Background: Chronic Obstructive Pulmonary Disease (COPD) is the fourth leading cause of death in the world. COPD is a progressive disease that could lead to chronic hypoxemia, which requires treatment as domiciliary Long-Term Oxygen Therapy (LTOT). There is a need for increased knowledge about self-care strategies used by individuals living with COPD and LTOT. Objective: The aim was to explore experiences and self-care strategies in patients living with both COPD and LTOT. Sample: The sample consisted of five men and five women diagnosed with COPD being prescribed LTOT for more than one year. Method: Ten interviews were undertaken and analyzed for both manifest and latent content. Results: Living with COPD and LTOT was associated with experiences of guilt although there were doubts about what had caused the lung disease. Both the lung disease and the oxygen therapy had a negative impact on their self-image. Anxiety was expressed when thoughts about the remaining time occurred. There was a constant balance between diminishing abilities and increasing restrictions related to the lung disease and the therapy. In order to compensate for arising imbalance, self-care strategies had been initiated aimed at preserving the present state of health, enabling and facilitating physical activity and promoting a positive attitude. Conclusion: The current study suggests that individuals living with COPD and LTOT are encouraged to adopt self-care strategies directed towards maintaining stability with regard to the lung disease, the oxygen therapy, physical capability and emotional reactions.

Background: Patients who repeatedly seek care directly at hospital based somatic emergency

departments take up a large proportion of health care resources, at the same time they appear to experience low satisfaction with the care they receive. The purposes of this pilot study were to describe: I) the development of a team model for taking care of frequent visitors to a somatic hospital based ED; II) Eventual changes, over six months, in costs and patients’ health care utilization related to pilot testing the model and III), the team’s experiences of implementing the model.

Methods: A mixed method convergent parallel design was used.

Results: The development of the model began as a top-down process and later on into a bottom-up approach once the inter-professional team became involved. The new model functioned as a support for all 12 patients included in the study and collectively their visits decreased by a total of 73 visits (55%).

Conclusion: The inference quality description is that a management induced project may be accepted and actively applied when those involved experience freedom to structure the project. Increased communication between different professionals within the hospital and between different caregivers such as ED, primary health care and community social- and health-care, increases the possibility for the patients to be cared for in a sustainable and non-fragmented way.

Patients who repeatedly seek care directly at hospital based somatic emergency departments take up a large proportion of health care resources, at the same time they appear to experience low satisfaction with the care they receive  The purposes of this pilot study were to describe: I) the development of a team model for taking care of frequent visitors to  a somatic hospital based  ED; II) Eventual changes, over six months, in costs and patients’ health care utilization related to pilot testing the model and III), the team’s experiences of  implementing the model. A mixed method convergent parallel design was used. The development of the model began as a top-down process and later on in the process into a bottom-up approach once the inter-professional team became involved. The new model functioned as a support for all 12 patients included in the study and collectively their visits decreased by a total of 55%. The inference quality description is that such a management induced project may be accepted and actively applied when those involved experience freedom to structure the project. The freedom of being able to structure the model led to steps being taken that were beyond the project’s original limitations.

The purpose of this paper is to describe the implementation of action research (AR) in the context of Swedish municipal care from a facilitator’s’ perspective. Four empirical studies using the AR approach were performed during 2007–2012 in six municipalities. Establishing support for AR was time-consuming when it concerns starting up processes that were created and were changeable over time. Further, the processes were focused on the sustainable development of practice, based on practitioners’ and care consumers’ knowledge, that is a precondition of organizational change. An important precondition was that the participants were motivated and participated actively in all phases of the AR cycle. Another important precondition was that the participants got along with each other and trusted each other. The participants’ engagement and the collaboration that was established between the participants and the facilitator were likely a result of this. Moreover, even positive interaction with participants representing a “top–down” perspective was important for the implementation of proposed changes to the practice. In conclusion, AR enhanced sustainable action based on participant’s everyday knowledge relating to areas they want to change and improve in the context of municipal care practice.

BACKGROUND: Knowledge of experiences from prostate cancer is sparse in a longitudinal perspective. From a nursing perspective, results from combined qualitative and quantitative studies are lacking however would present the broadest knowledge base for best practice. Present descriptions of medical-physical symptoms such as urinary, bowel and sexual dysfunction from quantitative inquiries need be complemented with qualitative results. Such knowledge is essential in relation to treatment and communication with patients over the years and not only shortly after surgery.

METHODS: A longitudinal study was formatted to investigate general and specific health quality and sense of coherence quantitative alterations over three years. A general health quality module (EORTC QLC-C30) and a disease-specific module (EORTC PR-25) were applied for the longitudinal study together with the Orientation to life questionnaire (SOC), measuring a persons' sense of coherence. In order to strengthen reliability and compensate for low participation we used the Directed content analysis for interviewing and analysis. The method allows using findings from earlier research when interviewing along with detecting new areas. Twenty-one men were followed over three years and six of them, in the third year, accepted to be interviewed.

RESULTS: We found high quality of life ratings and extended the study with follow-up interviews in year three, to investigate whether questionnaire results were in line with interview findings. We found high life quality and functioning ratings that were in line with qualitative descriptions. Interview analysis showed retrieval of life as lived before, yet in a different way, the men never forgot the diagnosis event, had a unique illness history worth hearing, and had come to terms with most treatment-related shortcomings. Sense of coherence ratings were medium to high and confirmed stability over time in comprehensibility, manageability and meaningfulness after prostate cancer treatment.

CONCLUSIONS: Over the years, the men's negative experiences from shifted into 'a good life' though in a different way than before. The interpretation is supported in the study by quantitative results showing a high degree of functioning. The men's sense of coherence seamed to support their handling of life three years after prostate cancer treatment.

Background: Making changes to municipal social care and service has been found to be challenging to realise and highly multifaceted. The aim of this study was to describe how the professionals can identify needs for improvement and improve Food Distribution (FD) service for the home-living elderly people in Sweden.

Methods: This study is part of a larger project with an action research approach focusing on to municipal FD to older people living in their own home in Sweden. The professionals involved in FD invited the first author to assist them in this process. The study participants were comprised of the following groups: “The Identification focus group” that identified need for improvement of FD (n= 5); “The Action focus group” that planned and choose suitable ‘action’ for improvement (n=5); “The First Evaluation group” (n=4) that evaluated the content of planned improvement and finally “The Second Evaluation group” (n=29) that evaluated the changes following improvement. The data was gathered and analysed by Story Dialogue Method.

Results: The need to update and increase the FD recipient’s knowledge in nutrition by sending them informative letters was found to be an important area to focus on. The information letters (n=1700) were distributed to the all FD recipients in six municipalities in southern Sweden during April 2011. The results were evaluated during May 2011. The overall general estimation was that the content of the letters indicated that this was a suitable method for gaining information to make a nutrition competence update. Following this, “The Action focus group” decided: firstly, to continue preparing and distributing information letters to all FD recipients to be sent out twice a year, and secondly: to make the information letters accessible on the websites of the six municipalities and county councils involved.

Conclusions: This study showed that systematic work inspired by an action research approach with motivated and involved participants can be beneficial and a starting point for the process of change in municipal service and care practice. The major conclusion of the study was that systematic reflection over everyday practice can be the vehicle for the future change of practice. The research process and the findings have implications for nursing, care of the elderly and gerontology.

Findings from international research as well as from Sweden show that food distribution as a single inter­vention involves various professional groups on the various levels in organisation.

The present research is one of several Action Research projects initiated as a result of a resolution on the highest political level aiming at achieving improvements within the care and service through collaboration between different levels in the organisations.

The overall aim of this specific study is to describe the “top-down” perspective i.e. decision-makers involvement in identifying areas for the development of the food distribution chain.

Data was collected in two steps, firstly by individual interviews with decision makers (politicians n=21, one administrative manager and one medical responsible nurse) and secondly by evaluation dialogue in group (n=23) discussion. The group discussions were based on findings from individual interviews and results from two previous studies focused on interviews with various professionals and food distribution recipients.

The findings were that food distribution was seen as a multifaceted system that included three interrelated issues: the administration of work, the professional’s competence in nutrition and the relationship between various professional groups. To achieve a change, the central component of complexity needs to be clarified. When the issues are multifaceted the solutions need to regard the whole picture rather than its parts.