Health and quality of care from older peoples' and formal caregivers' perspective

Aim: The overall aim of this thesis was to gain a deeper understanding of older people's view of health and care while dependent on community care. Furthermore to describe and compare formal caregivers' perceptions of quality of care, working conditions, competence, general health, and factors associated with quality of care from the caregivers' perspective. Method: Qualitative interviews were conducted with 19 older people in community care who were asked to describe what health and ill health((I), good and bad care meant for them (II). Data were analyzed using content analysis (I) and a phenomenological analysis (II). The formal caregivers; 70 nursing assistants (NAs) 163 enrolled nurses (ENs) and 198 registered nurses (RNs), answered a questionnaire consisting of five instruments: quality of care from the patient's perspective modified to formal caregivers, creative climate questionnaire, stress of conscience, health index, sense of coherence and items on education and competence (III). Statistical analyses were performed containing descriptive statistics, and comparisons between the occupational groups were made using Kruskal-Wallis ANOVA, Mann-Whitney U-test and Pearson's Chi-square test (III). Pearson's  product moment correlation analysis and multiple regression analysis were performed studying the associations between organizational climate, stress of conscience, competence, general health and sense of coherence with quality of care (IV). Results: The older people's health and well-being were related to their own ability to adapt to and compensate for their disabilities and was described as negative and positive poles of autonomy vs. dependence, togetherness vs. being an onlooker, security vs. insecurity and tranquility vs. disturbance (I).  The meaning of good care (II) was that the formal caregivers respected the older people as unique individuals, having the opportunity to live their lives as usual and receiving a safe and secure care. Good care could be experienced when the formal caregivers had adequate knowledge and competence in caring for older people, adequate time and continuity in the care organization (II). Formal caregivers reported higher perceived quality of care in the dimensions medical-technical competence and physical-technical conditions than in identity-oriented approach and socio-cultural atmosphere (III). In the organizational climate three of the dimensions were close to the value of a creative climate and in seven near a stagnant climate. The formal caregivers reported low rate of stress of conscience. The RNs reported to a higher degree than the NAs/ENs a need to gain more knowledge, but the NAs and the ENs more often received training during working hours. The RNs reported lower emotional well-being than the NAs/ENs (III). The formal caregivers' occupation, organizational climate and stress of conscience were associated with perceived quality of care (IV). Implications: The formal caregivers should have an awareness of the importance of kindness and respect, supporting the older people to retain control over their lives. The nursing managers should employ highly competent and adequate numbers of skilled formal caregivers, organize formal caregivers having round the clock continuity. Improvements of organizational climate and stress of conscience are of importance for good quality of care.

The Place of Writing in the Poetry of W. B. Yeats and Patrick Kavanagh

Abstract This article addresses the theme of place in the poetry of W. B. Yeats and Patrick Kavanagh, focusing on the concept of place as a physical and psychological entity. The article explores place as a creative force in the work of these two poets, in relation to the act of writing. Seamus Heaney, in his essay “The Sense of Place,” talks about the “history of our sensibilities” that looks to the stable element of the land for continuity: “We are dwellers, we are namers, we are lovers, we make homes and search for our histories” (Heaney 1980: 148-9). Thus, in a physical sense, place is understood as a site in which identity is located and defined, but in a metaphysical sense, place is also an imaginative space that maps the landscapes of the mind. This article compares the different ways in which Yeats and Kavanagh relate to their place of writing, physically and artistically, where place is understood as a physical lived space, and as a liberating site for an exploration of poetic voice, where the poet creates his own country of the mind.

Undersökande arbetssätt i NO-undervisningen i grundskolans tidigare årskurser

This thesis deals with the use of inquiry-based approaches in primary school science. The aim is to investigate the goals and purposes that are constituted by the curriculum and by the teachers in interviews and through their teaching in the classroom. The results are used to develop conceptual tools that can be used by teachers’ in their work to support students’ learning of science when using an inquiry-based approach. The thesis is comprised of four papers. In paper one a comparative analysis is made of five Swedish national curricula for compulsory school regarding what students should learn about scientific inquiry. In paper two 20 teachers were interviewed about their own teaching using inquiry. Classroom interactions were filmed and analyzed in papers three and four, which examine how primary teachers use the various activities and purposes of the inquiry classroom to support learning progressions in science. The results of paper one show how the emphasis within and between the two goals of learning to carry out investigations and learning about the nature of science shifted and changed over time in the different curricula. Paper two describes the selective traditions and qualities that were emphasized in the teachers’ accounts of their own teaching. The results of papers three and four show how students need to be involved in the proximate and ultimate purposes of the teaching activities for progression to happen. The ultimate purposes are the scientific purposes for the lesson (as given by the teacher or by the curriculum), whereas the proximate purposes are the more student-centered purposes that through different activities should allow the students to relate their own experiences and language to the ultimate purpose. The results show the importance of proximate purposes working as ends-in-viewin the sense of John Dewey, meaning that the students see the goal of the activity and that they are able to relate to their experiences and familiar language.

”Vi gör så gott vi kan” : Vårdpersonals upplevelser av amningsstöd till gravida ochnyblivna föräldrar

Amning, amningskomplikationer, stöd och råd vid amning är en del av den sexuella och reproduktiva hälsan och ingår i barnmorskans kompetensområde.Det finns mycket forskning som beskriver nyblivna föräldrars upplevelse av amningsstöd men inte lika mycket forskning på hur vårdpersonalen upplever amningsstödet som ges till gravida och nyblivna föräldrar. Syftet med denna studie var att undersöka vårdpersonals upplevelser av amningsstöd till gravida och nyblivna föräldrar.Studien utfördes genom en kvalitativ metod utifrån en induktiv ansats. Data hämtades från intervjuer med semistrukturerade frågor i 11 fokusgrupper. All data bearbetades genom kvalitativ, induktiv innehållsanalys.Resultatet i studien visade att vårdpersonal upplever amningsstödet de ger som en viktig del i deras arbete. Amningsstödet hade brister och en betydande brist uppgavs vara kontinuiteten av amningsstöd genom hela vårdkedjan.Informanterna ansåg att amningsstödet borde förbättras och många förslag nämndes för att främja amningen hos nyblivna föräldrar och barn.Denna studie kan öka medvetenheten av den egna och kollegornas upplevelse av amningsstöd vilket kan leda till ett bättre samarbete mellan enheterna och en bättre kommunikation samt förändringar i organisationen som gynnar och främjar amningen.

Sociologin i Grekland : från 1907 fram till Metaxas-diktaturen (1936–1940) och andra världskriget

Sociology in Greece from 1907 to the Metaxas dictatorship (1936–40) and the Second World War This paper focuses on pre-conditions for sociology to develop and the subject matters of emerging sociology in Greece. Pre-conditions were at hand but without continuity, and the opportunity for sociology to develop was lost. Sociology is said to have started in 1907 with the book The Social Question by Georgos Skliros. He presented sociology and Marxism as identical and deals with Greek society and (among other things) the language issue, all of which triggered off a vibrant debate. Sociological associations and journals were started. However, the initially reformist perspective of social science was gradually replaced by an approach that was more socio-philosophical, influenced by classical sociology, German sociology in particular. This turn was associated with the institutionalization of sociology at the universities during the 1920’s. The Metaxas dictatorship in 1936 put a stop to any further development of sociology for a long time.

What aspects of rehabilitation provision contribute to self-reported met needs for rehabilitation one year after stroke - amount, place, operator or timing?

BACKGROUND AND OBJECTIVE: To a large extent, people who have suffered a stroke report unmet needs for rehabilitation. The purpose of this study was to explore aspects of rehabilitation provision that potentially contribute to self-reported met needs for rehabilitation 12 months after stroke with consideration also to severity of stroke. METHODS: The participants (n = 173) received care at the stroke units at the Karolinska University Hospital, Sweden. Using a questionnaire, the dependent variable, self-reported met needs for rehabilitation, was collected at 12 months after stroke. The independent variables were four aspects of rehabilitation provision based on data retrieved from registers and structured according to four aspects: amount of rehabilitation, service level (day care rehabilitation, primary care rehabilitation and home-based rehabilitation), operator level (physiotherapist, occupational therapist, speech therapist) and time after stroke onset. Multivariate logistic regression analyses regarding the aspects of rehabilitation were performed for the participants who were divided into three groups based on stroke severity at onset. RESULTS: Participants with moderate/severe stroke who had seen a physiotherapist at least once during each of the 1st, 2nd and 3rd-4th quarters of the first year (OR 8.36, CI 1.40-49.88 P = 0.020) were more likely to report met rehabilitation needs. CONCLUSION: For people with moderate/severe stroke, continuity in rehabilitation (preferably physiotherapy) during the first year after stroke seems to be associated with self-reported met needs for rehabilitation.

The place of writing in the poetry of W.B Yeats and Patrick Kavanagh

This article addresses the theme of place in the poetry of W. B. Yeats and Patrick Kavanagh, focusing on the concept of place as a physical and psychological entity. The article explores place as a creative force in the work of these two poets, in relation to the act of writing. Seamus Heaney, in his essay “The Sense of Place,” talks about the “history of our sensibilities” that looks to the stable element of the land for continuity: “We are dwellers, we are namers, we are lovers, we make homes and search for our histories” (Heaney 1980: 148-9). Thus, in a physical sense, place is understood as a site in which identity is located and defined, but in a metaphysical sense, place is also an imaginative space that maps the landscapes of the mind. This article compares the different ways in which Yeats and Kavanagh relate to their place of writing, physically and artistically, where place is understood as a physical lived space, and as a liberating site for an exploration of poetic voice, where the poet creates his own country of the mind.

Omvårdnadspersonals upplevelser av vård i livets slutskede : En kvalitativ intervjustudie

Syftet: Syftet med studien var att beskriva hur omvårdnadspersonal inom kommunens särskilda boende och korttidsboende upplever att vårda personer i livets slutskede.Metod: Studien bygger på åtta kvalitativa intervjuer med undersköterskor. Datainsamlingsmetoden baserades på Critical Incident Technique och som analysmetod användes kvalitativ innehållsanalys. Resultat: I intervjuerna framkom att samarbetet till de övriga i teamet och närstående hade en stor och avgörande betydelse för hur vården utvecklades. Omvårdnadspersonalen kände ibland att sjuksköterskan saknades i vissa omvårdnadssituationer. Fördelning av personal under dygnet bidrog till kontinuitet i samverkan. De upplevde att olika faktorer i miljön kunde vara både till hjälp eller till hinder i samspelet till den döende och närstående. De intervjuade talade också om vikten av att respektera patientens vilja. Omvårdnadspersonalen gav även stöd till de närstående och de kom familjerna nära. De upplevde att närvaro utan krav och stress var av betydelse för interaktionen till den döende och dess närstående. Det var viktigt att både den döende och de närstående var tillfreds med symtomlindringen. Det var viktigt att få ge ett värdigt omhändertagande efter döden. Slutsats: Det genomgåendet temat visade att interaktion och samverkan med vårdteamet, närstående och patienten var av avgörande betydelseför hur vården i livets slut skulle bli trygg och värdig.

Patienters upplevelser av vilka faktorer som har betydelse i vården på specialistsjuksköterskeledda hjärtsviktsmottagningar. : En kvalitativ studie

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.

En översikt av vilka faktorer som har samband med patientens upplevelse av kontinuitet i vården : En litteraturstudie

Forskning visar på att patienter önskar kontinuitet, då de upplever att det bidrar till känslan av trygghet och närhet. Det ger sjuksköterskan möjlighet att lära känna personen och en möjlighet att bättre följa upp gjorda åtgärder. Syfte Syftet med denna studie var att beskriva vilka faktorer som har samband med patientens upplevelse av kontinuitet i vården. Metod Studien har genomförts som en litteraturstudie. Resultat Resultatet visade att det var viktigt för kontinuiteten att de fick träffa en sjuksköterska som de kände sedan tidigare och att det var samma sjuksköterska vid alla vårdtillfällen. Det var även viktigt att sjuksköterskan de träffade var uppdaterad på deras medicinska historia. En viktig faktor som höjde kontinuiteten var om patienten hade en kronisk sjukdom, då de patienterna oftare kräver regelbunden uppföljning med fler besök hos vården. Patienterna upplevde större kontinuitet om vården utfördes av sjuksköterska istället för av andra vårdgivare Sjuksköterskorna var mer anpassningsbara, flexibla och tog sig mer tid med patienten. Slutsats Studien visar att kontinuitet är något som patienter upplever som viktigt när de möter vården men det saknas forskning om hur vården ska organiseras, för att kontinuiteten ska upplevas bättre ur ett patientperspektiv, balanserat mot organisationens behov av att spara tid och pengar.

KONTAKTMANNASKAP INOM HEMTJÄNSTEN : EN KVALITATIV STUDIE AV KONTAKTMANNASKAP OCH DESS MÖJLIGHET TILL BRUKARINFLYTANDE

The present study's purpose was to investigate the home care staff's experiences of working as key workers, which factors they consider is relevant to key working and what obstacles and opportunities they experience in their work as a key worker. The study also focused on how the home care staff perceive that key working can enable user influence. A qualitative approach was used and the material for the study was collected through semi-structured interviews. The result shows that there are areas for improvement that may develop key working. The study shows that the staff generally feel that working as a key worker works well and that it can enable user influence in many areas. The study finally illustrates factors such as continuity, working relationship oriented, and taking responsibility, as significant for key working to work as successfully as possible.

‘Moving on’ : Violence, wellbeing and questions about violence in antenatal care encounters. A qualitative study with Somali-born refugees in Sweden

Background Somali-born women constitute one of the largest groups of childbearing refugee women in Sweden after more than two decades of political violence in Somalia. In Sweden, these women encounter antenatal care that includes routine questions about violence being asked. The aim of the study was to explore how Somali-born women understand and relate to violence and wellbeing during their migration transition and their views on being approached with questions about violence in Swedish antenatal care. Method Qualitative interviews (22) with Somali-born women (17) living in Sweden were conducted and analysed using thematic analysis. Findings A balancing actbetween keeping private life private and the new welfare system was identified, where the midwife's questions about violence were met with hesitance. The midwife was, however, considered a resource for access to support services in the new society. A focus on pragmatic strategies to move on in life, rather than dwelling on potential experiences of violence and related traumas, was prominent. Social networks, spiritual faith and motherhood were crucial for regaining coherence in the aftermath of war. Dialogue and mutual adjustments were identified as strategies used to overcome power tensions in intimate relationships undergoing transition. Conclusions If confidentiality and links between violence and health are explained and clarified during the care encounter, screening for violence can be more beneficial in relation to Somali-born women. The focus on “moving on” and rationality indicates strength and access to alternative resources, but needs to be balanced against risks for hidden needs in care encounters. A care environment with continuity of care and trustful relationships enhances possibilities for the midwife to balance these dual perspectives and identify potential needs. Collaborations between Somali communities, maternity care and social service providers can contribute with support to families in transition and bridge gaps to formal social and care services.

The hand of God is over their hands (Q. 48:10) : on the notion of covenant in al-Ṭabarī’s account of Karbalāʾ

This article is an analysis of the story of the killing of Ḥusayn b. ʿAlī at Karbalāʾ in 61/680, as it is presented by Abū Jaʿfar Muḥammad b. Jarīr al-Ṭabarī (d. 310/923). The main argument is that the notion of the divine covenant, which permeates the Qur’an, constitutes a framework through which al-Ṭabarī views this event. The Qur’anic idea of the covenant is read in structural/thematic continuity with the Hebrew Bible account of the covenant between Yahweh and the Hebrew people, which has, in turn, been traced back in its basic form to Late Bronze Era treaties between rulers and their vassals.   The present study focusses on four speeches ascribed to Ḥusayn during the encounter he and his group had with the vanguard of the Kūfan army led by al-Ḥurr. These are analysed in accordance with their use of Qur’anic covenant vocabulary. They are also categorised within the broader framework of the eight standard characteristics of Ancient West Asian and Biblical covenants, as presented by George Mendenhall and Gary Herion, which have recently been developed in a Qur’anic context by Rosalind Ward Gwynne. This article argues that al-Ṭabarī’s Karbalāʾ narrative presents the pact of loyalty to Ḥusayn as a clear extension of the divine covenant.

Faktorer som påverkar patienters upplevelse av omvårdnad under sin vistelse på akutmottagning. : - En litteraturstudie

Bakgrund: På en akutmottagning kommer patienter i olika tillstånd och behov. Det är sjuksköterskan som ofta gör de första bedömningarna och därför är det av stor vikt att bemötandet från sjuksköterskan är positivt för att skapa trygghet. Ökat patientflöde och långa väntetider är några faktorer som är påvisade att kunna påverka upplevelsen för patienterna av sin vistelse på akutmottagningen. Syfte: Syftet med litteraturöversikten var att beskriva faktorer som påverkar patienters upplevelse av omvårdnad under sin vistelse på akutmottagning. Metod: Studien genomfördes som en litteraturöversikt. Databaserna CINAHL och PubMed användes för att söka efter artiklar. Resultat: Sex underkategorier valdes ut: bemötande, delaktighet, information, väntetid, kommunikation och kontinuitet, sjuksköterskans kunskap och kompetens. Resultatet visade att många patienter ansåg att sjuksköterskan var skicklig i sina arbetsuppgifter och var nöjda med bemötandet från sjuksköterskan, men att långa väntetider och bristande information påverkade upplevelsen av omvårdnad. Det fanns en tydlig önskan över att få mer information om sin väntetid, behandling och undersökningar. Brister i detta, skapade en otrygghet och en känsla av vara bortglömd hos patienterna. Slutsats: Sjuksköterskor på en akutmottagning behöver besitta en stor kommunikationsförmåga. Detta för att kunna ge patienterna en så bra upplevelse som möjligt. Slutsatser av resultatet har påvisat att det krävs förbättring inom flera områden för att ge patienter en bättre upplevelse av omvårdnaden under sin vistelse på akutmottagningen.

Process evaluation of a knowledge translation intervention using facilitation of local stakeholder groups to improve neonatal survival in the Quang Ninh province, Vietnam

BACKGROUND: Annually, 2.8 million neonatal deaths occur worldwide, despite the fact that three-quarters of them could be prevented if available evidence-based interventions were used. Facilitation of community groups has been recognized as a promising method to translate knowledge into practice. In northern Vietnam, the Neonatal Health - Knowledge Into Practice trial evaluated facilitation of community groups (2008-2011) and succeeded in reducing the neonatal mortality rate (adjusted odds ratio, 0.51; 95 % confidence interval 0.30-0.89). The aim of this paper is to report on the process (implementation and mechanism of impact) of this intervention. METHODS: Process data were excerpted from diary information from meetings with facilitators and intervention groups, and from supervisor records of monthly meetings with facilitators. Data were analyzed using descriptive statistics. An evaluation including attributes and skills of facilitators (e.g., group management, communication, and commitment) was performed at the end of the intervention using a six-item instrument. Odds ratios were analyzed, adjusted for cluster randomization using general linear mixed models. RESULTS: To ensure eight active facilitators over 3 years, 11 Women's Union representatives were recruited and trained. Of the 44 intervention groups, composed of health staff and commune stakeholders, 43 completed their activities until the end of the study. In total, 95 % (n = 1508) of the intended monthly meetings with an intervention group and a facilitator were conducted. The overall attendance of intervention group members was 86 %. The groups identified 32 unique problems and implemented 39 unique actions. The identified problems targeted health issues concerning both women and neonates. Actions implemented were mainly communication activities. Communes supported by a group with a facilitator who was rated high on attributes and skills (n = 27) had lower odds of neonatal mortality (odds ratio, 0.37; 95 % confidence interval, 0.19-0.73) than control communes (n = 46). CONCLUSIONS: This evaluation identified several factors that might have influenced the outcomes of the trial: continuity of intervention groups' work, adequate attributes and skills of facilitators, and targeting problems along a continuum of care. Such factors are important to consider in scaling-up efforts.