Bakgrund: Ungefär en tredjedel av Sveriges befolkning uppskattas leva med långvarig smärta. Smärta är en komplex och subjektiv upplevelse som är svår att bevisa, och bedömningen av smärta utgår därmed från patientens upplevelse. Målet med behandling av långvarig smärta är att patienten ska leva ett så bra liv som möjligt trots smärtan, och innefattar olika behandlingsmetoder anpassat efter patienten som individ. Därmed är sjuksköterskans kärnkompetens personcentrerad vård en essentiell byggsten i vårdandet av långvarig smärta. Kunskap om patienters erfarenheter av att vårdas för långvarig smärta kan vägleda sjuksköterskor i omvårdnadsarbetet och möjliggöra personcentrerad vård. Syfte: Syftet med litteraturstudien var att belysa patienters erfarenheter av att vårdas för långvarig smärta i öppenvården. Metod: Litteraturstudie baserad på 11 studier med kvalitativ studiedesign genomfördes. Databassökningen utfördes i databaserna PubMed och CINAHL. Avgränsning av tillgänglig litteratur gjordes med hjälp av inklusions- och exklusionskriterier och relevanta studier kvalitetsgranskades utifrån SBU:s granskningsmall för kvalitativ forskningsmetodik. För att bearbeta data och identifiera teman utfördes en innehållsanalys. Resultat: Innehållsanalysen gav upphov till två teman: Påverkan av vårdpersonalens bemötande och Hantering av smärta samt sju subteman: Behovet av att bli betraktad som en unik person, Betydelsen av att vara involverad i sin vård, Kommunikationens betydelse, Känslan av att inte bli trodd, Betydelsen av att få en diagnos, Vikten av stöd från medpatienter och Att försöka acceptera smärtan. Konklusion: Långvarig smärta påverkar patientens fysiska, psykiska och emotionella välbefinnande. Vårdpersonalen bör bemöta patienterna med empati och eftersträva ett partnerskap med patienten. Det beskrevs som viktigt för patienterna att bli involverade i sin vård och att ses som en unik person. Att få en bekräftelse på att smärtan inte var inbillad och att bli trodd i sitt tillstånd gjorde att patienterna kunde acceptera smärtan och lära sig hantera den. / Background: About a third of Sweden's population is estimated to live with long- term pain. Pain is a complex and subjective experience that is difficult to prove, and the assessment of pain is thus based on the patient's experience. The goal of treating long-term pain is for the patient to live as good a life as possible despite the pain and includes different treatment methods adapted to the patient as an individual. Thus, the nurse's core competence person-centered care is an essential building block in the care of long-term pain. Knowledge of patients' experiences of being cared for for long-term pain can guide nurses in the nursing work and enable person-centered care. Aim: The aim of the literature review was to illustrate patients' experiences of being cared for for long-term pain in outpatient care. Method: Literature study based on 11 studies with qualitative study design was conducted. The information search was performed in the databases PubMed and CINAHL. Delimitation of available literature was done with the help of inclusion and exclusion criteria and relevant studies were quality reviewed based on SBU's review template for qualitative research methodology. To process data and identify themes, a content analysis was performed. Results: The content analysis resulted in two themes: Influence of health care providers' attitudes and Management of pain and seven sub-themes: The need to be considered a unique person, The importance of being involved in their care, The importance of communication, The feeling of not being believed, The importance of getting a diagnosis, The importance of support from fellow patients and Trying to accept the pain. Conclusion: Long-term pain affects the patient's physical, mental and emotional well-being. The care staff should treat the patients with empathy and strive for a partnership with the patient. It was described as important for patients to be involved in their care and to be seen as a unique person. Getting a confirmation that the pain was not imagined and being believed in their condition allowed the patients to accept the pain and learn to deal with it.

No description available.

What is known and objective: Amphotericin is the preferred treatment for pulmonary histoplasmosis during pregnancy. The long half-life of amphotericin supports less than daily administration. Case summary: A 28-year-old pregnant woman diagnosed with recurrent pulmonary histoplasmosis was initiated on liposomal amphotericin 250 mg (4 mg/kg) intravenously daily. After 2 weeks, the patient was discharged and successfully received 250 mg thrice weekly at a hospital-associated outpatient infusion centre. After 6 weeks of outpatient treatment, a chest X-ray demonstrated no remaining disease and therapy was discontinued. What is new and conclusion: Administration of thrice-weekly liposomal amphotericin in a hospital-associated, outpatient infusion centre may be a promising option for stepdown treatment in patients unable to take itraconazole.

Implementation of Evidenced-Based Practices to Improve Follow-up Care Following Inpatient Mental Health Hospitalizations. Jacqlyne W Bowman, Dr. Judy Rice, Dr. Beth Schreiner, Dr. Ernie Maupin, College of Nursing, East Tennessee State University Persons hospitalized for mental health conditions are frequently lost to follow up after discharge. The aim of this quality improvement project is to increase the rate of attendance at follow up appointments after hospital discharge back to the community. The focus of this project is the development and implementation of a discharge questionnaire for both clients and case management to better understand the needs of the clients during the discharge process. Behavioral health technicians employed by the agency are including the discharge questionnaire in the admission packet for a 12-week trial period. This discharge questionnaire asks clients their preferred location for follow up appointments, if they are active in their care, if transportation is needed for follow up appointments and verifies the patient’s phone number. Clients complete the discharge questionnaire and return it to the behavioral health technicians with their admission packet. The discharge questionnaire is then given to case managers to assess and address concerns outlined on the questionnaire. Data will be gathered over 12-weeks to determine if the rate of non-attendance decreases with the integration of the questionnaire. The project is in the implementation phase. The anticipated outcome is there will be an increase in the rate of attendance at follow-up appointments post discharge with the use of the discharge questionnaire. By utilizing the discharge questionnaire, case managers will be better able to determine barriers that lead to non-attendance to follow up appointments. With the barriers identified and addressed, individuals will be more likely to attend their follow-up appointments and medication compliance and rates of re-hospitalizations will improve.

Drivers under the influence of alcohol cause nearly one third of all fatal motor vehicle accidents. Ambulatory outpatient alcohol abuse treatment has been clinically shown to increase abstinence, which could decrease the chance of subsequent DWI offences. A barrier to successful completion is extended waiting periods prior to treatment engagement. The theory of patient waiting supports the longer a patient waits to begin treatment the lower the likelihood of successful completion. By exploring the impact of waiting times on DWI court mandated clients, referral courts and treatment facilities can work together to create a successful completion strategy for offenders. The research question focused on if days waiting can predict successful outpatient treatment completion in court mandated adults. The TEDS-D archival data set was used, consisting of data collected between 2006-€”2011 from federally funded substance abuse treatment centers throughout the USA. The variables time awaiting treatment, treatment level, gender, race, employment status, and age were used as controls. A logistic regression using a random sample of 4,947 participants determined days waiting was significant but weak in nature. The variables of employment status and age are stronger predictors of treatment completion. An interaction effect analysis of days waiting and age results in clients over 45 years old being significantly impacted by days waiting while younger clients are not. Court and treatment agencies can use this information to give priority intake appointments to older clients to increase chances of treatment completion.

The electronic health record (EHR) is an important part of the effort to improve health care and reduce costs in the United States. Primary care providers, among the largest group of caregivers in the nation, often experience difficulty with implementation and utilization of EHRs. Efforts to enhance the provider's effectiveness in the use of the EHR should result in improved patient outcomes as well as decreasing the overall cost of health care. Guided by the diffusion of innovation theory, this project was initiated to develop a plan for improved usage of the EHR in a primary care setting. A survey and observations were used to better understand how the providers and staff were using the EHR. Observations and a survey of 11 participants were completed. The observations utilizing a mock patient revealed issues related to the usability of screen information, information availability, and user preference for documentation. The mock patient scenario took 25-35 minutes, on average, to complete. All participants stated they had stayed late to input information on actual clinic patients or to clarify their documentation. The same 11 participants completed the Primary Care Information Project (PCIP) Post-Electronic Health Record Implementation: Survey of Providers responses. Descriptive statistics were used to analyze the results. Most participants indicated that the screen font was difficult to read (72.7%), they had difficulty using the EHR (72.8%) and were not satisfied with its use (63.6%). The project recommendations include working with the vendor to improve information access and ongoing training. Improvements to the EHR should support social change by improving access to information at the point of care, enhancing quality treatment and improving patient care outcomes.

Lower socioeconomic status, ethnicity, and race are associated with reduced health care use in the United States. Patients who continually miss their appointments suffer significant negative results, including a disruption in continuity of care, complications with their chronic illnesses, and an increase in hospital readmissions. The health belief model was used as the theoretical support for this project that investigated the underlying causes of no-shows at an urban hospital-based outpatient clinic in the United States. It used a quantitative, descriptive design and examined a minority, underserved, and underinsured population that was receiving care at the research site and had a fairly consistent 30% no-show rate. Data was collected by anonymous survey from 151 patients and 22 health care providers and analyzed via means, t tests, and an ANOVA. Female patients were significantly more likely than male patients to approve of the current scheduling system at the site, in which patients simply call the clinic for an appointment (p = 0.040). White (non-Hispanic) patients in general had a statistically lower interest in receiving appointment reminders via text compared to the rest of the population (p=0.024). Patients who were 29 years old and younger were significantly less likely than patients who were 30 years old and over to indicate that they did not show up to appointments due to a lack of insurance (p '? 0.001). This project promoted positive social change by increasing patient, staff, and stakeholder awareness of the reasons patients miss their appointments. The findings of this project can be used to improve appointment scheduling, reduce patient wait times, increase patient satisfaction, and increase cost savings to the clinic.

Avoidable hospitalizations of hospice patients cost Medicare $3 billion a year. When hospice nurses are able to identify early signs and symptoms of acute illness and provide appropriate interventions to prevent such admissions, 20-60% of the hospitalizations are preventable. The practice problem addressed in this quality improvement doctor of nursing project was the 30% hospital admission rate of hospice patients as evidenced by chart review, admission data, and revocation data. The first purpose of the project was to identify evidence-based nursing care paths in the literature for the top 5 medical diagnoses related to avoidable hospital admissions. The second purpose was to develop an educational curriculum to educate the staff on the care paths with a pretest/posttest to assess knowledge gained from the education. Rosswurm and Larrabee's conceptual model was used to frame the project. Three content experts evaluated the curriculum plan using a 4 item dichotomous rating of 1 (not met) and 2 (met). An average score of 2 revealed that the curriculum content met the course objectives. Content experts validated each of the 16 pretest/posttest items using a Likert scale ranging from 1 (not relevant) to 4 (highly relevant). The content validation index score was .94, indicating that the pretest/posttest reflected the course objectives and content. Recommendations were made for structuring the pretest/posttest. The project promotes social change by assessing, intervening, and treating patients in the outpatient hospice setting to prevent avoidable hospitalizations, thus promoting patient well-being and fiscal responsibility of healthcare dollars.

There has been a long standing discourse around youths involved in crimes in Sweden, which contributions are useful and which ones are not. This study examines how outpatient care organizations work with youths involved in crime and/or substance abuse. Also what strengths and shortcomings do the professionals experience when working with youths involved in crime and/or substance abuse during outpatient care treatment. We examined this by doing a qualitative study, interviewing an outpatient care organization with the target group youths involved in crime and/or substance abuse. Through open interviews the professionals gave insight to how their work is carried out, and what they believe to be it’s strengths and weaknesses. The study brought forward that flexibility, cooperation with other involved organizations and authorities and creating an alliance with the young receiving the care is what makes the outpatient care treatment work. The professionals question socio-economic structures that put youth at risk for this kind of norm-breaking behavior. System Theory is used to make an analysis of the work done by the informants, giving another perspective to how it can be interpreted. This alongside earlier research is the basis of this research paper to help us create a better understanding for how outpatient care organizations work with youths involved in crime and/or substance abuse and what interventions benefit the work and what exacerbate it.

Background: The prevalence of substance use in the general population is commonly mapped, as is the issue of substance prevalence among drug users themselves. There is no official research in the Czech Republic that deals with the prevalence of substance use among workers in addictology services. Objectives: The aim of the research is to map the prevalence of the use of legal and illegal addictive substances in a selected research population. The results of the mapping will show which addictive substances are most frequently used by members of the research population, which substances have the highest lifetime prevalence and which substances are not very popular in this population. Methods: The basic orientation of the empirical survey was quantitative. Data were obtained through an online questionnaire survey. Out of the total number of 589 employees, 41.9% of employees of outpatient or low-threshold addictology services participated in the research, ie 247 respondents. The research was carried out in the period from March 28, 2021 to April 17, 2021. Results: The prevalence of experience with legal and illegal addictive substances, both living, in the last 12 months or in the last 30 days is significantly higher for workers in drp-in centres and outpatient addictology services in the Czech...