Based on the 2011 annual report of the United States Renal Data Library System (the USRDS), the prevalence and incidence of dialysis patient in Taiwan were the first and second in the world and the population of dialysis patient has exceeded six million (65883). Where can provide dialysis medical services called the hemodialysis center. According to the setting standards of medical institutions,provisions of the Department of Health, hemodialysis center can be set by the hospitals under the division of of Nephrology (Medical Center, regional teaching hospital, district hospital) and also set by the specialised clinics, hemodialysis centers will attached to the hospital or the clinic. Taiwan have 571 hemodialysis centers where can provide dialysis medical services , separated to 262 hospitals and 309 clinics. We want to study the difference of quality of health care services provided by these two center categories ? Is it different from their patient satisfaction and patient behavioral intention ? Whether their own merits, can each play? This study is based by the 5Qs the model proposed by Zineldin (2006) upon the hemodialysis patients, we have chosen four quality dimensions including the quality of object, quality of process, quality of communication and the quality of atmosphere to see which quality of health care services will affect their satisfaction and behavioral intentions, and look forward to the results of a study on the different category of hemodialysis centers in the future to improve the quality ofhealth care services, strengthening the competitiveness and sustainable management, to provide effective strategic direction.The study included patients from the three hemodialysis centers, each centers have received 100 questionnaires (one is regional teaching hospital, one is district hospitals and the rest is nephrologist clinics ). Effective returned questionnaires is 240 and the rate is 80%. In this study, the quality of healthcare services is based on four quality dimensions as the unit of analysis, the patient`s satisfaction, patient`s behavior intension. The results of this study are summarized as follows: 1. Quality of healthcare services " quality of object " and " quality of process ", "quality of atmosphere " has a positive significant impact on patient`s satisfaction, particularly in the " quality of process ",but " quality of interaction " has no significant relationship. The quality of healthcare services, " quality of process " has a positive significant impact on patient behavior intentions, but the " quality of object " ," quality of process " and " quality of interaction " have no significant relationship. 3 Patient`s satisfaction has positive and significant impact to behavioral intentions each other. 4.Different category of hemodialysis centers all have significant correlation for the " quality of object ", " quality of process ", " quality of interaction ", "quality of atmosphere ", patient`s satisfaction and patient`s behavior intention".

Abstracts: The purpose of the study was to compare the efficacy and cost between intravenous patient-controlled analgesia (PCA) with intramuscular (IM) analgesics for women in the first two days after surgery. The study included 200 patients who were assigned to receive PCA or intramuscular injections opioid during a period of 2 days after surgery. The PCA group included 124 patients and IM group had 76 patients. The data were collected using a structured questionnaires, patient chart review and hospital charge data. The several findings were observed in this study. 1. The pain level in the PCA group was significantly lower than in the IM group (P< 0.01). The PCA group had significantly greater satisfaction with pain control than those in IM group (p< 0.01). The influence of activity by pain in the IM group had significantly greater than those in PCA group (p< 0.05). 2. The incidence of skin itching in PCA group was significantly higher than in the IM group ¡]P< 0.01¡^.3. Cost per patient was higher for PCA group¡]NT$ 420.9¡Ó22.6¡^than IM group¡]NT$228.4¡Ó60.1¡^. In conclusion, PCA produced better pain relief, get better patient¡¦s satisfaction than conventional on-demand IM opioid injections but it was more expensive.

Humor är så integrerad i mänskliga interaktioner att det ofta uppstår spontant och utan eftertanke eller planering. Humor förknippas vanligtvis med skratt, glädje och känslor av gemenskap och välbefinnande. Forskning visar att det är patienter som initierar mest humor i vårdrelationer. Denna litteraturstudie är en metasyntes och består av tio vetenskapliga artiklar. Syftet var att belysa obotligt sjuka patienters upplevelse av humor i den palliativa vården.  Det visade sig att humor var viktig och tjänade otaliga funktioner. Enligt patienterna var humor en värdefull del av kommunikationen generellt och den medkännande personliga omvårdnaden i synnerhet. Humor var närvarande igenom alla studiers intervjuer och observationer. En stor majoritet av patienterna värderade humor mycket både före och under sin sjukdom. Humor beskrevs av patienter som en bro till deras friska identitet. När vårdpersonalen använde humor kände sig patienter sedda som människor inte bara som mottagare av vård. Mild humor var den mest utbredda och bestod av leenden, spontana kommentarer, godmodiga skämt, stunder av värme och lättsam lekfullhet. Den empatiska, respektfulla, terapeutiska användningen av humor som personalen skapade genom sitt sätt att vara, skyddade patienternas integritet, självkänsla och känsla av värde. Humor hade en stor betydelse i vårdrelationer som blev djupare och mera personliga. Humor visade sig vara en viktig del i den medkännande och mera personliga omvårdnaden. Kombinerat med professionell skicklighet och empati, är humor för värdefull för att förbises.

Bakgrund: Hjärtsvikt är ett vanligt och allvarligt tillstånd med hög dödlighet, sjuklighet och försämrad livskvalité. Det beräknas att omkring en kvarts miljon personer i Sverige har kronisk hjärtsvikt. Inrättandet av specialistsjuksköterskeledda hjärtsviktsmottagningar med läkarstöd har förbättrat behandlingen av patienter med hjärtsvikt. Syfte: Syftet med denna studie var att undersöka patienters upplevelser av vilka faktorer som har betydelse i vården på specialistsjuksköterskeledda hjärtsviktsmottagningar. Metod: En intervjustudie med semistrukturerade frågor har använts. En kvalitativ manifest innehållsanalys användes för att analysera det material som framkom vid intervjuerna. Informanterna valdes ut genom ett strategiskt urval. Resultat: Resultatet visade att en fungerande vårdrelation med sjukvården som representerades av specialistsjuksköterska på hjärtsviktsmottagningen samt information för att klara av sin egenvård var av betydelse för informanterna. En god vårdrelation beskrivs av informanterna i studien att den innehåller kontinuitet, tillit till specialistsjuksköterska, samarbete med vårdpersonal, ett bekräftande bemötande samt tillgänglighet vid behov. Konklusion: Vården på specialistsjuksköterskeledda hjärtsviktsmottagningar är betydelsefull för patienters trygghet. Det förefaller viktigt att få veta vem hjärtsviktspatienterna ska kontakta vid behov av stöd och hjälp för att hantera sin situation. Möjligheten att kontakta specialistsjuksköterska när behovet fanns upplevdes betydelsefull. Information om egenvård uppfattades av informanterna som viktigt och som ett stöd i det dagliga livet. / Background: Heart failure is a common and serious condition with high mortality rate, morbidity and impaired quality of life. It is estimated that about a quarter of a million Swedish people have chronic heart failure. The creation of a specialist nurse-led heart failure clinic with medical assistance has improved the treatment of patients with heart failure. Aim: The aim of this study was to examine patients’ perceptions of the factors that are important in the care on specialist nurse-led heart failure clinics. Method: Interviews with semi- structured questions were used. A qualitative manifest content analysis was used to analyze the material found during the interviews. The informants were selected through a strategic selection. Results: The result showed that a functional relationship between patient and specially trained nurses at the heart failure clinic, and sufficient information to manage their own care, was of the most importance to the patients. A good healthcare relationship are described by the patients as containing continuity, trust to the nurse, friendly treatment, cooperation’s with healthcare staff and availability as needed. Conclusion: The care of a specialist nurse-led heart failure clinics are important for patient safety. It seems important to know whom heart failure patients should contact if necessary help and support to deal with their situation. To have the ability to contact a nurse when needed was very meaningful. The informants found the information on how to handling their own care as important and as a support in their daily life.

Bakgrund: Patienter som ofta vårdas inom den psykiatriska slutenvården är patienter med psykotiska störningar, depression och patienter med risk för självmord. Tvångsåtgärder som kan förekomma på en psykiatrisk vårdavdelning kan exempelvis vara bältesläggning, tvångsmedicinering och isolering. För att en sjuksköterska ska kunna vårda dessa patienter behövs såväl kunskap som förståelse. För att axla denna roll behöver sjuksköterskor mer forskning som är fokuserad på patienters erfarenheter. Syfte: Syftet med studien var att beskriva patienters erfarenheter av sluten psykiatrisk tvångsvård samt att beskriva de inkluderade artiklarnas urvalsmetod och undersökningsgrupp. Metod: Litteraturstudien genomfördes med en beskrivande design. Studien innefattas av elva stycken kvalitativa vetenskapliga artiklar som svarar på studiens syfte. Resultat: Fem teman var grunden till beskrivningen av denna litteraturstudie: Betydelsen av relationen till vårdpersonalen, Betydelsen av information, Förståelsen av att vårdas mot sin vilja, Erfarenheter av tvångsåtgärder samt Erfarenheter av vårdmiljön. Resultatet avslutas med en beskrivning av artiklarnas urvalsmetod och urvalsgrupp. Slutsats: Patienter beskrev både bra och dåliga erfarenheter av sluten psykiatrisk tvångsvård. Viktiga aspekter som framgick enligt patienterna var: God information, god relation till vårdpersonal, förståelse samt en god vårdmiljö. Det är av stor vikt att sjuksköterskan har god kunskap om patienters erfarenheter för att kunna ge så god omvårdnad som möjligt. / Background: Patient who is treated in a locked psychiatric coercive care unit is patient with psychotic disorders, depression and patients with risk for suicide. Coercive measures that may be present in a psychiatric ward could be, for example medical restraint, forced medication and isolation. For a nurse to be able to care this patients who is in a need for good care it´s important with knowledge and understanding. To handle this role, nurses need more research and focus at the experiences of patients. Purpose: The aim of this study was to describe patient´s experience of a locked psychiatric coercive care unit. Present the selected articles' selection method and study group. Method: This is a literature study with a descriptive design. In this study eleven articles of qualitative approach are included to answer to the purpose of this study. Results: The result is based on five themes: Significance of relationship with health professionals, Significance of information, Understandning of being cared against their own will, Experience of being cared under coercion and Experience of the care environment. The last part om the result descibe the selctions method and the of the study group of the article. Conclusion: Patients described both good and bad experiences of locked psychiatric care. According to the patient important aspects was: Good information, Good Relationships with the health professionals and understanding, God care environment. It´s of great importance that the nurses have good knowledge about patients experience to be able to give such good nursing care as possible.

Den psykiska ohälsan ökar mest i storstadsområdena, men ökar i alla regioner och i samtliga sociala grupper. Andelen stressrelaterade sjukskrivningar ökar, främst bland unga människor och kvinnor. Utmattningssyndrom tycks mest förekomma i s k välfärdsyrken; service, vård, skola och myndighetsutövande. Vid sekelskiftet 1900 uppvisades likartade symtom med fysisk och mental trötthet. Syftet var att beskriva hur personer med utmattningssyndrom upplever sin livssituation och effekterna av akupressurbehandling. Studien är kvalitativ, inspirerad av fenomenologi. Datainsamling har skett genom halvstrukturerade intervjuer med åtta kvinnor. Variation eftersträvades i urvalet. Genom analysen utkristalliserades sex huvudkategorier: symtombild – när orken tryter, emotioner vid utmattningsyndrom, det sociala samspelet, arbete – på gott och ont, vård och socialt skyddsnät samt akupressur och vägen tillbaka till livet. Resultatet visar att livssituationen kraftigt påverkas av sjukdomen. Sjukskrivningslängd liksom bemötande från arbetsgivare, sjukvård och försäkringskassa varierar. Såväl yrkesliv, familjeliv som socialt liv störs. Känslor av skam, skuld och värdelöshet är vanliga. Stöd från familjer, vänner och myndigheter påverkar rehabiliteringen i positiv riktning. Informanterna anser att akupressurbehandlingarna varit det som mest bidragit till att de återfått hälsan. Ytterligare studier av akupressurens effekter vid utmattningssyndrom behöver göras. / Mental disorders are increasing in all areas and in all social groups. Stress disorders are increasing, mostly among young people and women. Stress causes physical and mental illness. Employees in the service sector, the education field and in authorities are vulnerable groups. In 1900 there was also a physical and mental exhaustion. The aim of the study is to describe how burnout persons experience their life and the effects of acupressure treatment. It is a qualitative study, inspired by phenomenology. Data acquisition has been made through semi structured interviews with eight women. The analysis gave six main categories; symptoms – total fatigue, burnout emotions, social context, work – for good or for worse, care and social protection, acupressure and the way back to life. The result shows strongly influenced living conditions. Time on sick-leave, treatment from employers, health care system and regional social insurance offices vary. Working life, family life and social life are disrupted. Shame, guilt and feeling worthless are common feelings. Support from family, friends and authorities is essential for rehabilitation. The informants declare that acupressure has been essential for their recovery. Further studies of acupressure and burnout are needed.

Bakgrund: Sjukdomen åldersrelaterad makuladegeneration (AMD) är en är av de vanligaste anledningarna till grav synnedsättning i västvärlden. Sjukdomen medför att den centrala synen försämras för patienten. Det finns en torr och en våt form. Med den våta formen sker synförsämringen i ett snabbare förlopp men kan behandlas med läkemedel som injiceras i ögats glaskropp. Synförsämringen skapar olika problem för patienten att hantera i deras vardagsliv. I relation till vardagliga aktiviteter så som socialt och fysiskt finns den närvarande. Syfte: Att beskriva patientens uppfattningar av att leva med sjukdomen våt AMD. Metod: En kvalitativ design har använts med en fenomenografisk forskningsansats. Patienter från en ögonmottagning i Mellansverige har enskilt intervjuats. Data har sedan analyserats enligt en fenomenografisk analys. Resultat: Fyra stycken beskrivningskategorier identifierades som handlade om patienternas uppfattningar av sin sjukdom. Medvetenhet om sjukdomen, förlust av självständighet, att kunna anpassa sig och att känna tillit till sjukvården. Slutsats: Att leva med sjukdomen våt AMD medför förändringar i patientens vardagsliv och påverkar det på olika sätt. För att kunna förstå patientens uppfattningar med att leva med sjukdomen är det viktigt att belysa och lyfta fram dessa för att kunna hitta metoder för att uppmärksamma denna patientgrupps behov av stöd och hjälp vid besöken på ögonkliniken.

Estudos mostram um baixo grau de cooperação aos retornos de pacientes em controle e manutenção. Com o intuito de avaliar a cooperação dos pacientes da FOUSP, este trabalho foi dividido em duas fases: estudo transversal e estudo intervencional. A primeira análise revelou uma participação insatisfatória dos pacientes no Programa de Controle e Manutenção da Disciplina de Periodontia, durante 5 anos. Dos 402 indivíduos avaliados, 18,2% eram cooperadores completos, 8,2% eram irregulares e 73,6% abandonaram o programa. A partir desses grupos, foi realizado um estudo intervencional em 137 pacientes, que objetivou avaliar a influência de um método para melhorar a cooperação com o controle e manutenção. Durante 12 meses, o grupo Cooperação Completa recebeu os procedimentos habituais de uma consulta de Controle e Manutenção; o grupo Cooperação Irregular recebeu procedimentos habituais e motivação para aumentar sua cooperação; o grupo Nenhuma Cooperação recebeu cartas para incentivar seu retorno, sendo que, aqueles que retornaram ao programa receberam o mesmo tratamento do grupo Cooperação Irregular. Neste período de intervenção, a taxa de cooperação completa aumentou de 50,4% para 67,9%. Não houve associação entre gênero e grau de cooperação, não houve diferença significante entre os grupos de cooperação em relação à idade. Os resultados mostraram que o método empregado teve influência favorável sobre o grau de cooperação dos pacientes. / Previous studies have found poor patient compliance with periodontal maintenance therapy. In order to assess compliance with periodontal maintenance in University of São Paulo, this study was divided in two parts: cross-sectional study and intervention study. The cross-sectional analysis showed unsatisfactory compliance with maintenance program from the Graduate Periodontal Clinic, during 5 years. From 402 subjects evaluated, 18.2% were complete compliers, 8.2% were irregular compliers and 73.6% were non-compliers. A intervention study was undertaken with 137 patients chosen from those groups. The aim of this study was to assess the influence of a method to improve patient’s compliance with periodontal maintenance. In a period of 12 months, the complete compliance group received usual procedures of a maintenance visit; the irregular compliance group received usual procedures and motivation to change its behavior; to the non-compliers patients letters were sent in order to motivate them to resume the program, and those who returned received the same procedures as the irregular group. The degree of complete compliance increased from 50,4% to 67,9%, during the course of the second study. There was no correlation between gender and compliance. There was no significant difference in compliance in relation to age. The results showed that the method applied had favorable influence over the patient’s compliance.

Estudos mostram um baixo grau de cooperação aos retornos de pacientes em controle e manutenção. Com o intuito de avaliar a cooperação dos pacientes da FOUSP, este trabalho foi dividido em duas fases: estudo transversal e estudo intervencional. A primeira análise revelou uma participação insatisfatória dos pacientes no Programa de Controle e Manutenção da Disciplina de Periodontia, durante 5 anos. Dos 402 indivíduos avaliados, 18,2% eram cooperadores completos, 8,2% eram irregulares e 73,6% abandonaram o programa. A partir desses grupos, foi realizado um estudo intervencional em 137 pacientes, que objetivou avaliar a influência de um método para melhorar a cooperação com o controle e manutenção. Durante 12 meses, o grupo Cooperação Completa recebeu os procedimentos habituais de uma consulta de Controle e Manutenção; o grupo Cooperação Irregular recebeu procedimentos habituais e motivação para aumentar sua cooperação; o grupo Nenhuma Cooperação recebeu cartas para incentivar seu retorno, sendo que, aqueles que retornaram ao programa receberam o mesmo tratamento do grupo Cooperação Irregular. Neste período de intervenção, a taxa de cooperação completa aumentou de 50,4% para 67,9%. Não houve associação entre gênero e grau de cooperação, não houve diferença significante entre os grupos de cooperação em relação à idade. Os resultados mostraram que o método empregado teve influência favorável sobre o grau de cooperação dos pacientes. / Previous studies have found poor patient compliance with periodontal maintenance therapy. In order to assess compliance with periodontal maintenance in University of São Paulo, this study was divided in two parts: cross-sectional study and intervention study. The cross-sectional analysis showed unsatisfactory compliance with maintenance program from the Graduate Periodontal Clinic, during 5 years. From 402 subjects evaluated, 18.2% were complete compliers, 8.2% were irregular compliers and 73.6% were non-compliers. A intervention study was undertaken with 137 patients chosen from those groups. The aim of this study was to assess the influence of a method to improve patient’s compliance with periodontal maintenance. In a period of 12 months, the complete compliance group received usual procedures of a maintenance visit; the irregular compliance group received usual procedures and motivation to change its behavior; to the non-compliers patients letters were sent in order to motivate them to resume the program, and those who returned received the same procedures as the irregular group. The degree of complete compliance increased from 50,4% to 67,9%, during the course of the second study. There was no correlation between gender and compliance. There was no significant difference in compliance in relation to age. The results showed that the method applied had favorable influence over the patient’s compliance.

<p>Den psykiska ohälsan ökar mest i storstadsområdena, men ökar i alla regioner och i samtliga sociala grupper. Andelen stressrelaterade sjukskrivningar ökar, främst bland unga människor och kvinnor. Utmattningssyndrom tycks mest förekomma i s k välfärdsyrken; service, vård, skola och myndighetsutövande. Vid sekelskiftet 1900 uppvisades likartade symtom med fysisk och mental trötthet. Syftet var att beskriva hur personer med utmattningssyndrom upplever sin livssituation och effekterna av akupressurbehandling. Studien är kvalitativ, inspirerad av fenomenologi. Datainsamling har skett genom halvstrukturerade intervjuer med åtta kvinnor. Variation eftersträvades i urvalet. Genom analysen utkristalliserades sex huvudkategorier: symtombild – när orken tryter, emotioner vid utmattningsyndrom, det sociala samspelet, arbete – på gott och ont, vård och socialt skyddsnät samt akupressur och vägen tillbaka till livet. Resultatet visar att livssituationen kraftigt påverkas av sjukdomen. Sjukskrivningslängd liksom bemötande från arbetsgivare, sjukvård och försäkringskassa varierar. Såväl yrkesliv, familjeliv som socialt liv störs. Känslor av skam, skuld och värdelöshet är vanliga. Stöd från familjer, vänner och myndigheter påverkar rehabiliteringen i positiv riktning. Informanterna anser att akupressurbehandlingarna varit det som mest bidragit till att de återfått hälsan. Ytterligare studier av akupressurens effekter vid utmattningssyndrom behöver göras.</p> / <p>Mental disorders are increasing in all areas and in all social groups. Stress disorders are increasing, mostly among young people and women. Stress causes physical and mental illness. Employees in the service sector, the education field and in authorities are vulnerable groups. In 1900 there was also a physical and mental exhaustion. The aim of the study is to describe how burnout persons experience their life and the effects of acupressure treatment. It is a qualitative study, inspired by phenomenology. Data acquisition has been made through semi structured interviews with eight women. The analysis gave six main categories; symptoms – total fatigue, burnout emotions, social context, work – for good or for worse, care and social protection, acupressure and the way back to life. The result shows strongly influenced living conditions. Time on sick-leave, treatment from employers, health care system and regional social insurance offices vary. Working life, family life and social life are disrupted. Shame, guilt and feeling worthless are common feelings. Support from family, friends and authorities is essential for rehabilitation. The informants declare that acupressure has been essential for their recovery. Further studies of acupressure and burnout are needed.</p>