Search

Sustainability is an important issue in implementation processes in health care, and more knowledge is needed to facilitate improvement work in occupational therapy practice. The aim of this study was to explore how occupational therapists experienced continuous quality improvement work based on the Occupational Therapy Intervention Process Model after 17 years. Two focus group interviews were conducted with a total of 12 occupational therapists. The data were analysed using qualitative content analysis. The analysis resulted in three themes with related subthemes describing the occupational therapists' experiences of their model-based long-term improvement work. The themes were labelled as follows: 'sharing a safe and well-known professional reasoning', 'reaching normality and empowerment' and 'questioning and reshaping the too safe and too well-known normality'. The model functioned as a sustainable framework both for ordinary clinical practice and for continuous improvement work. By using the model, the occupational therapists had established a safe and well-known professional reasoning in which continual quality improvement work had become sustainable. [ABSTRACT FROM AUTHOR]

Examined experience of 150 persons related to the phenomenon "being at home." Common aspects identified entailed cognitive, emotional, and conative dimensions. The sense of being related was a common experience, that is, related to significant others, things, places, and activities. A progression in the experience throughout the life span was identified. (JBJ)

Aims: To (1) describe experiences of home from a well‐being perspective, (2) describe participant characteristics and well‐being measures in relation to housing type (3) and how the aforementioned aspects may affect well‐being in very old persons. Design: Cross‐sectional, convergent parallel‐results mixed method design with semi‐structured interviews analysed by qualitative content analysis, in relation to descriptive statistics and specific well‐being outcome measures related to home. Methods: A total of 50 persons 80 years or older living in ordinary housing were interviewed (July 2017 to November 2018) about home in relation to well‐being, along with collection of participant characteristics and well‐being measures related to home. Results: Participants described how home had become increasingly important as it provided autonomy and acted as a social and occupational hub. However, autonomy was not unconditional, and home could also be perceived as a place of inactive solitude. Results were interpreted as relating to being in the margins of home and had a major impact on well‐being. Housing type seemed of importance with higher measures of well‐being for participants in single‐living housing compared with those living in apartment. Conclusion: Home is increasingly central to well‐being in old age; however, very old persons also have to relate to being physically and mentally in the margins of being able to remain in the home. These aspects of home potentially have a major impact on well‐being. Impact: As very old persons living in ordinary housing will constitute a larger segment of society in coming years, aspects of home can potentially have a considerable impact on well‐being for this age‐group. This study describes aspects of home that contribute to, or has adverse impact on well‐being. These aspects need thorough consideration in policy‐making and planning of health care that can affect experiences of home. [ABSTRACT FROM AUTHOR]

One hundred and fifty persons aged two to 102 narrated their experiences related to the phenomenon 'being at home.' Several common interdependent and interrelated aspects of the experience of being at home were identified throughout the life span. These aspects are believed to entail cognitive, emotional, and conative dimensions of the experience: safety, rootedness, harmony, joy, privacy, togetherness, recognition, order, control, possession, nourishment, initiative, power, freedom. The sense of being related was found to be a common condition of the experience of being at home, i.e., related to significant others, significant things, significant places, significant activities, oneself, and transcendence. In the process of maintaining the experience of being at home throughout life the phenomena 'being given a home,' 'creating a home,' 'sharing a home,' and 'offering a home' were integral parts. A progression in the experience of being at home throughout the life span was identified.

Abstract Background There is conflicting and only scant evidence on the effect of gender on long-term survival after a myocardial infarction (MI). Our aim was to analyse sex-specific survival of patients for up to 23 years after a first MI in northern Sweden and to describe time trends. Methods The Northern Sweden MONICA Myocardial Infarction Registry was linked to The Swedish National Cause of Death Registry for a total of 8630 patients, 25 to 64 years of age, 6762 men and 1868 women, with a first MI during 1985-2006. Also deaths before admission to hospital were included. Follow-up ended on August 30, 2008. Results Median follow-up was 7.1 years, maximum 23 years and the study included 70 072 patient-years. During the follow-up 45.3% of the men and 43.7% of the women had died. Median survival for men was 187 months (95% confidence interval (CI) 179-194) and for women 200 months (95% CI 186-214). The hazard ratio (HR) for all cause mortality after adjustment for age group was 1.092 (1.010-1.18, P = 0.025) for females compared to males, i.e. 9 percent higher survival in women. After excluding subjects who died before reaching hospital HR declined to 1.017 (95%CI 0.93-1.11, P = 0.7). For any duration of follow-up a higher proportion of women were alive, irrespective of age group. The 5-year survivals were 75.3% and 77.5%, in younger ( Conclusions Age-adjusted survival was higher among women than men after a first MI and has improved markedly and equally in both men and women over a 23-year period. This difference was due to lower risk for women to die before reaching hospital.

Integrating health care services has proven to be important from both the patient and organizational perspectives. This study explores what defines a perceived well-functioning collaboration in the inter-organizational process of providing assistive devices in Sweden. Two focus groups comprising participants with profound knowledge of collaboration were performed, and data were analyzed in five steps, resulting in a data structure. Results yield the identification of three interacting processes: coordinating efforts to patient needs, ensuring evidence-based practice, and planning for efficient use of resources. These processes affected one another, and, therefore, would likely not have been effectively managed separately. The study contributes to theories of process management and organization by specifically focusing on how to analyze and improve sustainable collaboration in health care processes at both the management and professional levels. Theoretical frameworks that show different ways of organizing collaboration, as well as the concepts of action nets and boundary objects, can support both analysis and planning of collaboration. The intention would be to develop integration in inter-organizational health care processes, resulting in more person-centered care. [ABSTRACT FROM AUTHOR]

Studies show that healthcare professionals need inter-professional clinical ethics support (CES) in order to communicate and reflect on ethically difficult care situations that they experience in their clinical practice. Internationally, various CES interventions have been performed, but the communication processes and organisation of these interventions are rarely described in detail. The aim of this study was to explore communicative and organisational conditions of a CES intervention with the intention of promoting inter-professional communication about ethically difficult care situations. Eight audio- and video-recorded inter-professional CES sessions, inspired by Habermas' theory of communicative actions, were conducted. The observations were transcribed, sorted, and analysed using concept- and data-driven content analysis methods. The findings show three approaches to promoting communicative agreement, which include the CES facilitators' and participants' approaches to promoting a permissive communication, extended views, and mutual understanding. The CES sessions had organizational aspects for facilitating communicative agreement with both a given structure and openness for variation. The dynamic structure of the organization, promoted both safety and stability as well as a creativity and responsiveness, which in turn opened up for a free and dynamic inter-professional dialogue concerning ethically difficult care situations. The findings constitute a step towards a theory-based CES method inspired by Habermas' theory of communicative action. Further research is needed in order to fully develop the method and obtain increased knowledge about how to promote an inter-professional dialogue about ethically difficulties. [ABSTRACT FROM AUTHOR]