När äldre inte klarar av att bo hemma längre flyttar de ofta till ett vård-och omsorgs-boende, lever den sista tiden där och är i behov av palliativ vård. Palliativ vård är ett förhållningssätt som kännetecknas av en helhetssyn på människan utifrån individens behov. De som arbetar nära den äldre och den närstående är vård- och omsorgsperso-nalen och det är distriktssköterskan som har det övergripande ansvaret för omvårdna-den. Stöd till den närstående är av största vikt inom den palliativa vården. Syftet med studien var att beskriva vård- och omsorgspersonalens erfarenheter av att uppmärk-samma och stödja närstående till den äldre på vård- och omsorgsboende utifrån ett palliativt förhållningssätt. Datainsamlingarna gjordes i två omgångar, en fokusgrupp-sintervju 2017 och genomförda diskussionsgrupper 2010, analyserades med hjälp av kvalitativ innehållsanalys och tolkades med hjälp av Dosseys "Theory of integral nur-sing". I resultatet framkom kategorierna att skapa trygghet för den närstående, önskan att göra den närstående delaktig och att få kunskap om palliativ vård. Kategorierna utmynnade i temat: I ett palliativt förhållningssätt stöds närstående genom att de får känna trygghet och delaktighet. Slutsatsen är att vård- och omsorgspersonalens in-tention är att stödja de närstående men behöver arbeta mer i ett partnerskap med de närstående för att de ska känna en helhet och därmed trygghet och delaktighet.

How can discharge planning (DP) for patients who require care in the home following a period in hospital be understood and developed through the lenses of complexity theory? With the help of complexity theory and practice-based narrative research this study discloses the formal routines and complex dynamic practices that are associated with DP. A study of the literature established that there was an almost total absence of complexity-theoretical perspectives on interpreting and developing DP.                 

The researchers collected narratives about the DP processes using qualitative interviews with the nurses responsible for this in a hospital ward: these were audio-recorded and transcribed verbatim. They also participated in and documented meetings where these nurses, as a group, discussed DP.                 

The findings show that nurses have to continuously deal with uncertainty, surprises and the unknown. They have to make sense and take charge of dynamic complex events and new knowledge, and manage complex relations and information. The researchers argue that looking upon practice from the lenses of complexity theory, and therefore accepting the complexity of practice, could facilitate the development of nurses' skills in order to guarantee good quality in DP.

Background: SBAR has been suggested as a means to avoid unclear communication between health care professionals and in turn enhance patient safety in the healthcare sector.

Aim: to evaluate hospital-based health care professionals experiences from using the Situation, Background, Assessment and Recommendation (SBAR) communication model.

Methodology: A quantitative, descriptive, comparative pre- and post-intervention questionnaire-based pilot study before and after the implementation of SBAR at surgical hospitals wards. Open comments to questionnaire items were analyzed qualitatively.

Results: The introduction of SBAR increased the experience of having a well-functioning structure for oral communication among health care professionals regarding patients’ conditions. Qualitative findings revealed the categories: Use of SBAR as a structure, Reporting time, Patient safety, and Personal aspects.

Conclusions: SBAR is perceived as effective to get a structure of the content in patient reports, which may facilitate patient safety.

Background

Dissatisfaction with appearance is a common phenomenon, more frequent among women than men (Frisén & Holmqvist 2010, Neighbors & Sobal 2007) but so common that it can be considered a norm (Tantleff-Dunn, Barnes & Larose 2011). Health professionals are therefore in contact with the phenomenon on a regular basis in different health settings. Previous research have shown that health professionals experience time constraints and lack of confidence in relation to patients’ appearance issues (Persson et al 2009; Konradsen et al 2009). Little is however known about the resources needed from the professionals’ point of view. The aim of the study was therefore to explore the phenomenon from a nursing perspective in general and with particular emphasis on resources needed.

Methods

Five semi-structured focus group interviews were conducted with 24 health professionals in total (19 women and 5 men). Their age varied from approximately 20 to 45 years, with adherent variation in professional experience from a variety of health settings. The interviews were digitally recorded, transcribed verbatim and analyzed through thematic analysis (Braun & Clarke, 2006). The study was done in accordance with the Swedish Law of Research Ethics, SFS 2003:460.

Findings

The analysis resulted in the two themes knowledge development and operative support, representing different resources needed according to the respondents. The respondents own knowledge and professional competence was constantly referred to as the most important resource. The findings showed the importance of appearance being included in their education, the need for a continuous process of reflection and learning on an individual level but also on group level in terms of collegial learning. In order for the knowledge and competence to be put into practice there was also need for operative support. Sufficient time for communicating with the patients and the need for appropriate technical support in some nursing situations were emphasized by the participants.

Discussion

The findings clearly shows the central role that health professionals have in relation to patients’ appearance issues and their need for resources. The findings adds to existing body of knowledge and can be used as a framework for health promotion strategies in health settings, with regards to patients’ appearance issues and distress. More research as well as action is needed from a nursing as well as public health perspective.

BACKGROUND: Health care professionals frequently interact with unknown patients in a process involving appearance-based judgements and priority-setting, all of which has an effect on health care equality. The healthcare provider-patient interaction is also highly relevant for the awareness and support of patients' appearance concerns, with an associated possibility for improving patients' satisfaction with their appearance and health. The aim was therefore to explore nursing staff's experience of patients' appearance issues in various nursing situations, with the purpose to facilitate awareness raising and knowledge development.

METHOD: A qualitative research approach with focus group interviews was chosen due to the exploratory aim of the study. Five semi-structured focus group interviews were conducted with 24 nursing staff in total (19 women and five men). The participants' ages varied (20 to 45 years) as did their professional nursing experience. The interviews lasted approximately one hour, were digitally recorded, transcribed verbatim and analysed through thematic analysis.

RESULTS: The thematic analysis resulted in the two themes Patient perspective and Professional nursing role, with associated subthemes. The findings showed the importance and impact of appearance issues in nursing situations and how these are linked to the health of the patients. Some groups of patients were identified as more vulnerable than others, which was associated with health care inequalities and health disparities. Value-based strategies along with knowledge, and skills for holistic person-centred care were identified as important resources for the development of appearance-related awareness and support in various nursing situations.

CONCLUSION: Strategies for improvement can be realised through the educational system for nursing staff, but mainly by using collective reflective learning forums in different workplaces. An empowerment approach is considered a useful framework for the implementation of holistic person-centred care, functioning as a resource for appearance-related awareness and support in various nursing situations. However, more research is needed on the complex and challenging phenomenon of appearance issues in nursing situations. Knowledge development related to successful person-centred strategies for appearance-related awareness and support is important, especially strategies with a salutogenic perspective.

Forskningsplattformen för Hälsa i Samverkan är samordnare för flera projekt varavett är Preventiva Hembesök till Seniorer (Pre-H). Syftet med Pre-H programmet är attutveckla en gemensam modell för preventiva hembesök samt implementera och utvärderaden. Fokus ligger på utveckling av besökstjänsten, organisationen och av ettdigitalt stöd (digitalt bedömnings-, rådgivnings- och beslutsstöd). Grunden i det digitalastödet är en enkät uppbyggd med signalfrågor och följdfrågor. Det framtagna frågeformulärethar under 2016 genomgått en första remissgenomgång och är redo atttestas på seniorer för att ytterligare förbättringar ska möjliggöras innan den används ipraktiken. Syftet med denna pilotstudie var att undersöka seniorers uppfattningar omett frågeformulärs användbarhet som stöd för samtalet mellan besökare och seniorvid preventiva hembesök. Studien hade en kvalitativ induktiv ansats. Tio personer intervjuadesgenom ”fiktiva” hembesök. Seniorernas uppfattning om frågeformuläretsanvändbarhet som stöd i samtalet resulterade i tre kategorier och tolv subkategorier.Under kategorin ”Seniorens uppfattning om frågorna i frågeformuläret” erhölls tresubkategorier: Tydlighet och otydlighet, Relevans och Känsliga ämnen. Under kategorin”Seniorernas uppfattning av frågeformuläret uppbyggnad” erhölls två subkategorier:Struktur, Omfattning. Under kategorin ”Seniorernas uppfattning om utvecklingav frågeformuläret och besöket” erhölls sex subkategorier: Besökspersonen, Säkerhetoch hjälpmedel, Kost och motion, Undersökningar, Läkemedel samt Besökets avslutoch uppföljning. En enkät som stöd och struktur vid samtalet är av godo om frågornabegränsas och strukturen är tydlig. Av stor vikt är även att senioren ges återkopplinggenom konkreta förslag på åtgärder som senioren själv vill/kan vidta. Information iform av broschyrer kan med fördel lämnas till senioren som efter besöket kan ta delav texten i lugn och ro. Några områden kan utvecklas mer för att öka besökets värdetill exempel information kring läkemedel och äldre. För att hembesöket skall upplevasmeningsfullt för senioren ställs stora krav på besökspersonens kompetens.

I sjuksköterskeutbildningen vid Högskolan Kristianstad har sedan 2008 använts en modell för handledning och examination av examensarbetet med fokus på studenternas lärande. Trots att handledningsmodellen varit i bruk under några år visade genomförda kursutvärderingar att studenter uppfattade att det fanns skilda uppfattningar hos handledare och examinatorer om hur examensarbetet ska genomföras. På grund av detta ansöktes medel från Lärande Resurs Centrum (LRC) och Sektionen för Hälsa och Samhälle för att i kollegiet skapa möjligheter att diskutera vilka pedagogiska möjligheter och svårigheter som finns samt hur likheter och olikheter i syn på kunskap kan främja såväl som hindra studenternas lärandeprocess under examensarbetet. I denna rapport beskrivs projektets upplägg och genomförande samt centrala aspekter från den dialog som fördes i kollegiet under projektets gång.

Det kan ta flera år innan ny forskning används i praxis vilket medför att många inte erhåller vård eller förebyggande insatser enligt senaste forskningsrön. Om professioner involveras i forskningsprocessen, kan kunskapen som erhålls bli mer relevant och lättare att implementera i det dagliga arbetet. Vi vill öka förståelsen om hur professioner på bästa sätt kan involveras i forskning och kring vad detta kan bidra med. Vi valde därför att studera hur professioner från vård- och omsorgsverksamheter upplevde att medverka i forsknings- och utvecklingsprojektet Pre-H som samordnas av Forskningsplattformen för Hälsa i Samverkan vid Högskolan Kristianstad. Professionerna är från sju kommuner i Skåne och är med i utvecklingen och implementering av en evidensbaserad modell för förebyggande hembesök. Vår studie ledde till en teoretisk modell som beskriver professioners erfarenheter av att medverka i forskning.

Syftet med denna studie var att beskriva äldres upplevelser och erfarenheter av uppsökandeverksamhet i Osby kommun. Förebyggande hälsoinsatser för äldre bedrivs iSverige med olika benämningar. I Osby kommun bedrivs de med benämning uppsökandeverksamhet. Uppsökande verksamhet med förebyggande insatser och råd kanstärka äldres egenvård och skjuta upp funktionsnedsättning samt förbättra den äldrepersonens välbefinnande och livskvalitet. Ur samhällsekonomiskt perspektiv kan uppsökandeverksamhet också minska kostnader för vård och omsorg på sikt.Metoden är en kvalitativ intervjuundersökning med öppna frågor. Studien genomfördesunder juni- november år 2015 och tio äldre personer intervjuades. Av dessa var detfem kvinnor och fem män. Intervjuerna analyserades enligt Graneheim och Lundmanskvalitativa innehållsanalys.I resultatet framkom två kategorier och sju subkategorier. Essenserna som hittadesfrån intervjuerna var: förväntningar, tillit i mötet, attityder till förändring, information,utförarens kompetens och personlighet, vikten av relation och kreativitet. Resultatetvisar tydligt att äldre upplever arbetet med uppsökande verksamhet värdefullt och villse detta arbete fortsätta.Denna studie ger utan tvekan stöd att utföra uppsökande verksamhet och uppsökandeverksamhet kan ses som en redskap för de äldre att skapa bra förutsättningar att bevarahälsan och ger möjlighet till ett aktivt och självständigt liv.

Background: Older persons with multimorbidity being cared for at home often have complex needs which can´t be met by one player. Interprofessional collaboration is therefore considered necessary if care is to be organised according to the needs of the elderly. To achieve coherent healthcare, municipalities and regions need to develop this area.

Aim: The aim of the study was to illustrate how various professionals belonging to homemaker services, home care services in municipality and Hospital-Based Home Care Services experience their collaboration in caring for older persons with multimorbidity.

Method: Eleven informants took part in the study and individual interviewed. The material was analysed using a hermeneutic data analysis.

Result: The result shows that collaboration between players contains various types of experiences which influence not only the staff who are involved in collaboration but also the result of the collaboration itself. The informants´ experience of collaboration was defined by trust and distrust and by security and insecurity. These influenced both the staff who were involved in collaboration and the result of collaboration itself.

Conlusion: Complex situations could not be solved with simple models. Instead a flexible approach appears necessary with focus shifted from structures to interpersonal relations and interactions. Therefor the different professions have to work as a transprofessional team where close interactions, flexibility and improvisation is a key to success.   

Relevance to clinical practice: A transprofessional approach to teamwork collaboration can blur professional boundaries and take the competence of all staff into account when home health care to older people with multimorbidity is to be provided by multiple caregivers. This is suggested as an approach with potential to provide high quality and safe care to a vulnerable population.

The involvement of health professionals in research may ensure the acquisition of relevant and sustainable knowledge that is applicable in practice. However, knowledge is lacking about how professionals experience being involved. Therefore, the aim of this study was to explore how health professionals experienced the process of being involved in a project related to research on ageing and health. Data was collected through seventeen interviews and analysed using a grounded theory approach. The findings illustrate the health professionals’ experiences of an adaptation process that occurred, e.g., adapting practice and research to facilitate collaboration and the ability to co-create. Influenced by circumstances and through ongoing negotiations and breakthroughs, co-creation was experienced, based on the health professionals’ and researchers’ trustful relationships. In conclusion, this new knowledge may be useful in designing and implementing future studies that involve health professionals in research projects on ageing and health.

BACKGROUND: Research and practice are often considered as two different worlds with different values, which causes a gap between them. Involving professionals such as practitioners, managers, decision-makers, and policy-makers in research on ageing and health might address the gap between research and practice, strengthen the healthcare system, and increase older people's possibilities for healthy ageing. The aim of this study was to conceptualize professionals' involvement in research on ageing and health from the perspective of the professionals themselves.

METHODS: A mixed method called group concept mapping was used. Professionals with experience being involved in research on ageing and health participated in qualitative data collection through brainstorming sessions (n = 29) and by sorting statements (n = 29). Afterwards, they participated in a quantitative data collection by rating statements according to how much each statement strengthened practice (n = 30) and strengthened research (n = 28). Multidimensional scaling analysis and hierarchical cluster analysis were used to conduct quantitative analysis. Latent qualitative analysis was also conducted.

RESULTS: Analysis resulted in eight clusters which illustrated conceptual areas of professionals' involvement in research projects. The qualitative latent construct of the cluster map resulted in the themes: challenges for professionals; prerequisites and professionals' learning can contribute to development of practice; and integrated knowledge benefits older people. There was a strong correlation between what strengthens practice and research (r = 0.92).

CONCLUSIONS: This study illustrates conceptual areas of professionals' own perspectives on what their involvement in research can lead to. Their involvement may lead to knowledge being integrated, and the professionals may learn through their involvement, which can contribute to the development of practice. However, there can also be challenges that need to be handled when professionals are involved in research. The study can be useful for improving the understanding of and actual involvement of professionals in research, and for optimizing the involvement of professionals.

BACKGROUND: Researchers have shown an increased interest in involving professionals from outside academia in research projects. Professionals are often involved in research on ageing and health when the purpose is to address the gap between research and practice. However, there is a need to acquire more knowledge about what the involvement might lead to by exploring researchers' experiences of involving professionals in research on ageing and health and developing conceptual areas. Therefore, the aim of this study was to identify conceptual areas of professionals' involvement in research on ageing and health, from the perspective of researchers themselves.

METHODS: Group concept mapping, a participatory and mixed method, was used to conceptualize areas. Researchers with experience of involving professionals in research projects on ageing and health participated in qualitative data collection through brainstorming sessions (n = 26), and by sorting statements (n = 27). They then took part in quantitative data collection, where they rated statements according to how much a statement strengthened research (n = 26) and strengthened practice (n = 24). Data were analysed using multidimensional scaling analysis and hierarchical cluster analysis. In addition, a qualitative analysis of the latent meaning of the cluster map was conducted.

RESULTS: Analysis of the sorting stage generated five clusters illustrating conceptual areas of professionals' involvement in research projects on ageing and health. The five clusters are as follows: complex collaboration throughout the research process; adaptation of research to different stakeholders, mutual learning through partnership; applicable and sustainable knowledge; legitimate research on ageing and health. The qualitative latent meaning of the cluster map showed two themes: the process of involvement and the outcome of involvement. A positive strong correlation (0.87) was found between the rating of strengthened research and practice.

CONCLUSIONS: This study reveals conceptual areas on a comprehensive and illustrative map which contributes to the understanding of professionals' involvement in research on ageing and health. A conceptual basis for further studies is offered, where the aim is to investigate the processes and outcomes entailed in involving professionals in research on ageing and health. The study also contributes to the development of instruments and theories for optimizing the involvement of professionals in research.

In the sustainable development goals for 2030 the emphasis is on health promotion to enable healthy lives and wellbeing for all. Health promotion from an individual perspective focus on enabling the person to take control and improve health, by focusing on positive health related resources. Health promotion can be applied to older persons during a preventive home visit (PHV). Most of the studies made on PHVs to older persons have focused on risk factors. Suggestions for improvement of the PHV would be to add recommendations that promote health related resources, not only look at risk factors. In order to develop health promotion for older persons there is a need for research about positive health related resources. Therefore this study aim for exploring health related resources that could be found among older persons that have received a PHV.

Methods: A cross-sectional study design was used including older persons age ≥75 years old, living in their own homes, and that had received PHV. Data were collected during a period of nine months, in two municipalities in the south of Sweden. Questions covered wellbeing, nutrition, physical health, functional ability, housing and economy. Binary logistic regression was used to analyse data.

Results: In total 625 older persons were included in the study, 55.4 % were women, mean age was 80.6 (standard deviation 2.2 years). Preliminary results indicate that following factors are significantly associated with good general health (adjusting for age and gender): being able to do things that make one feel valuable, satisfied with existence, physically active several times per week, having no physical problems to participate in social activities, not feeling sad, not having reduced energy and not having reduced endurance.

Conclusion: This results indicate that it can be of importance to pay attention to some specific health related resources when giving health promotion advices during the PHV.  

Preventive home visits (PHVs) are offered to older persons with the purpose of promoting health and preventing risks on an individual level. However, aspects of health need to be considered on a societal level as well. This study aims to get a deeper understanding of perceptions of the usability of the information compiled during the PHVs to promote health, among older persons, on a societal level. Three online focus groups were conducted with heads of unit of PHVs, heads of department, and politicians responsible for health and welfare in seven municipalities in Sweden (n = 12). The findings were visualised in the core category Enable an inclusive society and the interrelated categories Monitoring determinants of health and Enabling exchange of information. The information from the PHVs could be used to monitor determinants of health by identifying assets, challenges, shifts, trends, and future needs in the society. Moreover, exchange of information from the PHVs could occur within and outside the health and welfare organisation. However, the potential use was affected by hindrances illustrated in the category Obstacles to interpreting and communicating the information. To conclude, using the information from the PHVs could possibly contribute to an inclusive society, where persons not usually represented in decision making are given a voice. 

BACKGROUND: Life expectancy is increasing all over the world. To be able to support this positive development, health interventions focusing on promotion and prevention are crucial. Preventive home visits represent one example of a health intervention which addresses both promotion through a supportive dialogue and prevention by giving advice. However, to give support and advice that older persons experience as beneficial, there is a need for more research.

AIM: The aim of this study was to explore older person's experiences of the benefits gained from the support and advice given during the preventive home visit.

METHOD: Individual semi-structured interviews were conducted with 13 older persons, median age 77 years old, living at home, who had received a preventive home visit. The interviews were analysed with content analysis.

FINDINGS: The overarching theme Becoming empowered and recognised as a person was experienced as the major benefit of the support and advice given during the preventive home visit. The support and advice generated conditions for the person to become empowered, by contributing to a feeling of control and preparedness for the future. Furthermore, the support and advice given contributed to a feeling of becoming recognised as a person, as an outcome of the supportive dialogue and the assessment of their health, behaviour and their surrounding environment.

CONCLUSION: The support and advice given during the preventive home visit were experienced as person-centred, and conditions for becoming empowered were created. In order to create a positive outcome from the support and advice given during the preventive home visit, it seems important to focus on providing both a supportive dialogue and a structured assessment.

Background: In order to maintain good health in old age, a comprehensive perspective including both health promotion and risk prevention is crucial. Preventive home visit is one intervention with the purpose to prevent risks and promote health among older persons. Support and advice given during the preventive home visit needs to be tailored towards the older person’s needs. In order to give advice and support that is targeting older persons prerequisites there is a need for more research about how older persons experience support and advice given during a preventive home visit. Therefore, the aim of this study was to explore older person’s experiences of the gains from the support and advice given in a preventive home visit program developed in collaboration between several municipalities, a county council and researchers.

Method: Individual semi-structured interviews were conducted with 13 older persons, mean age 79 years old, living at home who had received a preventive home visit. The interviews were analysed with content analysis.

Findings: The overarching preliminary theme Being empowered and recognised as a person reviled the participants feeling of that the support and advice given encountered all aspects of health and the whole person. The support and advice generated conditions for the person to be empowered by contributing to a feeling of control and preparedness for the future. Further the support and advice given contributed to a feeling of being recognised when health, behaviour and the surrounding environment were assessed.

Conclusion: Being empowered and recognised as a person might be central gains from the support and advice given during the preventive home visits, which enables good health among older persons.

BACKGROUND: The ageing population is increasing worldwide, and this trend is bringing challenges both for the older person and for society. In order to meet the challenges a comprehensive approach is needed involving both health promotion and risk prevention. The preventive home visit is a public health intervention used around the world with the purpose of promoting health and preventing risk among older persons. However, most preventive home visits are focused on questions asking about risks. In order to strengthen the health promotion perspective during the preventive home visits, factors associated with good health need to be identified. The aim of this study was therefore to determine which factors were associated with good self-rated health among older persons who received preventive home visit.

METHODS: This was a register study with a cross-sectional design, including older persons (≥75 years old), living in their own homes, and that had received preventive home visit. Data were collected during a period of 9 months, in two municipalities in the south of Sweden. A questionnaire covered mental, physical and lifestyle factors were used at home visit. Binary logistic regression was used to analyse the data.

RESULTS: In total, 619 older persons were included in the study; 55.4% were women, and the mean age was 80.6 years (standard deviation 2.2 years). The following items were significantly associated with good health (after adjustment for age and gender): being able to do things that make one feel valuable, having no physical problems affecting participation in social activities, not feeling sad, not having reduced energy, and not having impaired endurance.

CONCLUSIONS: The main conclusion of this study is that questions focusing on risks could be seen from a health promotion perspective and could thus be turned into assets with a positive impact on older persons' health. Furthermore, the mental and physical factors identified in the results as associated with good health have implications for the person's ability to feel valuable and participate in social activities. The results suggest that issues regarding both health promotion as well as risk prevention must be brought up during the preventive home visit.

Introduction: Social participation  can have a positive  impact  on  health; however, physical challenges  can be hindrances. During a preventive  home  visit a health  professional (visitor) assesses different aspects of  physical,  mental and social health. However,  there might  be a challenge  for the  visitor  to discover  the interrelationship  between physical  factors that hinder social  participation. Therefore,  the aim  of this  study was, in  the context  of preventive  home visits, to identify  physical  factors which  can hinder  older  persons from taking  part in  social contexts.  Methods: Cross-sectional  register  data from  preventive  home  visits  to older  persons (n=1,245, ≥77 years old,  without  home care) was used. Data was collected during a period of 17 months, in  seven Swedish  municipalities. Logistic  regression  was used to analyse  the association between physical factors and the item physical problems hindering social participation. Results: The mean age was 78.8  (standard  deviation 1.8 years), and 55% were women. The physical  factors significantly  associated with  physical  problems  hindering  taking  part in  social contexts were: having urinary  incontinence (women  only),  having  pain,  impaired  endurance and using  a mobility  device.  Conclusions: This study  provides  insights  into  how to  make the best use of  the questions asked during preventive  home  visits, in  order to enable  older  persons to  take part in  social contexts. The  results recognise  the importance  of taking  into  account physical  challenges  to be able  to support  social  participation. Furthermore, considering physical challenges for social participation on both  an individual  and  a societal  level  might  reduce inequalities  among  older persons.

Samhället står inför förändringar som innebär att andelen personer över 65 år har ökatoch över tid även de närmsta åren kommer att öka. För att möta den ökande andelenäldre i samhället behövs förebyggande insatser. Ett sätt att arbeta förebyggande äratt göra hembesök som syftar till att bibehålla självständighet och god hälsa. Osbykommun har sedan 2006 arbetat förebyggande med att besöka 75 åringar i ordinärtboende. För att kunna utvärdera effekten av verksamheten i Osby behövs det kunskapom hur personerna förhåller sig till rekommendationer som ges och vilka åtgärder devidtar. Denna studie syftade till att undersöka vilka åtgärder äldre personer utfört efteratt de fått ett förebyggande hembesök. En kvantitativ ansats valdes för att utförastudien. Enkäter sändes ut till 147 personer som fått förebyggande hembesök under6 månader. Frågorna som ställdes handlade om säkerhet i hemmet, träning och rörelse,mat och måltider samt kontakter angående hälsa. Svarsfrekvens var 83 personervilket motsvarar 56%. Analyser av enkäten gjordes i analysverktyget SPSS utifrånsignifikansprövning enligt McNemar och logistisk regression. Statistik togs fram på hurmånga som utfört åtgärder innan besöket och hur åtgärderna ökade efter rekommendationernasom lämnats under samtalet. Resultatet visade att signifikans uppmättespå flera områden runt säkerhet i hemmet och träning och rörelse. Flera av de som fåttförebyggande hembesök utförde åtgärder efter besöket inom dessa områden. Majoritetenav de äldre rörde på sig aktivt efter besöket och flertalet genomförde åtgärdersom förbättrade säkerheten i hemmet. Ingen signifikans framkom i de logistiska regressionernamellan kön, ålder, ensam/sammanboende eller läge på bostaden och deberoende variablerna, det vill säga insatser gällande säkerhet i hemmet, träning ochrörelse, mat och måltider samt kontakter angående hälsa. Studien har ett litet urvalvilket gör det svårt att dra slutsatser utifrån de framkomna resultaten. På det antalindivider som besvarat enkäten framkom att samtalet hade effekt och att åtgärderutfördes efter de rekommendationer som gavs. Distriktssjuksköterskorna påverkar desom besökts till att bli delaktiga runt förändringar i sin vardag. Vidare behövs fler studierför att resultatet ytterligare ska kunna säkerställas.

The objective of this paper is to describe, increase the understanding of, and contribute to a theoretical development of how to look at care planning in public health care in Sweden. By transferring some of the medical care from hospitals to a patient's actual home in the 1990s, valuable beds at hospitals were made available to other patients. Patients who have been properly medically treated at hospitals should be discharged from the hospital as soon as possible. This enables a transferral of aftercare to the patient's home or to a municipally organised living accommodation for e.g. the elderly. In order to make sure that patients receive continued care after their discharge from the hospital, Sweden introduced a law concerning co-ordinated care planning (SOSFS 2005:27). This law prescribed that professionals at hospitals should work together with the patient, close kin and caretaker representatives (primarily in the patient's municipal) in order to agree on the need for continued care. In practice this means that an assistance administrator (the person who makes decisions concerning municipal care efforts) a nurse from the municipal home health care system, a nurse from the hospital department at which the patient was admitted, alongside with the patient and his or her close kin should form a care planning team who meet in order to plan the continued need for care. Ultimately the doctors have formal responsibility. In addition to this law, there are agreements between the county council responsible for the medical care and municipals responsible for home health care, well prepared routines for practical approaches, as well as IT support making sure that information is properly transferred to safeguard the safety of the patient and smooth processes (Region Skåne 2011). Despite legislations, governing and control, there are a number of problems when it comes to actual co-ordinated care planning, why is that so? (Augustinsson 2010; Judge 2003; Czarniawska and Lindberg 2006; Lidén 2009; Lindström 2011). This was the basis of the research assignment, i.e. studying actual events behind co-ordinated care planning and developing theoretical models that may be of use to the care planning team. Rather than focusing on the research objective, we asked "What happens in the process of co-ordinated care planning?" This question formed the basis of ten semi-structured interviews with nurses working with co-ordinated care planning at a hospital. We focused on events, interpretations, experiences and emotions in order to follow up with questions that could offer more details on descriptions and analyses. At the introductory phase of the analysis of the transcribed interviews, we asked the following questions "What is going on here?" and "What do the natives [professionals] think they are up to?" From these analyses of the empirical material (interviews as well as documents) and previous theoretical viewpoints of researchers and their knowledge of the field, one overall question emerged: "What happens in the gap between formal structure such as legislations, routines and standardised procedures, and the informal meaning actual co-ordinated planning processes?" The empirical material also included observations of mutual meetings at the hospital between nurses working with co-ordinated planning. The empirical material, based on the answers to the questions above, have later been addressed from various theoretical aspects in order to open up and create new perspectives on events and new theoretical models. This approach means that neither empirical material nor theories are taken for granted. The conclusion of the study, albeit preliminary, is that too many routines and regulations in a co-operation will make professionals unable to see solutions found outside of the predetermined boundaries. The detail level of regulations may be such a problem. This has been frequently discussed and is a known phenomenon among researchers studying knowledge development, safety and quality in organisational work (Dreyfus and Dreyfus 2003; Weick 2009).

Background. In Sweden, attempts to implement core values to ensure high quality health and social care for older people are given high priority and concepts such as security and dignity are often used. As concepts are abstract they are difficult to transform into practical work. 

Aim: The aim of this study was to make sense of the Swedish concept ‘trygghet’ by using stories from daily life in a participatory action research project. Design: One group of six assistant nurses and one group of five registered nurses working in municipality participated in Story Dialogue Method and four older women were interviewed. Result: ‘Trygghet’ was found to be an internal sense – an intrinsic state based on faith and trust in oneself and others called security were situations Sense of security. External factors that strengthened Sense ofto be part of a community, to recognise and be familiar with things andand to use various kinds of aids. Conlusion and Relevance to Clinical Practice: A prerequisite for the professionals being able to support the care receivers adequately is that they have a sense of security themselves, and that they are allowed to operate in a system that facilitates for the care receivers to maintain trustworthy and reliable relations over time.

There is an ongoing debate about how to bridge the gap between theory and practise and use existing theory in everyday practice. To enhance knowledge, understanding and to promote change in clinical practice, Participatory Action Research (PAR) is recommended. PAR is a process of systematic inquiry as its methodology emphasise equality and participation. To promote change in the clinical practice the research is done with those who are concerned by the issue rather than on them. By involving and engaging, PAR brings collective ownership and responsibility of making use of the findings. Methods which emphasise reflection and dialogue help professionals to elucidate concerns about issues in their clinical practise, to challenge the status quo and to change.        

Story-telling is a tool in knowledge development as narratives are powerful to convey experiences. By using Story dialogue method narratives can be investigated in a systematic way. Dialogue and reflection enhance different ways of viewing a problem and a day to day problem can be examined in a systematic way.

This paper is about how to use Story dialogue method with the aim to support professionals to elucidate, investigate and take action towards significant problems in care planning situations.

The on-going research is performed in a multi-professional care planning network. The purpose of the network is to develop knowledge about care planning in clinical settings and to reach understanding about how to make care planning holistic. We decided in collaboration to examine what holism is in a care planning situation and used members’ narratives about care planning situations characterised by holism.       

The members and the researches have met four times. Narratives were investigated by using a structured dialogue, writing insight cards and building categories based on insights from the dialogue. Based on the categories we constructed an observation manual which later on will be tested in practise.

This paper presents an on-going research project where researchers and practitioners work together to bridge the gap between theory and practice. By using PAR and Story Dialogue Method the members in the care planning network enhance their collective knowledge and understanding about holism with the purpose to improve care planning in practice.

Health care systems in Europe face many challenges requiring greater integration of health and social care. The health policy response in government financed health systems has varied but a consistent feature has been continual change in an attempt to secure greater efficiencies and to meet patient expectations concerning service quality. This paper explores the manifestation of this phenomenon in a subregion of Sweden, where a new concept ‘Närsjukvård’ (literally Nearby Care) was introduced. Method: Data was collected through interviews and questionnaires. A convenience sample of 57 practitioners and managers was interviewed. A questionnaire with four statements based upon the findings from the interviews was answered by 1361 practitioners, managers and politicians working in primary health care, in municipalities and in hospitals. Results: The findings illustrated that the concept was interpreted as; accessibility to hospital beds, accessibility to primary health care, collaboration between care providers and continuity and developed home care. The study revealed different understanding and interpretations partly depending on the respondents’ professional domain and their organisational elonging. Conclusion: A prerequisite for creating a common meaning to the expression ‘Närsjukvård’ is that activities that help the creation of meaning are offered at and between all domain levels and organisations.

In spite of laws, rules and routines, findings from Swedish as well as international research show that discharge planning is not a simple matter. There is considerable knowledge about discharge planning, but the quality of the actual process in practice remains poor. With this in mind, a research and developmental health and social care network decided to use participation action research to explore the discharge planning situation in order to generate new ideas for development. This paper reports on the research process and the findings about our enhanced understanding about the discharge planning situation. Story dialogue method was used. The method is based on stories from everyday practice. The stories are used as ‘triggers’ to ask probing questions in a dialogical and structured form. Local theory is developed to help the participants to find solutions for action in the practice. Our findings were that the discharge planning situation could be seen as a system including three interconnected areas: patient participation, practitioners’ competence and organizational support. To reach good quality in discharge planning, all these three issues need to be developed, but not only as routines and forms. Rather, when developing a discharge planning situation, a system where relational aspects such as confidence and continuity are essential and thus needs to be considered. To achieve a change, the core problem needs to be clarified. When the issue is complex, the solution needs to consider the bigger picture and not just the parts. Telling stories from everyday practice, and to systematically reflect and analyse those in interprofessional groups can create opportunities for enhanced understanding, as well as be a vehicle for future change of practice.

Aim. To explore how people experienced leg ulcer care so as to inform practitioners about the patients' view as a vehicle for a changed leg ulcer care practice.

Background. Great numbers of people suffer from chronic leg ulcers and many have to live with their illness for a long time. Even when the illness is controlled by medical treatment, the person with leg ulcers has to deal with physical, emotional, cognitive and social problems and long-term encounters with practitioners.

Method. A Participatory Action Research approach was used. Nine older persons with chronic leg ulcers, treated in primary care, were asked about their experiences of the care. Content analysis and reflective dialogues with practitioners and persons with chronic leg ulcers was performed. The study was undertaken from autumn 2004 to spring 2005.

Result. Although the persons with chronic leg ulcers experienced their encounters with practitioners as satisfying, findings illuminated low participation in their own care and low practitioner involvement in issues about their daily living with chronic illness. In addition, the participatory action research project did not proceed from problem identification towards development and change.

Conclusion. Participation is about negotiation and transferring power and authority from practitioners towards patients and from researchers towards practitioners and patients. Undertaking a participatory action research project that brings sustainable change requires substantial work to involve practitioners in initiating and planning the research.

Relevance to clinical practice. Participation requires true partnership. To reach participation between researchers, practitioners and patients would need a significant change in attitude of all parties as well as a change in the care culture. Changing attitudes is not enough as long as practitioners and patients are stuck in a hierarchical structure with predetermined and taken for granted roles and relations in the medical culture.

Collaboration between different professions in community care for older people is often both difficult and complex. In this project, a participatory action research (PAR) was conducted in order to support the professions involved in the care for older people to develop individualized health and social care plans. Cases from daily work were discussed in different professional groups over a period of one year. A key finding was that lack of knowledge regarding the other professions' field of expertise and their underlying professional culture and values was a barrier in their collaboration. However, as the continuous reflective dialogue process progressed, the participants began to reflect more about the importance of collaboration as a prerequisite to achieve the best possible care for the recipient. This process of reflection led to the often complex needs of the care recipients being given a more central position and thus care plans being better tailored to each person's needs.5