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  • 1. Björck, M.
    et al.
    Sandman, Lars
    University of Borås, School of Health Science.
    Vårdrelation. Ett försök att tydliggöra begreppsanvändningen2007In: Vård i Norden, ISSN 0107-4083, E-ISSN 1890-4238, Vol. 27, no 4, p. 14-19Article in journal (Refereed)
  • 2. Björk Brämberg, Elisabeth
    et al.
    Sandman, Lars
    University of Borås, School of Health Science.
    Communication through in-person interpreters: a qualitative study of home care providers' and social workers' views2013In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 22, no 1-2, p. 159-167Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES: To describe the experiences of home care providers and social workers in communication, via in-person interpreters, with patients who do not share a common language, and to offer suggestions for practice based on this description. BACKGROUND: The use of interpreters is essential for successful communication to provide equal access to health care for patients not sharing a common language with care providers. Successful bilingual communication is probably even more complex within the home care services with its focus on medical treatment, care and daily support in relation to the more exclusive focus on medical treatment within hospital care. DESIGN: An explorative, qualitative, descriptive study. METHODS: Data were collected in seven focus group interviews. A total of 27 persons, working as registered nurses, assistant nurses and social workers in municipal home care, participated. The analysis was inspired by inductive content analysis. RESULTS: The results express a traditional view on interpretation where the in-person interpreter is supposed to act to a greater or lesser extent as an objective and neutral conduit or communicator of what is said. The interpreter is also expected to observe when medical terms and other concepts need to be explained, which thus exceeds the basic role as a communicator of what was said. CONCLUSIONS: This study emphasises the need to view the interpreter as an active and explicit party in a three-way communication. RELEVANCE TO CLINICAL PRACTICE: Viewing the interpreter as an active and explicit party in a three-way communication and as an essential part of the care team might reduce the possible threat to patient confidentiality, and could contribute to solve the problem of interpreting the patient's non-verbal signs.

  • 3. Björk Brämberg, Elisabeth
    et al.
    Sandman, Lars
    University of Borås, School of Health Science.
    Suggestions for strategies when communicating via in-person interpreters: A qualitative study on communication within home care services in Sweden.2014In: Clinical Nursing Studies, ISSN 2324-7940, E-ISSN 2324-7959, Vol. 2, no 3, p. 34-44Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to explore and suggest strategies for communicating via in-person interpreters, based on experiences of professional home care providers (i.e. nurses and nurse assistants) and social workers. Home care services with its multifaceted emphasis on physical, psychological, social aspects of care and focus on quality of life for the patients presents a challenge for successful interpreted communication as the communication have to cover a wide variety of topics. Previous studies have shown that non-medical issues tend to be less communicated about when using interpreters. The study has an interpretative design, and data were collected in seven focus groups interviews with registered nurses, assistant nurses and social workers in home care services. Data were analysed by means of inductive content analysis. The results reveal suggestions for strategies: making preparations for structure and transparency, creating a flowing conversation on multifaceted topics, forming an understanding of the patient’s voice and limiting the information content. This study concludes that the home care providers and social workers need to be prepared for communication via an interpreter about complex phenomena, that communicating information via an interpreter requires preparation prior to the meeting, as well as being an active part in the conversation. Infrequent use of professional interpreters could threaten the possibilities for care providers and social workers to communicate with linguistic diverse patients in an optimal way.

  • 4. Bond, Ken
    et al.
    Hofmann, Björn
    Sandman, Lars
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Prioriteringscentrum, Linköpings universitet.
    Examining ethical rationales for patient involvement in HTA.2015Conference paper (Refereed)
  • 5.
    Bremer, Anders
    et al.
    University of Borås, School of Health Science.
    Dahlberg, Karin
    Sandman, Lars
    University of Borås, School of Health Science.
    Balancing between closeness and distance: emergency medical services personnel's experiences of caring for families at out-of-hospital cardiac arrest and sudden death2012In: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 27, no 1, p. 42-52Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Out-of-hospital cardiac arrest (OHCA) is a lethal health problem that affects between 236,000 and 325,000 people in the United States each year. As resuscitation attempts are unsuccessful in 70-98% of OHCA cases, Emergency Medical Services (EMS) personnel often face the needs of bereaved family members. PROBLEM: Decisions to continue or terminate resuscitation at OHCA are influenced by factors other than patient clinical characteristics, such as EMS personnel's knowledge, attitudes, and beliefs regarding family emotional preparedness. However, there is little research exploring how EMS personnel care for bereaved family members, or how they are affected by family dynamics and the emotional contexts. The aim of this study is to analyze EMS personnel's experiences of caring for families when patients suffer cardiac arrest and sudden death. METHODS: The study is based on a hermeneutic lifeworld approach. Qualitative interviews were conducted with 10 EMS personnel from an EMS agency in southern Sweden. RESULTS: The EMS personnel interviewed felt responsible for both patient care and family care, and sometimes failed to prioritize these responsibilities as a result of their own perceptions, feelings and reactions. Moving from patient care to family care implied a movement from well-structured guidance to a situational response, where the personnel were forced to balance between interpretive reasoning and a more direct emotional response, at their own discretion. With such affective responses in decision-making, the personnel risked erroneous conclusions and care relationships with elements of dishonesty, misguided benevolence and false hopes. The ability to recognize and respond to people's existential questions and needs was essential. It was dependent on the EMS personnel's balance between closeness and distance, and on their courage in facing the emotional expressions of the families, as well as the personnel's own vulnerability. The presence of family members placed great demands on mobility (moving from patient care to family care) in the decision-making process, invoking a need for ethical competence. CONCLUSION: Ethical caring competence is needed in the care of bereaved family members to avoid additional suffering. Opportunities to reflect on these situations within a framework of care ethics, continuous moral education, and clinical ethics training are needed. Support in dealing with personal discomfort and clear guidelines on family support could benefit EMS personnel.

  • 6.
    Bremer, Anders
    et al.
    University of Borås, School of Health Science.
    Dahlberg, Karin
    Sandman, Lars
    University of Borås, School of Health Science.
    Experiencing Out-of-Hospital Cardiac Arrest: Significant Others’ Lifeworld Perspective2009In: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 19, no 10, p. 1407-1420Article in journal (Refereed)
    Abstract [en]

    When patients suffer out-of-hospital cardiac arrests (OHCA), significant others find themselves with no choice about being there. After the event they are often left with unanswered questions about the life-threatening circumstances, or the patient’s death, or emergency treatment and future needs. When it is unclear how the care and the event itself will affect significant others’ well-being, prehospital emergency personnel face ethical decisions. In this article we describe the experiences of significant others present at OHCA, focusing on ethical aspects and values. Using a lifeworld phenomenological approach, 7 significant others were interviewed. The essence of the phenomenon of OHCA can be stated as unreality in the reality, which is characterized by overwhelming responsibility. The significant others experience inadequacy and limitation, they move between hope and hopelessness, and they struggle with ethical considerations and an insecurity about the future. The study findings show how significant others’ sense of an OHCA situation, when life is trembling, can threaten values deemed important for a good life.

  • 7.
    Bremer, Anders
    et al.
    University of Borås, School of Health Science.
    Dahlberg, Karin
    Sandman, Lars.
    University of Borås, School of Health Science.
    To survive out-of-hospital cardiac arrest: a search for meaning and coherence2009In: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 19, no 3, p. 323-338Article in journal (Refereed)
    Abstract [en]

    The primary responsibility of prehospital emergency personnel at out-of-hospital cardiac arrests (OHCA) is to provide lifesaving care. Ethical considerations, decisions, and actions should be based in the patient's beliefs about health and well-being. In this article, we describe patients' experiences of surviving OHCA. By using a phenomenological approach, we focus on how OHCA influences patients' well-being over time. Nine survivors were interviewed. Out-of-hospital cardiac arrest is described as a sudden and elusive threat, an awakening in perplexity, and the memory gap as a loss of coherence. Survival means a search for coherence with distressing and joyful understanding, as well as existential insecurity exposed by feelings of vulnerability. Well-being is found through a sense of coherence and meaning in life. The study findings show survivors' emotional needs and a potential for prehospital emergency personnel to support them as they try to make sense of what has happened to them.

  • 8.
    Bremer, Anders
    et al.
    University of Borås, School of Health Science.
    Jimenéz-Herrera, Maria
    Axelsson, Christer
    University of Borås, School of Health Science.
    Burjalés Martí, D
    Sandman, Lars
    University of Borås, School of Health Science.
    Casali, Luca
    Ethical values in emergency medical services: A pilot study.2015In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 22, no 8, p. 928-942Article in journal (Refereed)
    Abstract [en]

    Background: Ambulance professionals often address conflicts between ethical values. As individuals’ values represent basic convictions of what is right or good and motivate behaviour, research is needed to understand their value profiles. Objectives: To translate and adapt the Managerial Values Profile to Spanish and Swedish, and measure the presence of utilitarianism, moral rights and/or social justice in ambulance professionals’ value profiles in Spain and Sweden. Methods: The instrument was translated and culturally adapted. A content validity index was calculated. Pilot tests were carried out with 46 participants. Ethical considerations: This study conforms to the ethical principles for research involving human subjects and adheres to national laws and regulations concerning informed consent and confidentiality. Findings: Spanish professionals favoured justice and Swedish professionals’ rights in their ambulance organizations. Both countries favoured utilitarianism least. Gender differences across countries showed that males favoured rights. Spanish female professionals favoured justice most strongly of all. Discussion: Swedes favour rights while Spaniards favour justice. Both contexts scored low on utilitarianism focusing on total population effect, preferring the opposite, individualized approach of the rights and justice perspectives. Organizational investment in a utilitarian perspective might jeopardize ambulance professionals’ moral right to make individual assessments based on the needs of the patient at hand. Utilitarianism and a caring ethos appear as stark opposites. However, a caring ethos in its turn might well involve unreasonable demands on the individual carer’s professional role. Since both the justice and rights perspectives portrayed in the survey mainly concern relationship to the organization and peers within the organization, this relationship might at worst be given priority over the equal treatment and moral rights of the patient. Conclusion: A balanced view on ethical perspectives is needed to make professionals observant and ready to act optimally – especially if these perspectives are used in patient care. Research is needed to clarify how justice and rights are prioritized by ambulance services and whether or not these organization-related values are also implemented in patient care.

  • 9.
    Bremer, Anders
    et al.
    University of Borås, School of Health Science.
    Jiménez Herrera, María
    Axelsson, Christer
    University of Borås, School of Health Science.
    Burjalés Martí, Dolors
    Sandman, Lars
    University of Borås, School of Health Science.
    Casali, Gian Luca
    Ethical values in emergency medical services: A pilot study2015In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 22, no 8, p. 928-942Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Ambulance professionals often address conflicts between ethical values. As individuals' values represent basic convictions of what is right or good and motivate behaviour, research is needed to understand their value profiles. OBJECTIVES: To translate and adapt the Managerial Values Profile to Spanish and Swedish, and measure the presence of utilitarianism, moral rights and/or social justice in ambulance professionals' value profiles in Spain and Sweden. METHODS: The instrument was translated and culturally adapted. A content validity index was calculated. Pilot tests were carried out with 46 participants. ETHICAL CONSIDERATIONS: This study conforms to the ethical principles for research involving human subjects and adheres to national laws and regulations concerning informed consent and confidentiality. FINDINGS: Spanish professionals favoured justice and Swedish professionals' rights in their ambulance organizations. Both countries favoured utilitarianism least. Gender differences across countries showed that males favoured rights. Spanish female professionals favoured justice most strongly of all. DISCUSSION: Swedes favour rights while Spaniards favour justice. Both contexts scored low on utilitarianism focusing on total population effect, preferring the opposite, individualized approach of the rights and justice perspectives. Organizational investment in a utilitarian perspective might jeopardize ambulance professionals' moral right to make individual assessments based on the needs of the patient at hand. Utilitarianism and a caring ethos appear as stark opposites. However, a caring ethos in its turn might well involve unreasonable demands on the individual carer's professional role. Since both the justice and rights perspectives portrayed in the survey mainly concern relationship to the organization and peers within the organization, this relationship might at worst be given priority over the equal treatment and moral rights of the patient. CONCLUSION: A balanced view on ethical perspectives is needed to make professionals observant and ready to act optimally - especially if these perspectives are used in patient care. Research is needed to clarify how justice and rights are prioritized by ambulance services and whether or not these organization-related values are also implemented in patient care.

  • 10.
    Bremer, Anders
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Jonasson, Lise-Lotte
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Sandman, Lars
    Chefers etiska värderingar2016In: Ledarskap i äldreomsorgen: Att leda integrerat värdeskapande i en röra av värden och förutsättningar / [ed] Lotta Dellve, Maria Wolmesjö, Borås: Högskolan i Borås, 2016, , p. 16p. 43-56Chapter in book (Other academic)
  • 11.
    Bremer, Anders
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Jonasson, Lise-Lotte
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Sandman, Lars
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Ethical values among managers in elderly care. Paper presented at the Dilemmas for Human Services 2015: Organizing, Designing and Managing2015Conference paper (Refereed)
  • 12.
    Bremer, Anders
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Kullén Engström, Agneta
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Fredman, Margareta
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Jonasson, Lise-Lotte
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Jutengren, Göran
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Karlsson, Per-Åke
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Sandman, Lars
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Wolmesjö, Maria (Editor)
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Ledarskap i äldreomsorgen: att leda integrerat värdeskapande i en röra av värden och förutsättningar2016Report (Refereed)
    Abstract [sv]

    Det övergripande syftet med denna rapport är att beskriva chefers etiska värderingar, dilemman och organisatoriska förutsättningar för att bedriva ett värdebaserat ledarskap i såväl kommunal som privat äldreomsorg.

    Det empiriska materialet består av en omfattande enkätstudie till nästan 500 studerande inom ramen för den nationella ledarutbildningen för chefer inom äldreomsorgen vid Högskolan i Borås under perioden 2013 till 2015. Utbildningen gavs på uppdrag av Socialstyrelsen och omfattade 30 högskolepoäng med två års studier på kvartsfart. Samtliga studerande var yrkesverksamma som chefer och ledare inom kommunal eller privat äldreomsorg i södra Sverige. Metoder som använts i bearbetning och analys av materialet är deskriptiva, jämförande och analytiska med regressionsmodeller och SEM-analys.

    Resultatet visar på att cheferna – oavsett utbildningsbakgrund, värderade följande etiska värden högst: att inte skada, respekt för individen och rätten till konfidentialitet. Värdedilemman i chefsarbetet är dock vanligt och sammanlänkat med andra utmaningar i arbetet, särskilt med utmaningar som rör hantering över organisationsnivåer (buffertproblem och containerproblem) och av olika ansvarsområden (logikkonflikter). Inom privat verksamhet skattade de medverkande cheferna värdekonflikter och andra utmaningar i lägre grad än chefer inom kommunal verksamhet.

    De flesta chefer var nöjda med hur de kunde fullfölja sitt ansvar för utveckling av verksamheten avseende värdegrund, kvalitet, processer, dagligt arbete, brukarmedverkan, brukarsäkerhet och arbetsmiljö. De flesta skattade också att de arbetade i mycket hög grad med strukturering och utveckling av dessa frågor.

    Stödresurser minskade upplevelsen av värdekonflikter, men det fanns skillnad i betydelsen relaterat till chefers grundprofession. Det organisatoriska stödet var också tydligare för chefer inom privat verksamhet. Organiserade stödresurser hade stor betydelse för hållbart integrerat och värdeskapande ledarskap samt för aktiva ledningsstrategier. Även sambandet mellan hållbart ledarskap och aktiva ledarstrategier modererades av grundprofession, där sambandet var moderat negativt för chefer med social grundutbildning. Det tycks således finnas ett utbildningsbehov bland äldreomsorgens chefer och behov av ett utvecklat stöd från arbets- HÖGSKOLAN BORÅS HÖGSKOLAN BORÅS 15 givaren då det varierar avseende omfattning, inriktning och nivå mellan kommunal och privat verksamhet.

    Sammanfattningsvis har chefer i äldreomsorgen många olika värden, på olika nivåer och utifrån olika perspektiv att förhålla sig till i sitt ledarskap. Att hantera och utveckla förståelse för dessa är utmanande i chefskapet och värdedilemman är vanliga. Majoriteten av cheferna i denna studie beskriver dock generellt en aktiv och god hantering och organisering av dessa. Konstateras att en integrerad förståelse och hantering, samt goda organisatoriska stödresurser tycks bidra till mer hållbart och värdeskapande ledarskap.

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  • 13.
    Bremer, Anders
    et al.
    University of Borås, School of Health Science.
    Sandman, Lars
    University of Borås, School of Health Science.
    Etiska aspekter på HLR2011Conference paper (Refereed)
    Abstract [sv]

    Hälso- och sjukvårdens övergripande mål kan uttryckas som främjande av optimal livslängd med god livskvalitet och ett gott liv. Målet kan betraktas som etiskt. Vid en patients hjärt-stopp är målet med den medicinska behandlingen (hjärtlungräddning, HLR) att personen överlever med åtminstone acceptabel livskvalitet. I det akuta, prehospitala skedet är det dock svårt att bedöma utfallet avseende framtida livskvalitet förutom i vissa få och relativt välbestämda fall. Det är dessutom svårt att få vetskap om patientens eventuella önskemål om sin vård. Som regel påbörjas därför HLR. Etiska riktlinjer kan ge viss vägledning i beslut om att avbryta HLR när det finns skäl att tro att målet inte kan uppnås. Ramarna för sådana riktlinjer bygger på respekt för patientens autonomi och integritet, rättvisa samt rimlighet i vårdarens yrkesroll. Detta innebära exempel-vis respekt för patientens eventuella önskemål avseende HLR, undvikande av att patienten exponeras samt ansvar för att resurserna används så rättvist som möjligt. Det sistnämnda kan ibland innebära att ambulanspersonal avviker från en HLR-plats efter att HLR avbrutits för något som är viktigare än vården av närstående. Vård av närstående bör dock betraktas som en rimlig uppgift i ambulanspersonalens yr-kesroll där ansvaret handlar om att tillvarata närståendes kunskap och erfarenhet, visa dem omtanke och respekt samt ge stöd, vägledning och information. Närståendes delaktighet ska främjas och kommunikationen med dem ske respektfullt, lyhört och empatiskt. Närståendes initiala roll vid en patients hjärtstopp är viktig genom att de kan bidra med värdefull informa-tion om patienten och även återge patientens vilja i förekommande fall. I händelse av att pati-enten avlider är målet att lindra närståendes lidande. Forskning visar dock att ambulansperso-nalens uppfattningar om närståendevården och närståendes närvaro under HLR varierar från att anses som viktig för närståendes sorgeprocess och återhämtning, till att inte ingå i vår-darrollen, negativt påverka HLR-beslut och innebära emotionell belastning för vårdarna. När-ståendes närvaro vid HLR tycks för en del ambulanspersonal innebära svårigheter att ge när-stående emotionellt stöd och ibland leda till att HLR fortsätter längre än vad som är medici-niskt motiverat, antingen som ett sätt att lindra närståendes lidande eller för att vårdarna inte förmår att skifta från patientvård till vårdande av närstående. Att utföra HLR för någon annan skull än för patienten och längre än medicinskt motive-rat är emellertid etiskt tveksamt och flyttar dessutom fokus från närståendes behov. Närståen-des känslor av överväldigande ansvar och ofrivillig ensamhet belyser istället vikten av att uppmärksamhet på närståendes verkliga behov, främjande av kontrollkänsla och försök till skuldavlastning. Ambulanspersonalens uppriktighet, medmänsklighet och närvaro framstår som centrala aspekter i en etiskt god vård av närstående i samband med en patients hjärtstopp och plötsliga död.

  • 14.
    Bremer, Anders
    et al.
    University of Borås, School of Health Science.
    Sandman, Lars
    University of Borås, School of Health Science.
    Futile cardiopulmonary resuscitation for the benefit of others: An ethical analysis2011In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 18, no 4, p. 495-504Article in journal (Refereed)
    Abstract [en]

    It has been reported as an ethical problem within prehospital emergency care that ambulance professionals administer physiologically futile cardiopulmonary resuscitation (CPR) to patients having suffered cardiac arrest to benefit significant others. At the same time it is argued that, under certain circumstances, this is an acceptable moral practice by signalling that everything possible has been done, and enabling the grief of significant others to be properly addressed. Even more general moral reasons have been used to morally legitimize the use of futile CPR: That significant others are a type of patient with medical or care needs that should be addressed, that the interest of significant others should be weighed into what to do and given an equal standing together with patient interests, and that significant others could be benefited by care professionals unless it goes against the explicit wants of the patient. In this article we explore these arguments and argue that the support for providing physiologically futile CPR in the prehospital context fails. Instead, the strategy of ambulance professionals in the case of a sudden death should be to focus on the relevant care needs of the significant others and provide support, arrange for a peaceful environment and administer acute grief counselling at the scene, which might call for a developed competency within this field.

  • 15.
    Byström, Katriina
    et al.
    University of Borås, Swedish School of Library and Information Science.
    Ekwall, Daniel
    University of Borås, School of Engineering.
    Ericson, Mathias
    University of Borås, School of Education and Behavioural Science.
    Sandman, Lars
    University of Borås, School of Health Science.
    Rolandsson, Bertil
    University of Borås, School of Education and Behavioural Science.
    Torstensson, Håkan
    University of Borås, School of Engineering.
    Risker och säkerhet i professionell vardag: tekniska, organisatoriska och etiska perspektiv2010Report (Other academic)
    Abstract [sv]

    Vid Högskolan i Borås bedrivs ett utredningsarbete med syfte att klargöra förutsättningarna för att inrätta ett centrum för studier av risk, profession och säkerhet. Parallellt med resonemang rörande lämpliga styr- och organisationsformer behandlas hur utbildningen inom området bör utformas. I skrivande stund är inriktningen att utveckla och erbjuda ett magisterprogram inom området management där en inriktning är mot risk och säkerhet. En satsning på utbildning fordrar forskningsanknytning och förekomsten av forskning inom området risk och säkerhet utgör därför en viktig utgångspunkt för det fortsatta arbetet. Vid högskolan finns idag forskning som belyser risk och säkerhetsfrågor inom skilda verksamhetsområden och med olika teoretiska utgångspunkter. Området spänner från hur risker hanteras i det vardagliga arbetet för olika professioner till hur risker kan elimineras och osäkerhet reduceras i samband med extra ordinära händelser. Högskolan i Borås ska vara ett komplett professionslärosäte och bedriva nydanande och samhällsrelevant utbildning och forskning. Ett flervetenskapligt ideal präglar utbildning och forskning, där problemet som ska belysas är i centrum och inte den akademiska disciplinen. Att bedriva utbildning och forskning inom risk och säkerhet är i enlighet med lärosätets ideal och inriktning. Genom att anlägga ett risk- och säkerhetsperspektiv på olika typer av samhälleliga fenomen i utbildning och forskning uppmärksammas dels nya frågor, dels beforskas områden och fenomen utifrån ett i förhållande till traditionell disciplinär forskning alternativt perspektiv, och därigenom kan ny kunskap erhållas. Ett led i utvecklingen av forskningsverksamheten vid högskolan är sammanställningen och publiceringen av föreliggande antologi. Två av de ledande forskarna inom området, Bertil Rolandsson och Håkan Torstensson, har tagit initiativ till antologin och fungerat som redaktörer. Fem bidrag publiceras i rapporten som tillsammans visar vad forskning kring risk och säkerhet kan vara och vilken inriktning forskningen har vid Högskolan i Borås. Tre bidrag har fokus på transportbranschen, ett på polisiär verksamhet och ett på vårdverksamhet. Det finns således en spridning över praktiska fält och även spridning vad gäller teoretiska utgångspunkter. Rapporten är nummer tretton i högskolans rapportserie Vetenskap för profession, vars syfte är att redovisa resultat från pågående och avslutade forskningsprojekt. Rapporten är också ett underlag för fortsatta resonemang inom högskolan om satsningen på utbildning och forskning inom området risk och säkerhet och kring frågan om vilken inriktning forskningen ska ha.

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  • 16. Carlsson, P
    et al.
    Liss, P-E
    Sandman, Lars
    University of Borås, School of Health Science.
    Svar till Nils-Eric Sahlin: Vi håller med om att vårt förslag till reviderade riktlinjer för prioriteringar behöver analyseras ytterligare2008In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 105, no 47, p. 3458-3459Article in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    Tvärtemot vad Nils-Eric Sahlin hävdar kräver en mer flexibel ordning mellan etiska principer mer av etisk reflektion. Vårt förslag är en vidareutveckling av den tidigare etiska plattformen, som i vissa avseenden innehöll brister i etisk reflektion och koppling av denna till praktiken. Nils-Eric Sahlin diskuterar i Läkartidningen 37/2008 (sidorna 2465-6) ett förslag från PrioriteringsCentrum i Linköping som bl a efterlyser en översyn av riksdagens principer och riktlinjer för prioriteringar från 1997. Vi välkomnar en livaktig diskussion kring hur arbetet med öppna prioriteringar ska kunna realiseras i vårt land.

  • 17. Carlsson, Per
    et al.
    Garpenby, Peter
    Nedlund, Ann-Charlotte
    Sandman, Lars
    University of Borås, School of Health Science.
    Öppna prioriteringar i vård och omsorg: var står vi idag och hur ska vi komma vidare?2014Report (Other academic)
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  • 18. Carlsson, Per
    et al.
    Hoffman, Mikael
    Levin, Lars-Åke
    Sandman, Lars
    University of Borås, School of Health Science.
    Wiss, Johanna
    Prioritering och finansiering av läkemedel för behandling av patienter med sällsynta sjukdomar2012Report (Other academic)
    Abstract [sv]

    Den pågående Läkemedels- och apoteksutredningen har i ett tilläggsdirektiv fått i uppdrag att analysera behovet av särskilda lösningar vid beslut om subventionering för särläkemedel. Ett särläkemedel är ett läkemedel som uppfyller vissa villkor och därmed omfattas av ett särskilda stimulansåtgärder innan godkännande av läkemedelsmyndighet samt möjlighet, men inte rätt, till ensamrätt på marknaden under 10 år. Till villkoren hör bl.a. att läkemedlet är avsett för att diagnostisera, förebygga eller behandla livshotande tillstånd eller tillstånd med kronisk funktionsnedsättning och som högst 5 av 10 000 personer i gemenskapen lider av vid ansökningstillfället.

  • 19. Carlsson, Per
    et al.
    Liss, Per-Erik
    Sandman, Lars
    University of Borås, School of Health Science.
    Fortsatt analys behövs av förslaget till reviderade riktlinjer för prioriteringar2008In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 105, no 47, p. 3458-3459Article in journal (Other (popular science, discussion, etc.))
  • 20. Carlsson, Per
    et al.
    Liss, Per-Erik
    Sandman, Lars
    University of Borås, School of Health Science.
    Replik till Nils-Eric Sahlin: Fortsatt analys behövs av förslaget till reviderade riktlinjer för prioriteringar2008In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 105, no 47, p. 3458-3459Article in journal (Other academic)
    Abstract [sv]

    Tvärtemot vad Nils-Eric Sahlin hävdar kräver en mer flexibel ordning mellan etiska principer mer av etisk reflektion. Vårt förslag är en vidareutveckling av den tidigare etiska plattformen, som i vissa avseenden innehöll brister i etisk reflektion och koppling av denna till praktiken.

  • 21. Dekkers, W
    et al.
    Sandman, Lars
    University of Borås, School of Health Science.
    Webb, P
    Good Death or Good Life as a Goal of Palliative Care2002In: The ethics of palliative care: European perspectives / [ed] Henk ten Have, D Clark, Buckingham: Open University Press , 2002, p. 106-125Chapter in book (Other academic)
  • 22.
    Erikson, Martin G
    et al.
    University of Borås, School of Education and Behavioural Science.
    Johannisson, Jenny
    University of Borås, Swedish School of Library and Information Science.
    Nolin, Jan
    University of Borås, Swedish School of Library and Information Science.
    Sandman, Lars
    University of Borås, School of Health Science.
    Sundeen, Johan
    University of Borås, Swedish School of Library and Information Science.
    Svengren Holm, Lisbeth
    University of Borås, Swedish School of Textiles.
    Från Högskolan i Borås till Humboldt, volym 32013Report (Other academic)
    Abstract [sv]

    Denna rapport är den tredje i ordningen som har sin upprinnelse i Humboldtuniversitetets 200-årsjubileum och i ambitionen att föra en kvalificerad diskussion om vilka roller som högskolor och universitet spelar idag. Rapporten ägnar särskild uppmärksamhet åt fenomenet tvärvetenskap och de utmaningar som en sådan ansats innebär, men den för också upp grundläggande principfrågor om akademiska friheter och värden till diskussion.

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  • 23. Gustafsson, Erik
    et al.
    Sandman, Lars
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Health-care needs and shared decision-making in priority-setting2015In: Medicine, Health care and Philosophy, ISSN 1386-7423, E-ISSN 1572-8633, Vol. 18, no 1, p. 13-22Article in journal (Refereed)
    Abstract [en]

    In this paper we explore the relation between health-care needs and patients' desires within shared decision-making (SDM) in a context of priority setting in health care. We begin by outlining some general characteristics of the concept of health-care need as well as the notions of SDM and desire. Secondly we will discuss how to distinguish between needs and desires for health care. Thirdly we present three cases which all aim to bring out and discuss a number of queries which seem to arise due to the double focus on a patient's need and what that patient desires. These queries regard the following themes: the objectivity and moral force of needs, the prediction about what kind of patients which will appear on a micro level, implications for ranking in priority setting, difficulties regarding assessing and comparing benefits, and implications for evidence-based medicine.

  • 24.
    Gustavsson, Erik
    et al.
    Linköpings universitet .
    Juth, Niklas
    Karolinska institutet.
    Munthe, Christian
    Göteborgs universitet.
    Sandman, Lars
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Prioriteringscentrum, Linköpings universitet.
    Etiska och praktiska utmaningar med ökat patientinflytande2015In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 112, no 17Article in journal (Refereed)
  • 25.
    Hansson, E.
    et al.
    Department of Plastic and Reconstructive Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Sandman, Lars
    University of Borås, Faculty of Police Work. National Centre for Priorities in Health, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden; Västra Götaland Region, Gothenburg, Sweden.
    Davidson, T.
    National Centre for Priorities in Health, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    A systematic review of direct preference measurements in health states treated with plastic surgery2021In: Journal of Plastic Surgery and Hand Surgery, ISSN 2000-656X, E-ISSN 2000-6764Article in journal (Refereed)
    Abstract [en]

    One way to compare health care needs and outcomes on common scales is by estimating the strength of preferences or willingness-to-pay (WTP). The aim of this study was to review directly measured preference values and WTP estimates for health states treated by plastic surgery. The included articles had to meet the criteria defined in the SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, Research type). Relevant databases were searched using predetermined strings. Data were extracted in a standardised manner. Included studies were appraised according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach for rating the importance of outcomes. In total, 213 abstracts were retrieved. Of these, 179 did not meet the inclusion criteria and were excluded, leaving 34 studies in the review. The risk of bias was considered moderate in four studies and serious in the rest. The overall certainty of evidence for directly measured preference values and WTP estimates for health states treated by plastic surgery is low (Grade ƟƟОО). The lowest preference scores were generally elicited for facial defects/anomalies and the highest for excess skin after massive weight loss. Scientific knowledge about preferences and the resulting health gains might play an essential role in deciding which procedures should be considered for public funding or rather rationed within the system. Better quality studies are required to allow for such applications.

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  • 26. Heintz, Emelie
    et al.
    Lintamo, Laura
    Hultcrantz, Monica
    Jacobson, Stella
    Levi, Ragnar
    Munthe, Christian
    Tranaeus, Sofia
    Ostlund, Pernilla
    Sandman, Lars
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Prioriteringscentrum, Linköpings universitet.
    FRAMEWORK FOR SYSTEMATIC IDENTIFICATION OF ETHICAL ASPECTS OF HEALTHCARE TECHNOLOGIES: THE SBU APPROACH2015In: International Journal of Technology Assessment in Health Care, ISSN 0266-4623, E-ISSN 1471-6348, Vol. 31, no 3, p. 124-130Article in journal (Refereed)
  • 27.
    Högberg, K
    et al.
    University of Borås, School of Health Science.
    Sandman, L
    University of Borås, School of Health Science.
    Nyström, M
    University of Borås, School of Health Science.
    Stockelberg, D
    Broström, A
    Prerequisites required for the provision and use of web-based communication for psychosocial support in haematologic care2013In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 17, no 5, p. 596-602Article in journal (Refereed)
    Abstract [en]

    Purpose: The purpose of this study was to describe the prerequisites required for the provision and use of web-based communication for psychosocial support within a haematology clinic, from a patient and family perspective. Method: A qualitative design using content analysis was used. A strategically selected sample of patients ( n ¼ 11) and family members ( n ¼ 6) were offered access to a web-based communication capability with a nurse. After four months, individual interviews were conducted with all participants, in order to identify necessary prerequisites. Results: Preferences and characteristics of the individual patient or family member are crucial as to whether web-based communication for support is perceived as useful. To feel comfortable with writing and to self-identify the need for support are fundamental in getting motivated to use web-based com- munication. An effective organization around psychosocial support in general is another prerequisite. Goals and responsibilities must be clearly de fi ned for patients and family members to understand their rights and enable the transformation of opportunities into practice. The use of web-based communi- cation must also be a convenient and naturally incorporated part of both individual and organizational use of the web in general. Conclusions: Prerequisites of taking into account caretakers ’ different preferences and needs, providing highly structured psychosocial support activities and providing a congruent range of web services, are necessary for successful provision and use of web-based communication for psychosocial support.

  • 28.
    Högberg, Karin
    et al.
    University of Borås, School of Health Science.
    Stockelberg, Dick
    Sandman, Lars
    University of Borås, School of Health Science.
    Nyström, Maria
    University of Borås, School of Health Science.
    Broström, Anders
    The meaning of web-based support: from the patients' perspective within a hematological healthcare setting.2015In: Cancer Nursing, ISSN 0162-220X, E-ISSN 1538-9804, Vol. 38, no 2, p. 145-154Article in journal (Refereed)
    Abstract [en]

    Background: Being critically ill with a hematological disease is a challenge, sometimes causing a need for support in the adjustment to the stressful life situation. By providing Web-based communication for support from a nurse, patients get access to an alternative and untraditional way to communicate their issues. Objective: The aim was to describe the meaning of using Web-based communication for support from a patient perspective. Methods: A comprehensive randomized pilot study (n = 30) was conducted, allowing 15 patients in the experimental group to have access to the Web-based communication, to evaluate feasibility. Of these 15 participants, 10 were interviewed, focusing on their experiences. An empirical hermeneutical approach was used and the interpretive analysis focused on the meanings. Results: Web-based communication for support means a space for patients to have their say, consolidation of a matter, an extended caring relationship, access to individual medical assessment, and an opportunity for emotional processing. The main interpretation indicates that the patient's influence on the communication strengthens according to the asynchronous, faceless, and written communication. The increased, and in some sense constant, access to an individual medical and caring assessment, in turn, implies a feeling of safety. Conclusion: Web-based communication for support seems to have the potential to enhance patients' participation on their own terms. Implications for Practice: To achieve the possible advantages of Web-based communication for support, nurses must acquire knowledge about caring writing. It requires respect for the patient and articulated accuracy and attention in the response given.

  • 29.
    Jonasson, Lise-Lotte
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Sandman, Lars
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Bremer, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Managers’ experiences of ethical problems in municipal elderly care: a qualitative study of written reflections as part of leadership training2019In: Journal of Healthcare Leadership, Vol. 11, no 63-74Article in journal (Refereed)
    Abstract [en]

    Background: Managers in elderly care have a complex ethical responsibility to address the needs and preferences of older persons while balancing the conflicting interests and requirements of relatives’ demands and nursing staff’s work environment. In addition, managers must consider laws, guidelines, and organizational conditions that can cause ethical problems and dilemmas that need to be resolved. However, few studies have focused on the role of health care managers in the context of how they relate to and deal with ethical conflicts. Therefore, the aim of this study was to describe ethical problems experienced by managers in elderly care.

    Methods: We used a descriptive, interpretative design to analyze textual data from two examinations in leadership courses for managers in elderly care. A simple random selection of 100 out of 345 written exams was made to obtain a manageable amount of data. The data consisted of approximately 300 pages of single-spaced written text. Thematic analysis was used to evaluate the data.

    Results: The results show that managers perceive the central ethical conflicts relate to the older persons’ autonomy and values versus their needs and the values of the staff. Additionally, ethical dilemmas arise in relation to the relatives’ perspective of their loved one’s needs and preferences. Legislations, guidelines, and a lack of resources create difficulties when managers perceive these factors as conflicting with the care needs of older persons.

    Conclusion: Managers in elderly care experience ethical conflicts that arise as unavoidable and perennial values conflicts, poorly substantiated values, and problematic organizational conditions. Structured approaches for identifying, reflecting on, and assessing ethical problems in the organization should therefore be implemented

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  • 30.
    Jonsson, Anders
    et al.
    University of Borås, School of Health Science.
    Lundberg, Kristina
    University of Borås, School of Health Science.
    Sandman, Lars
    University of Borås, School of Health Science.
    Kjellström, Sofia
    Experiences of Swedish military medical personnel in combat zones: adapting to competing loyalties2014In: Military medicine, ISSN 0026-4075, E-ISSN 1930-613X, Vol. 8, no 179, p. 821-826Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The aim of this qualitative study is to explore the Swedish military personnel's experience of what it means to perform a caring role in a combat zone. This study assesses the challenges faced by military medical personnel in the context of a combat zone. METHODS: The design was descriptive with a qualitative inductive approach. Twenty military medical personnel (physicians, nurses, and combat lifesavers) were interviewed individually. They had been involved in international military operations between 2009 and 2012. This study was analyzed using qualitative content analysis. RESULTS: The analysis produced four categories: being in a primarily noncaring organization, caring in emotionally charged relationships, lacking an open dialog about expectations of killing and having to prioritize scarce resources. CONCLUSIONS: This study shows that medical personnel easily adapt to a military setting. They care but also perform other tasks when they are in a combat zone. The medical personnel want to give care to host nation but use drugs they can spare.

  • 31.
    Lundberg, Kristina
    et al.
    University of Borås, School of Health Science.
    Kjellström, Sofia
    Jonsson, Anders
    University of Borås, School of Health Science.
    Sandman, Lars
    University of Borås, School of Health Science.
    Experiences of Swedish Military Medical Personnel in Combat Zones: Adapting to Competing Loyalties2014In: Military medicine, ISSN 0026-4075, E-ISSN 1930-613X, Vol. 179, no 8, p. 821-826Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The aim of this qualitative study is to explore the Swedish military personnel's experience of what it means to perform a caring role in a combat zone. This study assesses the challenges faced by military medical personnel in the context of a combat zone. METHODS: The design was descriptive with a qualitative inductive approach. Twenty military medical personnel (physicians, nurses, and combat lifesavers) were interviewed individually. They had been involved in international military operations between 2009 and 2012. This study was analyzed using qualitative content analysis. RESULTS: The analysis produced four categories: being in a primarily noncaring organization, caring in emotionally charged relationships, lacking an open dialog about expectations of killing and having to prioritize scarce resources. CONCLUSIONS: This study shows that medical personnel easily adapt to a military setting. They care but also perform other tasks when they are in a combat zone. The medical personnel want to give care to host nation but use drugs they can spare.

  • 32.
    Magnusson, Lennart
    et al.
    University of Borås, School of Health Science.
    Sandman, Lars
    University of Borås, School of Health Science.
    Rosén, Karl G
    University of Borås, School of Engineering.
    Nyttoeffekter med mobila trygghetslarm för personer med demenssjukdom och deras anhöriga2013Report (Other academic)
    Abstract [sv]

    För kommunerna utgör kostnaderna för personer med demenssjukdom mer än 40 procent av deras totala kostnader för vård och omsorg och vi vet att samhällets insats förväntas öka framgent. Risken är att resurserna inte kommer att räcka till för att bevara en optimal livskvalité. Ett sätt att möta detta är att utnyttja olika tekniska lösningar. Mobila trygghetslarm är en möjliggörande teknologi med stor potential. Huvudsyftet med studien var att se på vilken grund mobila trygghetslarm kan vara ett verktyg som utvecklar vården och omsorgen för personer med demenssjukdom och underlättar för deras familjer i den dagliga tillvaron. Studien fokuserade på personer med demenssjukdom i eget boende.

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  • 33. Magnusson, Lennart
    et al.
    Sandman, Lars
    University of Borås, School of Health Science.
    Rosén, Karl Gustaf
    University of Borås, School of Engineering.
    Hanson, Elizabeth
    Extended safety and support systems for people with dementia living at home2014In: Journal of Assistive Technologies, ISSN 1754-9450, E-ISSN 2042-8723, Vol. 8, no 4, p. 188-206Article in journal (Refereed)
    Abstract [en]

    Abstract Purpose – The purpose of this paper is to highlight the complexity surrounding the implementation of advanced electronic tracking, communication and emergency response technologies, namely, an extended safety and support (ESS) system for people with dementia (pwd) living at home. Results are presented from a Swedish demonstration study (2011-2012) conducted in 24 municipalities. Design/methodology/approach – It is a descriptive intervention study with a pre-post test design. Questionnaires were administered to pwd, carers and professionals at the outset and eight months later. ESS logging data were analyzed. Findings – ESS usage rates varied widely. A total of 650 alerts were triggered, mainly when the pwd was outdoors. Activities were reduced amongst pwd, most likely due to a progression of their disease. Carers noted that pwd were more independent than previously on those occasions when they engaged in outdoor activities. Staff considered that nearly half of pwd could remain living at home due to the ESS, compared with a third amongst carers. In total, 50 per cent of carers felt it was justified to equip their relative with an ESS without their explicit consent, compared to one in eight staff. Research limitations/implications – A limitation is the amount of missing data and high drop- out rates. Researchers should recruit pwd earlier in their illness trajectory. A mixed-methods approach to data collection is advisable. Practical implications – Carers played a crucial role in the adoption of ESS. Staff training/supervision about assistive devices and services is recommended. Social implications – Overall, use of ESS for pwd living at home was not an ethical problem. Originality/value – The study included key stakeholder groups and a detailed ethical analysis was conducted.

  • 34.
    Magnusson, Lennart
    et al.
    University of Borås, School of Health Science.
    Sandman, Lars
    University of Borås, School of Health Science.
    Rosén, KG
    University of Borås, School of Engineering.
    Hanson, Elisabeth
    Extended safety and support systems for people with dementia living at home.2014In: Journal of Assistive Technologies, ISSN 1754-9450, E-ISSN 2042-8723, Vol. 8, no 4, p. 188-206Article in journal (Refereed)
    Abstract [en]

    Purpose – The purpose of this paper is to highlight the complexity surrounding the implementation of advanced electronic tracking, communication and emergency response technologies, namely, an extended safety and support (ESS) system for people with dementia (pwd) living at home. Results are presented from a Swedish demonstration study (2011-2012) conducted in 24 municipalities. Design/methodology/approach – It is a descriptive intervention study with a pre-post test design. Questionnaires were administered to pwd, carers and professionals at the outset and eight months later. ESS logging data were analyzed. Findings – ESS usage rates varied widely. A total of 650 alerts were triggered, mainly when the pwd was outdoors. Activities were reduced amongst pwd, most likely due to a progression of their disease. Carers noted that pwd were more independent than previously on those occasions when they engaged in outdoor activities. Staff considered that nearly half of pwd could remain living at home due to the ESS, compared with a third amongst carers. In total, 50 per cent of carers felt it was justified to equip their relative with an ESS without their explicit consent, compared to one in eight staff. Research limitations/implications – A limitation is the amount of missing data and high drop- out rates. Researchers should recruit pwd earlier in their illness trajectory. A mixed-methods approach to data collection is advisable. Practical implications – Carers played a crucial role in the adoption of ESS. Staff training/supervision about assistive devices and services is recommended. Social implications – Overall, use of ESS for pwd living at home was not an ethical problem. Originality/value – The study included key stakeholder groups and a detailed ethical analysis was conducted.

  • 35. Munthe, C
    et al.
    Sandman, Lars
    University of Borås, School of Health Science.
    Cutas, D
    Person Centred Care and Shared Decision Making: Implications for Ethics, Public Health and Research2012In: Health Care Analysis, ISSN 1065-3058, E-ISSN 1573-3394, Vol. 20, no 3, p. 231-249Article in journal (Refereed)
    Abstract [en]

    This paper presents a systematic account of ethical issues actualised in different areas, as well as at different levels and stages of health care, by introducing organisational and other procedures that embody a shift towards person centred care and shared decision-making (PCC/SDM). The analysis builds on general ethical theory and earlier work on aspects of PCC/SDM relevant from an ethics perspective. This account leads up to a number of theoretical as well as empirical and practice oriented issues that, in view of broad advancements towards PCC/SDM, need to be considered by health care ethics researchers. Given a PCC/SDM-based reorientation of health care practice, such ethics research is essential from a quality assurance perspective.

  • 36. Munthe, Christian
    et al.
    Nykänen, Pia
    Sandman, Lars
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Prioriteringscentrum, Linköpings universitet.
    Delat beslutsfattande och evidensbaserad praktik inom socialtjänsten: mål, begrepp och etik för utformning och implementering2015Report (Other academic)
  • 37. Nygren, P
    et al.
    Sandman, Lars
    University of Borås, School of Health Science.
    Visst kan åldersdiskussionen smyga sig in2008In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 105, no 51, p. 3755-Article in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    Det är bra att Björn Öjerskog i sin kliniska vardag inte ser några konflikter mellan gällande etikplattform och terapibeslut avseende kronologisk ålder. Vi menar dock att den beskrivna åldersproblematiken är tillräckligt vanlig i rutinsjukvård vid cancer för att motivera den diskussion vi för i artikeln om hur vårdpersonals intuitiva inställning till kronologisk ålder som terapipåverkande faktor kan tolkas och hur man vid en eventuell revision av etikplattformen skulle kunna bygga in ett visst mått av hänsynstagande till kronologisk ålder. Det är nog snarast den diskussionen som Läkartidningen funnit rimlig att referentgranska.

  • 38. Nygren, Peter
    et al.
    Sandman, Lars
    University of Borås, School of Health Science.
    Är du ung så ska du få, men är du gammal så får du gå: Om ålderns betydelse för terapival och prioriteringar vid cancer2008In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 105, no 47, p. 3417-3420Article in journal (Other (popular science, discussion, etc.))
  • 39.
    Sandman, Lars
    University of Borås, School of Health Science.
    A Good Death on the Value of Death and Dying2001Doctoral thesis, monograph (Other academic)
  • 40.
    Sandman, Lars
    University of Borås, School of Health Science.
    A non-paternalistic value theory of occupational therapy: a comment to Dige.2012In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 19, no 1, p. 104-107Article in journal (Refereed)
    Abstract [en]

    In an article by Morten Dige in the Scandinavian Journal of Occupational Therapy, a value theory for occupational therapy is developed where the goals of occupational therapy, i.e. activity and participation, are seen as valuable in themselves. Such a value theory opens up for a paternalistic approach towards the person in need of occupational therapy who risks being excluded from certain types of activities and the theory even risks excluding certain groups of persons. In this comment to Dige, it is argued that adopting a more subjective approach to value, in which activity and participation are instrumental to values such as subjective well-being or the fulfilment of desires, the risk of inherent paternalism and exclusion is minimized. Moreover, activity and participation can still maintain their central role as goals of occupational therapy.

  • 41.
    Sandman, Lars
    University of Borås, School of Health Science.
    Analys av SU / HSN prioriteringsarbete2010Report (Other academic)
    Abstract [sv]

    Analysen av SU / HSNs prioriteringsarbete utgår från den modell för ransoneringar som presenteras i Sandman och Tinghög (kommande). Modellen går i korthet ut på att först karakterisera behovet och effekten av åtgärden med hänsyn till de ramar som ges av människovärdesprincipen. Därefter avgöra om effekten av åtgärden saknar eller har negativ effekt samt om behovet befinner sig inom ramen för acceptabel livskvalitet vilket innebär att man kan ransonera. Därefter bedöma och rangordna efter behovsgrad, bedöma och justera rangordningen efter nyttan av åtgärden, samt slutligen justera rangordningen efter den kostnadseffektivitet som åtgärden uppvisar. Vid bedömningen av behovet och nyttan får inte hänsyn tas till kronologisk ålder, kön, social och ekonomisk ställning, samt huruvida behovet är självförvållat eller ett resultat av tidigare livsstil. Däremot är det tillåtet att väga in framtida livsstil och biologisk ålder, eftersom detta påverkar individens möjligheter att tillgodogöra sig åtgärden ifråga (och därmed den individuella nyttan av åtgärden). Efter rangordning sker ransonering i följande ordning: i första hand litet behov, i andra hand liten effekt, i tredje hand låg kostnadseffektivitet.

  • 42.
    Sandman, Lars
    University of Borås, School of Health Science.
    Att få bestämma själv: autonomi inom äldreomsorgen2005In: VårdalinstitutetArticle in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    I vårt samhälle lägger vi stor vikt vid möjligheten att själva få välja det liv vi ska leva, inom de ramar som lagstiftning, ekonomi och hänsynen till andra människor tillåter. En viktig anledning till att vi värdesätter detta är att vi har olika uppfattningar om vad som är ett gott liv, beroende på sådant som bakgrund, uppfostran, religiös och kulturell uppfattning men kanske framförallt beroende på de egna överväganden vi gör över vad som är värdefullt i livet. När vi är yngre är detta självklart för de flesta, vi har olika musikstil, olika klädstil, lever i olika former av relationer, uppskattar olika former av nöjen, väljer olika former av arbete och har olika inställning i politiska, religiösa och andra livsfrågor. Samtidigt finns det en risk att när vi blir äldre, så blir vi mer och mer betraktade som en stor massa där vi alla har likadana uppfattningar och önskningar om hur livet ska vara. Men det finns egentligen ingen anledning att tro att det bland äldre skulle finnas en mindre variation i sätt att vilja leva sitt liv, utan även då är det väsentligt att ha möjlighet att välja det liv man vill leva.

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  • 43.
    Sandman, Lars
    University of Borås, School of Health Science.
    Att inte längre erbjuda åtgärder inom hälso- och sjukvården: en checklista för att ta hänsyn till etiska aspekter2012Report (Other academic)
  • 44.
    Sandman, Lars
    University of Borås, School of Health Science.
    Att prioritera mellan olika värden: En modell för avvägningar mellan patientintegritet, patientsäkerhet och andra etiska värden inom hälso- och sjukvården2013Report (Other academic)
    Abstract [sv]

    Denna rapport är resultatet av ett uppdrag från Utredningen om rätt information i vård och omsorg. En av de frågor som utredningen haft att ta ställning till handlar om hur avvägningen mellan patientens integritet å ena sidan och patientsäkerhet (samt andra värden som står på spel) å andra sidan ska ske. I rapporten presenteras en strukturerad modell för vilka frågeställningar en sådan avvägning måste ta hänsyn till, för att kunna identifiera behov av förändrad lagstiftning eller praxis. Detta utifrån den existerande patientdatalagstiftningen. Modellen är även tänkt att kunna fungera när avvägningsproblem uppkommer hos vårdgivare, för att ge vägledning för vilket utrymme patientdatalagstiftningen ger för andra centrala etiska värden inom hälso- och sjukvården.

  • 45.
    Sandman, Lars
    University of Borås, School of Health Science.
    Autonomi hemma och på hemmet2007In: Hemmets vårdetik - om vård av äldre i livets slutskede / [ed] Gunilla Silfverberg, Studentlitteratur , 2007, p. 181-199Chapter in book (Other academic)
  • 46.
    Sandman, Lars
    University of Borås, School of Health Science.
    Awareness in Open and Closed Contexts2009In: Encyclopedia of Death and the Human Experience / [ed] Clifton D. Bryant, Dennis L. Peck, SAGE Publications, Inc , 2009, p. 92-94Chapter in book (Other academic)
  • 47.
    Sandman, Lars
    University of Borås, School of Health Science.
    Developing a context-specific ethics framework for HTA2014Conference paper (Refereed)
  • 48. Sandman, Lars
    'Då var det dags att dö...': äldre och den goda döden2005In: VårdalinstitutetArticle in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    Många människor har uppfattningen att när en äldre människa dör så är det inte en lika stor tragedi som när en ung människa dör. Likaså förknippar vi ofta åldrande med död och vi säger sådant som att ’det var ju inte så konstigt att hon dog – hon var ju så gammal’. Utgående från detta kan man ställa sig frågan om hur man ska se på förhållandet mellan åldrande och död, och framförallt hur man ska se på förhållandet mellan en god död och åldrandet. Innan vi tar upp några konkreta aspekter av detta så behöver vi reda ut begreppen kring den goda döden. Med en god död kan vi mena åtminstone fyra olika saker: ett gott döende (dvs. att tiden fram till döden är så bra som möjligt), ett gott dödstillfälle (att själva dödsögonblicket är så bra som möjligt), en god död efter döden (dvs. om det kan hända något efter döden som kan påverka mitt liv) samt om det faktum att jag dör vid en viss tidpunkt är bra eller dåligt. I detta sammanhang ska vi framförallt beröra den första och sista frågan. Och vi börjar med den sista frågan.

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  • 49.
    Sandman, Lars
    University of Borås, School of Health Science.
    Etik inom missbruks- och beroendevård2012In: Handbok i missbrukspsykologi : teori och tillämpning / [ed] Claudia Fahlke, Sven-Eric Alborn, Liber, Stockholm , 2012, p. 492-510Chapter in book (Refereed)
  • 50.
    Sandman, Lars
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Prioriteringscentrum, Linköpings universitet.
    Etisk bedömning vid användning välfärdsteknologi för personer med nedsatt beslutsförmåga.: Delrapport till Myndigheten för delaktighet inom ramen för projekt kring nedsatt beslutsförmåga och välfärdsteknologi.2015Report (Other academic)
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