This thesis investigates management accounting systems in a Swedish health care environment. Through a qualitative case study of an activity-based cost accounting system that was introduced in 1994 at S:t Görans Sjukhus, a large Stockholm hospital, the following questions are addressed: What benefits can an activity-based cost accounting system offer the Swedish health care providers? What are the potential problems impeding the implementation of such a system? Main findings: an activity-based cost accounting system can improve the understanding of where costs are generated in the production processes. Comparisons between alternative production processes are improved, and the data may serve as a basis for internal pricing measures. Concerning the second question, difficulty in reconciliating the principles of economic control with the culture present in a hospital is identified as the main obstacle to a new management accounting system..

SammanfattningSyftet med studien var att beskriva och sammanställa befintlig forskning om de etiska konflikterna, som ambulanspersonal ställs inför i samband med HLR och att inventera om prehospitala HLR riktlinjer tar hänsyn till etiska aspekter på HLR. En litteraturstudie genomfördes där tretton vetenskapliga artiklar analyserades. Resultatet visade att etiska konflikter uppstod när det gällde ambulanspersonalens beslut om att påbörja HLR eller inte, på patienter som av litteraturen beskrevs som terminalt sjuka eller äldre terminalt sjuka patienter. Ibland kränkte ambulanspersonalen patienternas autonomi genom att påbörja HLR mot patienternas och de anhörigas vilja, trots att det existerade en Ej HLR önskan från patienterna och deras anhöriga. Den huvudsakliga orsaken till att sådana situationer uppstod var oklarheter i lagstiftningen omkring prehospitala HLR riktlinjer i USA och Kanada.

When the population is getting older, the need for complex care and nursing interventions in elderly care increases. To create a holistic view of the elder and their life situation, interprofessional team collaboration is often desirable and necessary. Teamwork is often described in positive terms, but previous research has shown that this work method is complicated and requires constant reflection and development. The purpose of this study was to investigate how elderly care teamwork is formed in the interaction between representatives of different professionals. To accomplish this purpose, we have studied how the team members define a well-functioning teamwork and difficulties, and how consensus is achieved in the team.

The aim of this study was to map out the quality of the treatment in the forensic outpatient care unity in Malmoe from a patient point of view. This target group, seriously mentally disordered law-offenders, has been neglected in the scientific research. This investigation will hopefully contribute to a positive change in this subject. To achieve a good understanding of this field a methodological triangulation was conducted which included an observational study, a pilotstudy and semistructured interviews. 14 patients and 10 staff members were interviewed.

Changes in swallowing function are common in elderly and chronically ill individuals. Therefore it is important to be aware of these changes and their prevalence. The aim of this study was to assess the prevalence of dysphagia in nursing homes in the municipality of Linköping, and to correlate dysphagia with variables that can be a cause or a consequence of dysphagia. These variables were gender, age, MMT-result, dentition, weight loss, medical diagnose or number of medications. The intention was also to examine the additional information regarding dysphagia supplied by pulse oximetry.Sixty nursing home residents aged 74-101 years were chosen to participate in the study.

Axelopererade personer har svårt att röra sig under några veckor efter operationen. Den som bor i glesbygden och blir opererad i axeln eller armen måste regelbundet åka långa sträckor för att besöka sjukvården och bli undersökt. Frågan är om det går att minska dessa bilturer och samtidigt behålla vårdkvaliteten? Man har kunnat reducera patienternas resande till och från sjukvården med hjälp av en enkel videokonferensanläggning som patienten får låna hem. Med denna utrustning kan patienten upprätta videomöten med vårdpersonalen istället för att åka till sjukvården.

Background:An increasing number of patients with an oncology diagnose will be seen in the future. The oncology care is complex and in great need of nurses with a high level of competence. There is a lack of previous research in the specialist oncology nurses competence and therefore knowledge of their skills can reveal an understanding of their competence.Aim:The aim of the study was to describe the competence of the specialist oncology nurse.Method:Four oncology nurses and two directors of oncology care were interviewed. The interview text was analyzed using qualitative content analysis.Results:The result showed that the oncology nurses had developed six different competences within different areas. These competence areas were assertiveness, patient-centered care, ethical and moral-, pedagogical-, to lead and develop- and theoretical competence.

Background: Nurses´daily has to face death and dying in their work with patients in a palliative state.  This means both emotionell and workrelated challenges. However nurses in this context are not experiencing more stress then others.Aim: The aim is to describe nurses´experiences of caring for patients in a palliative state.Method: A litterature review based on ten qualitative articles published between 2006- 2012. To collect data we used the databases Cinahl, PubMed, Nursing Allied Health Source and Medline. We worked with Fribergs (2006) model ?Contribute to evidensbased care with a base in analyses of qualitative science? in the analysis.Result: Four main themes were identified; The meaning of the nurses´ spirituality in the care, Why the nurse choose to work in this field, To be certain in the professional role and The meaning of the caring relationship.

Background: In studies about Romani people?s health, it becomes clear that the Romani inseveral countries have a poor health and avoid seeking health care.Objective: The purpose of this study was to explore Romani men's experiences of treatmentin the Swedish health care.Method: A qualitative interview study was conducted with respondents about theirexperiences in individual interviews. Seven male Romanis were elected with a purposefulsample. A content analysis by systematic text condensation on the data obtained was made asdescribed by Granheim & Lundman (2004).Results: The summed up impressions of the responses was perceived to be good, however,many men believe that the information is inadequate. Staff at the emergency department inUppsala should listen more to patients.

The aim of this study was to identify possible reasons for non-attendance related to mammographic screening. Using qualitative methods, sex women underwent a semi-structured interview on the following themes: social background, medical history, mammographic screening, invitation, and final decision.Social background was described using the "life-form theory". The concepts of illness, disease, and sickness were used in order to investigate medical conditions and their impact. The process of non-attendance was studied using a model by Zovko, balancing different needs affecting decisions and final action.According to their decision, and final action, women were defined as "participants", "passive non-attenders" or "active non-attenders". Most women belonged to the life-form "paid work" and had children.

This study aims to investigate the political reformation of the psychiatric care in Sweden, that took place 1995. The main purpose is to illuminate the transformation of subjectivity for mentally ill people after the reform 1995. The group of people which are present in the study are those who former were subjects of care in psychiatric hospitals, but with regarding to the reform have moved out from the institutions and instead become clients for community care. This new group of mentally ill people became, in connection with the reform, subjects for a new concept psykiskt funktionshinder. This new label and concept, that were attached to the present group, is the main concept for the investigation in the present study. The method, that was used in the study, develops a textual based analysis of the official documents, that were produced in connection with the political decision to reform the care of mentally ill people. With a theoretical conceptuality taken from Michel Foucault, with concepts such as discourse, power, and subjectivity, are the documents analysed in order to illuminate how the new subjectivity, under the concept of psykiskt funktionshinder arise.

Background: Young adults undergo a phase in life when they try to become independent individuals and are expected to take responsibility. The transition to adult life, cause hardship for all young adults, but with concurrent mental illness this transition can be more complicated. The young adults may need support from their parents in connection with care.Aim: The aim of this study was to describe nurses' perceptions of parental participation in the care of young adults with mental illness.Method: To describe the perceptions of a phenomenon, qualitative interviews with a phenomenographic approach were conducted. The interview texts were analyzed into five description categories and 10 perceptions. In the study, eight nurses were interviewed.Results: The result shows that parental participation in the care is based on the young adult's decision.

Aim: The aim of this study was to describe how immigrants have experienced nurse's attitude and how they would like nurse´s to care for them in the Swedish health care. Method: The authors have conducted an interview study with qualitative approach. The sampling method used was a convenience sample. The informants were recruited at a school after the authors received the principal's approval. Eight semi-structured interviews were performed with an interview guide for support.

The Northern Raccoon (Procyon lotor) belongs to the Carnivore-family and is a species endemic to North America. Every year hundreds of orphaned raccoon cubs are admitted into the Wildlife Rehabilitation Center of Minnesota (WRCM), a non-profit organization where all injured or orphaned wild animals are admitted and receive quality health care with the goal of being released out into the wild. The WRCM routinely vaccinate all of the admitted raccoon cubs with a killed feline panleucopenia vaccine, but despite this there are outbreaks of parvovirus infection every year where up to 50% of the admitted cubs have been euthanized or died. The objective of this study was to determine whether vaccinating the admitted raccoon kits has any significant protective effect to developing clinical parvoviral disease. A single-blinded cohort study was designed with two parallel, independent groups. One group was given a dose of killed feline parvovirus vaccine at admission, and the other group was not given any vaccination at all. Assignment to the vaccinated or unvaccinated group was on a per-litter basis and done randomly by drawing lots out of a box.

The purpose of our study is to interpret and understand the collaborative process around a regional model that is based on state developed guidelines for people with dementia. We have chosen to focus on the importance of interaction and have therefore interviewed participants in the project's steering committee. This group participates in efforts to develop a model for dementia care in Halland.The project work in Halland, to develop a joint model for people with dementia and their families was initiated in the spring of 2011 and is due to finish at the end of 2012. The Halland model has been named ?Annas led? and is about Anna and her husband Lars and living with dementia.