This research explored older Slovenians’ occupations, including the ways in which the transition into a care home influenced their occupational engagement. The research encompassed three stages. Stage 1 investigated Slovenian older people’s individual experiences of occupational engagement, with a particular emphasis on their personally meaningful occupations. Stage 2 aimed to enhance understanding of the impact of transition into a care home on older Slovenians’ meaningful occupations. Finally, Stage 3 sought to provide an insight into older people’s occupational engagement in one Slovenian care home. The first two stages of this research took a phenomenological approach; focusing on the participants’ individual experiences of occupational engagement; using Interpretative Phenomenological Analysis (IPA) to approach and analyse the data. Ten older adults were interviewed in Stage 1 and six older adults were interviewed in Stage 2 at three time points: before the relocation into a care home, one month after and six months after the relocation. The final stage was ethnographic in nature; exploring occupational engagement among Slovenian care home residents as a culture-sharing group; using observations for collecting the data and analysing the resulting field notes using Thematic Analysis. The findings consistently highlighted the significance of occupations and routines in participants’ everyday lives as important parts of their identities. The first two stages highlighted the importance of a continuous experience of meaning in occupation, across participants’ lives and throughout their transition into a care home. Some of these meanings were specific to Slovenian socio-cultural, historic and geographical context. The participants especially valued productive occupations such as gardening, family-related occupations such as looking after and passing knowledge to younger generations and occupations related to particular places, such as spending time at their weekend cottages and home surroundings, walking familiar pathways or hiking Slovenian mountains. These Slovenian older adults purposefully engaged in health-promoting occupations in order to maintain their health, in turn influencing their occupational engagement. Since their everyday routines were related to particular places, Stages 2 and 3 highlighted that some of these occupations were disrupted by their new living environment. The care home residents managed this situation by trying to maintain their engagement in occupations that they perceived personally meaningful and enjoyable. This research is foundational in the Slovenian context, with the findings also being transferrable to individuals and contexts outside Slovenia. From exploring the impact of older people’s living environments on their meaningful occupational engagement, the findings contribute original knowledge to occupational science regarding the link between occupation, place, identity and the transactional perspective of occupation. This indicates the need to develop further therapeutic programmes and services for older people making the transition to care home living.

Bakgrund: En ny lag om samverkan vid utskrivning från sjukhus infördes 2018. Varje patient med behov av uppföljning skulle tilldelas en fast vårdkontakt. Inom regioner och kommuner reviderades eller upprättades hemsjukvårdsavtal för att förtydliga vilken aktör som ansvarade för patienterna efter sjukhusvistelse. Detta innebar att ansvarsfördelningen av patienters tillhörighet kom att förändras. Uppföljning under första året, visar att den fasta vårdkontakten inom primärvården ofta fallit på en sjuksköterska och att oklarheter om vad den rollen innebar inte är helt klarlagd. Syfte: Syftet var att undersöka hur ett nytt hemsjukvårdsavtal påverkat arbetssituationen på hälsocentraler i en norrländsk region. Metod: Kvalitativ metod med semistrukturerade intervjuer av sjuksköterskor och distriktssköterskor i primärvård. Innehållsanalys användes. Resultat: Innehållsanalysen mynnade ut i tre kategorier: samverkan, belastning och inflytande. Samarbetet med kommunen hade påverkats och det nya hemsjukvårdsavtalet upplevdes svårtolkat vilket kunde leda till konflikter. Deltagarna uttryckte frustration över situationen på olika sätt och arbetsbelastningen hade ökat. Inflytandet över patienternas omvårdnad och möjligheten till egna bedömningar i omvårdnadsprocessen hade minskat. Deltagarna upplevde att deras helhetsbild av patienterna hade försämrats trots att avtalet inneburit bättre kännedom om patienterna. Diskussion: Deltagarna gav uttryck som indikerade delvis frånvaro av KASAM inom organisation. Forskning visar att utbildning och medverkan av berörd personal vid införande av nya arbetsmetoder har givit bättre resultat än när de inte tillfrågats. Slutsats: Personal bör göras delaktiga i processen kring organisationsförändringar. Dels för att göra syftet med förändringen mer begriplig för dem, dels för att ta tillvara kompetensen som personalen besitter. / Background: In 2018 a new law about cooperation during discharge planning was implemented. All patients with the need for monitoring after discharge were to be given a care contact. New agreements were made or redeveloped between the communities and the primary health care. All to establish clear boundaries of responsibility. This changed the way the responsibilities were distributed. A follow-up during the first year, showed that the care contact often fell on a nurse in primary care. The actual role of this contact was not satisfactory clear though. Aim: The aim was to examine how a new agreement regarding home care effected the work situation in primary care settings in northern Sweden. Method: Qualitative method with semi structured interviews with registered nurses and district nurses in primary health care units. Content analysis was used. Result: Three main subjects were recognized, cooperation, strain and influence. The cooperation with the community had changed. The new agreement felt difficult to understand which could lead to arguments. The participants felt frustrated. The workload had increased, and the participant’s influence had diminished. They expressed that the larger picture of the patients was lower even though they knew more about specific details concerning the patients they responsible over. Discussion: The participants expressed low SOC towards the new agreement. Studies show that inclusion of the persons it concerns have greater success during reorganizations. Conclusion: Staff should be made a part of the process around organizational changes. Partly to make the aim of the changes more understandable to them, partly to make use of the competence of the staff. / <p>Godkännandedatum: 2020-01-16</p>

Ziel der vorliegenden Masterarbeit ist die Entwicklung von Qualitätsindikatoren für den Prozess „Empfehlungen der Apotheke zur Weiterführung der Medikation“ im Klinikum Mutterhaus. Damit soll ein Instrument entwickelt werden, das patientenbezogene Dienstleistungen der Krankenhausapotheker an der intersektoralen Schnittstelle im Hinblick auf das Qualitätsziel Arzneimitteltherapiesicherheit messen und bewerten kann. Schwachstellen und Verbesserungspotentiale über den Verantwortungsbereich der Apotheke hinaus sollen identifiziert und in einen kontinuierlichen Verbesserungsprozess eingebracht werden können. Methodik: Zur Entwicklung der Qualitätsindikatoren wurde ein mehrstufiges Verfahren gewählt. Zunächst wurden die Qualitätsziele des Prozesses definiert und eine Prozessanalyse durchgeführt. Die Literaturrecherche auf nationaler und internationaler Ebene gab Anhaltspunkte zur Ableitung von Qualitätsindikatoren. Basierend auf der Prozessanalyse und der Literaturrecherche wurden Qualitätsindikatoren für den Prozess „Empfehlungen der Apotheke zur Weiterführung der Medikation“ entwickelt. Anhand einer retrospektiven Datenerhebung wurden die entwickelten Qualitätsindikatoren auf ihre Aussagekraft und Eignung geprüft. Der Prozess wurde mit Hilfe der Qualitätsindikatoren gemessen und bewertet. Schlussfolgerung: Mit Hilfe von fünf Qualitätsindikatoren-Sets kann der Prozess „Empfehlungen der Apotheke zur Weiterführung der Medikation“ umfassend untersucht werden. Die entwickelten Qualitätsindikatoren sind geeignet, die pharmazeutische Dienstleistung im Hinblick auf das Qualitätsziel Arzneimitteltherapiesicherheit zu messen und zu bewerten. Sie ermöglichen die Evaluation des Prozesses und zukünftiger Verbesserungsmaßnahmen. Anhand der Qualitätsindikatoren wird zukünftig ein Monitoring der Dienstleistung möglich sein. / Purpose: The aim of this thesis is the development of quality indicators for the process "recommendations of the pharmacy to continue patient’s medication" at Klinikum Mutterhaus. An instrument is to be developed that can measure and rate the patient-related services of the hospital pharmacist at the intersectoral interface in terms of quality target in medication safety. Weaknesses and potential improvements should be identified and incorporated into a continuous improvement process. Methods: A multistage process is selected for the development of the quality indicators. First, the quality objectives of the process are defined and a process analysis is performed. A literature review on national and international level shall provide evidence for the derivation of quality indicators. Based on the process analysis and the literature review the quality indicators for the "Recommendations of the pharmacy to continue patient`s medication” are developed. In a retrospective data collection, the developed quality indicators are tested for their validity and suitability. The process is finally measured by the quality indicators and evaluated. Conclusion: With the help of five quality indicator sets the process "recommendations of the pharmacy to continue patient’s medication" can be fully investigated. The developed quality indicators are suitable to measure and evaluate the process in terms of the quality target medication safety. So the evaluation of the process and future improvements are possible. On the basis of the quality indicators a monitoring of the process can be established in the future.

Ziel der vorliegenden Masterarbeit ist die Entwicklung von Qualitätsindikatoren für den Prozess „Empfehlungen der Apotheke zur Weiterführung der Medikation“ im Klinikum Mutterhaus. Damit soll ein Instrument entwickelt werden, das patientenbezogene Dienstleistungen der Krankenhausapotheker an der intersektoralen Schnittstelle im Hinblick auf das Qualitätsziel Arzneimitteltherapiesicherheit messen und bewerten kann. Schwachstellen und Verbesserungspotentiale über den Verantwortungsbereich der Apotheke hinaus sollen identifiziert und in einen kontinuierlichen Verbesserungsprozess eingebracht werden können. Methodik: Zur Entwicklung der Qualitätsindikatoren wurde ein mehrstufiges Verfahren gewählt. Zunächst wurden die Qualitätsziele des Prozesses definiert und eine Prozessanalyse durchgeführt. Die Literaturrecherche auf nationaler und internationaler Ebene gab Anhaltspunkte zur Ableitung von Qualitätsindikatoren. Basierend auf der Prozessanalyse und der Literaturrecherche wurden Qualitätsindikatoren für den Prozess „Empfehlungen der Apotheke zur Weiterführung der Medikation“ entwickelt. Anhand einer retrospektiven Datenerhebung wurden die entwickelten Qualitätsindikatoren auf ihre Aussagekraft und Eignung geprüft. Der Prozess wurde mit Hilfe der Qualitätsindikatoren gemessen und bewertet. Schlussfolgerung: Mit Hilfe von fünf Qualitätsindikatoren-Sets kann der Prozess „Empfehlungen der Apotheke zur Weiterführung der Medikation“ umfassend untersucht werden. Die entwickelten Qualitätsindikatoren sind geeignet, die pharmazeutische Dienstleistung im Hinblick auf das Qualitätsziel Arzneimitteltherapiesicherheit zu messen und zu bewerten. Sie ermöglichen die Evaluation des Prozesses und zukünftiger Verbesserungsmaßnahmen. Anhand der Qualitätsindikatoren wird zukünftig ein Monitoring der Dienstleistung möglich sein. / Purpose: The aim of this thesis is the development of quality indicators for the process "recommendations of the pharmacy to continue patient’s medication" at Klinikum Mutterhaus. An instrument is to be developed that can measure and rate the patient-related services of the hospital pharmacist at the intersectoral interface in terms of quality target in medication safety. Weaknesses and potential improvements should be identified and incorporated into a continuous improvement process. Methods: A multistage process is selected for the development of the quality indicators. First, the quality objectives of the process are defined and a process analysis is performed. A literature review on national and international level shall provide evidence for the derivation of quality indicators. Based on the process analysis and the literature review the quality indicators for the "Recommendations of the pharmacy to continue patient`s medication” are developed. In a retrospective data collection, the developed quality indicators are tested for their validity and suitability. The process is finally measured by the quality indicators and evaluated. Conclusion: With the help of five quality indicator sets the process "recommendations of the pharmacy to continue patient’s medication" can be fully investigated. The developed quality indicators are suitable to measure and evaluate the process in terms of the quality target medication safety. So the evaluation of the process and future improvements are possible. On the basis of the quality indicators a monitoring of the process can be established in the future.

No description available.

Introduction Transition care clinics (TCCs) have proven to be effective in meeting the time-sensitive needs of patients in the post-discharge period and ensuring smooth transitions of patients from hospital to home. These clinics have led to lower readmissions, lower emergency department visits, cost savings, and lower rates of other adverse events following discharge. However, TCCs, including the East Tennessee State University Family Medicine (ETSU-FM) TCC have been facing high rates of patient no-shows. Aim The aim of this dissertation is to identify the different components and outcomes of TCC based on the literature. We further aim to analyze the TCC implementation process at the ETSU-FM clinic, identify gaps, and provide recommendations to address those gaps. Methods A scoping review was conducted using three databases (PubMed, Web of Science, and PsycINFO) searches while following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews Checklist to identify different components of TCCs and the associated outcomes. Additionally, a mixed-methods study was conducted using patients and providers from the ETSU-FM clinic to identify different factors associated with patients’ no-shows to scheduled TCC appointments. Results Eighteen studies were analyzed and TCC components and patients’ outcomes were assessed. Predischarge communication with patients and caregivers, early post-discharge contacts, etc. were identified as some of the effective components of TCC. Our review also highlighted that TCC resulted in lower readmissions, lower ED visits, and cost-effectiveness. For the mixed-methods study, we included 520 patients in our quantitative analysis and interviewed 10 providers for the qualitative analysis. Several patient-level and system-level factors were found to be associated with TCC no-shows. A few of the factors that were deemed modifiable by the clinic have been identified and recommendations provided accordingly. Conclusion TCCs play a vital role in ensuring smooth care transitions of patients following discharge. It is crucial to conduct context-level studies to identify factors that are associated with TCC no-shows and design interventions accordingly. Doing so could lead to pursuit of the triple aim of healthcare: improving patients’ experience of care, improving the health of populations, and reducing the per capita cost of health care.