To Örebro University

Health care systems in Europe face many challenges requiring greater integration of health and social care. The health policy response in government financed health systems has varied but a consistent feature has been continual change in an attempt to secure greater efficiencies and to meet patient expectations concerning service quality. This paper explores the manifestation of this phenomenon in a subregion of Sweden, where a new concept ‘Närsjukvård’ (literally Nearby Care) was introduced.

Method: Data was collected through interviews and questionnaires. A convenience sample of 57 practitioners and managers was interviewed. A questionnaire with four statements based upon the findings from the interviews was answered by 1361 practitioners, managers and politicians working in primary health care, in municipalities and in hospitals.

Results: The findings illustrated that the concept was interpreted as; accessibility to hospital beds, accessibility to primary health care, collaboration between care providers and continuity and developed home care. The study revealed different understanding and interpretations partly depending on the respondents’ professional domain and their organisational belonging.

 Conclusion. A prerequisite for creating a common meaning to the expression ‘Närsjukvård’ is that activities that help the creation of meaning are offered at and between all domain levels and organisations.

Aims and objectives: The aim of this Participatory Action Research (PAR) project was to find out how the patients experienced their care in order  to allow the practitioners to reflect about the patients’ view as a vehicle for a changed leg ulcer care practice. This paper reports on findings from the project and from the PAR process.

Background: Great numbers of people suffer from chronic leg ulcers and many have to live with their illness for a long time. Even when the illness is controlled by medical treatment, the person with the chronic condition has to deal with physical, emotional, cognitive and social problems and usually has frequent and long-term encounters with practitioners. In one municipality in a southern part of Sweden researchers were engaged as consultants in a PAR project aiming to improve the care for persons with chronic leg ulcers.

Method: Nine older persons with chronic leg ulcers, mainly treated in primary care, were asked about their experiences of the care. The analysis proceeded in several steps including a number of content analysis and reflective dialogues with practitioners and persons with chronic leg ulcers.

Result: Although the persons with chronic leg ulcers experienced their encounters with practitioners as satisfying, findings illuminated low participation in their own care and low practitioner involvement in issues about their daily living with chronic illness. In addition, the PAR project did not succeed to proceed from problem identification towards development and change.

Conclusion and relevance to clinical practice: Participation is about negotiation and transferring power and authority from practitioners towards patients and from researchers towards practitioners and patients. This is however difficult to achieve in practice. This project illuminated that success in performing a PAR project that brings sustainable change requires substantial work to involve practitioners in initiating and planning the research.

In Sweden, attempts to implement core values to ensure high quality health and social care for older people are given high priority and concepts such as security and dignity are often used. As concepts are abstract they are difficult to transform into practical work. The aim of this study was to make sense of the Swedish concept ‘trygghet’ by using stories from daily life in a participatory action research project. One group of seven assistant nurses and one group of five registered nurses working in municipality participated in Story Dialogue Method and four older women were interviewed. ‘Trygghet’ was found to be an internal sense – an intrinsic state based on faith and trust in oneself and others called Sense of security.  External factors that strengthened Sense of security were to be part of a community, to recognise and be familiar with things and situations and to use various kinds of aids. A prerequisite for the professionals being able to support the care receivers adequately is that they have a sense of security themselves, and that they are allowed to operate in a system that facilitates for the care receivers to maintain trustworthy and reliable relations over time.

In spite of laws, rules and routines, findings from Swedish as well as international research show that discharge planning is not a simple matter. There is considerable knowledge about discharge planning but the quality of the actual process in practice remains poor. With this in mind, a research and developmental (R & D) health and social care network decided to use Participation Action Research (PAR) to explore the discharge planning situation in order to generate new ideas for development. This paper reports on the research process and the findings about our enhanced understanding about the discharge planning situation. Story Dialogue Method was used as a method. The method is based on stories from everyday practice. The stories are used as ‘triggers’ to ask probing questions in a dialogical and structured form. Local theory is developed to help the participants to find solutions for action in the practice. Our findings were that the discharge planning situation could be seen as a system including three interconnected areas: patient participation, practitioners’ competence and organisational support. To reach good quality in discharge planning all this three issues need to be developed, but not only as routines and forms. Rather, when developing a discharge planning situation a system where relational aspects such as confidence and continuity are essential and thus needs to be considered. To achieve a change the core problem needs to be clarified. When the issue is complex the solution needs to consider the bigger picture and not just the parts. Telling stories from everyday practice and to systematically reflect and analyse those in inter-professional groups can create opportunities for enhanced understanding as well as be a vehicle for future change of practice.