Contexte : Les troubles liés à l’usage des substances psychoactives constituent une priorité de santé publique dans le champ des pathologies chroniques. Les indicateurs de type Patient-Reported Outcomes (PRO) offrent des perspectives complémentaires aux indicateurs classiques pour la mesure de l’état de santé des patients et l’appréciation de la qualité des soins. Objectifs : Étudier les propriétés psychométriques de questionnaires de qualité de vie (QV) et les déterminants de la satisfaction précoce vis-à-vis des soins ambulatoires de patients dépendants aux substances de type alcool ou opiacés. Méthode : Les caractéristiques des patients et des médecins ont été recueillies à l’inclusion dans la cohorte SUBUSQOL. La satisfaction précoce a été mesurée quinze jours après la première consultation et ses déterminants ont été testés dans des modèles de régression linéaires multivariés. Les propriétés psychométriques du questionnaire spécifique Q-LES-Q-SF ont été étudiées au préalable sur un échantillon de patients. Résultats : La version française du Q-LES-Q-SF constitue un outil unidimensionnel robuste et fiable, les items du SF-12 et Q-LES-Q-SF présentent peu ou pas de fonctionnement différentiel selon l’âge, le sexe, le niveau d’éducation et le type d’addiction. Peu de variables recueillies sont associées à la satisfaction. Les patients dépendants à l’alcool se révèlent être plus satisfaits des modalités de contact et du délai de rendez-vous et ceux sans aucun antécédent de prise en charge pour leur dépendance plus satisfaits de leur consultation avec le médecin. Conclusion : Les questionnaires SF-12 et Q-LES-Q-SF peuvent être utilisés dans des populations de patients suivis en ambulatoire pour une dépendance aux substances psychoactives / Context: Of chronic diseases, substance use disorders are a public health priority. Patient-reported outcome indicators (PRO) offer additional insights into the classical indicators used to measure the patient’s health status and appreciation of their quality of care. Objectives: to study the psychometric properties of quality of life instruments and to study the determinants of early outpatient satisfaction with ambulatory care in alcohol- or opiate-dependent patients. Method: Patient and physician characteristics were collected in the SUBUSQOL cohort. Early satisfaction with care was measured fifteen days after the first consultation. The determinants of satisfaction were tested using multivariate linear models of regression. Prior data on the self-reported health status of a sample of alcohol- or opiate-dependent outpatients were used to investigate the psychometric properties of a specific questionnaire, the Q-LES-Q-SF. Results: Our results establish that the French version of the Q-LES-Q-SF is a unidimensional, valid and reliable instrument of self-reported health status assessment for use in care or medical research and that few items of the SF-12 and the Q-LES-Q-SF displayed differential functioning according to age, sex, educational level and type of substance use disorder. Our results show that few variables are associated with the level of patient satisfaction. Alcohol dependence was strongly associated with higher satisfaction with appointment making, and patients with no history of previous care for substance use disorders had a higher level of satisfaction with the doctor consultation. Conclusion: The use of the SF-12 and the Q-LES-Q-SF is recommended for outpatients suffering from substance use disorders

Bakgrund: Ett patientfokuserat vårdande innebär att även patientens närstående inkluderas i vården. Vilka som är närstående definieras av patienten och vilka hen väljer ut som viktiga personer i sitt liv. Närstående ser sig som viktiga informationskällor till individer som lever med psykisk ohälsa. Studier visar att hela deras tillvaro förändras och att hela familjen påverkas när någon insjuknar i psykisk ohälsa. Det är därmed av vikt att vårdpersonalen gör de närstående delaktiga i den vuxenpsykiatriska vården. Syfte: Syftet med denna studien är att undersöka vårdpersonalens upplevelse av att inkludera närstående inom vuxenpsykiatrisk öppenvård.  Metod: En kvalitativ studie är gjord och semistrukturerade intervjuer har genomförts med vårdpersonal som arbetar inom vuxenpsykiatrisk öppenvård. Vårdpersonalen bestod av sju specialistsjuksköterskor inom psykiatrisk vård, två sjuksköterskor och sex skötare. Insamlad data analyserades med en kvalitativ innehållsanalys.  Resultat: Vårdpersonalen uttryckte att det är av vikt att medvetandegöra och skapa en förståelse för närståendes situation, med en god relation upplevdes omvårdnadsarbetet betydligt lättare när det gäller att stödja patienten på rätt sätt. Vårdpersonalen uppmärksammade även närståendes behov av stöd och information. Det upplevdes även finnas en del utmaningar när det kom till att inkludera närstående i den vuxenpsykiatriska öppenvården.  Slutsats: Ett samarbete mellan patient, närstående och vårdpersonal underlättas om de närstående inkluderas i den vuxenpsykiatriska öppenvården. Studien kan användas som inspiration för utveckling av närståendearbete inom såväl psykiatrisk som somatisk vård. För att närståendearbetet ska kunna utvecklas vore det gynnsamt om stöd kom från verksamheten så att ett samarbete med närstående kan prioriteras på organisationsnivå. / Background: A patient-focused care means that the patient's relatives are also included in the care. Those who are related are defined by the patient and who choose them as important persons in their life. Related parties see themselves as important sources of information for individuals living with mental illness. Studies show that their entire life is changing and that the whole family is affected when someone falls ill in mental illness. It is therefore important that the healthcare staff participate in the adolescent psychiatric care. Aim: The aim of this study is to investigate the healthcare staff's experience of including close relatives in adult psychiatric outpatient care. Methodology: A qualitative study is done and semi-structured interviews have been conducted with healthcare professionals working in adult psychiatric outpatient care. The healthcare staff consisted of seven specialist nurses in psychiatric care, two general nurses and six caregivers. Collected data was analyzed with a qualitative content analysis. Result: The healthcare staff stated that it is important to raise awareness and create an understanding of the situation of close relatives, with a good relationship, the nursing work was felt much easier when it came to supporting the patient in the right way. The healthcare staff also noticed the relatives' need for support and information. There were also some challenges encountered when it came to including relatives in the adult psychiatric outpatient care. Conclusion: Collaboration between the patient, related persons and healthcare staff is facilitated if the related parties are included in the adult psychiatric outpatient care. The study can be used as inspiration for the development of close family work in both psychiatric and somatic care. In order for the related party work to be able to develop, it would be beneficial if support came from the business so that cooperation with related parties can be prioritized at the organizational level.

Made available in DSpace on 2016-06-02T20:44:11Z (GMT). No. of bitstreams: 1 4831.pdf: 2096066 bytes, checksum: d367da2e084bdb67e171029ec907527a (MD5) Previous issue date: 2012-12-18 / Financiadora de Estudos e Projetos / The clinical documentation in occupational therapy is developed whenever the service is offered to a client to register and report information pertaining to care. The aim of the study is to identify how this is done and what the perception of occupational therapists about the practice of outpatient clinical documentation is. The research was conducted in two stages: documentary research, through qualitative research of legal documents in Brazil; and field research, descriptive and exploratory study, conducted with 104 active occupational therapists in the state of Sao Paulo who worked in outpatient services. This was carried out using an online questionnaire and data was analyzed using quantitative methods, descriptive statistics and specific tests for comparison and correlation of variables. The results of the field research show: 64.4% of the records are held only on paper; all respondents perform assessment records; one makes no record of intervention / monitoring; and 13.5% do not carry records of patient discharge. Also, 91.9% reported some level of satisfaction with their own record. Virtually all clinical documentation was considered to be necessary and useful. The results revealed a significant correlation (p <0.05) with the level of satisfaction with their own practice of clinical documentation the variables: considered have sufficient knowledge for the development of the records, and values attributed to the practice of clinical documentation (those who consider it complex or difficult present a lower level of satisfaction when compared to those who consider it simple or easy). As for documentary research, 123 documents of different organs of origin were selected and will be analyzed qualitatively, with 103 consisting of reports, technical notes or orders, and the rest, ordinances, resolutions, and Decree. Only 13 of them are specific to the occupational therapy. It was considered that the data obtained allowed an initial approach to the topic, identifying as clinical records are held by occupational therapists working in outpatient care and what their perception of this practice, and identify aspects that influence this perception. The documentary research helped to understand and contextualize the practice of clinical documentation in Brazil, especially in relation to occupational therapy. The study could also contribute to the identification of topics of interest for future research on the topic and to produce knowledge that can guide the development of better quality of clinical documentation by occupational therapists. / A documentação clínica em terapia ocupacional é desenvolvida sempre que o serviço é oferecido a um cliente, para registrar e comunicar as informações pertinentes ao seu atendimento. Este estudo teve por objetivo identificar como é realizada e qual a percepção dos terapeutas ocupacionais sobre a prática da documentação clínica ambulatorial. A pesquisa foi desenvolvida em duas etapas: pesquisa documental, através de investigação e análise qualitativa de documentos jurídicos brasileiros; e pesquisa de campo, descritiva e exploratória, realizada com 104 terapeutas ocupacionais ativos do estado de São Paulo, que atuavam em serviços ambulatoriais. Esta etapa foi realizada através de aplicação on-line de questionário e os dados foram analisados por métodos quantitativos, com uso de estatística descritiva e testes específicos para comparação e correlação das variáveis. Os resultados da pesquisa de campo revelaram que 64,4% dos registros são realizados somente em papel. Todos os respondentes realizam registros de avaliação, um não realiza registros de intervenção/acompanhamento e 13,5% não realizam registros de alta. 91,9% referiram algum nível de satisfação com o próprio registro. Praticamente todos consideram a documentação clínica necessária e útil. Revelaram correlação significativa (p<0,05) com a satisfação em relação à própria prática da documentação clínica as variáveis: considerar possuir conhecimento suficiente para o desenvolvimento dos registros, e valores atribuídos à prática da documentação clínica, sendo que os que a consideram complexa, difícil e desgastante apresentam pior avaliação da satisfação do que aqueles que a consideram simples, fácil e tranqüila. Quanto à pesquisa documental, 123 documentos de diferentes órgãos de origem foram selecionados, sendo 103 constituídos por pareceres, notas técnicas ou despachos, e o restante, portarias, resoluções e decretos. Apenas 13 deles são específicos da terapia ocupacional. Considerou-se que os dados obtidos possibilitaram uma aproximação inicial com o tema, identificando como os registros clínicos são realizados pelos terapeutas ocupacionais que atuam em assistência ambulatorial e qual a percepção deles sobre esta prática, assim como a identificação dos aspectos que interferem nesta percepção. A pesquisa documental auxiliou a compreender e contextualizar a prática da documentação clínica no Brasil, especialmente em relação à terapia ocupacional. O estudo também pôde contribuir para a identificação de focos de interesse para futuras investigações sobre o tema e para a produção de conhecimento que possa orientar o desenvolvimento com melhor qualidade da documentação clínica por terapeutas ocupacionais.

Congestive heart failure (CHF) is a disease with increasing incidence, which requires an adequate and costly management. Repeated hospitalisations due to decompensated CHF contribute to disease progression and herald dismal prognosis. An important goal of heart failure clinics is reduction in number of hospitalizations due to decompensated CHF. The main approaches to reach this aim seem to be effective diagnostics and treatment of CHF, and importantly, education of patients and their families. We aimed to evaluate knowledge of CHF patients regarding self-care in secondary prevention of CHF. We constructed three hypotheses and three research questions to reach the goal of the project. The theoretical part described recommended life-style interventions, pharmacologic and non-pharmacologic CHF management, and specifically, the role of nurses in education of patients with CHF. The practical part described the methods of analysis, the study group and the process of evaluation. To fulfil the study goal, we performed collection of data using qualitative and quantitative methods of research. The qualitative part of the research project included a non-standardized questionnaire for patients with CHF. A total of 260 questionnaires were distributed in six heart failure clinics. 183 completed questionnaires were returned and analysed. The obtained data were evaluated using descriptive statistical methods. Pearson´s chi-test and Student´s t-test were applied to test the hypotheses. Collection of qualitative data was performed using the technique of a semi-structured interview based on pre-prepared questions. The study respondents included general nurses from out-patient heart failure clinics. Six of nine contacted nurse respondents agreed to participate. Answers were recorded on Dictaphone. Data were analysed using the method of "card display". The quantitative part tested the following hypotheses: 1. CHF patients know symptoms and signs of decompensated CHF. 2. CHF patients follow the life-style recommendations. 3. CHF patients perform daily self-monitoring of their weight, blood pressure and pulse. Our study revealed insufficient knowledge of patients regarding symptoms of possible CHF decompensation. This finding was alarming because suboptimal knowledge of symptoms of decompensated CHF may cause inadequate response of the patient and may delay initiation of treatment. Assessment of compliance with life-style measures revealed that most patients did not use tobacco products and had a limited alcohol consumption. Most individuals reported a regular use of heart failure medication and knew the timing of the next follow-up in their heart failure clinic. Life-style measures included also some dietary restrictions modified by the current nutritional status. Respondents preferred recommended food over inappropriate foodstuffs, however, they did not follow neither the salt restriction nor the optimal frequency of meals. Most respondents did not report a regular exercise A significant ignorance was found in the process of self-monitoring. Most respondents did not monitor their body weight, blood pressure and pulse. The qualitative assessment evaluated the following questions: 1. Do we educate the CHF patients appropriately? 2. Are we able as nurses to pass correct information to CHF patients? 3. How is the process of education implemented in practice? Based on the above mentioned methods, we found that the process of education is a domain of doctors. Nurses have only a limited role in education of CHF patients...

INTRODUÇÃO: O tabagismo é reconhecido, atualmente, como um dos maiores problemas de saúde em todo o mundo. Há uma \"epidemia\" global de uso de tabaco nos países em desenvolvimento, no século 21. OBJETIVOS: Analisar: as características gerais dos indivíduos matriculados espontaneamente em um ambulatório antitabágico; a eficácia geral do tratamento antitabágico e dos medicamentos; as mudanças nas características dos participantes antes e após a Lei Ambiente Fechado Livre do Cigarro em São Paulo e os níveis de cotinina urinária em fumantes ativos, passivos e controles. CASUÍSTICA E MÉTODOS: Foi realizado um estudo de coorte histórica cujo critério de inclusão foi a matrícula no ambulatório antitabágico do HU USP, no período de 2004 a 2011. Os dados foram coletados por meio de consulta a protocolos padronizados e ao sistema informatizado do serviço. Foram analisados os resultados de dosagens de cotinina e creatinina realizadas em amostras biológicas. RESULTADOS: Dentre os 1736 pacientes atendidos houve predomínio de mulheres (62,1%), brancos (75,3%) e indivíduos com idade entre 41 e 60 anos (63,1%). Aproximadamente 80% iniciaram o tabagismo antes dos 20 anos e 75% apresentaram grau de dependência moderado a grave. Dentre os 620 indivíduos acompanhados a partir de 2009, 34,5% abandonaram o tabagismo. Dentre eles, 21,5% obtiveram êxito até o quarto contato com o ambulatório. O uso de vareniclina e terapia de reposição de nicotina (TRN) aumentaram a probabilidade de sucesso (RRR= 2,73 e 2,78, respectivamente; p < 0,001 para ambas). Quanto maior o número de reuniões frequentadas no ambulatório, maior a probabilidade de sucesso terapêutico (p < 0,001). A análise da dosagem da cotinina urinária mostrou concentrações de cotinina urinária 18,7 vezes maior no grupo de tabagistas ativos comparados aos tabagistas passivos. CONCLUSÃO: O sucesso do ambulatório antitabágico do HU manteve-se em acordo com grande parte dos índices de sucesso terapêutico presentes na literatura médica. O abandono do hábito de fumar foi fortemente associado ao número de contatos dos fumantes com o grupo e a terapêutica medicamentosa. A cotinina urinária mostrou-se um bom marcador do tabagismo ativo / INTRODUCTION: Smoking is recognized today as one of the major health problems worldwide. There is a global \"epidemic\" of tobacco use in developing countries in the 21st Century. OBJECTIVES: Analyze: the general characteristics of individuals spontaneously enrolled in an outpatient smoking cessation clinic; the overall effectiveness of the smoking cessation treatment and medication; the changes in the characteristics of participants before and after the Smoke-Free Environment Act in São Paulo and the levels of urinary cotinine in active and passive smokers and controls. CASES AND METHODS: A historical cohort study was conducted, of which the inclusion criterion was the registration in the outpatient smoking cessation Clinic in the HU USP, in the period from 2004 to 2011. Data were collected by consultation of standardized protocols and of the computerized service system. The results of cotinine and creatinine measurements performed on biological samples were analyzed. RESULTS: Among the 1736 patients treated, there was a predominance of women (62.1%), whites (75.3%) and individuals aged between 41 and 60 years (63.1%). Approximately 80% began smoking before age 20 and 75% showed moderate to severe degree of dependence. Among the 620 individuals monitored from 2009 on, 34.5% quit smoking. Among them, 21.5% obtained success up to the fourth contact with the clinic. The use of varenicline and nicotine replacement therapy (NRT) increased the probability of success (RRR= 2.73 and 2.78, respectively; p < 0.001 for both). The greater the number of meetings attended at the clinic, greater the probability of treatment success (p < 0.001). The analysis of urinary cotinine dosage showed urinary cotinine concentrations 18.7 times higher in the active smokers group, compared to the passive smokers group. CONCLUSION: The success of the smoking cessation clinic in the HU remained largely in accordance with most therapeutic success rates found in medical literature. Quitting smoking was strongly associated to the number of contacts of the smokers with the group and drug therapy. Urinary cotinine proved to be an accurate marker for active smoking

Ziel der im Oktober 2015 in der Tagesklinik für Psychiatrie und Psychotherapie Görlitz durchgeführten prospektive Katamnesestudie war es, den Übergang der Patienten/innen von der Therapie in den Alltag, evtl. Unterstützungsbedarfe sowie mögliche Schnittstellenprobleme zu evaluieren. Dies geschah zum einem vor dem Hintergrund des Entlassungsmanagements als Aufgabe des Sozialdienstes und zum anderen mit Blick auf die sich verändernde Versorgungs- und Finanzierungsstruktur durch den Paradigmenwechsel im deutschen Gesundheitswesen sowie in Psychiatrie und Psychosomatik. Hierfür konnten 37 Studienteilneh-mer/innen, bis zu 21 Monate nach ihrer Behandlung, für die Erhebung gewonnen werden. Die Ergebnisse der Studie liefern Hinweise über die Zufriedenheit mit der Behandlung, zur Bewältigung des Übergangs und filterten darüber hinaus weitere Bedarfe der Patienten/innen. Ein überwiegender Teil der Studienpopulation (71%) war ‚sehr zufrieden’ oder ‚zufrieden’ mit der Behandlung und der Mehrheit der Patienten/innen gelang darüber hinaus der Übergang aus der Therapie zurück in den Alltag ‚gut’ (62,16 %). Obwohl die Mehrzahl der Patienten/innen den Übergang von der Therapie zurück in den Alltag ‚gut’ bewältigt haben, konnten spezifische Prädiktoren des Übergangs aus den Ergebnissen gefiltert werden, welche diesen positiv und negativ beeinflussen. Positive Prädiktoren sind die allgemeine Zufriedenheit mit der Behandlung und im speziellen die Zufriedenheit mit dem Sozialdienst und den Psychologen/innen und Psychiater/innen. Darüber hinaus gelang den Patienten/innen der Übergang gut, welche den Entlassungszeitpunkt als ‚genau richtig’ empfanden. Des Weiteren konnte ein positiver Zusammenhang zwischen der weiteren Einnahme von den in der Tagesklinik verschriebenen Medikamenten und der aktuellen Lebensqualität festgestellt werden. Obwohl viele Patienten/innen (83,78 %) weiter Unterstützungsangebote nach der Entlassung wahrnahmen, wünscht sich ein Großteil (67,57) bereits während der Therapie eine Vermittlung und Begleitung zu anderen, externen Hilfsangeboten oder weitere Beratungsgespräche durch den Sozialdienst (45,95 %). Aus diesem Grund wurden über die Forschung hinaus Optionen einer effektiven und an den Bedürfnissen der Patienten/innen ausgerichteten Entlassungsplanung durch den Sozialdienst diskutiert und spezifische Kooperationsempfehlungen ausgesprochen.

Bakgrund: Patienter med psykisk ohälsa har en högre överdödlighet i fysiska sjukdomar jämfört med populationen i stort. Dessa individer drabbas oftare av somatiska problem då denna patientgrupp har en sjukdomsbörda som är förknippad med en större förekomst av primära beteendemässiga risker för kronisk sjukdom förorsakade av levnadsvanor och livsstil. Syfte: Syftet med studien var att belysa specialistsjuksköterskors erfarenheter av att stödja hälsofrämjande livsstilsförändringar hos patienter i psykiatrisk öppenvård. Metod: Kvalitativ metod med induktiv ansats har använts. Datamaterialet har analyserats med kvalitativ innehållsanalys. Psykiatrisjuksköterskor inom vuxenpsykiatrisk öppenvård har intervjuats i Region Skåne. Nio stycken semistrukturerade intervjuer har genomförts. Resultat: Resultaten visar på följande kategorier: vikten av en bärande relation, betydelsen av kompetens och resurser samt nödvändigheten av riktlinjer och verktyg. Slutsats: Genom att bygga en allians och skapa en mellanmänsklig relation med patienten utformas strategier för motivation till livsstilsförändringar där patientens egna resurser främjas. Från sjuksköterskornas sida efterfrågas det ett mer strukturerat arbetssätt för att säkerhetsställa patientens rättighet till likvärdig vård bland annat genom att arbeta fram ett gemensamt verktyg för det hälsofrämjande arbetet gällande livsstilsförändringar. / Background: Patients with mental illness have a higher mortality rate from physical illnesses compared to the general population. These individuals are more likely to suffer from somatic problems as this patient group has a disease burden that is associated with a greater incidence of primary behavioral risks of chronic disease caused by poor lifestyle. Aim: The aim of this study was to shed light the master level mental health nurse's experiences of supporting health-promoting lifestyle changes for patients in psychiatric outpatient services. Method: Qualitative method with inductive approach has been used. The data material has been analyzed with qualitative content analysis. Psychiatric nurses in adult psychiatric outpatient care have been interviewed in Region Skåne. Nine semi-structured interviews were conducted. Results: The results show the following categories: the importance of a core relationship, the importance of skills and resources and the necessity ofguidelines and tools. Conclusion: By building an alliance and creating an interpersonal relationship with the patient shapes strategies for motivation for lifestyle changes where the patient's own resources are promoted. The nurses demand a more structured way of working to ensure the patient's right to equal care, among other things by working out a common tool for the health-promoting work regarding lifestyle changes.

Background: Parents have both a right and an obligation to decide in matters concerning children. At the same time, children have been given a stronger position in healthcare (settings). Research shows low agreement regarding children's and parents' attitudes to children's symptoms and treatment goals. The disagreement has importance for treatment outcomes and prognosis, as well as requiring adaption and strategies from the nurse. Purpose: The aim of the study was to describe nurses experience of nursing in the event of disagreement between children and parents in child and adolescent outpatient mental health care. Method: A qualitative method with an inductive approach was used. Eleven semi-structured interviews were conducted and data was analyzed based on qualitative content analysis. Results: The results are summarized in three categories: Balancing between children and parents 'perspectives, willingness to consider the child's perspective and willingness to consider parents' perspectives. Conclusion: Nurses described that it was a challenge to act so that both children and parents' needs were satisfied. They wanted to take the child's perspective and at the same time wanted to maintain a good relationship with the parents. Depending on the situation, the nurse alternated between acting as a representative for either the parents or children. Lack of strategies to handle disagreement led to feelings of frustration and incompetence. / Bakgrund: Föräldrar har både en rättighet och skyldighet att bestämma i frågor somrör barn. Samtidigt har barn och ungdomar fått en starkare ställning i vården.Forskning visar låg överensstämmelse avseende barns och föräldrars inställning tillbarnens symtom och behandlingsmål. Oenigheten har i sig betydelse förbehandlingsutfall och prognos och kräver anpassning och strategier frånsjuksköterskan. Syfte: Syftet var att belysa sjuksköterskors erfarenheter avomvårdnad vid oenighet mellan barn och vårdnadshavare inom barn- ochungdomspsykiatrisk öppenvård. Metod: Studien genomfördes med kvalitativ metodoch en induktiv ansats. Elva semistrukturerade intervjuer genomfördes och dataanalyserades utifrån kvalitativ innehållsanalys. Resultat: Resultatet sammanfattas itre kategorier: Balansera mellan barn och föräldrars perspektiv, en vilja att beaktabarnets perspektiv samt en vilja att beakta föräldrars perspektiv. Slutsats:Sjuksköterskor beskrev att det var en utmaning att agera så att både barn ochföräldrars behov tillgodosågs då de å ena sidan var måna om att ta barnets perspektivoch samtidigt ville behålla en god relation till föräldrarna. Beroende på situationpendlade sjuksköterskan mellan att agera ombud för antingen föräldrar ochbarn. Avsaknad av strategier att bemöta oenighet gav upphov till känslor avfrustration och maktlöshet.

Bakgrund: Lungemboli är den allvarligaste diagnosen av venös tromboembolism. Poliklinisk behandling istället för traditionell slutenvård kan erbjudas för patienter med LE som inte löper risk för plötslig död och allvarliga komplikationer. Men poliklinisk behandlingsmodell kräver att korrekt medicinsk behandling i hemmet och korrekt medicinsk uppföljning kan säkerställas. Det saknas dock kunskap avseende sjuksköterskor och läkares erfarenheter av polikliniskt omhändertagande av patienter med lungemboli. Syfte: Syftet var att belysa sjuksköterskors och läkares erfarenheter av polikliniskt omhändertagande av patienter med lungemboli Metod: En kvalitativ studie med 12 semistrukturerade intervjuer som analyserades induktivt enligt innehållsanalys.  Resultat: Utifrån analysen av intervjuerna framkom att det strukturerade omhändertagandet ledde till en känsla av kompetens där man kände att man kunde erbjuda denna patientgrupp en god och säker vård. Dessutom var det angeläget att arbeta på ett personcentrerat sätt med hänsyn till de individuella egenskaper och förutsättningar patienter hade och ha förmåga att bemöta deras oro och funderingar med respekt och empati. En viktig del utgjorde även insatser för att främja hos patienter delaktighet i egenvård. Slutsats: Sjuksköterskors och läkares erfarenheter tyder på att en välfungerande poliklinisk struktur skapar förutsättningar för en god och säker vård.  Enligt sjuksköterskor och läkare ligger fokus i möten med polikliniska patienter inte enbart på den medicinska behandlingen utan även på fysiska och psykiska påfrestningar som LE har orsakat. / Background: Pulmonary embolism is the most serious diagnosis of venous thromboembolism. Outpatient treatment instead of traditional inpatient care can be offered for patients with LE who are not at risk of sudden death and serious complications. But the outpatient treatment model requires that proper medical treatment at home and proper medical follow-up can be ensured. However, knowledge regarding nurses’ and physicians’ experiences of outpatient care is lacking of outpatient care for patients with pulmonary embolism.Purpose:The purpose was to illuminate nurses’ and physicians’ experiences of outpatient care of patients with pulmonary embolism.  Method: A qualitative study with 12 semi-structured interviews analysed inductively according to content analysis.  Results: Based on the analyse of the interviews it emerged that the structured outpatient care led to a feeling of competence to be able to offer this patient group good and safe care. In addition, it was important to work in a person-centered way, taking into account the individual characteristics and conditions patients had and to be able to respond to their concerns and questions with respect and empathy. Efforts to promote patients' involvement in self-care also constituted an important part.Conclusion:  The experiences of nurses and physicians indicate that a well-functioning outpatient structure creates the conditions for good and safe care. According to nurses and physicians, the focus in meetings with outpatients is not only on the medical treatment but also on the physical and psychological strains that LE has caused.

Bakgrund: Den psykiatriska öppenvården präglas av låg bemanning och långa vårdköer. Det finns stora svårigheter med att både rekrytera och behålla personal, vilket har medfört minskad kompetens och en mer krävande vårdmiljö. När vårdkvaliteten har minskat faller fler patienter “mellan stolarna”. Vissa sjuksköterskor har en tro på att vården kan utvecklas, och de vågar göra saker annorlunda. De kan även övertyga sina kollegor att göra saker annorlunda, speciellt när omvårdnaden står på spel. Dessa sjuksköterskor står ut och går mot strömmen, de bryter normer och regler. Deras önskan är att förbättra vården för patienterna samtidigt som de vill bidra till en mer positiv arbetsmiljö för sina kollegor. Dessa sjuksköterskor kallas för “rebellsjuksköterskor”. Genom denna studie kan en ökad förståelse fås för dessa rebellsjuksköterskor, och hur de ska uppnå sin önskan om att utveckla patientarbetet. Syfte: Syftet med studien var att beskriva sjuksköterskors erfarenheter av rebelledarskap i psykiatrisk öppenvård. Metod: Studien har genomförts genom deskriptiv design med kvalitativ innehållsanalys. Datainsamlingen har skett genom semistrukturerade intervjuer med 9 sjuksköterskor med erfarenhet av rebelledarskap i den psykiatriska öppenvården. Resultat: Resultatet består av trehuvudkategorier (1) Att rebellsjuksköterskan önskar stöd i sitt arbete (2) Att rebellsjuksköterskan har förmågan att hantera motstånd (3) Att rebellsjuksköterskan är självständig och tar ansvar för patientens vård. Slutsats: Genom att hitta lösningar för att göra vården mer anpassad efter patientens behov kan en rebelledare bidra till att utveckla den psykiatriska öppenvården. Sjuksköterskors rebelledarskap har inte tidigare belysts inom denna kontext. Mer forskning behövs för att ta reda på vilket sätt rebellsjuksköterskans arbete påverkar en patients återhämtningsprocess. Genom att påvisa en positiv effekt finns en större möjlighet att mer utrymme kan fås för vidare utvecklingsarbete.