In the year of 2009 the conditions for managing primary healthcare in the region of Västra Götalandchanged. The decision was taken by the regional assembly and resulted in that the citizens since thenhave had the opportunity to choose which health care provider they preferto stay with. Along with thisdecision a new market for private health careproviders was established, which resulted inincreasedcompetition between the providers.In order to manage the competition, the health care providers arenow forced to be more efficient in their operations andalso to beeven more focused on their patients.Backa Läkarhusgruppen is an example of a private healthcare provider in the region of Västra Götaland.In the same way it is also an example of anorganizationin need of analysing their operations to seehowit can be further optimized to meet patient needs and expectations.The aim of this study is to analyse Backa Läkarhusgruppen?s organization and its operationsin the hopeoffinding suggestions whichwill improve the patient flow.To allocate and solve the problems thatBacka Läkarhus suffer from,an approach inspired by Lean Healthcare is used throughout the report.Some of themost significant problems that were identified within the organization are:?The synchronization of demand and capacity is inadequate.?Absence of standardized routines.?Absence of present leadership.To be able to improve the patient flow Backa Läkarhus needs to handle these identified problem areas.By synchronizing the staffing level in relation to the trends in demand a reduction in the patient?swaiting times and throughput time will be possible. Creating clear responsibilities and routines for thestaff will contribute to a higher degree of patient focus and thus lead to a more efficient patient flow.

BACKGROUND: Several people die every year. The numbers of deceased in Sweden were 91449 in 2008. This often brings bereavement for the relatives and in hospital with end-of-life care it can be important for the health professionals to support and also take care of the relatives. AIM: The aim of this study is to illuminate relatives? experiences of the caring situation with end-of life-care when a close relative is dying METHOD: Literature review.

Background: Mental illness is a growing public health problem which can cause significant disabilities and lead to poor quality of life. As primary care nurses often are the first to encounter these patients they need knowledge to be able to respond appropriately to this group.Aim: The aim was to describe how the sufferer of mental illness experiences the introduction to primary care. Method: The literature review was based on the results of 11 scientific articles which were analyzed with the inspiration of a metasynthesis method.Results: Four categories emerged: the experience of being treated like a human being, the importance of a therapeutic space, the experience of time and availability as well as the importance of competent personnel and the importance of continuity. Patients described different aspects deemed important when encountering nursing staff. Conclusion: Patients experienced that they received good care when they felt listened to and seen as individuals with their own thoughts and feelings.

In the early 1990?s more and more companies of the Swedish public sector were exposed to competition, and this started the debate on how such actions might affect the business and even society.The first chapter examines how the public sector and especially health care, is financed and managed. We also explore what it means to be exposed to competition and find that there are many different ways of exposing the public sector to competition. The study examines dental care as an example of a market with both publicly and privately owned companies. The purpose of this paper is to explore how publicly and privately owned health care companies view their relationship with their consumers.

Bakgrund: Parenteral nutrition kan ges vid i stort sett alla tillstånd när magtarmkanalen ej fungerar eller kan utnyttjas tillfredställande. Benigna tarmsjukdomar, t ex Morbus Crohn eller short bowel syndrome av annan anledning är den vanligaste orsaken till HPN (home parenteral nutrition). En europeisk studie från 1997 visar att incidensen för HPN i Danmark är 2,8 patienter/miljoner invånare/år. Vanligen är patienten uppkopplad till HPN-utrustningen 12-14 timmar/dygn. WHO (World Health Organisation) har utarbetat en definition av livskvalitet; ?Quality of life is defined as individuals? perceptions of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns.? Syfte: Syftet med denna litteraturstudie är att undersöka och beskriva hur patienter med parenteral nutrition i hemmet upplever sin livssituation och behandlingens inverkan på livskvaliteten.

ABSTRACTAim: The aim of this study is to chart the experiences of Swedish general psychiatric care on a Swedish University hospital from a relative?s point of view. The study focus on how they are meet, satisfaction with and participation in the care. The study is done as an improvement project.Methods: The study was conducted by performing semi-structured interviews with eight close relatives to patients on a general psychiatric ward. The interviews lasted for 20-40 minutes.Results: The result shows that relatives are satisfied with the way they are meet by the staff on the ward, that they appreciate staff that are open, down to earth and are inviting to form a good relationship.

Syftet med denna studie var att klargöra eventuellt samband mellan nutrition och trycksår genom att söka svar på de tre frågorna: Har nutritionen någon betydelse för uppkomst och läkning av trycksår? Vilka näringsämnen behövs för att förhind-ra uppkomsten och främja läkningen av trycksår? Finns de något samband mellan malnutrition och/eller ätsvårigheter och trycksår? Metoden för denna litteraturstu-die innefattade systematisk databassökning och manuell sökning av artiklar från referenslistor. Tio vetenskapliga artiklar med kvantitativ forskning i ämnet har analyserats och sammanställts. Resultatet presenteras i följande fyra tema: Nutri-tionens betydelse, energiintagets betydelse, vitaminers och mineralers betydelse samt bifynd. Analysen indikerar på samband mellan förbättrad nutrition och både minskad incidens och förbättrad läkning av trycksår..

Regardless of what discipline nurses work in, wound care is one of the tasks. Caring for wounds involves early detection of signs of infection, in order to avoid complication. Wound infection extends suffering for the patient and causes unnecessary costs for society. The aim was to describe how nurses can identify infection in wounds. Method: The design of the study was a literature review, where13 scientific articles were examined and analyzed.

The main aim of this master thesis was to examine the visual ergonomics and the systematic work environment management concerning lighting issues for nurses within domiciliary care. Further aims were to examine a few existing lighting solutions, to come up with ideas for future possible lighting solutions, and to evaluate if the legal regulations for lighting is satisfying and if the regulations are obeyed in domiciliary nursing.The methods used were a questionnaire completed by 55 nurses, field studies of used lightings in cooperation with a student in industrial esign, test of ten existing lighting solutions in a laboratory environment, and a field test of five existing lighting solutions tested by nine nurses in the home of the patient.The result indicates that 40 % of the asked nurses were dissatisfied with the working light in the patient?s homes. All respondents reported poor working light close to the patient, 50 % reported that this problem occurred daily. One third reported that they had to work in uncomfortable working postures due to insufficient working light, and 15 % reported risk of making mistakes due to the same reason.

BackgroundWhen women have breast pain this usually is not associated with myocardial infarction, which results in that they get less attention and wrong treatment. The nurse has an important role in informing and educating patients and families during hospitalization, which is usually short. Continuous training, written information and repetition for patient and family throughout the hospital stay are of considerable importance to clarify that the patient understands and to reduce the anxiety of being discharged.AimThe aim is to describe nurses' experiences of caring for older women with myocardial infarction.MethodsA qualitative method was used. The collection of data was done by six interviews with nurses in geriatric care and elderly care. Dataset has been processed based on a content analysis and divided into subcategories and main categories using meaningful units.ResultsNot having knowledge of older women with myocardial infarction was expressed as frustrating and nurses described how they were afraid to ask their colleagues.

Background: Within palliative care setting persons with terminal illness is cared for. The aim of the care is to enhance the quality of life for the patient through a holistic approach. The disease can lead to major suffering and require the person to handle the situation. If the person´s ability and capacity to do so is insufficient the identity may be perceived as threatened and quality of life diminished. Self-care can help a person to cope with loss of identity, enhance independence and improve quality of life.Aim: The aim of this study is to explore self-care strategies of patients within palliative care setting.

Regardless of what discipline nurses work in, wound care is one of the tasks. Caring for wounds involves early detection of signs of infection, in order to avoid complication. Wound infection extends suffering for the patient and causes unnecessary costs for society. The aim was to describe how nurses can identify infection in wounds. Method: The design of the study was a literature review, where13 scientific articles were examined and analyzed.

Hand hygiene compliance is one of the most important factors to prevent healtcare associated infections (HAI), which can cause unnessesary suffering, prelonged insitutional care, invalidity and higher mortality rate. It has been shown that despite regulations for hygiene compliances in healthcare, these are used unadequately. HAI affects 5-10 % of all patients in industrailized countries, in development countries the number is estimated to be up to 20 times higher. The aim of this study was to illustrate healthcareworkers hygiene compliances in patient care at a rural healthcarecentre in western India. Participant observation was used as a method, fieldnotes was taken for qualitative analysis.

Aim: The aim of this study was to describe how patients with acute illness experience their given care in the emergency department. Method: A literature review of ten studies where differences and similarities were analyzed. These studies had been published between the years of 2000 and 2011. Results: The analysis showed a lack of sufficient care concerning patients? subjective experiences.

Bakgrund: I Sverige opereras 24% av de extremt för tidigt födda barn (EPT) för öppetstående ductus arteriosus (PDA). EPT barn som behandlas med ductuskirurgi riskerar få i sig för lite energi och makronutrienter på grund av volymrestriktioner och rädsla för att påbörja enteral nutrition efter genomförd operation och därigenom utveckla nekrotiserande enterokolit (NEC). NEC är ett ischemiskt och inflammatoriskt tillstånd hos prematura barn i vilket delar av tarmen nekrotiseras (vävnadsdöd).Syfte: Att beskriva tillförsel av energi, makronutrienter och vätska inför, under och strax efter ductuskirurgi hos EPT barn.Metod: En svensk populationsbaserad kohortstudie av EPT barn födda mellan åren 2004-2007 och som opererats för PDA (n=140, 83 pojkar, genomsnittlig födelsevikt 723 g). Utförlig information avseende perioperativ nutrition inhämtades retrospektivt från sjukhusjournaler. Det dagliga intaget av enteral- och parenteral nutrition samt blodprodukter användes för beräkning av intaget av energi, makronutrienter och vätskevolymer tre dagar före fram till och med tre dagar efter operation.