PURPOSE: The number of colorectal cancer patient survivors is increasing. Information and support during and after treatment are requested by patients, but questions remain on what to provide. The aim of this study was to understand what informational needs colorectal cancer patients and survivors have, with a focus on the potential support given by patient peers and the use of blended care.

METHODS: A qualitative study using focus groups was conducted with patients diagnosed at the same hospital at least one year prior to the initiation of the study. The focus group interviews were transcribed verbatim and analyzed using deductive content analysis.

RESULTS: The need for informational support varied over time and depended on individual patient characteristics. Timing was crucial and patients requested options of blended care and informational support after treatment cessation. The patients felt alone after treatment and requested assistance in communication with their next-of-kin. They also identified the value of peer support, especially to contextualize knowledge provided by healthcare.

CONCLUSION: This study showed a need for focus on individualized informational support. Blended care through integrating communication with peers online could be one way to support patients, both to enable shared decision-making as well as to provide person-centered care.

Bakgrund

Hållbart arbetsliv är idag ledord för arbetslivets förändrade villkor. Inom UoH i Sverige fanns i slutet av 2017 omkring 75 000 anställda varav ca 35 000 inom forskning och undervisning (UKÄ, 2017). Det är en sektor med stor betydelse för samhällsutvecklingen i Sverige. Arbetsmiljön inom sektorn ställer särskilda krav på personalen. Förvånansvärt få studier har gjorts i Sverige om arbetsmiljön för personal inom UoH. Med förebild från Norge implementeras nu för första gången i Sverige en forskningsbaserad (krav-resurs-modellen) och sektorsspecifik ny modell för att systematiskt arbeta med arbetsmiljön, den s.k. Ark-modellen (arbeidsmiljø- og klimaundersøkelser, se figur) vid Högskolan Väst. Arbetsmiljöverkets föreskrift 2015:4 betonar den organisatoriska och sociala arbetsmiljön, vilket väl tillgodoses i denna modell.

Syfte

Att systematiskt och långsiktigt arbeta med arbetsmiljön ur ett främjande, förebyggande och rehabiliterande perspektiv på såväl individ- som organisatorisk nivå för att utveckla förhållanden som bidrar till ett hållbart arbetsliv.

Metod

Genom KIWEST (Knowledge Intensive Work Environment Survey Target) kartläggs arbetsmiljön utifrån 28 olika dimensioner. Kategorier som belyses är t.ex. sociala, uppgiftsbaserade och organisatoriska resurser samt jobbkrav och tillhörighet till jobbet. Organisatoriska förhållanden mäts med FaktaARK 1 medan genomförda insatser mäts med FaktaARK 2.

Resultat

KIWEST sändes till all personal med 20 % anställning eller mer. Utav 539 tillfrågade personer svarade 376, vilket ger en svarsfrekvens på 69,8 %. Resultatet visar att specifikt för sektorn är upplevelsen av tidspress samtidigt som arbetet upplevs som meningsfullt och viktigt. Nu följer analyser, planering, genomförande och utvärdering av insatser på olika nivåer inom högskolan. KIWEST-formuläret sänds till personalen med 3-års intervall. I förbättringsarbetet ingår även att granska och utvärdera genomförandet, därvid ingår även metodutveckling. Förbättringsarbetet sätts in i ett större organisatoriskt perspektiv och är en naturlig del i kvalitetssäkringsprocessen och ledningssystemet. ARK-processen förväntas bidra till teoriutveckling av krav- och resursmodellen samt öka kunskapen om arbetsmiljön inom UoH.

Introduction: After treatment for myocardial infarction (MI) quite a few persons will experience different symptoms, including fatigue, during the recovery phase. The aim of the present study was to construct the multidimensional Post-Myocardial Infarction Fatigue (PMIF) scale, based on empirical data gathered in coronary heart disease contexts. Methods: The construction of the post-MI fatigue scale was conducted in seven steps, ending in a psychometric evaluation of the internal structure of the scale, using confirmatory factor analysis, as well as testing of convergent and discriminant validity, using correlational analysis, in a sample of 141 persons treated for MI. Results: The results showed that the PMIF scale represents three dimensions: physical, cognitive and emotional fatigue. It was also found that the scale is suitable for summing the items to obtain a total score representing a post-MI global fatigue dimension. Conclusion: The PMIF is a brief and easily completed scale for identifying persons experiencing post-MI fatigue. Early identification of fatigue, together with health behavior support, might prevent progression toward a more severe state of fatigue.

Aims: Frail elderly patients who have multiple illnesses do not fare well in modern health care systems, mainly due to a lack of care planning and flawed communication between health professionals in different care organisations. This is especially noticeable when patients are discharged from hospital. The aim of this study was to explore health care professionals’ experience of obstacles and opportunities for collaboration. Methods: Health professionals were invited to participate in three focus groups, each consisting of a hospital physician, a primary care physician, a hospital nurse, a primary care nurse, a municipal home care nurse or an assistant officer, a physical or occupational therapist and a patient or a family member representative. These individual people were then asked to discuss the obstacles and opportunities for communication between themselves and with the patients and their relatives when presented with the case report of a fictitious patient. Content analysis was used to identify categories. Results: Several obstacles were identified for effective communication and care planning: insufficient communication with patients and relatives; delayed collaboration between care-givers; the lack of an adequate responsible person for care planning; and resources not being distributed according to the actual needs of patients. The absence of an overarching responsibility for the patient, beyond organisational borders, was a recurring theme. These obstacles could also be seen as opportunities. Conclusions: Obstacles for collaboration were found on three levels: societal, organisational and individual. As health care professionals are well aware of the problems and also see solutions, management for health care should support employees’ own initiatives for changes that are of benefit in the care of frail elderly patients with multiple illnesses.

All new parents in Sweden are invited to participate in parent groups by the Child Health Service (CHS), but not all choose to attend. The aim of this study was to identify factors that promote and impede the participation of parents in parent groups managed by the CHS during their child's first year. Twelve parents with children aged 10–12 months were interviewed during 2013. The interview text was analysed using qualitative manifest content analysis. The analysis resulted in eight categories. Those describing promoting factors were: feeling personally invited; having social hopes; being influenced by those around you; experiencing social fellowship; and being satisfied with the group leader. Categories describing impeding factors were: the parent group is not perceived to be addressed to both parents; the parents do not prioritise the group sessions offered; and expectations are not met. The study found that it is important for parents to feel personally invited and that the group leader's actions may be significant both for promoting and impeding participation in parent groups. The CHS nurse needs to be aware of parents' and children's individual needs and work actively to make all group participants feel included.

Background: Patients' understanding of their illness is of great importance for recovery. Lacking understanding of the illness is linked with the patients' level of reflection about and interest in understanding their illness. Objective: To describe patients’ variations of reflection about and understanding of their illness and how this understanding affects their trust in themselves or others. Method: The study is based on the “Illness perception” model. Latent content analysis was used for the data analysis. Individual, semi-structured, open-ended and face-to-face interviews were conducted with patients (n=11) suffering from a long-term illness diagnosed at least six months prior to the interview. Data collection took place in the three primary healthcare centres treating the participants. Results: The results show variations in the degree of reflection about illness. Patients search for deeper understanding of the illness for causal explanations, compare different perspectives for preventing complication of their illness, trust healthcare providers, and develop own strategies to manage life. Conclusion: Whereas some patients search for deeper understanding of their illness, other patients are less reflective and feel they can manage the illness without further understanding. Patients' understanding of their illness is related to their degree of trust in themselves or others. Patients whose illness poses an existential threat are more likely to reflect more about their illness and what treatment methods are available.

AIMS AND OBJECTIVES: To describe how healthcare professionals facilitate patient illness understanding.

BACKGROUND: Healthcare professionals and patients differ in their illness understanding. If the information provided by healthcare professionals is not adapted to the patient's daily life it may be unusable for the patient. Previous research has found that healthcare professionals should individualise the information to enable the patient to apply the knowledge to the personal situation and to develop illness understanding. However, little is known of how healthcare professionals can facilitate patient illness understanding.

METHOD: A qualitative descriptive study based on individual, semi-structured, open-ended and face-to-face interviews was conducted with healthcare professionals (n=11) concerning how they facilitate patients illness understanding. Three health centres were involved during the period of March to November 2014. The interviews were analysed with qualitative content analysis.

RESULTS: The result identified a continuous and collaborative process with three strategies used by healthcare professionals to facilitate the patient's illness understanding: 1) assess the patient's illness understanding, 2) interact with the patient to develop illness understanding, and 3) support the patient's personal development for illness understanding. The steps in the process depend on each other.

CONCLUSIONS: The results of our analysis indicate that healthcare professionals can use the continuous and collaborative process to enhance the patient's self-care ability and turn his or her knowledge into action for improving illness understanding.

RELEVANCE TO CLINICAL PRACTICE: The three continuous and collaborative process strategies involving pedagogical approaches can create conditions for healthcare professionals to obtain a holistic view of the patient's life and to be a key resource for person-centred care. This article is protected by copyright. All rights reserved.

Aims and objectives. To explore the associations between illness perceptions offatigue, sense of coherence and stress in patients one year after myocardial infarc-tion.Background. Post-myocardial infarction fatigue is a stressful symptom that is dif-ficult to cope with. Patients' illness perceptions of fatigue guide professionals inpredicting how individuals will respond emotionally and cognitively to symptoms.Individuals' sense of coherence can be seen as a coping resource in managingstressors.Design. A cross-sectional study design was used.Method. One year post-myocardial infarction, a total of 74 patients still experi-encing fatigue completed four questionnaires: the Multidimensional Fatigue ScaleInventory -20, the Brief Illness Perception Questionnaire, the Sense of Coherencescale (sense of coherence-13) and a single-item measure of stress symptoms.Descriptive statistics, correlations and stepwise regression analysis were carriedout.Results. Strong negative associations were found between illness perceptions offatigue, sense of coherence and stress. Sense of coherence has an impact on illnessperceptions of fatigue. Of the dimensions of sense of coherence, comprehensibilityseemed to play the greatest role in explaining illness perceptions of fatigueone year after myocardial infarction.Conclusion. To strengthen patients' coping resources, health-care professionalsshould create opportunities for patients to gain individual-level knowledge thatallows them to distinguish between common fatigue symptoms and warning signsfor myocardial infarction.Relevance to clinical practice. There is a need to improve strategies for copingwith fatigue. It is also essential to identify patients with fatigue after myocardialinfarction, as they need explanations for their symptoms and extra support

Recovery from a myocardial infarction (MI) can be a very difficult process and some patients are also stricken by fatigue. The aim of the study was to describe the difficulties experienced by men with fatigue during the first year following their MI. The study was conducted using qualitative content analysis of semi-structured interviews with nine men in working age (mean age: 55 years) with verified fatigue (≥12 of 20 on the Multidimensional Fatigue Scale with a mean of 17) one year after their MI. During the first year after the MI the men suffering from fatigue experienced various difficulties in terms of both themselves and the care received. The analysis generated three themes with difficulties described by the interviewed men. 1) Going through involuntary change: not recognizing their body and the inability to recognize themselves. 2) Lacking individualized care: To be denied satisfactory health care treatment and to be denied respectful treatment. 3) Not being seen in the light of the social context: The MI affects the whole family and caregivers do not pay attention to the family. In order to make both the patient and relatives feel secure and cared for, it is essential that caregivers be aware of the importance of providing individualized care over time with particular attention for the patient’s social context.

Bakgrund Flera svenska rapporter visar att de mest sjuka äldre ofta far illa på grund av bristande samordning och oklar ansvarsfördelning mellan olika behandlingsinstanser. Primärvården, hemtjänsten och den kommunala hemsjukvården anses i otillräcklig omfattning ta över ansvaret efter utskrivningen av de sjuka äldre från sjukhuset. Svenska erfarenheter stämmer väl med vad man funnit i flera internationella studier: sjukvården är illa rustad för att möta de mest sjuka äldres komplexa behov av vård och omsorg.