Background: Person-centred care (PCC) is when the person seeking care get’s involved in their care and are seen as more then their illness or ailment. PCC as a concept began in dementia care, but is now the approach that most healthcare institutions strive after. To achieve the improved care that PCC can bring, there is need for a well- planned and clear implementation plan from the management.

Aim: To describe the nursing staffs experience of implementing person-centred care as a work procedure in inpatient care.

Method: An inductive qualitative study where eleven interviews was completed. Eight interviews were strategically chosen and a content analysis was carried out.

Result: There is hope among the participants that implementation will bring a better and safer care, but also concerns about fear of change among the healthcare staff and increased workloads. Participants experience that PCC will place higher demans on the healthcare staff, especially nurses, regarding time, knowledge and communication skills.

Conclusion: To provide the best care, there has to be dedicated and competent staff who also have the support and understanding from the management. Despite the obstacles that seem to exist, there is a positive spirit among the nurses in relation to the implementation of person-centred care.  There is hope that person-centred care, among other things, will increase participation that could lead to shorter hospital stays and risk of needing to seek care again short after being discharged from the hospital. Ultimately it provides a better care in the whole for the individual person seeking care.

Studiens syfte är att ur professionellas perspektiv undersöka hur personer med kognitiva funktionshinder är delaktiga i beslut gällande flytt till egen bostad samt hur professionellas handlingsutrymme påverkar besluten. Studien genomfördes som en kvalitativ intervjustudie med hermeneutisk ansats och kvalitativ innehållsanalys som bearbetningsmetod. Intervjuer gjordes med fem anställda, de flesta av dem socionomer inom en offentlig organisation som producerar tjänster för personer med kognitiva funktionshinder. Resultatet visar att personer med kognitivt funktionshinder har begränsad delaktighet och få valmöjligheter i beslut gällande flytt till egen bostad. Delaktigheten påverkas av klientens och socialarbetarens förmåga att kommunicera med varandra men trots det användes inga kommunikationshjälpmedel i utredningen. Anhöriga antar ofta rollen som klientens tolkningsföreträdare och när det gäller beslut om flytt till egen bostad är det anhöriga som tar beslutet oberoende klientens grad av funktionshinder. Socialarbetarna upplever sig styrda av överordnade men det hindrar dem inte från att ibland överskrida det formella handlingsutrymmet för att göra det som de anser vara det bästa för klienten.

The overall aim was to investigate municipal guidelines for paid dependent care which were available online, i.e. documents regarding situations where a relative is hired to care for a next-to-kin. The overall aim has been built on the following three research questions regarding how municipalities describe: 1) which situations qualify for paid dependent care, 2) how the elderly person’s needs are met in case of paid dependent care and 3) how the dependent caregivers’ rights and well-being are ensured?

There is no legal basis for demanding cash-for-care setting, and the local self-government determines whether the municipality offers this form of care. Recently, paid dependent care has been restricted and banned in several Swedish municipalities, and according to some statistics paid dependent care is allowed in 55–65 % of the Swedish municipalities. It is mostly women of foreign origin who are dependent caregivers nowadays, and feminist care research and the media lift up cash-for-care settings as a trap for women and for migrant integration.

The study included guidelines from a total of 21 municipalities, which were analyzed using qualitative content analysis according to Elo & Kyngäs (2007). The guidelines analysed were found from the websites of Sweden's 121 medium and large municipalities (more than 20 000 inhabitants). The results were processed using feminist theory (Hirdman 2012).

The results show that overall there are few guidelines available in Sweden's municipalities and that the regulations differ in the different municipalities’ guidelines. The guidelines that are available often contain general or vague descriptions. One conclusion is therefore that many municipalities ensure their own discretion and prevail through vague and general rules in their guidelines. From a feminist perspective, these different municipal policies create unfair structures and differences in conditions and terms for the elderly and their family caregivers regarding cash-for-care settings. Finally, the result shows that the few detailed descriptions prioritize elder people's rights over their caregivers'. Ensuring the paid dependent caregivers’ rights is mainly described to be done by checking and controlling them. In other words, the paid dependent caregivers are often invisible in the guidelines, are often regarded as pseudo-employees and therefore fall between the cracks in terms of their need for support (Sand 2010).

When society is viewed in a social constructive manner, the social worker is as affected as the general population by the media and the image it portrays. A prejudice or bias social worker will not be as effective in his work as his intentions are.

The purpose of this thesis was to discover if there are any visible cultural differences in the usage and description of the concept of psychopathy or a psychopath himself in the media, more specifically, daily newspapers. There are three American newspapers and three Swedish newspapers examined in this study.

The study is based on a quantiative content analysis of articles published between 1st of January 2008 and 1st of July 2012. The collected data is categorized where the articles can fall under one or more of five available categories. Even though no clear results occurred, some interesting indications are visible between American newspapers and Swedish newspapers, but more so between different American newspapers. Psychopaths, people with an Antisocial Personality Disorder, are most frequently mentioned as criminals or maniacs/madmen in both countries with a modestly higher percentage for the United States of America.

We used national surveys to study how older persons’ changing household patterns influence the gender balance of caregiving in two countries with distinct household structures and cultures, Spain and Sweden. In both countries, men and women provide care equally often for their partner in couple-only households. This has become the most common household type among older persons in Spain and prevails altogether in Sweden. This challenges the traditional dominance of young or middle-aged women as primary caregivers in Spain. In Sweden, many caregivers are old themselves. We focus attention to partners as caregivers and the consequences of changing household structures for caregiving, which may be on the way to gender equality in both countries, with implications for families and for the public services.

Usually it is women who take care of family members in the home, but with age, gender differences become less pronounced and, from 80 years onwards, there are more men caring for a family member – generally their partner – than women. Social and demographic changes are presenting new challenges for public services. In particular, in two-person households with elderly inhabitants, one of whom is dependent, it is necessary to tackle not only the needs of the dependent partner but also those of the carer partner. For this reason, carer support programmes are needed.

During the simulation, participants experience different degrees of stress and anxiety. It could be described as “Anxiety is like perpetually hearing the enemy music but never seeing the threat”. This study aimed to describe the Emergency Medical Services personnel's feelings of anxiety during simulation. The study had a qualitative design with interviews of 28 participants. The data were analyzed using content analysis. The result shows how the simulation could be perceived as a stage performance in the form of a theatre. The perceived acting was unpleasant and embarrassing due to unfamiliarity to perform. To be scrutinized meant having spectators reviewing ones' performance. It was considered more natural to care for actors than manikins. The interaction and connection with a human, even unconscious, were more natural. To care for a human did not require the imagination to empathize in the simulation.

A common feature of prehospital emergency care are short and fragmentary patient encounters with in­creased demands for efficient and rapid treatment. Crucial decisions are often made, based on the premise of the ambulance staff`s ability to capture the situation instantaneously. The assessment is, therefore, a pre-requisite for decisions about appropriate actions. However, a low exposure to severe trauma cases leads to vulnerability for the ambulance staff, which makes the assessment more difficult. Assessment of severe trauma patients at the scene of accident is difficult and complicated. No trauma scenarios are alike and practical skills, training, and feedback are therefore necessary.

Purpose – The purpose of this paper was to describe firefighters’ experiences of First Response Emergency Care.

Design/methodology/approach – An explorative descriptive design with a qualitative approach. Data was collected through group interviews of 35 firefighters and subjected to qualitative content analysis.

Findings – The results showed that the firefighters’ professional role and their uniform serve as protection against mentally strenuous situations. It is important to protect the dignity of the injured or dead, as well as to protect and safeguard colleagues from the experience of the tragedy of an accident. Having a solid and sterling medical education gives a sense of security when providing emergency care, as well as when caring for the relatives. Debriefing brings thoughts and feelings to the surface for processing and closure. The sense of sadness lingers for those they were unable to save, or the ones that had been dead on arrival or were forgotten.

Originality/value – A firefighter’s work situation is exposed and stressful. The firefighter’s uniform as a mental barrier, colleagues, time to mentally prepare and being allowed to show feelings are factors all needed to cope. It is therefore important to encourage, promote and strengthen the protective role of camaraderie for the firefighter, which can likely be emphasized for other uniform-wearing professions such as police, military and ambulance personell. Being acknowledged for their contribution to other peoples’ lives and wellbeing can confirm the firefighters’ importance.

Takotsubo can be detected as a kindred disease, predominantly affecting post-menopausal women. By correctly identifying these patients as having an acute heart failure syndrome, the outcome can be favorable.

Purpose

The purpose of this paper is to investigate the effects of the intervention of low-dose, high-frequency cardiopulmonary resuscitation (CPR) training with feedback for firefighters for one month.

Design/methodology/approach

The study had a quantitative approach. Data were collected through an intervention by means of simulation. The data collection consisted of a pre- and post-assessment of 38 firefighter’s CPR performance.

Findings

There was a statistically significant improvement from pre- to post-assessment regarding participants’ compression rates. Compression depth increased statistically significantly to average 2 mm too deep in the group. Recoil decreased in the group with an average of 1 mm for the better. There was a statistically significant improvement in participants’ ventilation volume from pre- to post-assessment.

Originality/value

Prehospital staff such as firefighters, police, and ambulance perform CPR under less than optimal circumstances. It is therefore of the utmost importance that these professionals are trained in the best possible way. The result of this study shows that low-dose, high-frequency CPR training with an average of six training sessions per month improves ventilation volume, compression depth, rate, and recoil. This study concludes that objective feedback during training enhances the firefighters’ CPR skills which in turn also could be applied to police and ambulance CPR training.

The aim of this study was to describe specialist ambulance nurse students’ experiences of ethical conflicts and dilemmas in prehospital emergency care. In the autumn of 2015, after participating in a mandatory lecture on ethics, 24 specialist ambulance nurse (SAN) students reported experiences and interpretations concerning conflicts and ethical dilemmas from prehospital emergency care. The text consisted of 24 written critical incidents which were interpreted using hermeneutic text interpretation. The text revealed three themes: Not safeguarding a patient’s body and identity; Not agreeing on the care actions; and Not treating the patient with dignity. The SANs experiences ethical dilemmas and conflict of values when they witness how others violate a patient’s dignity. Discussion and reflection is based on ethical conflicts and dilemmas experienced when students see how caregivers do not safeguard the patient’s body or identity. When caregivers have a conflicting will, it results in patients not being treated in an ethical manner. Also, seeing how caregivers put themselves in a power position over patients is described as an ethical dilemma that students experience when they choose not to intervene.

Introduction. We focus on trauma care conducted in the context of a simulated traumatic event. This is in this study defined as a four-meter fall onto a hard surface, resulting in severe injuries to extremities in the form of bilateral open femur fractures, an open tibia fracture, and a closed pelvic fracture, all fractures bleeding extensively. 

Methods. The simulated trauma care competence of 63 ambulance nurses in prehospital emergency care was quantitatively evaluated along with their perception of their sufficiency. Data was collected by means of simulated trauma care and a questionnaire. 

Results. Life-saving interventions were not consistently performed. Time to perform interventions could be considered long due to the life-threatening situation. In comparison, the ambulance nurses’ perception of the sufficiency of their theoretical and practical knowledge and skills for trauma care scored high. In contrast, the perception of having sufficient ethical training for trauma care scored low. 

Discussion. This study suggests there is no guarantee that the ambulance nurses’ perception of theoretical and practical knowledge and skill level corresponds with their performed knowledge and skill. The ambulance nurses rated themselves having sufficient theoretical and practical knowledge and skills while the score of trauma care can be considered quite low.

Introduction. As a part of the emergency medical services, the Swedish fire brigade can increase the survival rate in out-of-hospital cardiac arrests.

Aim. To compare the quality of cardiopulmonary resuscitation (CPR) performed by firefighters at a routine CPR practice versus when involved in a simulated life-saving event.

Methods. In this study, 80 firefighters divided into two groups performed CPR according to guidelines: one group indoors during a routine training session; the other group outdoors during a smoke diving exercise wearing personal protective clothing and self-contained breathing apparatus. Descriptive and inferential statistics were used to analyze the data.

Results. The results showed a tendency for the outdoor group to perform CPR with better ventilation and compression quality, as compared to the indoor group. The ventilation of the manikin was not hampered by the firefighters wearing personal protective clothes and self-contained breathing apparatus, as the Swedish firefighters remove their facial mask and ventilate the patient with their mouth using a pocket mask.

Conclusions. Overall, the results in both groups showed a high quality of CPR which can be related to the fire brigade training and education traditions. CPR training is regularly performed, which in turn helps to maintain CPR skills.

Introduction

During military missions medical care is provided to military personnel as well as civilians. Although cardiopulmonary resuscitation (CPR) may not be a common task in a military field hospital, all personnel need to be trained to deal with cardiac arrest.

Methods

This study was a comparative simulation study. Participants (n=36) from the Swedish armed forces performed CPR for 2 minutes at one of three different locations: at ground level, a military bed, or a transportable military stretcher. Compression depth and rate after 2 minutes of CPR and at the time of the participants’ own request to be relieved were measured. Descriptive and inferential analysis was conducted.

Results

There is a direct correlation between compression depth and working level, concluding that the higher working level, the lower the compression depth. There is in total an overall low percentage of participants within limits for correctly conducted CPR regarding both compression depth and rate. Time to fatigue is related to working level, where increased level results in early fatigue.

Conclusion

The quality of CPR is affected by the level at which it is performed. The quality of CPR was satisfactory when working at ground level, but suboptimal when working at hospital bed level or military stretcher level. When working at raised levels, participants appeared to misjudge their own compression depth and rate. This may indicate that changes are needed when CPR is practised in the military hospital setting. Future studies regarding the use footstools are required due to the height of military beds and transportable stretchers.

INTRODUCTION: Swedish firefighters are a part of the emergency medical services. Therefore, they perform prehospital cardiopulmonary resuscitation (CPR) on a regular basis. Training becomes crucial for maintaining the CPR skills and increasing the patients’ chances of survival. Training with visual feedback is for Swedish firefighters a new way of training CPR. The aim of this study was to evaluate firefighters’ perception of a CPR manikin with visual feedback.

METHOD: This study had a qualitative approach. Data were collected by interviews with 16 firefighters after performing CPR on a manikin with visual feedback. The data were analyzed with a manifest content analysis.

RESULTS: Visual feedback makes it easy to identify and maintain correct compression rate. There is a need for identifying too deep compressions. Uncertainty regarding the closeness to the stomach arises when using the whole hand during compressions instead of just the wrist. To accomplish an open airway requires a bit of adjustment of the manikins’ head.

DISCUSSION: To train and learn CPR is feasible with visual feedback. The firefighters can maintaing a correct compression rate and correct compression depth during the sessions. Ventilating a patient with bag-valvemask or pocket mask may require training with visual feedback to guarantee the firefighters being able to secure an open airway of the patient. All these skills are essential and improve the chance of survival for the patients.

OBJECTIVE: The aim of this study was to evaluate the simulated emergency care performed by firefighters and their perception of simulation as an educational method.

METHODS: This study had a mixed method with both a quantitative and a qualitative approach. Data were collected by simulation assessment, a questionnaire, and written comments. Descriptive analysis was conducted on the quantitative data whereas a qualitative content analysis was conducted on the qualitative data. Finally, a contingent analysis was used where a synthesis configured both the quantitative and the qualitative results into a narrative result.

RESULTS: The cognitive workload that firefighters face during simulated emergency care is crucial for learning. In this study, the severity and complexity of the scenarios provided were higher than expected by the firefighters. Clearly stated conditions for the simulation and constructive feedback were considered positive for learning. Patient actors induced realism in the scenario, increasing the experience of stress, in comparison to a manikin.

CONCLUSION: To simulate in a realistic on-scene environment increases firefighters' cognitive ability to critically analyze problems and manage emergency care. Simulation of emergency care developed the firefighters as professionals.

Simulation provides the opportunity to learn how to care for patients in complex situations, such as when patients are exposed to high-energy trauma such as motor vehicle accidents. The aim of the study was to describe nurses' perceptions of high-energy trauma care through simulation in prehospital emergency care. The study had a qualitative design. Interviews were conducted with 20 nurses after performing a simulated training series. Data were analyzed using a phenomenographic method. The result indicates that simulation establishes, corrects, and confirms knowledge and skills related to trauma care in prehosp ital emergency settings. Trauma knowledge is readily available in memory and can be quickly retrieved in a future trauma situation. 

Well-educated ambulance staff is a prerequisite for high-quality prehospital trauma care. The aim of this study was to examine how nurses in the ambulance service experienced participation in trauma simulation. Sixty-one nurses, working in an emergency ambulance service, performed simulated trauma care on four different occasions and afterward rated three statements on a 5-point Likert scale. A descriptive and inferential analysis was conducted. There are statistically significant increases between the pre- and posttests regarding all three statements: I think simulation of severe trauma with manikins is realistic (0.23 or 6% increase), Simulation is a suitable method for learning severe trauma care (1.3 or 38% increase), and I am comfortable in the situation learning severe trauma care through simulation (0.74 or 19% increase). With the experience of realism in simulation, participants become more motivated to learn and prepare for future events. If the participants instead feel uncomfortable during simulation training, they focus on their own feelings instead of learning. In a realistic simulated environment, participants are prepared to understand and manage the emergency care situation in clinical work. Participants learn during simulation when they are outside their comfort zone but without being uncomfortable or experiencing anxiety.

Introduction: Microscopy is gold standard for urine sediment analysis, although the method is often insufficiently standardized. Several automated instruments, such as UF-5000, are commercially available on the market. Urine sediment analysis is crucial for diagnosis of kidney and urinary tract diseases where elements such as erythrocytes, leukocytes, epithelial cells, casts and crystals can be identified. Aim: The aim was to evaluate the performance of UF-5000 and compare the method with manual microscopic analysis of urine sediment. Method: Analysis with UF-5000 and microscopy was conducted on 69 samples. Data were processed with Passing Bablok-regression, Bland-Altman bias plot and Spearman's rank order correlation. Result: Comparison showed statistical significance between the two methods. Performance evaluation showed high accuracy apart from the coefficient of variation for low concentration of leukocytes and systematic error for linearity. Discussion: Since microscopy of urine sediment is an insufficiently standardized method, differences were acknowledged caused by discrepancies in the reference method. Further studies where UF-5000 is compared to a more standardized manual microscopy with a larger amount of pathological urine samples is of great importance. Reduction for cut-off may also be relevant. For further analysis of linearity, an additional instrument should be used as a complement.

Sammanfattning

Bakgrund: Antalet personer med diabetes Mellitus typ 2 växer snabbt i världen. Egenvård krävs för att bromsa progressionen av DMT2 och förhindra eller fördröja komplikationer. Många personer med DMT2 sköter emellertid inte sin egenvård enligt rekommendationer.

Syftet: Att beskriva erfarenheter av egenvård hos personer med DMT2.

Metod: Med hjälp av Fribergs femstegsmodell gjordes en litteraturöversikt av elva kvalitativa studier om erfarenheter av egenvård hos personer med DMT2.

Resultat: Att integrera egenvården i vardagen är en utmaning. Familjen och vårdpersonalen har en nyckelroll och kan utgöra såväl ett hinder som ett stöd för egenvården. Andra personer med diabetes upplevs som ett entydigt positivt stöd. Att acceptera sjukdomen är en förutsättning för att kunna bedriva egenvården. Brist på förståelse och okunskap kring DMT2 utgör ett hinder mot egenvård. Personliga mål och feedback är avgörande för motivationen.

Slutsatser: Socialt stöd, acceptans av sjukdomen, positiv feedback och individualiserad information upplevs underlätta egenvård.

Background. Samis are indigenous people in north Europe. In the territory called Sa´pmi (Lapland), reindeer herding is the traditional base for the Sami economy. The relation between living conditions and positive health of the Swedish Samis has been sparsely studied. As health is closely linked to sense of coherence (SOC), an understanding of the background factors to SOC may contribute knowledge that might be useful in promoting living conditions and health.

Methods. The study examines relations between the level of SOC and background factors from surveys in a Sami population (n=613) in comparison to a non-Sami population (n=525) in Sweden, and in comparison between 2 subsamples of Samis, that is, herders and non-herders.

Results. There are more similarities than differences between the Sami and non-Sami populations. However, dividing the Sami population, reindeer herders had significantly lower SOC, and in specific the subcomponent manageability, that is, less ability to use available resources to meet different demands in life, compared to non-herders.

Conclusions. In addition to age and health, predictors of SOC are related to the life form of reindeer husbandry and the belonging to the herding community

The aim was to evaluate and test the psychometric properties of the Dental Hygienist Beliefs Survey (DHBS) in a Swedish sample of different patient groups and students. It was hypothesized that negative dental hygienist beliefs would discriminate between fearful and non-fearful study groups. The DHBS was distributed together with the revised Dental Beliefs Survey (DBS-R) and the Dental Anxiety Scale (DAS). The study sample included 394 subjects (130 students, 144 general dental patients, 90 periodontal patients and 30 patients on a waiting list for dental fear treatment). The results verified that the DHBS discriminates well between dentally fearful and non-fearful study groups. The DHBS had high internal consistency (Cronbach's alpha = 0.96-0.98) in all the groups. The correlation between the DHBS and the DBS-R was high (rho = 0.82, P < 0.001). Furthermore, the DHBS correlated significantly with the DAS, as well as with a low but significant correlation to age (more negative attitudes in younger age groups) and gender (more negative attitudes amongst women). Regression analysis showed that gender and the DHBS items: 23, 16 and 28, i.e. items related to feeling helpless, worries/fears not being taken seriously and fear about 'bad news' possibly preventing treatment, were the most important predictors of dental fear. The results suggest that the DHBS may be a valid and reliable scale to use in order to assess patient's specific attitudes to dental hygienists. However, the psychometric properties including test-retest analysis and the underlying factor structure of the DHBS need to be further explored.

The aim of this study was to evaluate and to test the psychometric properties of a Swedish version of the revised Dental Beliefs Survey (DBS-R) in different patient groups and in a non-clinical sample of students. It was hypothesized that negative dental beliefs, assessed using the DBS-R, would discriminate between fearful and non-fearful study groups. The questionnaire was distributed together with the Dental Anxiety Scale (DAS). The sample included 550 adults who responded to the questionnaires (206 students, 177 general dental patients, 105 periodontal patients and 62 patients at a waiting list for dental-fear treatment). The internal drop-out rate was low. The results confirmed that the DBS-R discriminates well between fearful patients and the other study groups. The DBS-R had a high internal consistency in all the study groups. Furthermore, the DBS-R correlated significantly with age (higher values in younger age groups) and the DAS. Regression analyses showed that the DBS-R subdimensions of 'communication' and 'control'/or 'trust', respectively, were significant predictors for dental fear. The results suggest that the DBS-R is a reliable and valid instrument for use in different Swedish patient- and non-clinical population groups in order to assess attitudes to dentists. However, the underlying factor structure of the DBS-R needs to be further explored and established.

Background: Children with intellectual disabilities living in developing countries are vulnerable to participation restrictions. Few studies have been made regarding their own perspectives. Aim: To describe how children in a low income country aged 13-17 with an intellectual disability perceive their participation in everyday life activities. Method: This bachelor thesis was conducted as a descriptive study and had a quantitative approach. Participants were collected through a non-probability, goal-oriented consecutive sampling. Data were collected by using “Picture my Participation”, an instrument designed as a structured interview with quantitative questions. The data were analyzed with IBM SPSS Statistics 21. Tables and diagrams were made in Microsoft Excel 2013. Result: The activity that the children participated in most frequently was “Daily routines at home for personal care (dressing, choosing clothing, hair care, brushing teeth)”. The activity that most children prioritized as most important, and they were most involved in was “Organised leisure activities”. “Services and policies” and “Social environment” were the factors seen as “Facilitators” to participation, whereas “Family attitudes” was seen as a “Barrier” to participation. Conclusion: The children perceived their participation in the prioritized activities as high and experienced few barriers in the context of participation.

Summary

Background: Diabetes type-1 is an autoimmune disease and one of the most common chronic diseases in Sweden. Diabetes type-1 can be developed at any age, but usually appears during childhood and adolescence. Living with the disease implicates being responsible for their self-care.

Aim: The aim of the study was to describe the young adult’s experiences of living with diabetes type-1, based on Orem’s self-care deficit nursing theory.

Method: This study is a qualitative study with deductive approach. The study is based on three blogs. Orem’s self-care deficit nursing theory was used in this study.

Results: The relationship with family and other diabetics are perceived to be a great support and can serve as an aid in self-care. Self-care can be difficult to achieve and sometimes they can experience that planning and structure be in vain. According to the individuals, it is important not to let the disease limit the social life. There is a major ignorance of diabetes type-1 in the society which leads to insecurity and lack of trust. Despite an environment of supportive people, individuals with diabetes type-1 can experience loneliness.

Conclusion: An insight of young adult’s experiences of living with diabetes type-1 is important for the nurse because of the ability to reduce conflicts between nurse and patient and thereby improve conditions for a successful self-care.

Information technology has been suggested to improve patient health outcomes and reduce healthcare cost. This study explored the business model and effects of collaborative innovation between caregivers and patients on healthcare delivery through remote patient monitoring by interviewing caregivers and surveying atrial fibrillation patients. Findings indicate that remote monitoring enhanced early detection of potential risks and quality of clinical decision-making with patients feeling more empowered and involved in their own care. The remote monitoring system which consisted of a home-based ECG and a web-based service and was offered free to patients, brought together caregivers, patients, service provider and the government as actors. The introduction of remote monitoring increased the workload of caregivers and facilitation of timely diagnostics and decision-making were not realized. IT is an enabler of innovation in healthcare, but it must be integrated into work processes with a viable business model to realize potential benefits and sustain it. 

Aim

Enhancement of participation has been described as the ultimate outcome for health and educational interventions. The goal of this systematic review was to identify and critically appraise studies that aimed to improve the participation outcomes of children with disabilities.

Method

Nine databases that index literature from the fields of health, psychology, and education were searched to retrieve information on research conducted with children with disabilities aged between 5 years and 18 years. Articles were included if the author(s) reported that participation was an intended outcome of the intervention. The articles included were limited to those reporting high-level primary research, as defined by Australia's National Health and Medical Research Council evidence hierarchy guidelines. No restrictions were placed on the type of intervention being investigated.

Results

Seven randomized controlled or pseudo-randomized studies were included. Only three of these studies identified participation as a primary outcome. Both individualized and group-based approaches to enhancing participation outcomes appeared to be effective. Studies of interventions with a primary focus on body function or activity level outcomes did not demonstrate an effect on participation outcomes.

Intepretation

Few intervention studies have focused on participation as a primary outcome measure. Approaches using individually tailored education and mentoring programmes were found to enhance participation outcomes, while exercise programmes, where participation was a secondary outcome, generally demonstrated little effect.

AIM:

We aimed to identify measures used to assess the participation of disabled children and to map the measures' content to the family of participation-related constructs (fPRC) to inform future research and practice.

METHOD:

Six databases were searched to identify measures used to assess participation in health, psychology, and education research. Included studies involved children aged 0 to 18 years with a permanent impairment or developmental disability and reported use of a quantitative measure of participation. A second search sought relevant literature about each identified measure (including published manuals) to allow a comprehensive understanding of the measure. Measurement constructs of frequently reported measures were then mapped to the fPRC.

RESULTS:

From an initial yield of 32 767 articles, 578 reported one or more of 118 participation measures. Of these, 51 measures were reported in more than one article (our criterion) and were therefore eligible for mapping to the fPRC. Twenty-one measures quantified aspects of participation attendance, 10 quantified aspects of involvement as discrete scales, and four quantified attendance and involvement in a manner that could not be separated.

INTERPRETATION:

Improved understanding of participation and its related constructs is developing rapidly; thoughtful selection of measures in research is critical to further our knowledge base.

WHAT THIS PAPER ADDS:

The fPRC can support our rapidly evolving and expanding understanding of participation. Instruments selected to measure participation do not always align with emerging concepts. Matching research aims to a chosen measure's content will improve understanding of participation. Opportunities exist to develop validated participation measures, especially self-reported measures of involvement.

We linked individual-level data from the 2004 wave of the National Long-Term Care Survey with state-level data from the National Aging Program Information Systems (NAPIS) State Program Reports to predict care mix and unmet need for assistance. Our sample consisted of 2422 community-dwelling individuals aged 65 and older (69% women, 8% nonwhite) who reported at least one limitation in an instrumental or basic activity of daily living. We used the data to predict the mix of formal and informal support received, and the probability of having at least one unmet need from individual (predisposing, enabling, and need) characteristics with state-level home help coverage rates, intensity of home help services, and proportion of population aged 60+ residing in institutional settings. Consistent with past research, a majority (52.6%) of the disabled sample reported unmet need. At the individual level, enabling (availability of kin support) and need (number of basic and instrumental activity of daily living impairments, BADLs and IADLs) were most strongly associated with care mix and unmet need. State-level services were not associated with receipt of informal supports. In states providing home help services to a higher proportion of elders, women were more likely to receive formal help. In states providing more intensive services, women were less likely and individuals living alone more likely to receive formal supports. In states where a higher proportion of elders lived in nursing homes, individuals living alone were more likely to receive formal assistance, less likely overall to report unmet needs, but the oldest-old were more likely to report unmet need.

This article draws from sociological and socio-legal studies of dispute between patients and doctors to examine how healthcare professionals made sense of patients’ complaints about healthcare. We analyse 41 discursive interviews with professional healthcare staff working in eight different English National Health Service settings to explore how they made sense of events of complaint and of patients’ (including families’) motives for complaining. We find that for our interviewees, events of patients’ complaining about care were perceived as a breach in fundamental relationships involving patients’ trust or patients’ recognition of their work efforts. We find that interviewees rationalised patients’ motives for complaining in ways that marginalised the content of their concerns. Complaints were most often discussed as coming from patients who were inexpert, distressed or advantage-seeking; accordingly, care professionals hearing their concerns about care positioned themselves as informed decision-makers, empathic listeners or service gate-keepers. We find differences in our interviewees’ rationalisation of patients’ complaining about care to be related to local service contingences rather than to fixed professional differences. We note that it was rare for interviewees to describe complaints raised by patients as grounds for improving the quality of care. Our findings indicate that recent health policy directives promoting a view of complaints as learning opportunities from critical patient/consumers must account for sociological factors that inform both how the agency of patients is envisaged and how professionalism exercised contemporary healthcare work.

Objective:This study explored how professionals in interdisciplinary teams perceived the implementation of the World Health Organization’s International Classification of Functioning, Disability and Health, version for Children and Youth (ICF-CY) in Swedish habilitation services.

Design:Descriptive longitudinal mixed-methods design.

Methods:Following participation in a 2-day in-service training on the ICF-CY, 113 professionals from 14 interdisciplinary teams described their perceptions of the implementation of the ICF-CY at 3 consecutive time-points: during in-service training, after 1 year, and after 2.5 years.

Results:Implementation of the ICF-CY in daily work focused on assessment and habilitation planning and required adaptations of routines and materials. The ICF-CY was perceived as useful in supporting analyses and in communication about children’s needs. Professionals also perceived it as contributing to new perspectives on problems and a sharpened focus on participation.

Conclusion:Professionals indicated that the ICF-CY enhanced their awareness of families’ views of child participation, which corresponded to organizational goals for habilitation services. An implementation finding was a lack of tools fitting the comprehensive ICF-CY perspective. The study points to the need for ICF-CY-based assessment and intervention methods focusing on child participation.

Purpose: The aim was to determine professionals’ views of everyday life situations (ELS) of importance for children and to explore how ELS correlate with the construct ‘Participation’. This study was part of a larger work to develop a structured tool with code sets to identify child participation and support children with disabilities to describe what matters most for them in intervention planning.

Method: The study had a concurrent mixed methods design. Information from one open-ended question and questionnaires were linked to the ICF-CY component Activities and Participation. Two concurrent data sets were compared.

Results: Proposed ELS were distributed across ICF-CY categories from low to high level of complexity and context specificity. The correlation with participation became stronger for the later chapters of the component (d7-d9). Differences between respondents due to working field, country, and children’s ages were explored. Acts and tasks seemed most important for the youngest children whereas ELS shifted towards societal involvement for adolescents.

Conclusion: Eleven categories related to ICF-CY chapters d3-d9 emerged as ELS. Two age groups (infants/preschoolers and adolescents) are required to develop code sets for the new tool. The results need triangulation with other concurrent studies to provide corroborating evidence and add a family perspective.

Participation as a construct can be applied on all ecological levels from participation for individual children in their everyday life to participation for all as a societal goal. It is defined in the ICF-CY as involvement in a life situation. Participation is occurring at the nodal point between children and their environments. Contexts vary with socio-economical standards, culture and geographical characteristics and thus also the expressions of participation. This presentation will discuss cultural diversity in children’s participation in relation to the universal characteristics of participation defined as “being there” and participation defined as “degree of engagement while being there”. The utility of the ICF-CY as a tool to analyze universal characteristics and cultural diversity in conditions for, and actual experiences of, participation are examined in findings from five studies: 1) Maxwell et al. have analyzed national, regional and local educational policy documents in Scotland and Sweden regarding children in need of special support  in relation to conditions for participation and participation; 2) Ståhl et al. have linked and compared ICF-CY codes to information regarding children’s health in Child Health Care and School Health Care and analyzed whether biomedical or participation information is the focus of the information; 3) Adolfsson et al. have collected and compared data from respondents in Sweden, the USA, and Portugal concerning what professionals consider to be important everyday situations for child participation; 4) Klang et al. has studied domains of participation and environment related to child and caregiver interaction in a Russian context to identify factors related to participation; and 5) Ullenhag et al. have studied participation in  leisure activities and  leisure activity preferences  of Swedish children and compared with data from the Netherlands and Canada using the same questionnaire.

Purpose. This study was part of a larger work to develop an authentic measure consisting of code sets for self- or proxy-report of child participation. The aim was to identify common everyday life situations of children and youth based on measures of participation.

Method. The study was descriptive in nature and involved several stages: systematic search of literature to find articles presenting measures for children and youth with disabilities, identifying measures in selected articles, linking items in included measures to the ICF-CY, analysing content in measures presented as performance and participation and identifying aggregations of ICF-CY codes across these measures.

Results. A large number of measures for children and youth with disabilities were identified but only 12 fulfilled the inclusion criteria. A slight distinction in content and age appropriateness appeared. Measures presented as performance covered all the ICF-CY Activities and Participation chapters, whereas measures presented as participation covered five of nine chapters. Three common everyday life situations emerged from the measures: Moving around, Engagement in play and Recreation and leisure.

Conclusion. Only a small number of life situations for children and youth emerged from items in selected measures, thus, other sources are needed to identify more everyday life situations.

Child Participation is defined by the International Classification of Functioning, Disability and Health forChildren and Youth (ICF-CY) as involvement in life situations but knowledge on children´s specific everydaylife situations (EDLs) is lacking. Professionals in early intervention services need a structured tool to identifyand assess child participation in everyday life situations. It should support children with disabilities indescribing what matters most for them in intervention planning. With the long term goal to create ICF-CY codesets, EDLs were identified by a systematic literature search for measures of performance or participation andby collecting professional opinions on EDL and participation. Information was linked to the ICF-CY andtriangulated with research exploring family opinions. Most items in measures were linked to moving around,play, and recreation and leisure. The six measures of performance and six of participation differed regardingcontent and content dependent on age group.Descriptions on EDLs from 297 professionals were linked to ICF-CY codes. Frequent linkages were Self-care,such as eating and hygiene; Major life areas, such as play and education; and Relationships, but also sleep. Byrelating EDLs directly to predefined ICF-CY categories in the ICF-CY component Activities and Participation,five EDLs across categories were identified based on responses from 207 professionals. These concernedsleep, communication, dressing, family relationships and play. Some differences emerged dependent onparticipants’ culture and on age group. A triangulation between professional and family opinions concerningEDL’s revealed relatively high agreement. As a final result, a set of approximately 12-15 everyday lifesituations is expected to be identified in this study to be used for development of code sets.