Entlassungsmanagement in der Pflege

Basierend auf der Theorie des Case und Caremanagements hat sich Entlassungsmanagement in den letzten Jahren vom Fremdwort zum Kernwort moderner, patientenorientierter Versor-gung entwickelt. Der Anspruch an das Entlassungsmanagement ist die Lösung der Schnittstel-lenproblematik zwischen dem intra- und extramuralen Bereich des Gesundheitswesens in Ös-terreich. Die Leistungserbringung sowie die Finanzierung im österreichischen Gesundheitswesen ist sehr stark reglementiert und fragmentiert. Diese Situation fördert die Problematik im Schnittstellenbereich dahingehend, dass Lücken im Informationstransfer entstehen, welche wiederum zu Diskrepanzen in den Zuständigkeiten und zu Fehlversorgungen der PatientInnen führen. Von kostspieligen Doppelgleisigkeiten bis hin zu mangelhaften Entlassungsvorberei-tungen ist in der Gesundheitslandschaft Österreichs alles zu finden. Daraus resultiert, dass nicht nur die materiellen und finanziellen Ressourcen unnötig überstrapaziert werden, sondern vor allem die PatientInnen selbst vermeidbare Belastungen und Frustrationen erfahren, die in unnötigen Krankenhausaufnahmen und Pflegeheimeinweisungen gipfeln können. Die vorlie-gende Arbeit behandelt das Problemfeld Entlassungsmanagement aus dem Krankenhausbe-reich. Sie soll einen das Entlassungsmanagement betreffenden wissenschaftlichen Zugang für KollegInnen aus der Praxis bieten und als Motivation und Überzeugungshilfe für die Notwen-digkeit eines einheitlichen, koordinierten und standardisierten Entlassungsmanagement die-nen. Die Arbeit konzentriert sich auf die gelebte Praxis in Österreich mit speziellem Fokus auf Niederösterreich. Als Basis des Erkenntnisgewinnes werden internationale Daten und Litera-turquellen verwendet sowie Best Practice Modelle aus Österreich behandelt. Ziel ist die Zusammenführung und Darstellung der bereits bestehenden Literatur zum Thema Entlassungsmanagement mit den aktuellen Erkenntnissen aus einem laufenden Reformpoolp-rojekt in Niederösterreich. Im Rahmen der vorliegenden Arbeit wird der PIK Standard Österreich und DNQP Standard Entlassungsmanagement behandelt. Speziell für Niederösterreich wird ein entwickeltes und bereits implementiertes Konzept „Entlassungsmanagement“ dargestellt und die praktische Anwendung analysiert.Based on the theory of the Case and Care Management, discharge management has developed from a foreign word to a key word of modern patient oriented care during the last years. The discharge management should deliver the solution to interface problems between the intra- and the extramural area within the Austrian health services. Both the achievement performance and the financing in the Austrian health services are strongly regulated and fragmented. This situation enhances the problems within the interface area from that point of view that gaps appear in the information transfer, which lead to discrepancies in competence and false care of patients. Everything can be found in Austria´s health services form work duplication to incomplete discharge preparations. This doesn’t only lead to a wasteful overspending of material and financial resources, but patients themselves are confronted with avoidable burdens and frustrations which even can lead to unnecessary hospitalisation and nursing home referrals. This thesis deals with the problem area of hospital discharge management. It shall offer a scientific access for practicing colleagues and support motivation and conviction for the need of a unified, coordinated and standardised discharge management. The objective of this work is the illustration of the existing literature in discharge management and its consolidation with the recent findings from a running project in Lower Austria. It concentrates on the actual practice in Austria, with a special focus on Lower Aus-tria. As a base of knowledge gain international literature and data sources will be used as well as best practice models from Austria. The aim is the reunion and presentation of the existing literature with the latest findings from an ongoing Project in Lower Austria. Within the framework of this thesis the PIK standard Austria and the DNQP standard dis-charge planning is discussed. Especially for Lower Austria is already a developed and im-plemented concept “discharge planning” represented and analyzes the practical application

Medarbeiderskap : hva er det og hvordan kan man legge tilrette for det?

Medarbeiderskap er et begrep med økende popularitet, både i forskning og i arbeidslivet. Men det finnes ingen felles definisjon, eller enighet om hva begreper innebærer. Denne oppgaven søker å svare på problemstillingene: «Hva er medarbeiderskap?» og «Hvordan kan man legge tilrette for medarbeiderskap på en arbeidsplass?». Det ble gjennomført en kvalitativ undersøkelse, hvor fire informanter ble intervjuet en-til-en. Tematisk analyse ble valgt som analyseverktøy. Temaene for medarbeiderskap ble i mine funn definert som å kunne oppgaven, ansvar, samarbeid og åpenhet og personlige egenskaper og relasjoner. Jeg delte temaene for hvordan man kan legge tilrette for medarbeiderskap inn i forutsetninger og motivasjon. Temaene i forutsetninger er basert på mine funn tilbakemelding, frihet og tillit, medvirkning og eierskap og trivsel og arbeidsmiljø. Og personlig gevinst og at oppgaven er motiverende i seg selv kategoriseres under motivasjon. Disse funnene underbygger flere funn fra tidligere litteratur. Dypere innsikt i medarbeiderskap er viktig fordi det kan gi oss en felles forståelse av begrepet. Da kan det utvikles gode målevektøy som kan benyttes både i praksis i næringslivet og i forskningssammenheng. Om en leder eller organisasjon vet hva de kan gjøre for å legge tilrette for medarbeiderskap kan de iverksette tiltak som kan gjøre at medarbeiderne utnytter mer av sitt potensiale

Quality of occlusal outcome following space closure in cases of lower second premolar aplasia using lingual orthodontic molar mesialization without maxillary counterbalancing extraction

Abstract Background Controlled space closure in cases of isolated lower second premolar aplasia (ILSPA) without maxillary counterbalancing extraction is challenging. Anterior anchorage loss may occur during space closure resulting in compromised occlusal results in terms of an absence of proper canine guidance during laterotrusive mandible movements. In order to evaluate the effectiveness of Herbst telescope anchorage in combination with double-cable, pull mechanics and a completely customized lingual appliance for orthodontic space management in cases of ILSPA, we tested the null hypothesis that there is a significant deterioration in the sagittal canine relationship towards an Angle-Class-II occlusion expressed as a loss of anterior anchorage following space closure with molar mesialization. Methods Twenty-five consecutively de-bonded subjects (female / male 17 / 8; aged at T0 (start of MB Tx) 12.3 to 20.6 years; mean age 15.0 / SD 1.7 years) were included in this retrospective analysis using the inclusion criteria of least of one lower second premolar aplasia; completed treatment with a totally customized lingual appliance (CCLA) in combination with Herbst telescopes. Exclusion criteria were the absence of counterbalancing maxillary extractions, as well as additional tooth aplasia other than lower second premolars. A total of 33 single, lower premolar aplasia space closures (right / left sided 17 / 16) were assessed using plaster casts and intra-oral photographs scaled to the plaster casts, at bonding (T0), Herbst insertion (T1), following gap closure (T2) and de-bonding (T3). Parallelism of roots was controlled by panoramic x-rays at T3. Results The mean aplasia space at T0 was 7.5 mm (SD 2.6). Complete space closure was achieved in all 33 situations. The null hypothesis was rejected. There was a significant improvement in the initial canine relationships (mean 3.5 mm distal occlusion at T0) to a mean 0.1 mm at T3. When evaluated against the individual treatment plan, the following amounts of planned improvements were achieved: space closure 100%, canine relationship 97.5%, overjet 93.9%, overbite 96.4%, parallel roots in space closure site 93.9%. Conclusion Herbst telescope anchorage in combination with double-cable pull mechanics and a CCLA for orthodontic space closure can deliver predictable, high-quality treatment results