensional lumber necessary to meet the structural needs of the industry. Using factor analysis and perceptual mapping techniques, dimensional lumber was not perceived to be as suited for structural building applications as engineered lumber. However, respondents felt that engineered lumber tended to be more expensive. Perceptual mapping also identified gaps between the ideal needs of building applications and the ability of current materials to meet those needs. Opportunities for new product development exist where gaps occurred. / Master of Science

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