The formalized nurse practitioner (NP) role in British Columbia is relatively new with the majority of roles implemented in primary care. The majority of primary care is delivered by physicians using the fee-for-service model. There is a shortage of general practitioners (GP) and difficulties with recruitment and retention, particularly in rural and remote locations. The uptake of the primary care NP role has been slow with challenges in understanding the extent of its contributions. This study was to identify the impacts and outcomes associated with the NP role in collaborative primary care practice. Multiple case studies where NPs were embedded into rural fee-for-service practices were undertaken to determine the outcomes at the practitioner, practice, community, and health services levels. Interviews, documents, and before and after data, were utilized to identify changes in practise, access, and acute care service utilization. The results showed that NPs affected how care was delivered, particularly through the additional time afforded each patient visit, the development of a team approach with interprofessional collaboration, and a change in style of practise from solo to group practise. This resulted in improved physician job satisfaction. Patient access to the practice improved with increased availability of appointments and practice staff experienced improved workplace relationships and satisfaction. At the community level, access to primary care improved for harder to serve populations and new linkages developed between the practice and their community. The acute care services experienced a statistically significant decrease in emergency use and admissions to hospital (p= .000). The presence of the NP improved their physician colleagues desire to remain in their current work environment. This study identified the diversity of needs that can be addressed by the NP role; the importance of time to enhance patient care, and its associated benefits, especially in the fee-for-service model; the value of the NP’s role in the community; the acceptance of the clinical competence of NPs by their physician colleagues; the outcomes generated at the practice level in terms of organizational effectiveness and service provision; and substantiated the impact of the role in improving primary care access and reducing acute care utilization. / Graduate

No description available.

Abstract Background:Sweden has in the past year received several thousand unaccompanied minors. The workload for district nurses in primary care has increased drastically . Many of these children have complex needs for healthcare , which places high demands on the district nurse. Purpose: The purpose of this study was to describe district nurses experiences of caring for unaccompanied refugee children in primary healthcare. Method: The design of the study is qualitative. The data was collected through a convenience and snowball sample and then conducted eight semi-structured interviews . The data were analyzed using qualitative content analysis in which the latent content is the core.Results: Three categories were identified ; " The experiences of caring for an unaccompanied refugee children ", " Obstacles in everyday work " and "A desire for change ." The most prominent results was that the district nurses wanted to give a good and equal health care despite many obstacles, and that they had desires of several organizational changes .Conclusion: It takes a lot of a district nurse to care for unaccompanied refugee children. They have both physical and mental injuries, and many of them suffer from severe mental illness as a result of traumatic experiences they had to undergo. By making small changes of the organization the district nurse's work environment would improve and the patients would also get a more secure and equitable care . / Abstrakt Bakgrund: Sverige har det senaste året tagit emot flera tusen ensamkommande flyktingbarn. Arbetsbelastningen för distriktssköterskor inom primärvården har därför ökat drastiskt. Många av dessa barn har komplexa vårdbehov vilket ställer höga krav på distriktssköterskan. Syfte: Syftet med studien var att belysa distriktssköterskors erfarenheter av att vårda ensamkommande flyktingbarn inom primärvården. Metod: Studiens design är kvalitativ. Datan samlades in genom ett bekvämlighets- samt snöbollsurval och därefter genomfördes åtta semistrukturerade intervjuer. Datamaterialet analyserades med en kvalitativ innehållsanalys där det latenta innehållet är kärnan. Resultat: Tre kategorier identifierades; ”Erfarenheter av att vårda ett ensamkommande flyktingbarn”, ”Hinder i det dagliga arbetet” samt ”En önskan om förändring”. Det som genomsyrande resultatet var att distriktssköterskorna ville ge en god och jämlik vård trots många hinder samt att de hade önskningar om flera organisatoriska förändringar. Slutsats: Det krävs mycket av en distriktssköterska som ska vårda ensamkommande flyktingbarn. Barnen har både fysiska och psykiska skador och många av dem lider av svår psykisk ohälsa tilll följd av de traumatiska händelser de tvingats genomgå. Genom små medel kan förändringar av organisationen göras vilket förbättrar distriktssköterskans arbetsmiljö, men patienten får också en mer säker och jämlik vård.

The consultation is the GP’s form of work. How long a consultation should be, and what short/long consultations imply with regard to the satisfaction of patient and doctor has been much debated. The aim of this thesis was to study consultations with regard to content and time consumption in a short term and long term perspective. Three studies were carried out. 1. Consultations with the members of a group of GPs were investigated, where patients and doctors separately assessed different aspects of the consultation, and their ratings were related to the real length of the consultations. The following questions were posed: Was there time enough? Could the patient tell the doctor about her/his problems? Were the problems physical or psychological? 2. Nurses at the primary care health centres were interviewed about their considerations in booking short or long appointments for the patients. 3. Patients who frequently attended one health centre during one year and consumed much time were studied. Quantitative and qualitative methods were used. The results of the first study (Papers I-III) show that the average length of the consultations was 21 minutes; there was considerable variation (ranging from 3 to 60 minutes). (About 600 consultations with 7 male doctors were registered in two batches). The doctors’ mean consultation length also varied widely, from 13-28 minutes. Consultations dealing with psychological problems were longer than those dealing with physical problems. Older patients had longer consultations than younger patients, and female patients had somewhat longer consultations than male patients. The patients were generally more satisfied with the consultations than the doctors were, and there were no clear affinities between long consultations and high satisfaction. Male patients and patients with physical problems mainly received short consultations, whereas patients with ”mixed" problems and older patients received long consultations. The single factors most decisive for the length of a consultation were ‘the doctor factor’, the character of the problem and the age of the patient. "Good” consultations (operational definition) were associated primarily with ‘the doctor factor’, and the real length of the consultations was less important. The interviews with ten experienced primary care nurses (Paper IV) showed that the nurses worked in two perspectives: in the ”immediate” perspective, appointments were booked according to rules which directly impacted the length of the visit, and in the "reflective" perspective, appointments were booked with a view to the quality of the work at the health centre and the long-term time consumption. Other factors of importance were the patient’s age and problem(s), the doctor’s experience and working style, and the current situation at the health centre. Frequent attenders (FAs) at one health centre (Paper V) were compared with a contrast group of matched patients (CPs). The FAs represented 1.7% of the population of the catchment area and made 15% of the visits. The FAs were a heterogeneous group where small boys, women of working age and pensioners of both sexes were overrepresented. The FAs had higher consultation frequency than the CPs during the year of investigation, but few remained FAs for longer periods. The FAs had more problems and more complex problems than the CPs. Complaints regarding the musculo-skeletal organs, and psychosocial problems were common among these patients, often in combination. The present work thus shows that longer consultations do not naturally imply higher patient satisfaction. Other factors than the time factor, in particular ‘the doctor factor’ seem to be more important. ‘The doctor factor’, the characteristics of the patients, the type of problem and the situation at the health centre also have a bearing on consultation length and time consumption in a short-term as well as long-term perspective. The implications of these factors and their relative importance are discussed, but further studies of certain issues, such as ‘the doctor factor’, are necessary. / <p>Diss. (sammanfattning) Umeå : Umeå universitet, 1995, härtill 5 uppsatser.</p> / digitalisering@umu

Bakgrund: Övervikt och fetma ökar i Sverige i dag. Ett BMI över 30 ökar markant risken för följdsjukdomar och för tidig död. Inom primärvården är det ofta distriktssköterskan som möter och initierar behandling av denna patientgrupp. Forskning visar att patienter som har övervikt eller fetma upplever diskriminering, skam och brist på värdighet och empati i kontakten med hälso- och sjukvården. Syfte: Syftet med detta examensarbete var att belysa distriktssköterskors attityder till vuxna patienter som har övervikt eller fetma inom primärvården.Metod: I examensarbetet användes en kvalitativ innehållsanalys med induktiv ansats. Intervjuer genomfördes med nio distriktssköterskor som arbetade inom primärvården. Resultat: I resultatet framkom tre teman: Att skapa en vårdande relation, att se kroppen och att förändra. Under dessa tre teman beskrevs den vårdande relationen som en förutsättning för förändring. Genom att se kroppen kunde distriktssköterskorna få information angående patienternas levnadsvanor. Det visade sig även finnas hinder för viktnedgång. Konklusion: Detta examensarbete beskriver komplexiteten i att som distriktssköterska vårda patienter som har övervikt eller fetma. Detta utifrån att övervikt och fetma är ett känsligt ämne att samtala om. En fungerande vårdande relation är förutsättningen för ett framgångsrikt hälsofrämjande arbete. Utifrån denna kunskap finns möjligheten att utveckla vården och mötet med denna patientgrupp. / Background: Overweight and obesity are on the rise in Sweden today. A BMI over 30 significantly increases the risk of consequential diseases and premature death. It is often the primary care nurse who meets and initiates treatment of this patient group in the primary care. Research shows that patients who are overweight or obese experience discrimination, shame and lack of dignity and empathy in contact with the health care system.Aim: The aim of this thesis was to highlight primary care nurses' attitudes towards adult patients who are overweight or obese in the primary care.Method: The degree project used a qualitative content analysis with an inductive approach. Interviews were conducted with nine primary care nurses who worked in primary care.Results: The results revealed three themes: Creating a caring relationship, looking at the body and to changing. Under these three themes, the caring relationship was described as a prerequisite for change. By seeing the body, the informants were able to obtain information about the patients' living habits. There were also obstacles to patients losing weight. Conclusion: This thesis describes the complexity of caring for patients who are overweight or obese as primary care nurse. This is on the basis that overweight and obesity is a sensitive topic to talk about. A functioning caring relationship is the prerequisite for successful health promotion work. Based on this knowledge, there is anopportunity to develop care and the meeting with this patient group.

Övervikt har idag blivit den största kroniska sjukdomen världen över och anses vara den näst största behandlingsbara dödsorsaken. Patienter som blir medvetna om sin övervikt kan i större utsträckning gå ner i vikt än de som inte upplyses. Primärvården anses vara den enhet som har störst möjlighet att förmedla kunskap om levnadsvanor. Det är viktigt att med hjälp av livsstilsrådgivning stödja människor, distriktssköterskor anses vara den mest passande professionen för denna uppgift. Genom livsstilsrådgivning kan människor få en ökad kunskap och förståelse för hur vår livsstil påverkar vår hälsa. Initiativ till att ställa frågor och diskutera om levnadsvanor bör tas även när det inte finns en nära koppling till de besvär eller den sjukdom patienten söker för. Trots detta finns risk att livsstilsrådgivning utförs i bristande omfattning. Syftet med studien var att belysa distriktssköterskors erfarenheter av livsstilsrådgivning med överviktiga vuxna som söker vårdcentral för andra besvär. Metoden var kvalitativ och genomfördes med ett semistrukturerat frågeformulär. Det väsentliga resultatet var att distriktssköterskorna upplevde livsstilsrådgivning som deras ansvar men att det var ett känsligt område. Trots detta upplevde flertalet av patienterna samtal om levnadsvanor som positivt. Livsstilsrådgivning beskrevs vara nedprioriterat av arbetsgivaren, trots primärvårdens preventiva ansvar. En önskan om förändring på arbetsplatsen var tydlig. Förändringarna som beskrevs var att livsstilsrådgivning skulle prioriteras av arbetsgivaren. Riktlinjer behövdes och utbildning krävdes för ett optimalt omhändertagande av överviktiga vuxna. Vidare önskades mer tid avsatt för området så att undersökningar och livsstilsrådgivning kunde möjliggöras. Ett behov av samarbete med andra professioner sågs också. Studien diskuterar hur livsstilsrådgivning skulle kunna hanteras med aktuella resurser utan förändring på arbetsplatsen men även arbetsgivarens ansvar för att distriktssköterskorna ska kunna bedriva en hälsofrämjande vård. Vidare diskuteras förslag på implementering av bland annat en modell för viktkontroll. Förslagen skulle sannolikt kunna bidra till ett förbättrat preventivt arbete inom primärvården. Distriktssköterskorna ansåg att livsstilsrådgivning var viktigt och kunde se flera fördelar med att prioritera det hälsofrämjande arbetet. / Overweight has now become the largest chronic disease worldwide and is considered the second largest treatable cause of death. Patients that become aware of their overweight may increasingly lose weight than those who are not informed. Primary care is considered to be the unit that has the best opportunity to mediate knowledge about living habits. It is important that by using lifestyle counseling support people, primary care nurses are considered the most suitable profession for this task. Through lifestyle counseling people can get a better knowledge and understanding of how our lifestyle affects our health. Initiative to ask questions and discuss about living habits should be taken even when there isn´t a close link to the symptoms or disease the patient searching for. Despite this, there is a risk that lifestyle counseling performed in the lack of scope. The purpose of the study was to lighten primary care nurses experiences of lifestyle counseling to overweight adults who seek health center for other conditions. The method was qualitative and was conducted using a semi-structured questionnaire. The important outcome was that the primary care nurses experienced lifestyle counseling as their responsibility but that it was a sensitive area. Despite this, most of the patient experienced talk about lifestyle habits as positive. Lifestyle counseling was described to be given lower priority by the employer, even though the primary cares preventive responsibility. A desire for change in the workplace was clear. The changes described were that lifestyle counseling would be given priority by the employer. Guidelines were needed and education required for optimal treatment of overweight adults. Further, there was a desire of more time set aside so that screening and lifestyle counseling could be made possible. A need for collaboration with other professions was also seen. The study discusses how lifestyle counseling could be dealt with current resources without change in the workplace, but also the employer´s responsibility to primary care nurses so they can conduct health care. Proposals on the implementation of including a model for weight management are also discussed. The proposals would likely contribute to an improved preventive work in primary care. Primary care nurses felt that lifestyle counseling was important and could see several benefits to prioritize health promotion.

Bakgrund: Antalet ammande mammor sjunker i Sverige, en bidragande faktor till den sjunkande amningsfrekvensen kan vara bristen på tillit till sin förmåga att amma. Det är viktigt att identifiera mammor med låg tillit till sin förmåga att amma för att göra det möjligt att vända den sjunkande amningsfrekvensen och för distriktssjuksköterskan att kunna stärka kvinnan i rollen som ammande mamma. Syfte: Syftet med studien var att beskriva och jämföra mammors tillit till sin förmåga att amma. Metod: Med enkäten, The breastfeeding self-efficacy scale - short form (BSES-SF) som mäter tillit till sin förmåga att amma, samlades data in för att kunna identifiera mammor med låg eller hög tillit. Resultat: Mammorna i åldersgrupperna 18-25 år och 35-45 år, oberoende av barnets ålder, skattade den lägsta tilliten till sin förmåga att amma gällande att de alltid kunde genomföra varje amning på ett för dem tillfredställande sätt. Den högst skattade tilliten hos samtliga mammor, oberoende av deras egen ålder eller barnets ålder, var att de alltid kan komma fram till att de vill fortsätta att amma. Mammor som ammade barn mellan 10 veckor (v) – 17 v + 6 dagar (d) skattade totalt enligt BSES-SF sin tillit till sin förmåga att amma signifikant högre än mammor som ammade barn mellan 0 v – 9 v + 6 d. Slutsats: Mammorna i föreliggande studie som ammade barn mellan 10 v – 17 v + 6 d skattar sin tillit till sin förmåga att amma högre, än mammorna som ammade barn mellan 0 v – 9 v + 6 d. Nyckelord: Amning, distrik / Background: The number of breastfeeding mothers is reducing in Sweden, a contributing factor to the decrease can be the lack of confidence in their ability to breastfeed. It is important to identify mothers with low confidence in their ability to breastfeed in order to make it possible to reverse the declining number of breastfeeding mothers, and for the primary care nurse to strengthen the woman in the role of a breastfeeding mother. Aim: The purpose of the study was to describe and compare mothers’ confidence in their ability to breastfeed. Method: With the survey, the breastfeeding self-efficacy scale - short form (BSES-SF) that measures trust in its ability to breastfeed, data was collected to identify mothers with low or high confidence. Results: The mothers’ of the age groups 18-25 years and 35-45 years, regardless of the age of the child, estimated the lowest confidence in their ability to breastfeed that they could always perform each breastfeeding in a satisfactory manner. The highest ranked trust of all mothers, regardless of their own age or child's age, was that they could always come to the conclusion that they would want continue to breastfeed. Mothers who breastfeed children in the higher age group, 10 weeks (w) – 17 w + 6 days (d), estimated in total according to BSES-SF, their confidence in breastfeeding significantly higher than mothers who breastfeed children between 0 w – 9 w + 6 d. Conclusion: The mothers’ in this study who breastfeed babies between 10 w – 17 w + 6 d estimate their ability to breastfeed higher than the mothers who breastfeed children between 0 w – 9 w + 6 d.

Bakgrund: Statistik visar att 8% av alla legitimerade sjuksköterskor inte arbetar inom hälso- och sjukvården. Anledningen till det är bland annat hög arbetsbelastning och arbetsrelaterad stress. Tidigare forskning visar att arbetsplatser som arbetar proaktivt för vårdpersonalens välbefinnande har i en större utsträckning mer välmående personal. Utan ett gott välbefinnande hos sjuksköterskan blir patientsäkerheten och kvaliteten på omvårdnaden sämre. Syfte: Studiens syfte var att beskriva primärvårdssköterskans skattande av psykosocial arbetsmiljö och välbefinnande samt studera sambandet mellan dessa variabler. Metod: En kvantitativ tvärsnittsstudie med deskriptiv och korrelativ design. Totalt skickades 170 enkäter ut till sjuksköterskor och distriktssköterskor arbetande inom regionstyrd och privatägd primärvård i Mellansverige. Svarsfrekvens: 58%. Använda instrument var; Factors perceived stress symptoms, Thriving Scale, Copenhagen Psychosocial Questionnaire Version III. Huvudresultat: Resultatet visar starkt samband mellan ökad konflikt mellan arbete och privatliv och sämre skattat symtom på stress, det innebär att variablerna samvarierar med varandra negativt. Högt arbetstempo korrelerar med stress-symtom negativt. Positiv korrelation sågs mellan upplevelsen att känna stolthet över sin organisation och välbefinnande, vitalitet, lärande och blomstrande på arbetsplatsen. Vitalitet och lärande skattades högt, vilket indikerar hög nivå av thriving hos deltagarna. Slutsats: Flertal statistiskt signifikanta samband mellan psykosocial arbetsmiljö och välbefinnande konstaterades. Det innebär att den psykosociala arbetsmiljön samvarierar med primärvårdssköterskans välbefinnande. Resultatet understryker vikten av att organisationer prioriterar att skapa ett hållbart arbetsliv för att välbefinnandet ska bevaras och förbättras. / Introduction: Statistics show that 8% of all licensed nurses do not work in healthcare. Causes are high workload and work-related stress. Previous research presents that workplaces proactively work for the well-being of staff have more prosperous employees. Without the feeling of well-being of the nurse, patient safety and the quality of care will be worse. Aim: Aim to describe the primary care nurse’s assessment of the psychosocial work environment and well-being and study the relationship between these variables. Method: A quantitative cross-sectional study with descriptive and correlational design. A total of 170 questionnaires were sent out to nurses and district nurses working in regionally managed and privately owned primary care in Central Sweden. Response rate: 58%. Instrument used; Factors perceived stress symptoms, Thriving Scale, Copenhagen Psychosocial Questionnaire Version III. Result: Strong correlation between high work-privacy conflicts and higher stress symptoms were seen, this means the variables co-vary negatively. High work pace correlates negatively with stress symptoms. Positive correlation was seen between feeling pride in the organization and well-being, vitality, learning and thriving at the workplace. Vitality and learning were rated high, which indicates high levels of thriving. Conclusion: Several statistically significant relationships between psychosocial work environments and well-being were found. This implies that psychosocial work environment affects primary care nurse’s well-being. It underlines the importance of organizations prioritizing creating a sustainable work environment for the well-being to be preserved and improved.

Alcohol abuse has been a major burden on the society. In the fight against it a key issue the education of the primary care nurses has been ignored. This study evaluates the effect of education program on the attitudes, beliefs, and confidence levels of primary care nurses regarding alcohol abuse and its treatment. Data from the Project Mainstream educational intervention were used with permission from the investigators. Two hundred one students and faculty of nursing at Vanderbilt University participated in the intervention, which was designed to train primary care providers in the Brief Negotiated Intervention technique for early detection and treatment of alcohol problems. Participants completed questionnaires before and after the educational intervention. Analysis of the data using paired samples t-test and one way analysis of variance showed statistically significant positive change in the nurses' attitudes, beliefs, and confidence levels regarding alcohol abuse and its treatment after the educational intervention. This study has shown the importance of educational intervention in dealing with alcohol abuse.

Bakgrund: Övervikt och fetma ökar i världen och är ett vanligt förekommande folkhälsoproblem. Konsekvenser hos patienten är en försämrad livskvalité och ökad risk av att drabbas av följdsjukdomar. Distriktssköterskor och sjuksköterskor inom primärvården kan ge stöd till patienter med övervikt att genomgå livsstilsförändringar genom att identifiera riskfaktorerna som patienterna har och främja hälsa. Syfte: Syftet med studien var att beskriva primärvårdssköterskors erfarenheter av att möta och motivera patienter med övervikt till livsstilsförändringar. Metod: En beskrivande design med en kvalitativ induktiv ansats har använts. Datainsamlingen genomfördes via semistrukturerade intervjuer med nio deltagare som var både distriktsköterskor och sjuksköterskor som arbetade inom primärvården och hade erfarenhet av att möta och motivera patienter med övervikt till livsstilsförändringar. Intervjuerna analyserades med hjälp av en kvalitativ innehållsanalys. Huvudresultat: Primärvårdssköterskorna beskrev att de arbetade med att motivera patienter med övervikt till livsstilsförändringar men att det inte gjordes i den utsträckning som önskades. Primärvårdssköterskorna hade ett personcentrerat förhållningsätt, en helhetssyn kring patienterna och det var viktigt i patientbemötandet. Att tala om övervikt var ett svårt och stigmatiserat ämne och de ville inte vara för rak på sak med att ta upp det med patienten. Tidsbristen var en anledning. Om patienterna sökte vård för ett problem så blev det lätt fokus på enbart det. Det fanns tid och utrymme att diskutera med patienter för de primärvårdssköterskor som hade specialistmottagningar för diabetes och hypertoni. Slutsats: Primärvårdssköterskorna beskrev att samtal om övervikt var stigmatiserat och att de upplevde behovet av en bättre struktur, mer tid och resurser i arbetet med att motivera patienter med övervikt till livsstilsförändringar. / Background: Obesity is increasing in the world, and it is a common public health problem. Consequences for the patient are that it entails an increased risk of suffering from sequelae and a poorer quality of life. District nurses and nurses in primary care can provide support to patients with obesity to undergo lifestyle changes by identifying the risk factors that the patients have and promote health. Purpose: The purpose of this study was to describe primary care nurses' experiences of meeting and motivating patients with obesity to lifestyle changes. Method: A descriptive design with a qualitative inductive approach has been used. The data collection was conducted through semi-structured interviews with nine participants who were either district nurses or nurses who worked in primary care and who had experience of meeting and motivating patients with obesity to lifestyle changes. The interviews were analyzed using a qualitative content analysis. Result: The primary care nurses described they motivated patients with obesity to lifestyle changes but that was not done to the extent they desired. Talking about obesity was difficult and stigmatized subject and the nurseswere very careful not to be too straight to the point about bringing it up with the patient. The primary nurses found it better to approach the subject with caution and that it was better to create a relationship with the patient and they also sought to have a suitable amount of time for this discussion. As patients sought health care for a problem, it was easy and comfortable to just focus on one problem and not see the bigger picture. The primary care nurses who had specialist receptions for diabetes and hypertensiondescribed that they had time to discuss lifestyle changes with patients. They had a person-centred approach, a holistic view of the patients and this was important for the treatment of their patients. Conclusion: The primary care nurses described that talking about obesity was stigmatized and that they felt the need for a better structure, more time and resources in the work of motivating overweight patients to make lifestyle changes.Keywords: Experiences, lifestyle change, motivation, obesity, primary care, prim