Case management for older persons with multi-morbidity. Experiences of an intervention from the perspectives of older persons, family members, case managers and health and social care staff members

Complex health systems make it difficult to ensure a continuity of care for older persons with multi-morbidity, and risk fragmented care. Fragmented care could affect the quality and safety of the care provided. Case management could provide an approach to counteract this unfavourable situation. Case management is practised by case managers and aims to improve the coordination of healthcare and social services. To better understand and to advance the progress of case management, there is a need for knowledge that provides rich descriptions of case management in practice. This knowledge must come from different perspectives important for the intervention. Thus, the overall aim of this thesis was to explore the experiences of a case management intervention aimed at older persons with multi-morbidity, from the perspectives of case managers, older persons, family members and health and social care staff members.The work of this thesis is based on an ethnographic approach and explores case management from multiple perspectives. For Study I, the sample consisted of case managers (n=9). Data were collected by a group interview, individual interviews and participant observations. Data analysis was informal and formal, and comprised a thematic analysis of the interview material. For Study II, the sample consisted of family members of older persons with multi-morbidity (n=16). Data were collected by individual interviews and analysed using interpretive phenomenology. For Study III, the sample consisted of older persons (75+) with multi-morbidity (n=13). Individual interviews and participant observations were part of the data collection. Data analysis was influenced by Roper and Shapira’s framework for ethnographic analysis. For Study IV the sample consisted of health and social care staff members (n=10). Individual interviews were conducted and subsequently analysed using thematic analysis. The findings from all studies (I-IV) illustrated different perspectives of a case management intervention, conducted by case managers. In Study I, the case managers’ experiences of their everyday work could be interpreted as challenging current professional identity. Study II showed that the family members’ experiences could be interpreted as helps to fulfil my unmet needs. In Study III, the older persons’ experiences were interpreted into four themes which were someone providing me with a trusting relationship; someone assisting me; someone who is on my side; and someone I do not need at present. In Study IV, health and social care staff members’ experiences were interpreted into the following three themes: could bridge gaps in an insufficient health system; emerging improvements call for engagement; and an intervention in the mist with vague goals and elements.In summary, the findings indicate that establishing trusting relationships was important and this trust enabled the case managers to conduct their everyday work. Consequently, case management interventions need to put emphasis on building trust between the case managers and the participants. To facilitate trusting relationships it is envisaged that it could be of help if the case managers are in a neutral position, act as an individual contact, and have regular contact with the participants. Continuity of the case managers’ services seems to be important for developing trusting relationships. The case managers’ everyday work put forth challenges of trying to make sense of their role as case manager. Thus, when intervening with case management it is important to present a clear description of the case manager’s professional responsibility to all involved. Using working groups as an intermediate for conducting improvement work at an organisational level seems to show promises. But, engagement amongst its representatives is vital for it to be successful. Expectations regarding the working groups and the intervention needs be made clear and discussed throughout the course of the intervention. Thus, a vital part of the preparation for the case management intervention should be to explicitly set the expectations for all involved parties

Mass evacuation - human behavior and crowd dynamics - What do we know?

The field of mass evacuation has existed for a long time. Already during the Roman Empire era evacuation problematic was considered. In modern times the field has gained more attention during the last couple of decades, especially for sports grounds and stadiums. Through analysis of some well-known historical crowd disasters and through a literature survey the aim has been to compile the most important findings. The aim has also been to analyze problem areas, knowledge and development opportunities. Regarding the problems of mass evacuation, preventive measures like design and contingency plan is of high importance. In addition there is a need for good communication and to take proper actions when an accident occurs. Some phenomenon that may arise during crowded situations have been found. These phenomenon are an indication that a catastrophic situation might emerge. With knowledge and understanding of those the expectation is, with the help of live video recordings and simulation softwares, to get a warning about the elevated risk for the crowd

Under Rosen : IB: Nationell säkerhetstjänst, Politisk polis eller Stat i staten?

Civilian control over military forces is a prerequisite within democracies in the study of civil-military relations. This requirement extends to military intelligence, as they are a part of the military. However, this relationship needs to balance secrecy with transparency concerns, a relationship which can prove difficult. In Sweden during the 1970’s, this discussion came to a fore when the intelligence organisation IB was revealed to the public. This sparked an ongoing debate within the academic community regarding the limits of intelligence organisations authority, their need for secrecy and the government’s ability to control them. This thesis aims to investigate IB and the government’s control over it during 1965-1973, the years it operated as the sole military intelligence organisation in Sweden. With perspectives derived from Peter Gills thoughts on intelligence control and oversight, this thesis examines the mechanism of intelligence control and inquiry that were present in Sweden during the relevant timeframe. The findings are then judged with Gill’s concepts as a framework, in order to evaluate IB´s role as an intelligence organisation within a liberal democracy. These findings will thereafter be compared with the image of IB as presented by leading contemporary politicians and intelligence commanders, in order to give nuance to the findings. The thesis will show, with support of the theory and methodology, that IB can’t be described as a national intelligence agency, but as a political police. Its lack of transparency, secret existence and politicly motivated goals are the main reasons for this result. The absence of key mechanism of control as described by Gill, made it impossible for the organisation to be controlled, with some reservations for the ruling party’s ability to do so. It also contextualises these findings with the presented opinions of the contemporary actors. These results shed new light on intelligence accountability during the cold war in Sweden. It also reaffirms previous findings on IB with the use of new perspectives. The Thesis provides another lens to view Swedish intelligence history through and contributes to that field of history

Under Rosen : IB: Nationell säkerhetstjänst, Politisk polis eller Stat i staten?

Civilian control over military forces is a prerequisite within democracies in the study of civil-military relations. This requirement extends to military intelligence, as they are a part of the military. However, this relationship needs to balance secrecy with transparency concerns, a relationship which can prove difficult. In Sweden during the 1970’s, this discussion came to a fore when the intelligence organisation IB was revealed to the public. This sparked an ongoing debate within the academic community regarding the limits of intelligence organisations authority, their need for secrecy and the government’s ability to control them. This thesis aims to investigate IB and the government’s control over it during 1965-1973, the years it operated as the sole military intelligence organisation in Sweden. With perspectives derived from Peter Gills thoughts on intelligence control and oversight, this thesis examines the mechanism of intelligence control and inquiry that were present in Sweden during the relevant timeframe. The findings are then judged with Gill’s concepts as a framework, in order to evaluate IB´s role as an intelligence organisation within a liberal democracy. These findings will thereafter be compared with the image of IB as presented by leading contemporary politicians and intelligence commanders, in order to give nuance to the findings. The thesis will show, with support of the theory and methodology, that IB can’t be described as a national intelligence agency, but as a political police. Its lack of transparency, secret existence and politicly motivated goals are the main reasons for this result. The absence of key mechanism of control as described by Gill, made it impossible for the organisation to be controlled, with some reservations for the ruling party’s ability to do so. It also contextualises these findings with the presented opinions of the contemporary actors. These results shed new light on intelligence accountability during the cold war in Sweden. It also reaffirms previous findings on IB with the use of new perspectives. The Thesis provides another lens to view Swedish intelligence history through and contributes to that field of history

Konstruktion av en surdegsvagn till bageriproduktion

This thesis involves the process of designing a wagon for the company Majgården AB, a company working with bakery production. The used method follows mostly Fredy Olsson´s (1995) work process using Principle Design as well as Primary Design in order to design a final concept. Initially, in the beginning of the thesis, it was analyzed how the product will be used and in what kind of environment. The analysis allowed a definition of requirements that the product needs to fulfill. Next step included extracting different product sketches that could be used as possible solutions. The solutions were compared against the requirements and a final, optimal concept was chosen to continue the work with. The final sketch was then further improved. The design of the final concept was then fully finalized with help of a 3D program.

Care experiences of younger people and next of kin following myocardial infarction

Background/Aims Coronary heart diseases, including myocardial infarction, remain a major health problem worldwide. Little is known about the cardiac care experiences post myocardial infarction of younger people and their next of kin. This study aimed to describe the cardiac care experiences of post-myocardial infarction younger people (<55 years old) and their next of kin. Method This study employed an exploratory inductive qualitative design involving individual interviews with younger people (n=17) and their next of kin (n=13). Results Three categories were identified and patients were deemed to be in need of: tailored information, recognition or a post-discharge rehabilitation plan Conclusions Findings demonstrated the importance of using the experiences of younger people and their next of kin as the starting point when planning care and cardiac rehabilitation. Health professionals must systematically and purposefully provide person-centred care, both in hospital and post-discharge settings. Next of kin must be regarded as an important resource in post-myocardial infarction care for younger people, as they tend to be engaged in providing their relatives with support, which is valuable for the recovery of young people post myocardial infarction. Further research is warranted to investigate what makes person-centred interventions directed towards post-myocardial infarction younger people and their next of kin effective

Nursing students’ experiences of applying problem-based learning to train the core competence teamwork and collaboration : An interview study

Aim: To explore nursing students’ experiences of applying problem-based learning to train the core competence teamwork and collaboration. Design: The study used a qualitative descriptive design. Method: The data were collected using individual interviews with a purposive sample of 11 students and analysed using inductive qualitative content analysis. Results: The students’ experiences of applying problem-based learning to train the core competence teamwork and collaboration were described in two generic categories: prerequisites to train teamwork and collaboration and abilities practised in the base group. The generic category “prerequisites to train teamwork and collaboration” includes three subcategories: previous experience and education, composition of the base group, and common goals and values in the base group. The generic category “abilities practised in the base group” includes four subcategories: taking personal responsibility, practising role distribution and leadership, developing communication skills and creating togetherness in the base group.open access</p

Registered nurse case managers’ work experiences with a person-centered collaborative healthcare model : an interview study

Background Multimorbidity is increasingly acknowledged as a significant health concern, particularly among older individuals. It is associated with a decline in quality of life and psychosocial well-being as well as an increased risk of being referred to multiple healthcare providers, including more frequent admissions to emergency departments. Person-centered care interventions tailored to individuals with multimorbidity have shown promising results in improving patient outcomes. Research is needed to explore how work practices within integrated care models are experienced from Registered Nurse Case Managers’ (RNCMs) perspective to identify areas of improvement. Therefore, the aim of this study was to describe RNCMs’ work experience with a person-centered collaborative healthcare model (PCCHCM).  Methods This study used an inductive design. The data were collected through individual interviews with 11 RNCMs and analyzed using qualitative content analysis. Results Data analysis resulted in four generic categories: ‘Being a detective, ‘Being a mediator’, ‘Being a partner’, and ‘Being a facilitator of development’ which formed the basis of the main category ‘Tailoring healthcare, and social services to safeguard the patient’s best.’ The findings showed that RNCMs strive to investigate, identify, and assess older persons' needs for coordinated care. They worked closely with patients and their relatives to engage them in informed decision-making and to implement those decisions in a personalized agreement that served as the foundation for the care and social services provided. Additionally, the RNCMs acted as facilitators of the development of the PCCHCM, improving collaboration with other healthcare professionals and enhancing the possibility of securing the best care for the patient. Conclusions The results of this study demonstrated that RNCMs tailor healthcare and social services to provide care in various situations, adhering to person-centered care principles and continuity of care. The findings underline the importance of implementing integrated care models that consider the unique characteristics of each care context and adapt different case managers’ roles based on the patient’s individual needs as well as on the specific needs of the local setting. More research is needed from the patients’ and their relatives’ perspectives to deepen the understanding of the PCCHCM concerning its ability to provide involvement, security, and coordination of care