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- Jönsson, Marie, 1966-
(författare)
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Everyday activities in older adults readmitted to hospital
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The coordination of health care and social care at discharge are particularly important for older adults with complex health and social needs, as approximately 30 % of these persons are readmitted to hospital on an unplanned basis within three months of discharge. In order to provide adequate care for this group of older adults, we need a deeper understanding of their experiences regarding their functional ability at hospital and at home.The overall aim of this thesis was to describe older readmitted adults in terms of their abilities at hospital, everyday activities at home and of healthcare professionals’ conception of the care of older adults. Four studies were conducted using descriptive design. Data were gathered using four different methods of data collection. In this thesis, older readmitted adults are, defined as persons aged 75 years or older who have been readmitted to hospital on an unplanned basis three or more times within 12 months. In Study I, older adults readmitted to hospital (n=60), were assessed regarding personal activities of daily living, cognitive function, risk of falls, pressure sores and malnutrition. They were compared with samples from the general population. In order to describe everyday activities at home, semi-structured interviews were carried out with older readmitted adults (n=16) in Study II, and with close relatives (n=20) in Study III. In Study IV, focus group interviews were performed with healthcare professionals (n=29) about care at discharge and which measures that may be appropriate in order to prevent readmission.The major findings were that the participants had a higher risk of pressure sores, falls and dependency on ADL at hospital compared to age-matched samples. 40% of the participants had a cognitive limitation. At home, older adults strived to perform everyday activities but the ability was limited. Close relatives described that social relations were fundamental to perform everyday activities and social activities at home. Healthcare professionals stated that older readmitted adults were vulnerable. Multidisciplinary teamwork and geriatric expertise were fundamental but were perceived as lacking. Medical resources and rehabilitation resources should be developed and include rapid follow-up appointments at home in order to prevent readmission.Overall, health care and social care must identify this group and offer preventive assessments and interventions.
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| 2. |
- Sundqvist, Ann-Sofie, 1971-
(författare)
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Perioperative patient advocacy : having the patient's best interests at heart
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Patient advocacy implies taking action on someone else’s behalf, and has been described as a key element of nurses’ professional care. In the perioperative setting, it involves not only critical decision making, but also all the small things that the nurses do for the sake of the patients during their working day. Since previous research on the advocacy role of a registered nurse anesthetist (RNA) is sparse, and has not been conducted in a Swedish context, this thesis was intended to contribute to a greater understanding of advocacy in the perioperative context. The overall aim was therefore to explore the characteristics and consequences of perioperative patient advocacy (Study I), and to describe RNAs’ views of advocacy in anesthetic nursing through interviews (Study II), a questionnaire (Study III), and observations (Study IV).The synthesis of the characteristics and consequences of perioperative patient advocacy was interpreted in this thesis as the RNAs having the patient’s best interests at heart, in that they (1) had control of the situation, (2) preserved human values, and finally (3) were emotionally affected, as the results from the four studies suggested this as the core of perioperative patient advocacy.Perioperative patient advocacy is not always perceived as easy. In praxis, it is linked to the code of ethics outlined by the International Council of Nurses, which states that all registered nurses, regardless of their working context, shall respect human rights, promote health, prevent illness, and ensure that the individual receives accurate and sufficient information. This thesis elaborates on how this is done by describing how RNAs exert perioperative patient advocacy and how they interact in order to facilitate the best possible care for the patient. The results deepen the understanding of perioperative patient advocacy from the RNA’s perspective and contribute to a new insight in the RNA’s professional role.
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| 4. |
- Luhr, Kristina, 1959-
(författare)
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Patient participation from the patient's preferences, that's what counts
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Patient participation is a core element in legislation in most western countries today. From the patient’s perspective, patient participation includes respect, equality, sharing of knowledge, joint planning, and self-management. However, participation is not always experienced, and the patient’s experiences and preferences are seldom mapped.The general aim of this thesis was to enhance the knowledge on patient participation from the preferences of patients with long-term conditions in outpatient healthcare by evaluating a measure (The Patient Preferences for Patient Participation: the 4Ps) on patient participation and by investigating a self-management programme’s impact on patient participation.Qualitative evaluations of the 4Ps included Think Aloud interviews with patient experts (n = 11) and research experts (n = 10) in Study I. Psychometric evaluations were performed in Study II (n = 108) and after amendments in Study III (n = 150). Effects of the self-management programme on patient participation were investigated in a randomised controlled trial with the 4Ps as the outcome measure in Study III (n = 118), and in Study IV were influences investigated qualitatively in nine focus group interviews (n = 36).The 4Ps was found to be sufficiently valid and reliable. As measured with the 4Ps, patients with long-term conditions had both set preferences in and experiences of patient participation, regardless of randomised to a self-management programme or not. Qualitatively the programme was found to include patient participation and to influence self-management.The use of diverse methods was beneficial and complementary. The sufficiently valid and reliable 4Ps can fil the gap of a measure to map preferences for and experiences of patient participation. Patients with long-term conditions have set preferences for participation. The self-management programme can be applied to influence participation and future responsibilities.
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