| 1. |
- Ali, Lilas, 1981-, et al.
(författare)
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Effectiveness of Web-Based versus Folder Support Interventions for Young Informal Carers of Persons with Mental Illness : a Randomized Controlled Trial
- 2013
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Konferensbidrag (refereegranskat)abstract
- Background: Changes in psychiatric services mean more young persons have to care for a mentally ill family member or friend while they themselves are in the sensitive transition to adulthood.Objective: Compare the impact of two interventions, a web-based support and a folder support, for young persons who care for people who suffer from mental illness.Method: This study was a randomized control trial, following the CONSORT statements and eConsort support. Primary outcome variable was stress, and secondary outcome variables were caring situation, general self-efficacy, well-being, health, and quality of life of young informal carers (N=241). Data were collected in June 2010 to April 2011, with self-assessment questionnaires three times, four months apart, comparing the two interventions and also to detect changes.Results: The result showed that stress levels were high in both groups at baseline, but decreased significantly in the folder group. The folder group had significant improvement in their caring situation (also significantly different from the web group), general self-efficacy, well-being, and quality of life. The web group show significant increase in well-being.Conclusion: Young informal carers who take on the responsibility for people close to them with mental illness; suffer consequences on their own health. They live in a life-situation characterized by high stress and low well-being. This signals a need for support for these young persons.Clinical relevance: The findings in this study are uniquely valuable because of the target group and the comparison of two different interventions to support them. The non-significant differences in the data show that each intervention can be effective, and that it depends upon the individual’s preferences. This highlights the importance of adopting person-centred approach, in which young persons can themselves choose support strategy
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| 2. |
- Ali, Lilas, 1981, et al.
(författare)
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Support for young informal carers of persons with mental illness : A mixed-method study
- 2013
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Ingår i: Issues in Mental Health Nursing. - New York : Informa UK Limited. - 0161-2840 .- 1096-4673. ; 34:8, s. 611-618
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to explore how young (16-25 year old) informal carers of a person with a mental illness experience and use support. In a mixed method approach, we interviewed 12 young carers, and 241 completed a self-administered questionnaire. While the young carers strive to maintain control, their main support seems to be others in their lives, who often define the situation differently. The carers said web-support, counseling, and group counseling might be helpful, yet very few had any professional support. Young carers are greatly in need of support and it should be provided.
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| 3. |
- Ali, Lilas, 1981, et al.
(författare)
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Effectiveness of web-based versus folder support interventions for young informal carers of persons with mental illness: A randomized controlled trial
- 2014
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Ingår i: Patient Education and Counseling. - Shannon, Irland : Elsevier BV. - 0738-3991 .- 1873-5134. ; 94:3, s. 362-371
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: Compare the impact of two interventions, a web-based support and a folder support, for young persons who care for people who suffer from mental illness. Methods: This study was a randomized control trial, following the CONSORT statements, which compared the impact of two interventions. Primary outcome variable was stress, and secondary outcome variables were caring situation, general self-efficacy, well-being, health, and quality of life of young informal carers (N= 241). Data were collected in June 2010 to April 2011, with self-assessment questionnaires, comparing the two interventions and also to detect changes. Results: The stress levels were high in both groups at baseline, but decreased in the folder group. The folder group had improvement in their caring situation (also different from the web group), general self-efficacy, well-being, and quality of life. The web group showed increase in well-being. Conclusion: Young informal carers who take on the responsibility for people close to them; suffer consequences on their own health. They live in a life-situation characterized by high stress and low well-being. This signals a need for support. Practice implications: The non-significant differences show that each intervention can be effective, and that it depends upon the individual's preferences. This highlights the importance of adopting person-centered approach, in which young persons can themselves choose support strategy. © 2013 Elsevier Ireland Ltd.
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| 4. |
- Alwin, Jenny, 1978-, et al.
(författare)
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Health economic and process evaluation of AT interventions for persons with dementia and their relatives - A suggested assessment model
- 2007
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Ingår i: Technology and Disability. - 1055-4181. ; 19:2-3, s. 61-71
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Tidskriftsartikel (refereegranskat)abstract
- There is growing interest in assistive technology (AT) as a means of enabling participation in everyday activities for persons with dementia and their relatives. Health economic assessment of AT in dementia is of importance due to the consequences of the disease for both patients and relatives and to the high societal costs for dementia care. The aim of this article is to outline a model for assessment of AT interventions for persons with dementia. The model expands existing assessment models as it also includes evaluation of the intervention process. Methodological challenges and possibilities in making health economic assessments, including outcomes and costs, as well as process evaluation, are discussed in the article. © 2007 IOS Press. All rights reserved.
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| 5. |
- Alwin, Jenny, 1978-, et al.
(författare)
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Teknik för personer med demens : En utvärderingsstudie av teknikintervention för personer med demenssjukdom och deras närstående
- 2008
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Denna rapport är framtagen av Centrum för utvärdering av medicinsk teknologi (CMT), Institutionen för medicin och hälsa, vid Linköpings universitet på uppdrag av Hjälpmedelsinstitutet. Utvärderingsstudien1 som presenteras i rapporten har gjorts av en intervention som utvecklats inom ramen för projektet ”Teknik och Demens”.Författarna till rapporten vill tacka medarbetare i Teknik och Demensprojektet:Arbetsterapeuter på de kliniska enheterna: Barbro Askenborg, Carina Boström, Ulla Haraldson, Malin Lundberg, Anna Rosshagen, Sofia Starkhammar samt Inger Lindblad från Stockholms sjukhem och Margret Rosenberg från Arbetsterapeuterna primärvården Gästrikland.Medarbetare på FoU-enheterna: Ulla Johansson, Staffan Josephsson och Åke Seiger.Projektledningsgruppen: Susann Forsberg och Ingela Månsson från Hjälpmedelsinstitutet, Inge Dahlenborg från Demensförbundet och Kerstin Lundström från Alzheimerföreningen i Sverige.Vi vill även tacka Magnus Husberg, CMT, för konsultinsatser vad gäller analys och databehandling samt Olle Eriksson, LiU, som rådgivare vad gäller statistiska beräkningar. Tack till alla personer som bidragit med synpunkter på rapporten.Slutligen ett varmt tack till alla deltagare i Teknik och Demensprojektet som under studiens gång besvarat många frågor.Linköping 2008-04-22Jenny Alwin Jan Persson Barbro Krevers
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| 6. |
- Balducci, C, et al.
(författare)
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Negative impact and positive value in caregiving : Validation of the COPE index in a six-country sample of carers
- 2008
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Ingår i: The Gerontologist. - 0016-9013 .- 1758-5341. ; 48:3, s. 276-286
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The present study attempts to further validate the COPE Index on a large sample of carers drawn from six European countries. Design and Methods: We used a cross-sectional survey, with approximately 1,000 carers recruited in each of six countries by means of a common standard evaluation protocol. Our saturation recruitment of a designated quota of carers occurred by means of several channels, in identified geographical zones within countries. Interviews were carried out with primary informal carers by use of a common assessment tool. We subjected items of the COPE Index to principal component analysis and we assessed emergent components through the use of Cronbach's alpha reliability procedures. We examined factor components as summative scales for confirmatory correlations with caregiving and psychological variables. Results: Three components emerged, which we identified as the negative impact of caregiving, the positive value of caregiving, and the quality of support for caregiving. Internal consistency was good for negative impact and satisfactory for positive value and quality of support. Negative value was most consistently and strongly correlated with caregiving and psychological variables, although we did find diverse associations between these variables and the COPE Index subscales. Implications: The COPE Index is a brief, first-stage assessment of some sophistication that can enable health and social care professionals to develop appropriately targeted interventions to enhance the positive aspects of the caregiving experience and quality of support, as well as reduce the negative impacts of caregiving. Copyright 2008 by The Gerontological Society of America.
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| 7. |
- Broqvist, Mari, 1958-
(författare)
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Asking the public : Citizens´ views on priority setting and resource allocation in democratically governed healthcare
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Resource allocation in publicly funded healthcare systems is inevitably linked with priority setting between different patient groups and between different service areas, so-called meso level priorities. Behind every priority-setting decision (investments, reallocating or rationing), are values affecting both the content of the decisions and how the decisions are made. The importance for priority-setting to reflect social values, has been emphasised for the legitimacy of the healthcare systems and the decision makers. Also important, if supposed to provide enough guidance in practice, is that content values, expressed in ethical principles and criteria, are further operationalised. Few studies exist where Swedish citizens have been asked about priority setting and rationing at meso level, and findings from other countries cannot automatically be transferred to the Swedish context.The overall aim of this thesis is to extend and deepen the knowledge of the Swedish citizens´ views on acceptance of rationing in healthcare, on appropriate decision makers for rationing, and on the severity criterion for priority setting. Two qualitative and one mixmethod study were conducted, where citizens were interviewed. Citizens´ views on severity were also compared, both with a Severity Framework, derived from parliamentary-decided ethical principles and used for resource allocation, and with health professionals´ and politicians´ ranking of different aspects of severity in a quantitative, survey study.Study I shows that citizen participants perceived that acceptance of rationing at meso level is built on the awareness of priority-setting dilemmas between patient groups. No such spontaneous awareness was found. Depending on reactions of self-interest or solidarity, acceptance was also perceived to be built on acceptable principles for rationing and/or access to alternatives to public care. Study II shows that awareness of the meso level forms the basis for awareness of different risks of unfairness, linked with potential decision makers (even health professionals). Collaborative arrangements were promoted in order to control for such risks, especially the risk of self-interest. Politicians, in contrast to previous studies, were favoured as final decision makers for rationing healthcare. In study III, citizen participants identified the same severity aspects as health professionals and experts had done in the Severity Framework. They contributed with some possible refinements, but also promoted aspects not in line with established ethical criteria for priority setting in Sweden. Study IV shows that citizen respondents differ to a larger proportion compared to politicians´ ranking of severity aspects, than with that of health professionals´. The greatest number of significant differences was found between politicians and health professionals.This thesis has several implications. Politicians ought to strive for greater public awareness of the priority-setting dilemma at the meso level in healthcare, both according to the process and the content values behind the decisions. Social values not in accordance to the parliamentary decision indicate a need to facilitate an ongoing dialogue, reason-giving activities and promotion of content values of solidarity. To capture social values on priority setting and rationing, ambitious public deliberation is not the only way. Methodologically stringent research, with a variety of study designs, could contribute in many important ways.
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| 8. |
- Broqvist, Mari, 1958-, et al.
(författare)
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The meaning of severity - do citizenś views correspond to a severity framework based on ethical principles for priority setting?
- 2018
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Ingår i: Health Policy. - : Elsevier. - 0168-8510 .- 1872-6054. ; 122:6, s. 630-637
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Tidskriftsartikel (refereegranskat)abstract
- The importance for governments of establishing ethical principles and criteria for priority setting in line with social values, has been emphasised. The risk of such criteria not being operationalised and instead replaced by de-contextualised priority-setting tools, has been noted. The aim of this article was to compare whether citizenś views are in line with how a criterion derived from parliamentary-decided ethical principles have been interpreted into a framework for evaluating severity levels, in resource allocation situations in Sweden. Interviews were conducted with 15 citizens and analysed by directed content analysis. The results showed that the multi-factorial aspects that participants considered as relevant for evaluating severity, were similar to those used by professionals in the Severity Framework, but added some refinements on what to consider when taking these aspects into account. Findings of similarities, such as in our study, could have the potential to strengthen the internal legitimacy among professionals, to use such a priority-setting tool, and enable politicians to communicate the justifiability of how severity is decided. The study also disclosed new aspects regarding severity, of which some are ethically disputed, implying that our results also reveal the need for ongoing ethical discussions in publicly-funded healthcare systems.
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| 9. |
- Bäckman, Karin, 1967-, et al.
(författare)
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Prioriteringar över kommunala förvaltningsområden : ett utvecklingsarbete i Motala kommun
- 2017
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Motala kommun är den första kommunen som på ett systematiskt sätt tagit sig an prioritering och resursfördelning inom alla sina förvaltningsområden med utgångspunkt i de etiska principer och riktlinjer för prioriteringar som gäller för hälso- och sjukvård. Arbetet omfattar utveckling av ett verktyg för prioritering, anpassat till ett kommunalt sammanhang och att använda det i ett systematiskt prioriteringsarbete kombinerat med politiska mål och visioner. Avsikten är att prioriteringsarbetet ska utvecklas till en hållbar rutin, integrerad i befintlig budgetprocess.Syftet med denna rapport är att beskriva det första skedet i utvecklingsarbetet, med tillhörande arbetsprocesser samt att analysera det utifrån ett förbättringsoch implementeringsperspektiv. Rapporten omfattar åren 2013-2015.Prioriteringscentrums engagemang i Motala kommun har inneburit att vi genom s k aktionsforskning har studerat utvecklingen av prioriteringsarbetet samtidigt som vi gett stöd till kommunen och deltagit i utvecklingsarbetet av verktyg och processer. Datainsamling har skett genom observationer, dokument, enkäter och olika typer av kontakter.I Motala kommun har prioriteringsprocessen och dess verktyg utvecklats i nära samarbete med involverade aktörer, de som skulle bli användarna. Prioriteringsarbetet har integrerats i kommunens befintliga ledningssystem och rutiner. Utvecklingen har skett stegvis i små förbättringscykler. På detta sätt har kunskap och lärande byggts upp inom organisationen och arbetet har präglats av långsiktighet.Motala kommuns utveckling av verktyg och processer för prioritering visar att det är möjligt att vägledas av nationella etiska principer för prioritering inom hälso- och sjukvård och att det går att kombinera dessa med politiska mål och visioner. Det har också varit möjligt att inkludera kommunens alla förvaltningar i prioriteringsarbetet i en öppen, systematisk process som kopplats till ordinarie budgetarbete.
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| 10. |
- Carlsson, Staffan, et al.
(författare)
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Vägledning för prioriteringar i en behovsstyrd hälso- och sjukvård för god och jämlik hälsa i hela befolkningen.
- 2022
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Sammanfattande synpunkter från deltagande regionerI projektet beskrev deltagarna hur prioritering och resursfördelning går till i respektive region idag och hur de skulle vilja utveckla arbetet framöver.Deltagarna beskrev ett antal viktiga förutsättningar för att på ett systematiskt sätt, med utgångspunkt från befolkningens hälsa och behov av hälso- och sjukvård, kunna prioritera och fördela resurser till de med störst behov.Ett tydligt uppdrag från politiken att leverera strukturerade underlag som underlättar diskussion och beslut om prioriteringar.En tydlig mottagare av underlag och analyser med uppdrag att agera vidare utifrån dessa.Ett strukturerat arbetssätt och tydliga roller för både förtroendevalda och tjänstepersoner.Skapa förutsättningar i organisationen för att genomföra hela processen.En god dialog mellan förtroendevalda, tjänstepersoner och vårdprofession.En gemensam förståelse för vad som ska uppnås med prioriteringarna.Behovsanalyser både avseende bredd (stora grupper) och djup (specifika tillstånd).Beskrivning av utfallet av hälso- och sjukvårdens åtgärder i form av hälsovinster i befolkningen samt kostnaderna för att åstadkomma dessa hälsovinster.Beslut om prioriteringar som grundas på fakta och framtagna underlag.Uppföljning av beslutade prioriteringar genom dialog på flera nivåer (politik, tjänsteperson, vårdprofession, patient och befolkning).För att få genomslag för politiska prioriteringar i en hel region har förtroendevalda i fullmäktige, styrelser och nämnder ett särskilt ansvar.Regiondirektör, hälso- och sjukvårdsdirektör, ekonomidirektör och budgetchef behöver vara engagerade och tjänstepersoner med kompetens från hälso- och sjukvård, regional utveckling, ekonomi och analys behöver bilda ett tvärprofessionellt team.Det är nödvändigt att säkra en gemensam förståelse för behovet av politiska prioriteringar i verksamheterna och hos befolkningen.
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| 11. |
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| 12. |
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| 13. |
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| 14. |
- Krevers, Barbro, 1955-, et al.
(författare)
-
Modell för prioriteringsarbete i kommuner : Processer och verktyg vid resursfördelning i en övergripande ledningsprocess
- 2023
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Kommuner och regioner är huvudsakligen är offentligt finansierade och har begränsade resurser. Dessa resurser måste fördelas i första hand till det som bedöms vara mest angeläget. För detta bör det finnas en etablerad rutin som är transparent och som upplevs som rimlig och rättvis av de som är berörda. Att koppla ihop en process för strukturerat prioriteringsarbete med det ordinarie ledningssystemet har många fördelar, vilket tas upp i rapporten.För hälso- och sjukvård finns etiska principer som skall vägleda beslut om prioriteringar, uttryckta i lag sedan många år, efter ett riksdagsbeslut. Motsvarande vägledning finns inte för andra välfärdsområden. Emellertid har dessa principer visat sig vara tillämpliga även för andra välfärdssektorer, vilket också utredningen som föregick riksdagsbeslutet ansåg.Syftet med denna rapport är att presentera en modell för prioriteringsarbete i kommuner – processer och verktyg vid resursfördelning i en övergripande ledningsprocess, vilken kan inkludera flera olika förvaltningsområden med dess verksamheter och politiska organ.I rapporten beskrivs de etiska principer för prioritering som modellen utgår ifrån, vanliga begrepp som används i resurshushållning, kvalitet på faktaunderlag, verktyg och processer för att skapa strukturerade horisontella prioriteringar som gäller många olika områden. Verktygen kan användas i olika moment i prioriteringsarbetet och bidrar till att skapa tydliga beslutsunderlag. Strukturen på verktygen bidrar till att ett antal viktiga frågor ställs och besvaras inför beslut om resursfördelning. Rapporten beskriver processer, moment och aktiviteter som kan integreras och bli rutiner i en ledningsprocess. Rapporten tar också upp vad som kan vara viktigt att tänka på då en organisation vill ta sig an ett prioriteringsarbete.Rapporten riktar sig främst till tjänstemän, politiker och verksamhetsansvariga i kommuner, men innehållet kan även vara relevant för regioner och olika typer av verksamheter som ingår i en kommun eller region.
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| 15. |
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| 16. |
- Krevers, Barbro, 1955-
(författare)
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Patient and relative perspective regarding quality in hospital care for older people : Theory and Methods
- 2003
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Although the elderly population consumes a relatively large proportion of health care, international research has focused little attention on older people and their perception of health care and its outcome. Information is also scanty concerning relatives in hospital care and their actions and the circumstances related to relatives' participation in the care process.The overall aim of this thesis is to contribute to a better knowledge and understanding of the perspectives of older patients and relatives regarding hospital care and how this knowledge can be used in measurements of quality of hospital care from the patient perspective.This thesis uses both qualitative and quantitative methods. Study I and II are based on semistructured interviews. In study I a midrange theory and a theoretical model of patients' evaluation process regarding the care was derived. In study II relatives' actions and the circumstances related to their participation in the care process were described. In study III the knowledge obtained in study I was used as a base for development of an instrument 'Patients perspectives on care and rehabilitation process' (POCR) containing structured questions for measuring patients' perceptions regarding the care process. The instrument was used in telephone-interviews for the data collection in study III and IV. In study IV analyses were conducted regarding the interrelation between some of the concepts in the model of patients' evaluation process.The patient and relative perspectives on hospital care, are based on complex processes that involve their past experiences, present situation and expectations of the of future regarding care and illness/health. The encounters patients and relatives have with staff and the organisation lay the foundations for their future expectations and experiences regarding a potential forthcoming care process. Relatives carry out a variety of actions and engagements based on their own knowledge and ability. Patients and relatives have disparate realities and needs. The three-part interaction between patient, relative and staff is an important factor in patients' and relatives' actions and participation in the care process and in how their needs are met.Patient perceived needs differ during the different phases of the care process. Patients' perception of needs and care are associated with patients' previous experiences with illness and care, their perception of themselves and the situation, and their expectations regarding health and care.Patient-perceived results of the care process include how needs were met as well as health outcome. Patients' evaluation of the hospital care is shown to be associated with their previous experiences of the care unit, perceived health outcome including their overall lifesituation post-discharge, as well as patients' expectations regarding their future health postdischarge. These aspects ought to be focused in measures regarding quality of care from patients' perspective.The POCR instrument was found to have adequate validity and reliability. The instrument reflects patients' different needs during the care process and measure patients' perceptions regarding fulfilment of needs and their importance. Using the telephone interview technique makes it possible for data collectors to learn more about the patient perspective and it resulted in high response rate.
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| 17. |
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| 18. |
- Krevers, Barbro, 1955-, et al.
(författare)
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Patient evaluation of the care and rehabilitation process in geriatric hospital care
- 2002
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Ingår i: Disability and Rehabilitation. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 24:9, s. 482-491
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To gain a deeper understanding of how elderly persons experience and evaluate the care and rehabilitation process. Method: Qualitative interview data from elderly patients were analysed using a grounded theory approach. The patients were interviewed twice, at the beginning of geriatric hospital care and some weeks after discharge. Results: The patient-perceived outcome of the care and rehabilitation process reflected two dimensions, the effect on their health and the quality of the process, i.e. how their needs were met. The analysis revealed that the patients' needs differed during the care and rehabilitation process. It also indicated that patients perceived their needs and the care differently based on their previous experience of the care unit, their perceived trajectory of illness and their 'patient character' which represented the patient's definition of himself/herself and the situation. A hypothetical model of the patients' evaluation process has been derived. Conclusion: The results indicate the importance of using a process perspective in the assessment and the interpretation of patient-perceived outcome of care and rehabilitation, and that patient expectations, trajectories of illness and the patient character must be taken into consideration.
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| 19. |
- Krevers, Barbro, 1955-
(författare)
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Patienter, hälso- och sjukvårdens främsta angelägenhet : från objekt till aktör
- 2016
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Ingår i: Perspektiv på utvärdering, prioritering, implementering och hälsoekonomi. - Linköping : Linköping University Electronic Press. - 9789176857441 ; , s. 55-61
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- Numera framhålls det ofta att patienter och medborgare ska ta ett aktivt ansvar för sin hälsa och att patienter ska vara aktiva parter i hälso- och sjukvård. Det har inte alltid varit så, synen på patienter och deras ställning i hälso- och sjukvård har genomgått och genomgår en ständig förändring. Denna förändring avspeglar skeenden i samhället i stort när det gäller synen på individens inflytande, självbestämmande och ansvar. För att förstå vår nutid behöver vi känna till och förstå vår dåtid brukar det sägas. Det mottot har även bäring på vår förståelse av samspelet mellan hälso- och sjukvården och patienter. Vi behöver känna till förändringarna som synen på patienter har genomgått eftersom vården möter och ska tillgodose vårdbehov hos människor i alla åldrar, inte minst de som snart är ett sekel gamla. De som varit med länge kan ha andra förväntningar på vad det innebär att vara patient än de som är unga idag.
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| 20. |
- Krevers, Barbro, 1955-, et al.
(författare)
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Prioriteringsarbete integrerat i ett kommunalt ledningssystem : fortsatt utveckling i Motala kommun
- 2021
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Motala kommun startade år 2013 en långsiktig utveckling av ett systematiskt prioriteringsarbete. Deras vision är att öka möjligheterna att uppfylla politiskt prioriterade mål för kommunen. Under åren 2013–2015 utvecklades verktyg och arbetssätt för prioriteringsbeslut på politisk ledningsnivå, vilket finns beskrivet i en tidigare rapport. Den aktuella rapporten visar deras fortsatta utvecklingsarbete under åren 2016–2018.Syftet med denna rapport är att beskriva och analysera hur verktyg och processer för systematiskt prioriteringsarbete implementeras och slutligen blir en beslutad rutin i Motala kommuns ledningssystem för alla deras förvaltningsområden.Författarna har genom aktionsforskning både studerat och gett stöd i utvecklingsarbetet. Data baseras på observationer, dokument, enkäter, samtal och e-post. Det har analyserats både deskriptivt och ur ett förbättrings- och implementeringsperspektiv.Prioriteringsarbetet i Motala kommun har utvecklats i förbättringscykler och samtidigt som det har implementerats. Det har skett i nära samverkan mellan tjänstemän, verksamhetsansvariga, politiker och med författarna. Genom det har gemensamt lärande och kunskap utvecklats både i organisationen och i forskning.Implementeringen har bl a innehållit aktiviteter för att skapa gemensam kunskap och medvetenhet om principer och centrala begrepp såsom prioritering, ransonering och effektivisering samt hur dessa kan användas i strukturerade faktaunderlag vid hushållning och fördelning av resurser. Dessa faktaunderlag har varit centrala utgångspunkter för diskussioner och beslut om prioritering och resursfördelning. En viktig informationskälla har varit verksamhetsanalyser utifrån verksamhetsmål och kvalitetsindikatorer i kommunens kvalitetssystem.Prioriteringsarbetet har medfört att nya arbetssätt har integrerats i kommunensplanerings-, uppföljnings- och budgetarbete. Motala kommun har nu en beslutad och använd rutin för systematisk prioriteringsprocess i sitt ledningssystem. Det ger dem förutsättningar att på goda grunder diskutera och göra medvetna prioriteringar vid fördelning av resurser, i såväl ansträngda som goda tider.
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| 21. |
- Krevers, Barbro, 1955-, et al.
(författare)
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The sense of security in care-relatives' evaluation instrument : its development and presentation.
- 2015
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Ingår i: Journal of Pain and Symptom Management. - : Elsevier BV. - 0885-3924 .- 1873-6513. ; 49:3, s. 586-94
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Tidskriftsartikel (refereegranskat)abstract
- CONTEXT: Relatives' sense of security in their family members' palliative home care is important, and a valid and reliable instrument is needed to measure this.OBJECTIVES: The aim of this article is to report the development, structure, and psychometric properties of a new instrument, the Sense of Security in Care-Relatives' Evaluation (SEC-R), in palliative home care.METHODS: Instrument development was based on a previous study and review of the literature; 213 relatives (55% women) of patients in palliative home care were recruited (response rate 73%) and participated in a structured interview based on a questionnaire. Principal component analysis (PCA) was used to identify subscales. The construction was tested in correlation with other scales and questions representing concepts expected to be related to sense of security in care.RESULTS: The PCA resulted in three subscales, namely care interaction, mastery and patient situation, which had an explained variance of 53%. Internal consistency of the subscales ranged from 0.76 to 0.78. The final instrument comprises 17 items. The scales were associated with the quality-of-care process and the relatives' situation, perceived health, quality of life, stress, general sense of security, and general sense of security in care.CONCLUSION: The SEC-R provides a three-component assessment of palliative home care settings using valid and reliable scales associated with other concepts. The SEC-R is a manageable means of assessment that may contribute to quality-of-care measures and to further research on relatives' sense of security in care.
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| 22. |
- Mc Kee, K J, et al.
(författare)
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The COPE index - A first stage assessment of negative impact, positive value and quality of support of caregiving in informal carers of older people
- 2003
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Ingår i: Aging & Mental Health. - : Informa UK Limited. - 1360-7863 .- 1364-6915. ; 7:1, s. 39-52
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Tidskriftsartikel (refereegranskat)abstract
- Data was collected in five countries from informal carers of older people (n=577) via a common protocol. Carers completed: (1) a 17-item version of the Carers of Older People in Europe (COPE) Index, an assessment of carers' perceptions of their role, (2) a questionnaire on demographic and caregiving circumstances, and (3) three instruments included for the criterion validation of the COPE Index (the General Health Questionnaire, the Hospital Anxiety and Depression Scale, and the World Health Organization Quality of Life-BREF). Principal Component Analysis of the COPE Index was followed by internal consistency analysis of emergent components. Scales derived by summing items loading on the components were analyzed for their association with the criterion measures. Two components, negative impact and positive value, emerged consistently across countries. A third component, quality of support was less consistent across countries. Scales derived from the negative impact and positive value components were internally consistent and significantly associated with the criterion validity measures. These two scales and four items drawn from the quality of support component were retained in the final COPE Index. While further testing is required, the COPE Index has current utility in increasing understanding of the role perceptions of carers of older people.
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| 23. |
- Milberg, Anna, et al.
(författare)
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Patients' sense of support within the family in the palliative care context : what are the influencing factors?
- 2014
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Ingår i: Psycho-Oncology. - : John Wiley & Sons. - 1057-9249 .- 1099-1611. ; 23:12, s. 1340-1349
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Mutual support within the family is of great importance to maintain its proper functioning. The study aim, which was based on a family system approach, was to evaluate which variables are associated with patients' sense of support within the family in the palliative care context.METHODS: We recruited 174 adult patients (65% of those eligible) from six palliative home care units, who had non-curable disease with an expected short-term survival, such as disseminated cancer or non-malignant diagnosis. The relationship between the endpoint and individual factors were evaluated in a stepwise model-building procedure using generalised linear model (ordinal multinomial distribution and logit link).RESULTS: The respondents' ratings of their sense of support within the family ranged from 1 (never) to 6 (always), with a mean value of 5.2 (standard deviation 1.06). Patients who less frequently sensed family support experienced more often stress, worry about their private economy, lower self-efficacy, lower sense of security with palliative care provided (lower ratings on subscales of care interaction, mastery and prevailed own identity), more often anxiety, less often perceived general well-being for closest ones and less often sense of support from more distant family members. In the model building, three variables were selected to predict the patients' sense of support within the family.CONCLUSIONS: The dying patients' sense of support within the family related to several factors, and these may help the palliative care teams to identify patients at risk and to alleviate suffering, for example, through supporting the closest family members.
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| 24. |
- Skärsäter, Ingela, 1952-, et al.
(författare)
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Health and lifestyle among young informal carers who support family members or close friends with mental illness
- 2013
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Ingår i: Horatio, European Psychiatric Nursing Congress 2013. ; , s. 135-135
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Konferensbidrag (refereegranskat)abstract
- In the last decades it has been stated that the mental health of young people has deteriorated. Young persons’ report depressive feelings, anxiety and sleep-disturbance. The tendency is most pronounced for young women in the ages 16-24 years. Nowadays, the main parts of the psychiatric care are out-patient care. Family, relatives and close friends get involved and need to take great responsibility for their relative or friend with mental illness, which has consequences for their own health. This study will explore health situation among young persons’, age 16-25 years, who are identifying themselves as supporting a family member or a friend with mental illness. The collected data in this study is based on baseline data from the research project “Ps Young Support”. That research project aimed to develop and evaluate web-based health efforts for young persons’ who were close to people who suffered from mental illness. Data was collected by means of questionnaires in June 2010, which the informants (N=241, 170 females and 71 males) responded. Sociodemographic and lifestyle characteristics were obtained and self-rated health questions were asked about their general health, well-being, physical and mental illnesses. The results revealed high levels of stress, as well as different psychosomatic symptoms, such as sleeping problems, and head- or stomach ache. Over half of the young persons stated that they used some kind of non-prescriptive pharmacological treatments against pain. This is alarming and preventive health care resources should be offered to these young informal carers.
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| 25. |
- Stålberg, Valerie, et al.
(författare)
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Study protocol for a modified antenatal care program for pregnant women with a low risk for adverse outcomes - a stepped wedge cluster non-inferiority randomized trial
- 2022
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Ingår i: BMC Pregnancy and Childbirth. - London, United Kingdom : BioMed Central. - 1471-2393 .- 1471-2393. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: It is crucial to provide care based on individual needs. Swedish health care is obliged to give care on equal conditions for the entire population. The person with the greatest need should be given the most care, and the health care system should strive to be cost-efficient. Medical and technical advances have been significant during the last decades and the recent Covid-19 pandemic has caused a shift in health care, from in-person visits to virtual visits. The majority of pregnant women with a low risk assessment have an uncomplicated antenatal course without adverse events. These women probably receive excessive and unnecessary antenatal care. This study will investigate if an antenatal care program for healthy pregnant women with a low risk for adverse outcomes could be safely monitored with fewer in-person visits to a midwife, and with some of them replaced by virtual visits.Methods: This is a non-inferiority trial where a stepped wedge cluster randomized controlled design will be used. Data collection includes register data and questionnaires that concern antenatal, obstetric and neonatal outcomes, patient- and caregiver-reported experiences, healthcare-economy, and implementation aspects. The modified antenatal care (MAC) study is performed in parts of the southeast of Sweden, which has approximately 8200 childbirths annually. At the start of the study, all antenatal care centers included in the study will use the same standard antenatal care (SAC) program. In the MAC program the in-person visits to a midwife will be reduced to four instead of eight, with two additional virtual meetings compared with the SAC program.Discussion: This presented study protocol is informed by research knowledge. The protocol is expected to provide a good structure for future studies on changed antenatal care programs that introduce virtual visits for healthy pregnant women with a low risk for adverse outcomes, without risking quality, safety, and increased costs.
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| 26. |
- Turesson, Christina, 1969-, et al.
(författare)
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Experiences of men living with Dupuytren's disease : Consequences of the disease for hand function and daily activities
- 2020
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Ingår i: Journal of Hand Therapy. - : HANLEY & BELFUS-ELSEVIER. - 0894-1130 .- 1545-004X. ; 33:3, s. 386-393
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Tidskriftsartikel (refereegranskat)abstract
- Study Design: Qualitative descriptive. Introduction: Dupuytren's disease (DD) is a chronic hand condition causing impairment in hand function. Research describing persons' experiences of living with DD is limited. Understanding the subjective experience of illness is valuable for planning and implementing health-care services. Purpose of the Study: To explore experiences among men living with an impaired hand function due to DD and the consequences of the disease for daily activities. Methods: Interviews were conducted with 21 men before surgery. The model of the patient evaluation process guided data collection. Data were analyzed using problem-driven content analysis. Results: Participants described DD as a chronic disease caused by heredity, previous injury, hard work, or aging. DD was, according to the participants, an uncomfortable and sometimes painful condition, causing a feeling of constant stiffness in the affected hand. DD could cause participants to have fear of hurting the hand, feelings of shame or embarrassment, and a sense of being old. Participants handled the deteriorating hand function by avoiding or refraining from activities, adapting their performance, or performing activities with less quality. The ideal hand function was seen as being able to use the hands without effort. Discussion: The diverse experiences of DD and if the hand is experienced as something that causes distress can be understood further using body-self dialectic and Gadow's states of embodiment, as well as the process of adapting and learning to live with the functional limitations. Conclusions: A clinical implication for hand therapy is to acknowledge patients' individual experiences and support self-modifications and development of new skills.
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| 27. |
- Turesson, Christina, et al.
(författare)
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Patients' needs during a surgical intervention process for Dupuytren's disease.
- 2019
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Ingår i: Disability and Rehabilitation. - : Taylor & Francis Group. - 0963-8288 .- 1464-5165. ; 41:6, s. 666-673
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To explore and describe clients' needs during a surgical intervention process for Dupuytren's disease.MATERIALS AND METHODS: Design: Interview study with 21 men undergoing surgical intervention for Dupuytren's disease. Qualitative content analysis was performed with the model of Patient Evaluation Process as a theoretical framework.RESULTS: The primary reason for seeking medical care was to receive an intervention to improve hand function. The need for knowledge was evident during the care process, and was connected to involvement in decision-making. During surgery and rehabilitation, participants needed support with pain relief, a sense of security, support for self-care, or sick leave. There was also a need for participation in the evaluation and improvement of care. Clients' life situations contributed to the occurrence of needs or were a resource for handling them. Depending on patient character, clients handled their perceived needs differently.CONCLUSIONS: Clients' needs during a surgical intervention process include needs for improvement of hand function, knowledge, and support during treatment, and participation in evaluation. Clients' needs change during the care process and can be influenced by their life situation or their character. The identified needs ought to be included in quality assessments from the carers' perspective, to ensure that important needs of the clients are met by the surgical intervention process. Communication and interaction between client and health care provider is a key aspect of fulfilling clients' needs. Implications for rehabilitation Patients have need for knowledge throughout the care process: about the disease, risk factors, treatment options, practical and medical information related to the treatment and recovery, and about the care process as a whole. Need for knowledge is closely connected to patients' experience of being involved in decision making. Patients need support with both general human and specific medical issues during surgery and rehabilitation. Patients' needs change during the care process and can be influenced by the patient's life situation or character. From the carers' perspective, the identified needs ought to be included in quality assessments to ensure that important needs of the clients are met by the surgical intervention process.
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| 28. |
- Ågren, Axel, 1985-, et al.
(författare)
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Dying as an issue of public concern : cultural scripts on palliative care in Sweden
- 2021
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Ingår i: Medicine, Health care and Philosophy. - : Springer. - 1386-7423 .- 1572-8633. ; 24, s. 507-516
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Tidskriftsartikel (refereegranskat)abstract
- In Sweden, palliative care has, over the past decades, been object to policies and guidelines with focus on how to achieve“good palliative care”. The aim of this study has been to analyse how experts make sense of the development and the currentstate of palliative care. Departing from this aim, focus has been on identifying how personal experiences of ‘the self’ areintertwined with culturally available meta-level concepts and how experts contribute to construct new scripts on palliativecare. Twelve qualitative interviews were conducted. Four scripts were identifed after analysing the empirical material: 1.script of paths towards working within palliative care; 2. script of desirable and deterrent reference points; 3. script of tensions between improvement and bureaucracy; and 4. script of low status and uncertain defnitions. The fndings of this studyillustrate how experts in complex ways intertwine experiences of ‘the self’ with meta-levels concepts in order to make senseof the feld of palliative care. The participants did not endorse one “right way” of “good” deaths. Instead, palliative care wasconsidered to be located in a complex state where the historical development, consisting of both desirable ideals, death denialsand lack of guidelines, and more recent developments of strives towards universal concepts, “improvement” and increasedbureaucracy altogether played a signifcant role for how palliative care has developed and is organised and conducted today.
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| 29. |
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| 30. |
- Ågren, Axel, 1985-
(författare)
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Loneliness and Dying as Issues of Public Concern in Sweden
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Loneliness among older people and how the dying should be cared for are issues that evoke public debate. These issues are often described as universal and existential aspects of the human experience. Societal understandings of loneliness and dying have, however, changed dramatically over the past decades. Loneliness among older people and how we die are surrounded with ideals of how to "age well" and "good deaths", where failure to meet these expectations is associated with tabus, stigma and personal and societal failures. Consequently, studying loneliness among older people and care of the dying gives rise to the question of to what degree loneliness and dying are personal or public concerns. The aim of this dissertation is to study how loneliness among older people is constructed in the Swedish news press and how care of the dying is constructed in policies and through the perspectives of experts in palliative care. Specifically, the analysis explores to what extent these issues have become public concerns, and how "old and lonely" and "the dying" are positioned and constructed. In Paper I, the focus is on identifying overall discourses on loneliness among older people in the Swedish news press. Paper II is an analysis of how the responsibility for reducing loneliness is designated in the Swedish news press. Paper III explores how policies on palliative care have emerged and developed in Sweden over time since the 1970s up until today. Paper IV highlights the perspectives of experts, in palliative care, on the development and current state of palliative care, and the role of policymaking in this context. The findings of Paper I illustrate that although loneliness among older people have seemingly gained increased attention, much of the news articles are about the deficiencies in the organisation of eldercare and volunteer work with aims of reducing loneliness. In Paper II, the main finding is that the task of reducing loneliness is discussed, defined, and designated by and to those who were "non-old" and "non-lonely", where ambitions of inclusion result in constructing old people as the "others". Paper III shows how policies on palliative care have changed, from an emphasis on psychological end-of-life care and an overarching critique of the hospice care philosophy, to claims for care to be instead inspired by the very same philosophy. Furthermore, ideals of dying at home have lost their significance as palliative care should be universal and carried out everywhere. Based on interviews with experts in palliative care, the results of Paper IV highlight the complex development of palliative care in between deficiencies in end-of-life care of the past and improvements of the present. These improvements resulted, however, in risks of too much bureaucracy.The overall findings of this dissertation indicate that loneliness among older people and care of the dying serve as symbols for criticising the idea of the development of "modern society", which is altogether viewed as individualistic, bureaucratised and medicalised. Throughout the studies included in this dissertation, the issues of individual autonomy and activity as well as responsibility have shown to be central. In the context of palliative care, the concept of autonomy has a key position and responsibility is on the dying person to make choices in order to achieve "good palliative care". Regarding loneliness among older people, emphasis is on how to make older people physically and socially active. Loneliness is constructed as a problem which should be avoided and solved by "society" bearing the responsibility for enabling older people not to be lonely.
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| 31. |
- Ågren, Axel, 1985-, et al.
(författare)
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Policy Narratives on Palliative Care in Sweden 1974–2018
- 2023
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Ingår i: Health Care Analysis. - : Springer. - 1065-3058 .- 1573-3394. ; 31, s. 99-113
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Tidskriftsartikel (refereegranskat)abstract
- In Sweden, efforts to govern end-of-life care through policies have been ongoing since the 1970s. The aim of this study is to analyse how policy narratives on palliative care in Sweden have been formulated and have changed over time since the 1970s up to 2018. We have analysed 65 different policy-documents. After having analysed the empirical material, three policy episodes were identified. In Episode 1, focus was on the need for norms, standards and a psychological end-of-life care with the main goal of solving the alleged deficiencies within end-of-life care in hospital settings. Episode 2 was characterised by an emphasis on prioritising end-of-life care and dying at home, and on the fact that the hospice care philosophy should serve as inspiration. In Episode 3, the need for a palliative care philosophy that transcended all palliative care and the importance of systematic follow-ups and indicators was endorsed. Furthermore, human value and freedom of choice were emphasised. In conclusion, the increase of policy-documents produced by the welfare-state illustrate that death and dying have become matters of public concern and responsibility. Furthermore, significant shifts in policy narratives display how notions of good palliative care change, which in turn may affect both the practice and the content of care at the end of life.
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| 32. |
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| 33. |
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