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  • 1.
    Abrahamsson, Amanda
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sörlin, Anna
    Umeå University, Faculty of Medicine, Department of Nursing.
    Att vara förälder till ett barn med Diabetes typ 1: En kvalitativ litteraturstudie som beskriver föräldraras självupplevda erfarenheter2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    ABSTRACT

    Title: Being a parent of a child with type 1 diabetes

    Background: Type 1 diabetes is a common chronic childhood disease. The prevalence is increasing in several countries worldwide. Type 1 diabetes require a lifelong treatment. There is a risk of complications unless the blood sugar is maintained at normal levels.

    Aim: To describe parents self-perceived experiences of living with children with type 1 diabetes.

    Method: A literature study was conducted. The article search was done in PubMed and CINAHL databases. The results of ten qualitative studies were reviewed, analyzed and compiled. 

    Result: The result is presented in four main categories: Entering a new parent role, relate to a new everyday situation, the need for support and take and give responsibility.

    Conclusion: Parents are constantly exposed to challenges and adaptations in their daily lives. Transferring responsibility of the child was hard for the parents because of distrust and concern. Through the nurses encouragement and support about parents self-care ability, parent could be helped to feel safe about their children's daily care.

     

     

     

  • 2.
    Abrahamsson, Linnéa
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Ljungdahl Ristare, Martin
    Umeå University, Faculty of Medicine, Department of Nursing.
    Att vara man i ett kvinnodominerat yrke: Manliga vårdares upplevelser av att bemöta kvinnor i situationer som kan upplevas intima och de hanteringsstrategier som används2018Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Throughout history, the healthcare has been dominated primarily by female caregivers. There are areas for men in nursing which can be considered as taboo. These areas can often be related to intimate care of the opposite sex. Men do primarily work in technical positions in healthcare, for example as a radiographer. At present there is a knowledge gap regarding male radiographers’ intimate care of the opposite sex.

    Aim: Illuminate male caregivers' experiences of dealing with women in situations that can be experienced intimate in Western culture, and management strategies used.

    Method: Nine quality controlled qualitative studies were used in the result. These studies have been analysed by means of qualitative content analysis. The outcome resulted in two domains divided into three categories each, illuminating the experiences and handling strategies for how male caregivers perform and experiences giving intimate care to female patients.

    Results: Male caregivers’ express concern about sexual charges. They also experience prejudice and feel placed in stereotypical compartments that may affect their work with intimate care. To protect themselves they use methods such as communication, breaking the ice or taking help of female colleagues. Several male caregivers describe shortcomings in their education to learn how to handle intimate care.

    Conclusion: Further research is needed in the field of gender in healthcare and radiography linked to the male caregivers’ perspective of providing care. 

  • 3.
    Abrahamsson, Marléne
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Viklund, Mikael
    Personers upplevelse av att leva med diabetesfotsår: En litteraturstudie2016Independent thesis Basic level (university diploma), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Peoples experience of living with diabetic foot ulcers

    Abstract

    Background: Foot ulcers related to diabetes is a global problem. These ulcers can be difficult to heal and very painful for the affected person. Risk for infections and amputations are high. Diabetic foot ulcers can change the affected person’s life world.

    Aim: The purpose of the literature study was to illustrate people's experiences of living with diabetic foot ulcers.

    Method: A literature study based on twelve articles with qualitative approach. The results from respective article has been reviewed, analyzed and compiled. The databases that were used was CINAHL, PubMed, MEDLINE och PsycINFO.

    Result: The analyze resulted in two categories and a total of five subcategories. The categories were: Lost autonomy and Emotional suffering.

    Conclusion: The experience of living with diabetic foot ulcers varies between individuals, but common to many is that they suffer in different ways and that the quality of life deteriorate. The nurse can be a cause of the suffering, but also a hopeful mainstay. To provide person-centered care and see the whole individual is a prerequisite for good nursing care.

    Keywords: Diabetic foot ulcers, experience, suffering.

  • 4.
    Abrahamsson, Mirjam
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Furufalk, Helena
    Umeå University, Faculty of Medicine, Department of Nursing.
    Jämställdhet är...en alldeles för stor fråga: Barnmorskors uppfattningar om unga mäns ansvarstagande, delaktighet och möjlighet till råd och stöd, vid oönskade eller oplanerade graviditeter.2016Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Abstract

    Objective: The aim of this study was to investigate midwives perceptions about young men’s responsibility and participation in case of unwanted and unplanned pregnancies and their ideas of support aimed at men, from an equality standpoint.

    Design: Semi-structured interviews with seven midwives in the north of Sweden. The interviews were analyzed with a qualitative content-analysis and from a Critical theory-perspective. It resulted in eleven sub-categories, four categories and one theme.

    Result: Four categories as follows, The excluded young men, shows midwives attitudes regarding that young women, the society and sexual and reproductive healthcare tends to exclude young men when it comes to men´s issues. It is a woman’s world: The midwives saw that their primary work was all about the women, where pregnancy and contraceptives overall was a woman´s matter, in which only women made the decisions. Young men acts according to the masculinity norms of the society: The young men were perceived as rarely looking for support and help with their reproductive and sexual health and were often perceived as having an immature approach to sex. Long way until the sexual and reproductive health is equal: Sex education for young men took place in large groups and was - according to the midwives, often focusing on the wrong things. Sex education needs to start early on and preferably with the support of parents. The midwives had the knowledge requested by young men, but were not routinely sharing it. The theme: Equal responsibility for reproduction no reality in practice includes all categories.

    Conclusion: Young men are considered important in theory but not in practice. The young men are perceived as absent from unplanned pregnancies. With their great knowledge within sexual and reproductive healthcare, midwives are considered ideal working with this group.

  • 5.
    Adolfsson, Katarina
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Berggren Nylund, Inga
    Umeå University, Faculty of Medicine, Department of Nursing.
    Upplevelser av primärvården hos vuxna med Neurofibromatos typ 12015Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Aim: To describe how adults with Neurofibromatosis type 1 experience their encounter with primary care

    Background: Neurofibromatosis type 1 (NF1) is an autosomal dominant condition including café au lait spots on the skin and multiple benign tumours that grow from peripheral nerves. The severity of the condition varies. Pains and the unpredictability of the disease may cause concern and result in repeated visits to health centres. Nursing patients with NF1 can be a challenge. 

    The presence of multiple symptoms can cause difficulties in creating a holistic approach towards the patient. Despite the fact that one of 3000 has the condition it is relatively unknown. Few studies describe how people with NF1 experience primary care.  

    Design: A quantitative cross sectional study

    Method:  In 2015, 30 participants took part in a survey with multiple choice questions and space for comments about their experiences of primary care. 

    Results: Half of the participants perceived primary care generally as good or very good. However, 93 % perceived health professionals’ knowledge about NF1 as poor or very poor.  

    Conclusion: Many professions in primary care had insufficient knowledge and understanding of NF1. This study indicates the need of improved care and a deeper insight into patients’ problems. The authors suggest establishing more centres for rare diseases. Also care planning programmes for NF1 may result in improved care at health centres. More nursing research is needed on providing information about rare diseases.     

  • 6.
    af Bjerkén, Agneta
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Åslund, Mia
    Umeå University, Faculty of Medicine, Department of Nursing.
    Anestesisjuksköterskors erfarenheter av vård av patienter med missbruksproblem: En intervjustudie2017Independent thesis Advanced level (degree of Master (One Year)), 40 credits / 60 HE creditsStudent thesis
    Abstract [en]

    Purpose The aim of this study was to describe anaesthetic nurses' strategies for the nursing of patients with misuse dependency within anaesthetic care.Background Anaesthetic nurses daily meet patients with different backgrounds, conditions and needs. There are often different physiological and psychological factors that affect the anaesthesia and the anaesthetic care for persons with misuse problems than for persons without similar problems. These factors could be for example increased tolerance for drugs, impaired ability to digest drugs, increased bleeding tendency, stress and anxiety. The anaesthetic nurses' knowledge and understanding for earlier mentioned factors are of utmost importance for them to be able to perform a good and optimum anaesthetic care.Design The study was made with qualitative research design with semi-structured interviews.Methods The participants were chosen on a representative basis. The data collection consisted of semi-structured interviews with anaesthetic nurses in five hospitals in Sweden. The interviews were written down and analyzed using a qualitative content method.Results Twelve interviews were made during the autumn 2016. The analysis of the material resulted in three categories titled ”Having preparedness for action”, ”Communicating with the patient” and ”Being security conscious”. The categories consisted of eight subcategories that were titled ”Being prepared to adjust the doses”, ”Choosing the adequate medicine”, ”Managing bleeding tendency”, ”Handling difficulties with giving injections”, ”Establishing trust”, ”Being explicit”, ”Ensuring safety for the staff” and ”Ensuring safety for the patient”.Conclusion Anaesthetic nurses are aware of the physiological and psychological factors that affect the anaesthesia of patients with misuse dependency. They have conceived strategies for planning the anaesthesia and for preventing the emerging of problems. The predominant strategies contain drug related measures such as dose adjustment and selection of drugs. There are different opinions whether a PM or a general routine would increase the safety and improve the handling of patients with misuse dependency.Keywords: Anaesthetic nurse; Misuse; Strategies; Experiences

  • 7.
    Ahl, Caroline
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Nyström, Maria
    To handle the unexpected: the meaning of caring in pre-hospital emergency care2012In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 20, no 1, p. 33-41Article, review/survey (Refereed)
    Abstract [en]

    The patient's voice has not been present to the same degree as the professional perspective in caring research in a pre-hospital context. In order to further develop and improve pre-hospital care, it is therefore important to explore patients' situations not only in life threatening but also in non-traumatic situations. This is especially important as these patients might be defined as inappropriate attendees of ambulance services. The aim of this study was to interpret and explain experiences of caring in pre-hospital care situations that are not defined as traumatic or life threatening. Twenty informants aged between 34 and 82 years were interviewed. The design of the study was exploratory, and it used an interpretative approach in order to understand the meaning of pre-hospital caring. The findings show that pre-hospital caring can be understood and explained as a matter of interplay between carer(s) and patient with potentials for positive as well as negative outcomes. Our conclusion is that the initial meeting is of vital importance in how patients experience pre-hospital care. It is suggested that general public information on the development of Swedish pre-hospital care received in turn may facilitate the first encounter between patient and carer(s). 

  • 8.
    Ahl, Caroline
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. School of Health Sciences, University Collage of Borås, SE-501, 90 Borås, Sweden.
    Nyström, Maria
    Jansson, Lilian
    Umeå University, Faculty of Medicine, Department of Nursing.
    Making up one's mind: patients' experiences of calling an ambulance2006In: Accident and Emergency Nursing, ISSN 0965-2302, E-ISSN 1532-9267, Vol. 14, no 1, p. 11-19Article in journal (Refereed)
    Abstract [en]

    The issue of the inappropriate use of ambulance transport and care has mainly been studied from the professionals' and caregivers' perspective, with few studies focusing on the patient and his/her experiences. To further understand whether patients use ambulance care in an inappropriate manner and, if so, why, it is important to obtain an overall picture of the patients' existential situation at the time they call an ambulance. The aim of this study was to analyse and describe patients' experiences related to the decision to call an ambulance and the wait for it to arrive. The design was explorative, and twenty informants aged between 34 and 82 years were interviewed. Qualitative content analyses were performed. The findings showed that calling for an ambulance is a major decision that is preceded by hesitation and attempts to handle the situation by oneself. Our conclusion is that the definition of inappropriate use of valuable health care resources should not be based solely on the professionals' point of view but also take account of the patients' reactions when they experience a threat to their life and health.

  • 9.
    Ahlberg, Camilla
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Johansson, Viola
    Umeå University, Faculty of Medicine, Department of Nursing.
    Vårdpersonalens kunskap om trycksårsprofylax: – En litteraturstudie2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    ABSTRAKT

    Bakgrund: Att förebygga sjukdom och lindra lidande är två av sjuksköterskans huvuduppgifter. Trycksår räknas som vårdskada och är ett universellt problem med relativt konstant frekvens som innebär mycket smärta och lidande för patienten. Trycksår kan förebyggas i de flesta fall vilket är en del av vårdpersonalens ansvar.

    Syfte: Denna litteraturstudie avser att beskriva vårdpersonalens kunskap om trycksårsprofylax.

    Metod: 11 kvantitativa forskningsartiklar om vårdpersonals kunskap beträffande trycksårsprofylax har granskats och sammanställts för att få en klarare syn på kunskapen.

    Resultat: Även om vårdpersonalens kunskap om trycksårsprofylax överlag är relativt god så har man ändå kunnat identifiera stora kunskapsluckor.

    Konklusion: Dessa kunskapsluckor kan vara en av orsakerna till att undvikbara trycksår fortfarande uppstår.    

    Nyckelord: Sjuksköterska, trycksår, prevention, profylax, kunskap 

  • 10.
    Ahlberg, Jane
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Dannvik, Rebecka
    Umeå University, Faculty of Medicine, Department of Nursing.
    Omvårdnadsåtgärder: En litteraturstudie om omvårdnadsåtgärder vid Anorexia nervosa.2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Anorexia nervosa är en ätstörning som debuterar i allt yngre ålder och kan yttra sig på olika sätt beroende på individen. Detta leder till att det inte finns ett enkelt svar på hur sjukdomen ska behandlas. Det ställer krav på både kunskap och erfarenhet hos sjuksköterskorna för att förstå komplexiteten av anorexia nervosa, vilket är nödvändigt för att uppnå ett lyckat behandlingsresultat.

     

    Syfte: Syftet är att beskriva sjuksköterskans omvårdnadsåtgärder vid behandling av anorexia nervosa hos unga kvinnor.

     

    Metod: En litteraturstudie grundad på åtta kvalitativa artiklar. Artiklarnas resultat har granskats, analyserats och sammanställts för att besvara syftet. Databassökningen har genomförts i Cinahl, Pubmed samt PsykInfo.

     

    Resultat: Sammanfattningen av artiklarnas resultat bildade tre kategorier som beskriver de omvårdnadsåtgärder sjuksköterskorna använder: 1) Bygga och upprätthålla en god relation till patienten, 2) Säkerställa viktökning och 3) Återställa ett normalt ätbeteende.  

     

    Slutsats: Litteraturstudien beskriver hur behandlingen påverkas av hur sjuksköterskorna genomför omvårdnaden. Att skapa en god relation till patienten är en avgörande komponent för att lyckas med viktökning och en beteendeförändring hos patienten.   

     

    Nyckelord: Anorexia nervosa, behandling, kvinnor, omvårdnad, ungdomar

  • 11.
    Ahlström, Hanna
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sjöstedt, Pamela
    Umeå University, Faculty of Medicine, Department of Nursing.
    Den äldre människans bästa vän: En litteraturstudie om vårdhundens positiva effekter på personer med demenssjukdom2014Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Många personer med demenssjukdom bor på särskilda boenden. Vårdmiljön på de särskilda boendena består både av fysiska och psykosociala faktorer, vilka påverkar hälsan. Demenssjukdom är ett kroniskt tillstånd som kan orsaka flera olika symtom. Beteendemässiga och psykiska symtom vid demenssjukdom (BPSD) är vanligt förekommande och har en negativ påverkan på livskvalitén hos personer med demenssjukdom samt personer i deras närhet. BPSD behandlas oftast med läkemedel, men det finns flera kompletterande icke- farmakologiska behandlingsmetoder och djurassisterad intervention är en av dem. Inom vården har djur visat sig ha flera positiva effekter på hälsan. Hundar är det djur som används mest och finns inom exempelvis hospice, rehabilitering och demensvård.  Syfte: Syftet var att belysa positiva effekter av att använda vårdhundar inom demensvård på särskilt boende. Metod: En litteraturstudie där resultatet baserats på nio kvantitativa studier. Först genomfördes systematiska sökningar i olika databaser med utvalda sökord. Därefter granskades, analyserades och sammanställdes de valda studierna. Resultat: Sammanställningen resulterade i fyra huvudkategorier; påverkan på BPSD, påverkan på kognition, påverkan på livskvalité samt påverkan på läkemedelsanvändning. Djurassisterad intervention kan minska BPSD, förbättra orienteringsförmågan, ökad social interaktion och förbättra livskvalitén hos personer med demenssjukdom. Inom läkemedelsanvändningen sågs inga skillnader. Konklusion: Litteraturstudiens slutsats är att vårdhundar kan ha flera positiva effekter på personer med demenssjukdom. Det krävs mer forskning om interventionens utformning och om dess potentiella förmåga att komplettera eller ersätta läkemedelsanvändning.   

  • 12.
    Albinsson, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Nordlander, Anna-Lena
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sjuksköterskors upplevelser och erfarenheter av samtal med äldre personer som vårdas i livets slutskede2017Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background. Ensuring good care in the end of life is a multifaceted task. Focus often tends to be of pharmacological orientation and mostly on relieving physical symptoms such as pain.For a person-centered care based on a holistic view, the nurse's communication with the patient is also important.The aim of this study was to describe the nurses' experiences of communicating with elderly people cared for in the end of life.Design. This study has a qualitative descriptive design and is based on interviews.Method. A total of ten nurses participated in semistructured interviews at the beginning of the year of 2017. The material was analyzed with qualitative content analysis.Findings. Eight categories emerged during analysis. The result shows that late insight and denial approach to end of life are perceived as obstructing circumstances for communication. A number of other impeding considerations such as lack of time, language barriers, lack of knowledge and experience, as well as relatives' presence are also described in this study. The nurse's closeness in a neutral relationship, the patient's ability of acceptance and the nurse's balance between professionalism and trustworthy commitment, appear on the other hand as supportive conditions for communication. A united palliative focus around the patient creates better opportunities for communication and support to adaption and acceptance in the final stage of life.Conclusions. The result shows that trustful communication is found meaningful both for the patient and for the nurse. The nurse finds that the connection to the patient through the communication is an important and necessary basis when creating a person-centered care. The communication consequently need to be highlighted as a self-evident and prioritized part in the care of the elderly person at the end of life.

  • 13.
    Alex, Lena
    Umeå University, Faculty of Medicine, Department of Nursing.
    Feministiska perspektiv på omvårdnad - finns det?1998In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 75, no 1-2, p. 57-61Article in journal (Other (popular science, discussion, etc.))
  • 14.
    Alex, Lena
    Umeå University, Faculty of Medicine, Department of Nursing.
    Resilience among old Sami women2016In: Ageing & Society, ISSN 0144-686X, E-ISSN 1469-1779, Vol. 36, p. 1738-1756Article in journal (Refereed)
    Abstract [en]

    There is lack of research on old indigenous women’s experiences. The aim of thisstudy was to explore how old women narrate their experiences of wellbeing andlack of wellbeing using the salutogenetic concept of resilience. Interviews fromnine old Sami women were analysed according to grounded theory with the followingthemes identified: contributing to resilience and wellbeing built up from the categoriesfeeling connected, feeling independent and creating meaning; andcontributing to lack of lack of resilience and wellbeing built up from the categoryexperiencing lack of connectedness. The old Sami women’s narratives showedthat they were to a high extent resilient and experienced wellbeing. They felt bothconnected and independent and they were able to create meaning of being anold Sami woman. Having access to economic and cultural capital were for the oldSami women valuable for experiencing resilience. Lack of resilience was expressedas experiences of discrimination, lack of connectedness and living on the borderof the dominant society. Analysis of the Sami women’s narratives can give wider perspectiveson women’s health and deepen the perspectives on human resilience andincrease the understanding of minority groups in a multicultural world.

  • 15.
    Alex, Lena
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lehti, Arja
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Professionell Development.
    Experiences of Well-Being Among Sami and Roma Women in a Swedish Context2013In: Health Care for Women International, ISSN 0739-9332, E-ISSN 1096-4665, Vol. 34, no 8, p. 707-726Article in journal (Refereed)
    Abstract [en]

    Our aim was to explore the experiences of well-being and lack of well-being among middle-aged and older women belonging to two national minority groups in Sweden. Interviews from nine older Sami women and four middle-aged Roma women were analyzed using grounded theory with the following categories identified: contributing to well-being (with the subcategories belonging to a healthy family, being spiritual, cultural norms as health promoting, and having had a life of one's own); and contributing to lack of well-being (with the subcategories living subordinate to the dominant society, living in a hierarchical family, and living in the shadow of tuberculosis.)

  • 16.
    Alex, Lena
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Wikberg, A
    Feministisk kritik av kurslitteratur inom ämnet professionell omvårdnad1994In: Omvårdaren, ISSN 0280-4123, no 2, p. 24-27Article in journal (Other (popular science, discussion, etc.))
  • 17.
    Algotsson, Elin
    Umeå University, Faculty of Medicine, Department of Nursing.
    Undersökningar med magnetkamera av fullgångna och prematura barn: En litteraturstudie om risker och patientsäkerhet2015Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: MRI is a relatively safe diagnostic method with non-ionizing radiation used, as is not the case in conventional radiography. Despite this there are still risks to take into account, some common to all patients. For neonates, premature and full-term, these risks differ, and thereby also affect the neonatal staff and the radiographer's ability to meet the child's special need of patient safety. Purpose: This study aims to describe specific risk factors that affect patient safety during examination with MRI, regarding the full term and preterm neonatal child. Method: scientific articles were searched in PubMed, Cinahl and Medline, eight quantitative articles were selected for quality review. Results: After analysis of these eight articles, four categories were recognized and distinguished; image quality, hypothermia, low oxygen saturation, and anesthetics. The results also showed that the use of an MR-compatible incubator further impacted patient safety positively. Conclusion: Image quality, hypothermia, low oxygen saturation and anesthetics are specific risk factors that need to take into account when considering the patient safety in preterm and full-term neonates.

    Keywords: magnetic resonance imaging, infant premature, patient safety

  • 18. Alvariza, Anette
    et al.
    Årestedt, Kristofer
    Boman, Kurt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Umeå University, Arctic Research Centre at Umeå University.
    Brännström, Margareta
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Arctic Research Centre at Umeå University.
    Family members' experiences of integrated palliative advanced home and heart failure care: a qualitative study of the PREFER intervention2018In: Palliative & Supportive Care, ISSN 1478-9515, E-ISSN 1478-9523, Vol. 16, no 3, p. 278-285Article in journal (Refereed)
    Abstract [en]

    Objective: Chronic heart failure is a disease with high morbidity and symptom burden for patients, and it also places great demands on family members. Patients with heart failure should have access to palliative care for the purpose of improving quality of life for both patients and their families. In the PREFER randomized controlled intervention, patients with New York Heart Association classes III–IV heart failure received person-centered care with a multidisciplinary approach involving collaboration between specialists in palliative and heart failure care. The aim of the present study was to describe family members' experiences of the intervention, which integrated palliative advanced home and heart failure care.

    Method: This study had a qualitative descriptive design based on family member interviews. Altogether, 14 family members participated in semistructured interviews for evaluation after intervention completion. The data were analyzed by means of content analysis.

    Results: Family members expressed gratitude and happiness after witnessing the patient feeling better due to symptom relief and empowerment. They also felt relieved and less worried, as they were reassured that the patient was being cared for properly and that their own responsibility for care was shared with healthcare professionals. However, some family members also felt as though they were living in the shadow of severe illness, without receiving any support for themselves.

    Significance of results: Several benefits were found for family members from the PREFER intervention, and our results indicate the significance of integrated palliative advanced home and heart failure care. However, in order to improve this intervention, psychosocial professionals should be included on the intervention team and should contribute by paying closer attention and providing targeted support for family members.

  • 19. Alverbratt, Catrin
    et al.
    Berlin, Johan
    Åström, Sture
    Umeå University, Faculty of Medicine, Department of Nursing. Department of Nursing, Health and Culture, University West, Trollhättan.
    Kauffeldt, Anders
    Carlström, Eric
    A New Working Method in Psychiatric Care: The Impact of Implementation2017In: International Journal of Public Administration, ISSN 0190-0692, E-ISSN 1532-4265, Vol. 40, no 3, p. 295-304Article in journal (Refereed)
    Abstract [en]

    An equal mix of organizational cultures is important for a successful implementation process. The aim of this study was to examine the implementation of a new working method in psychiatric hospital wards, representing different cultural characteristics. Descriptive quantitative data were collected at two hospitals (intervention and control). The results revealed one ward characterized by a mix of organizational cultures. This ward, compared with other intervention wards, showed the best results regarding patient assessed empowerment and participation. The result shows tentatively that organizational culture may have an impact on the implementation processes.

  • 20.
    Aléx, Jonas
    Umeå University, Faculty of Medicine, Department of Nursing.
    Cold exposure and thermal comfort among patients in prehospital emergency care: innovation research in nursing2015Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background

    Patients’ cold exposure is a neglected problem in prehospital emergency care. Cold stress increases pain and anxiety and contributes to fear and an overall sense of dissatisfaction. When left untreated, cold stress disturbs vital body functions until ultimately reaches hypothermia.

    Aim

    The overall aim was to investigate patients’ experiences of thermal comfort and reactions to cold exposure in prehospital emergency care and to evaluate the effects of an intervention using active warming from underneath.

    Method

    Study I:

    Persons (n=20) injured in a cold environment in the north of Sweden were interviewed. Active heat was given to 13 of them.

    Study II:

    In wintertime, 62 patients were observed during prehospital emergency care. The field study was based on observations, questions about thermal discomfort, vital signs, and temperature measurements.

    Study III:

    Healthy young persons (n=23) participated in two trials each. Data were collected inside and outside a cold chamber. In one trial, the participants were lying on a regular ambulance stretcher and in a second trial on a stretcher supplied with a heated mattress. Outcomes were the Cold Discomfort Scale (CDS), back, finger, and core body temperature, four statements from the State-TraitAnxiety-Inventory (STAI), vital signs, and short notes about their experiences of the two stretchers.

    Study IV:

    A quantitative intervention study was conducted in prehospital emergency care in the north of Sweden. The patients (n=30) in the intervention group were transported in an ambulance supplemented with a heated mattress on the stretcher, whereas only a regular stretcher was used in the ambulance for the patients (n=30) in the control group. Outcomes were the CDS, finger, core body, and air temperature, and questions about cold experiences.

    Results

    Study I:

    Patients suffered more because of the cold than from the pain of their injuries. The patients were in a desperate need of heat.

    Study II:

    Patients are exposed to cold stress due to cold environments. There was a significant decrease from the first measurement in finger temperature of patients who were indoors when the ambulance arrived, compared to the measurement taken in the ambulance. In the patient compartment of the ambulance, 85% of the patients had a finger temperature below the comfort zone and almost half of them experienced the patient compartment in the ambulance to be cold. The regular mattress surface temperature at the ambulance ranged from -22.3 to 8.4 ºC.

    Study III:

    A statistical increase of the participants’ back temperature was found between those lying on the heated mattress compared to those lying on the regular mattress. The heated mattress was experienced as warm, comfortable, providing security, and easy to relax on.

    Study IV:

    Thermal comfort increased for the patients in the intervention group and decreased in the control group. A significant higher proportion of the participants rated the stretcher as cold to lie on in the control group compared to the intervention group.

    Conclusion

    The ambulance milieu is too cold to provide thermal comfort. Heat supply from underneath increased comfort and might prevent cold stress and hypothermia

  • 21.
    Aléx, Jonas
    Umeå University, Faculty of Medicine, Department of Nursing.
    Effect evaluation of a heated ambulance mattress-prototype on thermal comfort and patients’ temperatures in prehospital emergency care -an intervention studyManuscript (preprint) (Other academic)
    Abstract [en]

    Background: The ambulance milieu does not offer good thermal comfort to patients during the cold Swedish winters. Patients’ exposure to cold temperatures combined with a cold ambulance mattress seems to be a major factor leading to an overall sensation of discomfort. As far as we have seen, there is still little research on the effect of active heat delivered from underneath in ambulance care. Therefore, the aim of this study was to evaluate the effect of an electrically heated ambulance mattress-prototype on thermal comfort and patients’ temperatures in the prehospital emergency care.

    Methods:

    A quantitative intervention study conducted in ambulance care in the north of Sweden. The ambulance used for the intervention group (n=30) was equipped with a heated mattress on the stretcher compared to the control group (n=30) where no active heat was provided on the stretcher. Outcome variables were measured as thermal comfort on the Cold Discomfort Scale (CDS), finger, ear, and air temperatures along with subjective comments on cold experiences.

    Results:

    Thermal comfort, measured by CDS, was improved during the ambulance transport to the Emergency Department (ED) in the intervention group (p= 0.001) but decreased in the control group (p=<0.014). A significant higher proportion (57%) of the control group rated the stretcher as cold to lie down on compared to three percent in the intervention group (p<0.001). Concerning finger, ear, and compartment air temperature no significant difference between groups was found. Mean transport time was approximately 15 minutes.

    Conclusion:

    The use of active heat, from underneath, increases the patients’ thermal comfort and may prevent the negative consequences of cold stress.

  • 22.
    Aléx, Jonas
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    GYLLENCREUTZ, LINA
    Umeå University, Faculty of Medicine, Department of Nursing.
    Brister i systematiskt omhändertagande på olycksplatser: En studie av traumasimuleringar inom ambulanssjukvården.2018In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 115, article id EWFHArticle in journal (Refereed)
    Abstract [en]

    Trauma care at an accident site is of great importance for patient survival. The purpose of the study was to observe the compliance of ambulance nurses with the Prehospital Trauma Life Support (PHTLS) concept of trauma care in a simulation situation. The material consisted of video recordings in trauma simulation and an observation protocol was designed to analyze the video material. The result showed weaknesses in systematic exam and an ineffective use of time at the scene of injury. Development of observation protocols in trauma simulation can ensure the quality of ambulance nurses' compliance with established concepts. Our pilot study shows that insufficiencies in systematic care lead to an ineffective treatment for trauma patients which in turn may increase the risk of complications and mortality.

  • 23.
    Aléx, Jonas
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Arctic Research Centre at Umeå University.
    Karlsson, Stig
    Umeå University, Faculty of Medicine, Department of Nursing.
    Björnstig, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Arctic Research Centre at Umeå University. Center for Disaster Medicine, Umeå University, Umeå, Sweden.
    Effect evaluation of a heated ambulance mattress-prototype on thermal comfort and patients' temperatures in prehospital emergency care - an intervention study2015In: International Journal of Circumpolar Health, ISSN 2242-3982, E-ISSN 2242-3982, Vol. 74, article id 28878Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The ambulance milieu does not offer good thermal comfort to patients during the cold Swedish winters. Patients' exposure to cold temperatures combined with a cold ambulance mattress seems to be the major factor leading to an overall sensation of discomfort. There is little research on the effect of active heat delivered from underneath in ambulance care. Therefore, the aim of this study was to evaluate the effect of an electrically heated ambulance mattress-prototype on thermal comfort and patients' temperatures in the prehospital emergency care.

    METHODS: A quantitative intervention study on ambulance care was conducted in the north of Sweden. The ambulance used for the intervention group (n=30) was equipped with an electrically heated mattress on the regular ambulance stretcher whereas for the control group (n=30) no active heat was provided on the stretcher. Outcome variables were measured as thermal comfort on the Cold Discomfort Scale (CDS), subjective comments on cold experiences, and finger, ear and air temperatures.

    RESULTS: Thermal comfort, measured by CDS, improved during the ambulance transport to the emergency department in the intervention group (p=0.001) but decreased in the control group (p=0.014). A significant higher proportion (57%) of the control group rated the stretcher as cold to lie down compared to the intervention group (3%, p<0.001). At arrival, finger, ear and compartment air temperature showed no statistical significant difference between groups. Mean transport time was approximately 15 minutes.

    CONCLUSIONS: The use of active heat from underneath increases the patients' thermal comfort and may prevent the negative consequences of cold stress.

  • 24.
    Aléx, Jonas
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Karlsson, Stig
    Umeå University, Faculty of Medicine, Department of Nursing.
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Nursing.
    Patients' experiences of cold exposure during ambulance care2013In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 21, article id 44Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Exposure to cold temperatures is often a neglected problem in prehospital care. Cold exposure increase thermal discomfort and, if untreated causes disturbances of vital body functions until ultimately reaching hypothermia. It may also impair cognitive function, increase pain and contribute to fear and an overall sense of dissatisfaction. The aim of this study was to investigate injured and ill patients' experiences of cold exposure and to identify related factors.

    METHOD: During January to March 2011, 62 consecutively selected patients were observed when they were cared for by ambulance nursing staff in prehospital care in the north of Sweden. The field study was based on observations, questions about thermal discomfort and temperature measurements (mattress air and patients' finger temperature). Based on the observation protocol the participants were divided into two groups, one group that stated it was cold in the patient compartment in the ambulance and another group that did not. Continuous variables were analyzed with independent sample t-test, paired sample t-test and dichotomous variables with cross tabulation.

    RESULTS: In the ambulance 85% of the patients had a finger temperature below comfort zone and 44% experienced the ambient temperature in the patient compartment in the ambulance to be cold. There was a significant decrease in finger temperature from the first measurement indoor compared to measurement in the ambulance. The mattress temperature at the ambulance ranged from -22.3°C to 8.4°C.

    CONCLUSION: Cold exposure in winter time is common in prehospital care. Sick and injured patients immediately react to cold exposure with decreasing finger temperature and experience of discomfort from cold. Keeping the patient in the comfort zone is of great importance. Further studies are needed to increase knowledge which can be a base for implications in prehospital care for patients who probably already suffer for other reasons.

  • 25.
    Aléx, Jonas
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lundgren, Peter
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Henriksson, Otto
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Nursing.
    Being cold when injured in a cold environment: patients' experiences2013In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 21, no 1, p. 42-49Article in journal (Refereed)
    Abstract [en]

    Background: Patients in prehospital care, irrespective of diseases or trauma might experience thermal discomfort because of a cold environment and are at risk for decreasing body temperature which can increase both morbidity and mortality.

    Objective: To explore patients' experiences of being cold when injured in a cold environment.

    Method: Twenty persons who had been injured in a cold environment in northern Sweden were interviewed. Active heat supply was given to 13 of them and seven had passive heat supply. The participants were asked to narrate their individual experience of cold and the pre- and post-injury event, until arrival at the emergency department. The interviews were transcribed verbatim, then analyzed with qualitative content analysis.

    Results: Patients described that they suffered more from the cold than because of the pain from the injury. Patients who received active heat supply experienced it in a positive way. Two categories were formulated: Enduring suffering and Relief of suffering.

    Conclusion: Thermal discomfort became the largest problem independent of the severity of the injuries. We recommend the use of active heat supply to reduce the negative experiences of thermal discomfort when a person is injured in a cold environment.

  • 26.
    Aléx, Jonas
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lundin, Helena
    Joansson, Charlotta
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Nursing.
    Preparedness of Swedish EMS Personnel for Major Incidents in Underground Mines2018In: Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to survey the EMS (emergency medical services) personnel preparedness for major incidents in the underground mining industry in Sweden. Every year, a high number of incidents, workplace accidents and fires are reported from the Swedish mining industry. Taking care of patients located in an underground mine represents a challenge to EMS personnel. Today, knowledge about EMS personnel preparedness for major incidents in the mining industry is limited. The study design was a cross-sectional survey. The questionnaires were distributed to EMS personnel working in ambulance stations geographically located near an underground mine. Thirteen ambulance stations were included and 137 of 258 personnel answered. Demographic data were analyzed using descriptive statistics. Differences among groups were analyzed with the Chi-Squared test, continuity correction and t-test. Results showed about half of the participants reported that they do not feel prepared to work in a major incident in an underground mine. The majority wished to receive educational training to enhance their preparedness. The most commonly requested type of education was practical drills on the scene, in an underground mine. The reported preparedness was significantly higher among the participants who had received some kind of education, or had authentic experience of a mission in an underground mine than those who did not. This study reveals shortcomings in the preparedness of EMS personnel. The perceived low preparedness of EMS personnel may affect their ability to work in a major incident in the mining industry. Study findings may be used in planning the future education, including practical drills, of EMS personnel.

  • 27.
    Aléx, Lena
    Umeå University, Faculty of Medicine, Department of Nursing.
    Att balansera mellan olika diskurser: konsten att leva som gammal samisk kvinna2008In: Människor i norr: samisk forskning på nya vägar / [ed] Sköld, Peter, Umeå: Centrum för samisk forskning , 2008, p. 287-301Chapter in book (Other academic)
  • 28.
    Aléx, Lena
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Shift in power during an interview situation: methodological reflections inspired by Foucault and Bourdieu2008In: Nursing Inquiry, ISSN 1320-7881, E-ISSN 1440-1800, Vol. 15, no 2, p. 169-176Article in journal (Refereed)
    Abstract [en]

    This paper presents methodological reflections on power sharing and shifts of power in various interview situations. Narratives are said to be shaped by our attempts to position ourselves within social and cultural circumstances. In an interview situation, power can be seen as something that is created and that shifts between the interviewer and the interviewed. Reflexivity is involved when we as interviewers attempt to look at a situation or a concept from various perspectives. A modified form of discourse analysis inspired by subject positioning was used to reflect on power relations in four different interview situations. The analyses indicate that reflection on the power relations can lead to other forms of understanding of the interviewee. The main conclusion that can be drawn from this study is that power relations are created within an interview situation and therefore it is important to be aware of dominant perspectives. Researchers and nurses face the challenge of constantly raising their level of consciousness about power relationships, and discursive reflexivity is one way of doing this. Thus, reflexivity is an important part of the qualitative research process.

  • 29.
    Aléx, Lena
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lundman, Berit
    Umeå University, Faculty of Medicine, Department of Nursing.
    Construction of masculinities among men aged 85 and older in the north of Sweden2008In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 17, no 4, p. 451-459Article in journal (Refereed)
    Abstract [en]

    AIM: The aim was to analyse the construction of masculinities among men aged 85 and older. BACKGROUND: All societies have a gender order, constructed from multiple ideas of what is seen as feminine and masculine. As the group of men aged 85 and older is increasing in size and their demand for care will increase, we must recognize the importance of studying these men and various discourses of masculinities. DESIGN: Qualitative explorative. METHODS: Qualitative content analysis was used to analyse thematic narratives. Masculinity theories provided the point of departure for the analysis. RESULTS: The analysis coalesced into three masculinities. 'Being in the male centre', developed from subthemes as: taking pride in one's work and economic situation; being in the centre in relation to others; regarding women as sexual objects; and belonging to a select group. 'Striving to maintain the male facade' developed from subthemes as: emphasizing 'important' connections; having feelings of loss; striving to maintain old norms and rejecting the fact of being old. 'Being related' was formulated from subthemes as: feeling at home with domestic duties; being concerned; accepting one's own aging; and reflecting on life. CONCLUSIONS: Our study indicates the importance of being aware of the existence of multiple masculinities, in contrast to the generally unproblematic and unsubtle particular healthcare approaches which consider men as simply belonging to one masculinity. Relevance to clinical practice. Diverse masculinities probably affect encounters between men and healthcare providers and others who work with an older population and therefore our results are of importance in a caring context.

  • 30. American Delirium Society,
    et al.
    European Delirium Association,
    The DSM-5 criteria, level of arousal and delirium diagnosis: inclusiveness is safer.2014In: BMC Medicine, ISSN 1741-7015, E-ISSN 1741-7015, Vol. 12Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Delirium is a common and serious problem among acutely unwell persons. Although linked to higher rates of mortality, institutionalisation and dementia, it remains underdiagnosed. Careful consideration of its phenomenology is warranted to improve detection and therefore mitigate some of its clinical impact. The publication of the fifth edition of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-5) provides an opportunity to examine the constructs underlying delirium as a clinical entity.

    DISCUSSION: Altered consciousness has been regarded as a core feature of delirium; the fact that consciousness itself should be physiologically disrupted due to acute illness attests to its clinical urgency. DSM-5 now operationalises 'consciousness' as 'changes in attention'. It should be recognised that attention relates to content of consciousness, but arousal corresponds to level of consciousness. Reduced arousal is also associated with adverse outcomes. Attention and arousal are hierarchically related; level of arousal must be sufficient before attention can be reasonably tested.

    SUMMARY: Our conceptualisation of delirium must extend beyond what can be assessed through cognitive testing (attention) and accept that altered arousal is fundamental. Understanding the DSM-5 criteria explicitly in this way offers the most inclusive and clinically safe interpretation.

  • 31.
    Aminoff, Carina
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lind, Nadja
    Umeå University, Faculty of Medicine, Department of Nursing.
    Distriktssköterskors upplevelse av sitt arbete efter kommunalisering av hemsjukvården: en intervjustudie2014Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Syftet med denna studie var att beskriva hur distriktssköterskor på hälsocentral uppleversitt arbete sedan hemsjukvården överförts till kommunen. Åtta distriktssköterskor på fyraolika hälsocentraler intervjuades, texten analyserades med kvalitativ innehållsanalys. Iresultatet framkommer tre kategorier med vardera två underkategorier; en dimension somförsvann som beskriver förlust av frihet och förlust av helhet, distriktssköterskan som bromellan organisationerna som beskriver distriktssköterskan som mellanhand och dennesoro för patientsäkerheten samt distriktssköterskans mottagning i fokus som beskrivermindre splittring, mer tid, ökad trivsel och att variationen i arbetet har fortsatt medinriktning mot specialisering och prevention. Sammanfattningen är att distriktssköterskorupplevde en förlust över att inte vara verksam i hemsjukvård, men som positivtövervägdes av möjligheten att fokusera på hälsocentralens mottagning, men trotskommunaliseringen upplevde distriktssköterskorna att de behövde utföra vissahemsjukvårdsuppdrag åt kommunens sjuksköterskor på bekostnad av hälsocentralens tid.

  • 32.
    Andersson, Anneli
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Andersson, Catarina
    Umeå University, Faculty of Medicine, Department of Nursing.
    Att leva med svårläkta venösa bensår: En litteraturstudie som beskriver patienters upplevelser av att leva med svårläkta venösa bensår2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Många människor lever idag med svårläkta bensår, varav ca 80 % avbensåren är venösa. Det är av stor vikt att rätt diagnos fastställs samt bakomliggandeorsaker behandlas. Idag finns merparten av dessa patienter i den kommunala sektorn.Vården av patienter med bensår genererar stora ekonomiska kostnaderna församhället. Svårläkta sår på underbenen kan orsakas av olika sjukdomstillstånd. Attleva med svårläkta venösa bensår har betydande inverkan på det dagliga livets olikaaktiviteter samt människors välbefinnande. Denna litteraturstudie inriktar sig påpatienternas upplevelser av att leva med svårläkta venösa bensår.Syfte: Syftet med studien var att beskriva patienters upplevelser av att levamed svårläkta venösa bensår.Metod: En litteraturstudie med resultat från nio kvalitativa studier.Artiklarna kvalitetsgranskades, analyserades och sammanställdes.Resultat: I resultatet framkom varierade patientupplevelser av att leva medsvårläkta venösa bensår. Resultatet kategoriserades in i tre huvudkategorier och 11subkategorier. Huvudkategorierna bestod av: upplevelser av att leva medsårsmärta, upplevelser i samband med sårets uppkomst och behandling,psykologisk påverkan av patientens livssituation och upplevelser av förändring idet dagliga livet. Ett tema framkom: att uppleva ett såväl fysiskt som psykisktlidande.Konklusion: Resultatet i vår litteraturstudie indikerar ett lidande fysiskt,psykiskt samt socialt (i varierande grad) hos alla patienter som lever medsvårläkta venösa bensår. Viktigt att sjuksköterskan har ett helhetsperspektiv ochser hela människan och inte bara ett bensår.Nyckelord: venösa sår, bensår, svårläkta bensår, patientupplevelser, omvårdnad

  • 33.
    Andersson, Arvid
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Johansson, Magnus
    Papperslösas rätt till vård: En kvantitativ studie2015Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Undocumented migrants in Sweden are a group that does not have the same legal right to health care as other citizens in the nation. Ambiguity in the law and the lack of knowledge among health care staff has led to a situation where undocumented migrants run into obstacles to get access to the care they are entitled to.Aim: The aim of the study was to describe the knowledge and information needs among health care staff at the health centres and the emergency room in the municipality of Umeå concerning the right to health care for undocumented migrants according to swedish law.Method: This empirical study has a quantitative approach with a descriptive design. A survey was handed out to health care staff at the emergency room and health care centres in the municipality of Umeå.Result: 65,8% had experience of undocumented migrants seeking care. 39,7% percieved they had good knowledge of the rights the law afforded. 38,2% percieved they were adequately informed on the matter in the workplace. 75% percieved they need more education in the matter. 66,2% percieved there to be routines in the matter. 57,4% percieved their knowledge adequate for good and lawful care. 39,7% percieved the existence of discussion on the matter in the workplace. 44,5% felt they could assess "care that cannot be deferred". 61,8% percieved a sense of security in meeting undocumented migrants. 5,9% deemed it reasonable to contact law enforcement. 64,7% did not believe themselves to be bound by law to contact law enforcement.Conclusion: The majority had experience with meeting undocumented migrants. Approx. one third had no knowledge of the law 2013:407. Many did not know what rights the law afforded to undocumented migrants or if confidentiality applied to such patients. Self-assessed ability to provide lawful care rated considerably higher. Most found the workplace to have routines related to undocumented migrants. A majority considered they had not recieved enough information on the workplace in the matter and felt in need of more education.

  • 34.
    Andersson, Caroline
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Olivia, Carlsson
    Umeå University, Faculty of Medicine, Department of Nursing.
    Kvinnors upplevelser av ofrivillig barnlöshet: En litteraturstudie2015Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: I Sverige är 7-8 % av kvinnorna ofrivilligt barnlösa. Orsakerna till infertilitet kan vara hormonrubbningar, skador på äggledarna, kvinnor senarelägger familjebildningen och livsstilsfaktorer. Infertilitet medför många olika känslomässiga reaktioner. Syfte: Syftet med denna litteraturstudie var att belysa kvinnors upplevelser av ofrivillig barnlöshet. Metod: Artikelsökningen genomfördes i EBSCO som innehåller omvårdnadsinriktade databaser. I litteraturstudien ingick det 12 kvalitativa studier som har analyserats och sammanställts med inspiration av Fribergs analysmetod. Resultat: Resultatet delades in i följande fem kategorier: "Känslomässiga upplevelser", "upplevelsen av förändrad kvinnlighet", "upplevelsen av utanförskap", "upplevelsen av meningen med livet" och "upplevelsen av ett livslångt fenomen". Konklusion: Litteraturstudiens resultat visar att kvinnans upplevelse av ofrivillig barnlöshet är ett komplext fenomen. Kvinnor behöver psykosocialt stöd för att kunna hantera och bearbeta sin situation på bästa sätt. Som sjuksköterskan är det viktigt att ha ett holistiskt synsätt. Mer forskning behövs inom området.

  • 35.
    Andersson, Elin
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Nilsson, Amanda
    Umeå University, Faculty of Medicine, Department of Nursing.
    Att axla ett vårdaransvar: Att vara anhörig till en närstående med Alzheimers sjukdom - en litteraturstudie2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Alzheimers sjukdom påverkar inte bara den närstående med Alzheimer utan även anhöriga drabbas, både fysiskt och psykiskt då sjukdomen bidrar till stora förändringar i anhörigas livssituation. Därför är det viktigt att öka kunskapen om anhörigas situation för att bättre kunna stödja dem. Syfte: Syftet med denna studie var att beskriva erfarenheter av att vara anhörig till en person med Alzheimer som bor hemma.

    Metod: En litteraturstudie har genomförts och nio kvalitativa artiklar har valts genom sökningar i Cinahl, PubMed och Scopus. Artiklarna har sedan granskats, analyserats och sammanställts.

    Resultat: Anhörigas erfarenheter av att ha en närstående med Alzheimer beskrevs i fyra huvudkategorier; ’Att ställas inför ett vårdaransvar som anhörig’, ’Påfrestningar på den egna hälsan’, ’Behovet av kunskap och stöd’ samt ’Förändrat vardagsliv med närstående’.

    Konklusion: Att vara anhörig till en närstående som har Alzheimers sjukdom är mycket påfrestande både fysiskt och psykiskt. Genom ökad kunskap och ökat stöd kan anhöriga förhoppningsvis bli tryggare i vårdarrollen, förebygga egen ohälsa eller förbättra den.

    Nyckelord: Alzheimers sjukdom, Anhöriga, Erfarenheter

  • 36.
    Andersson, Erika
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sandström, Rosmarie
    Umeå University, Faculty of Medicine, Department of Nursing.
    Att vårda personer med demens på särskilt boende: Vårdpersonalens upplevelser av beteendemässiga och psykiska symtom vid demens2017Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Aim: The aim of the study was to describe nursing staff´s experience of caring for persons with dementia and behavioral and psychological symptoms of dementia (BPSD) in aged care facilities Background: Dementia is common in elderly and often leads to BPSD which puts high demands on nursing staff. The work is affected by the knowledge of the staff and the shape of the organization which could lead to stress of conscience, risk of burn out and that they distanced themselves from the elderly. Design: The study was a qualitative semi-structured interview study. Methods: The participants consisted of enrolled nurses and nursing aides in municipal aged care facilities. 10 interviews were analyzed through inductive content analysis. Findings: Five categories were distinguished in the content analysis – “Knowledge about the elder behind the dementia”, “To meet and validate the reality of the elder”, Commitment to the elderly´s well-being”, “The demands for working cooperation and flexibility”, “Demands for a supportive organization”. Getting to know the person was important to be able to work with persons with BPSD which consisted of different ways to gain information and the staff´s own knowledge about the person. The staff tried to reach the elderly by adapted treatment depending on the situation. The work was seen as challenging and it touched a broad emotional spectrum within themselves when working with the elderly. To work with BPSD put great demands on good cooperation between professions, dialogue, flexibility and to strive towards common goals. Support from the employer and the organization was important. Conclusion: To be able to implement new approaches in the work procedure in the organization the nursing staff needs more education in dementia, support from the employer and the organization.

  • 37.
    Andersson, Gun
    Umeå University, Faculty of Medicine, Department of Nursing.
    Höj-och sänkbara arbetsbord på 1177 sjukvårdsrådgivning och vårdcentral2015Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    AbstractBackgroundOccupations involving more sedentary at work occurs in today´s society to a greater extent, and even in their spare time, several are less physically active. Around 1.2 million acquisition workers felt that their work contained an excessive amount of sedentary.PurposeThe aim of this thesis was to examine the self-assessed work environment amongst medical staff who uses height-adjustable work desks.MethodThe study was conducted as a quantitative survey with validated questionnaires from QPS Nordic- 34 + questions from AFS 2012:2 checklists from the Swedish Work Environment Authority. A convenience sample of 1177 medical counseling and a health center of Uppsala led to 53 completed questionnaires. The study material was analyzed through the development of descriptive statistics and related analysis.ResultThe majority of the 53 respondents had a height- adjustable desk. The group that had height- adjustable desk were able to switch working position frequently during the day. There is no significance between those with and without height- adjustable work desks regarding the questions about the self assessed work.ConclusionThe majority of the staff from both the 1177 medical counseling and the health centers had height- adjustable work desks and were using them.KeywordsOccupational sitting, sit-stand work station, sit-stand desk, height- adjustable workstations, muscle fatigue.

  • 38.
    Andersson, Jonas
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Liljekvist, Torkel
    Umeå University, Faculty of Medicine, Department of Nursing.
    Ambulanspersonalens upplevelser av återhämtning mellan uppdragen2015Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Ambulance personnel face daily stress and high workload. This leads to increased risk of health problems among ambulance personnel and risk to affect care.

    Purpose: The purpose of this study was to elucidate the ambulance personnel experiences of recovery between missions.

    Participants: In the study contributed ten employees in prehospital care at two mid-sized cities in Sweden and surrounding rural areas.

    Method: The study was based on ten semi-structured interviews conducted in December 2014. The interviews were recorded and analyzed using qualitative content analysis.

    Results: Four categories emerged: Prerequisites for recovery, Circumstances that provides recovery, Circumstances that impairs recovery and Consequences of lack of recovery. To the four categories 14 subcategories were created. The factors that were considered most important for good recovery is daytime, meals and social interaction. During nighttime sleep was described as the most elementary. It was pointed out that it is difficult to plan for rest and recovery, partly because the workload, partly because of uncertainty about the workshifts progression.

    Conclusion: The result of the study shows that ambulance personnel feel that the most important recovery occurs through sleep, meals and socializing. Prerequisites for rest and recovery has a fundamental role. What may limit the recovery is perceived to be; lack of adequate crisis management, short time for recovery and poor peer support. Which can lead to impaired care and risk of adverse health effects.

  • 39.
    Andersson, Katarina
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Personlig hygiejne som en intim situation2016In: Det nære sundhedsvæsen: perspektiver på samfundsudvikling og møder mellem mennsker / [ed] Stinne Glasdam & Jette Westenholz Jørgensen, Københamn: Munksgaard Forlag, 2016, 1, p. 115-122Chapter in book (Other academic)
  • 40.
    Andersson, Lars
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Larsson, Ida
    Umeå University, Faculty of Medicine, Department of Nursing.
    Tolken som min röst: Sjuksköterskors upplevelser av att arbeta medtolksamtal i asylhälsan2016Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Aims: The aim was to study nurses' experience of working with interpreter conversations inmigrant health.Background: The last years increase in refugees has created rising demands on migranthealth and interpreters in primary healthcare. Lack of communication can hinder nurses' careand knowledge of the experience of interpreter conversations is therefore important,something lacking in research. The National Board of Health and Welfares survey describedproblems of availability of medical interpreters and an unequal situation nationwide.Methods: The study was a qualitative interview study with seven nurses. Interviews wererecorded, transcribed and analyzed with qualitative content analysis.Results: Three main categories were identified: The interpreter’s role affects the conversationdescribed how interpreter professionality could enable or disable the conversation as couldinterpreter sex and culture. The nurses' role affects the conversation described how theprofessionality of the nurse was essential as they needed to find own solutions workwise aswell as the pursuit of a caring conversation with the patient. The organization affects theconversation described a limiting organization with a lack of interpreters, structure andcooperation between healthcare and authorities. Education was stressed as quality-assurance.Conclusions: Nurses need the interpreter as bridge for their voice to enable good care. Thereis need for a systematic way to work with interpreters through education and Nurse-Interpreter training. This would quality-assure healthcare and improve working conditions.Competence in transcultural nursing is important for equal health care in today's multiculturalSweden

  • 41.
    Andersson, Linda
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå universitet.
    Lövström, Jennifer
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå universitet.
    Att leva med bipolär sjukdom: En litteraturstudie om patienters erfarenheter av att leva med bipolär sjukdom2015Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Bipolar disorder is a chronicle disease characterized by changes in the

    patient ́s activity level and mood. These episodes are referred to as mania-,

    hypomania- and depressive episodes. Treatment and care are focused on relieving

    symptoms.

    Aim: The aim of this study was to illuminate patients’ experiences of living with

    bipolar disorder.

    Method: This literature review study used 8 qualitative scientific articles. These

    were compiled and analyzed with the inspiration of a qualitative content analysis.

    When searching for articles, databases like Cinahl, PsycInfo and PubMed were used.

    Results: The result shows that factors affecting living with bipolar disorder was to

    accept or deny the disease. Patients experienced identity change and concern about

    the future. Everyday life is affected in a large extent, especially when regular

    medication and blood sampling was needed in order to control the disease. Varying

    emotion occurred while oscillation in moods. In order to control the disease patients

    describes how important it is to have support, this in order to manage the symptoms

    and being able to identify warning signs. Motivation to change is strengthened by

    good relationships as well as knowledge and understanding, both in patients,

    relatives and health professionals.

    Conclusion: The results of the literature review showed that the diagnosis can

    produce serious consequences for those involved, their family and those related.

    Therefore it requires a lot of support, education and information for all involved.

  • 42.
    Andersson, Maja
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Ebbvik, Caroline
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sjuksköterskan på plats vid en humanitär katastrof: En litteraturöversikt i sjuksköterskors erfarenheter av att tjänstgöra vid humanitära katastrofer2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    ABSTRACT

    Background: The humanitarian needs are on the rise and Sweden has a long tradition of assisting with various types of relief work. Humanitarian relief work aims to save lives and alleviate the people in need affected by natural disasters or armed conflicts. Nurses constitutes the largest work group in the disaster relief and are often assigned leadership on site.

    Aim: To describe nurses' experiences of serving in humanitarian disasters.

    Method: This literature review contains eight articles with qualtitative approach. The result from each article was analyzed and compiled. The databases CINAHL, PubMed and Swemed+ were used.

    Results: The result have been divided into four main categories with eight subcategories. The main categories are: to be insufficient, to face a new environment, to feel an emotional involvement with other people and to find the role as a nurse.

    Conclusion: The result of the literature review shows that nurses could experience feelings of stress and a feeling of being unprepared in the humanitarian disaster work. A disaster can rarely be predicted, therefore it is important with disaster preparedness for all nurses.

    Keywords: disaster medicine, humanitarian disaster, disaster relief, humanitarian aid.

  • 43.
    Andersson, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Nironen, Kristina
    Umeå University, Faculty of Medicine, Department of Nursing.
    Skolsköterskans upplevelser av att hantera mötet med föräldrar till överviktiga barn och motivera till en hälsosam livsstil.2013Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Syftet med studien var att belysa skolsköterskans upplevelser av att hantera mötet med föräldrar till överviktiga/feta barn för att kunna motivera familjen till en mer hälsosam livsstil.Insamlandet av material skedde genom frågeformulär som skickades ut via mail till 30 skolsköterskor i Västra Götalandsregionen. Totalt deltog sju skolsköterskor. Det insamlade materialet analyserades med kvalitativ innehållsanalys. Skolsköterskan upplevde ett flertal hinder i mötet med föräldrar till överviktiga/feta barn. De hinder som upplevdes vara mest förekommandevar föräldrars känsla av att ha blivit kränkta och kritiserade av skolsköterskan samt att det fanns tillfällen där föräldrarna ville klara av problemet med barnens övervikt/fetma själva. Skolsköterskan upplevde även att det fanns möjligheter i arbetet medatt påverka familjerna till en bättre livsstil. Skolsköterskan ansåg att det var viktigt att skapa en bra och tillitsfull relation till familjen. Dessutom ansåg skolsköterskan att ansvaret för barnets övervikt/fetma låg hos föräldrarna och vände sig därmed till dem i första hand för att motivera till en bättre kosthållning och livsstil. Författarna till denna studie uppmärksammade att samtalet mellan skolsköterskan och föräldrarna ofta upplevdes som spänt vilket ibland resulterade i försvårat samarbete. Här spelade ett empatiskt förhållningssätt hos skolsköterskan en mycket stor roll och det kunde vara avgörande för om hon lyckades motivera familjen till livsstilsförändring. Det verkar inte finnas så mycket forskning om huruvida ekonomi försvårar förändringav livsstil eller om en sämre ekonomi påverkar förekomsten av övervikt/fetma hos barn

  • 44.
    Andersson, Sofia
    Umeå University, Faculty of Medicine, Department of Nursing.
    Vård i livets slutskede på särskilt boende för äldre personer: närstående och vårdpersonals skattade och berättade erfarenheter2017Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background Hospital care for older people in Europe is being replaced by other care facilities such as residential care homes (RCHs). RCHs are therefore playing an increasing and important role in end-of-life (EOL) care. The goal of palliative care is to improve quality of life both for persons with life-threating diseases and for their family members. Care pathways such as the Liverpool Care Pathway for the Dying Patient (LCP) are used to improve the quality of EOL care. There is a lack of research focusing on family members’ and care professionals’ perspectives on the use of pathways in EOL care in RCHs. This thesis is part of a larger research project on the implementation of the LCP in RCHs.

    Aim The overall aim of this thesis was to describe family members’ and care professionals’ perspectives on end-of-life care in residential care homes for older people.

    Methods This thesis consists of four studies, two quantitative and two qualitative. The data in Study I were based on the questionnaire, “Views of Informal Carers – Evaluation of Services” (VOICES), filled in by family members (n=189) of older persons who had died in RCHs. Descriptive statistics were used to analyse the data. Study II was based on registered expected deaths in RCHs (n=22 855) reported to the Swedish Register of Palliative Care (SRPC) by care professionals. The data were explored with univariate and multivariate logistic regression analysis. In Study III and IV, a descriptive qualitative design was used. Data in study III were collected through focus groups and individual interviews with care professionals (n=24). The data in Study IV were collected through individual interviews with family members of residents who had died in RCHs (n=15). The data in Studies III and IV were analysed with qualitative content analysis.

    Results The family members in Study I reported that they had been given enough help with nursing such as getting dressings change and with medication, and personal care such as bathing, dressing, help with eating and going to the bathroom, in the last three days of life. They also reported that they were told (86.2%) that the resident was likely to die shortly, and most of them (94.1%) reported that they felt that the resident had died in their preferred place. Just under half of the residents (46.5%) had experienced pain, with the majority (86.4%) receiving treatment for this symptom, and slightly more than half (55.9%) had experienced shortness of breath, with around a third of them (39.7%) receiving treatment for this. Shortness of breath was significantly more common in the younger age group (<85 years; p=0.01) and they were significantly more likely to have received treatment (p=0.006).

    In Study II, the SRPC data revealed high prevalence of pain (68.8%) and anxiety (44.0%). Shortness of breath (14.1%) and nausea (10.2%) were less common. In the multivariate regression analyses, two explanatory factors were significantly associated with symptom relief, of pain, nausea, anxiety and shortness of breath: use of validated pain assessment scales, and assessment of oral health. In both the univariate and multivariate logistic regression analysis, individual presciptions of injections to be administered when required (PRN, pro re nata) for pain, nausea, and anxiety were significantly associated with relief of symptom.

    The care professionals in Study III described several aspects of their experiences of EOL care after implementation of the LCP: they became more confident through a shared approach, they were supported in tailoring the care to the residents’ individual needs, they were supported in involving the family members in decision-making and care, and they had become more aware of the care environment.

    The family members in Study IV also described several aspects of their experiences of care of the dying in RCHs where an EOL care pathway was used: they felt confident in a familiar and warm atmosphere, they were involved or not in the EOL care, and they were consoled by witnessing the care professionals’ endeavours to relieve suffering.

    Conclusion The results described in this thesis indicate a high quality of nursing care and personal care, but also inadequate management of symptom relief in the last days of life for residents in RCHs. Still, despite a high prevalence of symptoms such as pain, shortness of breath, and anxiety, RCHs were described as a natural and appropriate place of death. The results confirm that use of a validated pain assessment scale and medication PRN prescribed could be a way to increase the quality of EOL care. The results also indicate that a standardized care pathway can offer one way to improve the quality of care. The care professionals felt supported in involving the family members in care and decision making, and both family members and care professionals felt supported in the care by the use of the LCP. 

    The full text will be freely available from 2019-01-12 10:00
  • 45.
    Andersson, Sofia
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lindqvist, Olav
    Umeå University, Faculty of Medicine, Department of Nursing. Department of Learning, Informatics, Management and Ethics/MMC, Karolinska Institutet, Stockholm, Sweden.
    Fürst, Carl-Johan
    The Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden.
    Brännström, Margareta
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Arctic Research Centre at Umeå University.
    Care professional's experiences about using Liverpool Care Pathway in end-of-life care in residential care homes2018In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 32, no 1, p. 299-308Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Residential care homes (RCHs) play an important role in end-of-life care, being the most common place of death for elderly people in several European countries. Care pathways such as the Liverpool Care Pathway for the Dying Patient (LCP) are used to improve and ensure quality care at the end of life. There is a lack of scientific evidence supporting the use of care pathways.

    DESIGN: A descriptive qualitative study.

    OBJECTIVE: The aim was to describe care professionals' experiences of using the Liverpool Care Pathway for the Dying Patient in the care of dying residents in residential care homes.

    METHODS: Five focus group interviews and two individual interviews with enrolled nurses (n = 10), Registered Nurses (n = 9) and general practitioners (n = 5) were carried out and analysed using qualitative content analysis.

    RESULTS: Care professionals expressed that they became confident through a shared approach to care, were supported to tailor the care according to the residents' individual needs, were supported to involve family members in decision-making and care and became more aware of the care environment.

    CONCLUSION: The results of this study indicate that the LCP might be a useful tool for care professionals in improving end-of-life care in RCHs through increased attention to the goals of care, the individual needs of residents and family involvement.

  • 46.
    Andersson, Sofia
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lindqvist, Olav
    Umeå University, Faculty of Medicine, Department of Nursing. Department of Learning, Informatics, Management and Ethics/MMC, Karolinska Institutet, Stockholm, Sweden.
    Fürst, Carl-Johan
    Brännström, Margareta
    Umeå University, Faculty of Medicine, Department of Nursing.
    End-of-life care in residential care homes: a retrospective study of the perspectives of family members using the VOICES questionnaire2017In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 31, no 1, p. 72-84Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In Europe, residential care homes (RCHs) are replacing hospitals as the place where death occurs, and they play an important role in end-of-life (EOL) care.

    OBJECTIVE: The aim was to describe the quality of care during the last 3 months and last 3 days of life of those who died in RCHs as reported by family members. We also investigated whether there were differences in the EOL care of younger patients (<85 years) vs. the oldest old patients (≥85 years) as reported by family members.

    DESIGN: A retrospective survey design.

    METHODS: Deaths (n = 189) at 19 RCHs in one municipality in Sweden were included. Family members were sent the VOICES questionnaire 1 month after their elderly relative had died. Descriptive statistics were used.

    RESULTS: In the last 3 days before death, most family members reported there was enough help with nursing (93%) and personal care (78.5%). Among the family members, 86% were told that the resident was likely to die shortly. Most (94.1%) of residents were reported to have died at their preferred place. No significant difference was found between age groups. Family members also reported that about half of the elderly had pain (46.5%) and 86.4% received treatment; 55.9% had breathlessness and 39.7% received treatment. Breathlessness was significantly (p = 0.01) more common in the younger group, and they were treated more often (p = 0.006) than the oldest old.

    CONCLUSION: This study revealed an overall positive picture of personal and nursing care and communication. These findings indicate that the quality of EOL care at RCHs is high. Inadequate management was found for symptom relief the last days of life. This suggests that this subject merits further attention by care professionals. To achieve better quality of EOL care at RCHs, we emphasise the importance of systematically working to improve symptom relief.

  • 47.
    Andersson, Sofia
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lindqvist, Olav
    Umeå University, Faculty of Medicine, Department of Nursing. Department of Learning, Informatics, Management and Ethics/MMC, Karolinska Institutet, Stockholm, Sweden.
    Fürst, Carl-Johan
    The Institute for Palliative Care, Faculty of Medicine, Department of Clinical Science, Lund University and Region Skåne, Lund, Sweden.
    Brännström, Margareta
    Umeå University, Faculty of Medicine, Department of Nursing.
    Family members' experiences of care of the dying in residential care homes where the Liverpool Care Pathway was used2018In: International Journal of Palliative Nursing, ISSN 1357-6321, E-ISSN 2052-286X, Vol. 24, no 4, p. 194-202Article in journal (Refereed)
    Abstract [en]

    Background: Residential care homes (RCHs) are increasingly becoming a common place of death for older people.

    Aim: The aim of this study was to describe family members' experiences of care of the dying in RCHs where the Liverpool care pathway for the dying patient was used.

    Methods: This study had a descriptive qualitative study design. Fifteen (n=15) individual interviews were analysed using qualitative content analysis.

    Results: The analysis resulted in three themes: being confident in a familiar and warm atmosphere, being involved vs not being involved in end-of-life (EoL) care, and being consoled by witnessing the health professional's endeavour to relieve suffering.

    Significance of results: The results indicated that taking part in a care plan seems to increase family members' feelings of involvement in EoL care. This study also highlights the family members' needs for increased possibilities for EoL discussions with the GP.

  • 48.
    Andersson, Sofia
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Vestberg, Maria
    Umeå University, Faculty of Medicine, Department of Nursing.
    Patientens karaktäristika påverkar upplevelsen av vårdpersonalens bemötande2018Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Patientens karaktäristika påverkar upplevelsen av vårdpersonalens bemötandeSyfte:Att undersöka patienters upplevelse av bemötande från vårdpersonal samt om graden av självrapporterad ångest och depression påverkar denna upplevelse. Bakgrund:Den vård som utförs kan spegla både skillnader i tillgång till vård och sociodemografiska faktorer. Bemötande inom psykiatrisk slutenvård är av stor betydelse för hur patienter upplever sin vård. Ett gott bemötande definieras som en upplevelse av att vårdpersonal tar sig tid och att patienten blir sedd samt att patienten erbjuds medverka i den kliniska beslutsprocessen. På individnivå kan ett bristande bemötande bland annat leda till komplikationer som sämre återhämtning för patienten. Sammantaget är det därför angeläget att utvärdera patientens upplevelse av vårdpersonalens bemötande.Design:I denna tvärsnittsstudie användes en kvantitativ design. Metod:Studien genomfördes vid tre psykiatriska slutenvårdsavdelningar i Norra Sverige under januari och februari 2017. Totalt inkluderades 85 patienter. Utfallsmåtten baserades på data från tre separata enkäter; The Caring Professional Scale som mäter patientens upplevelse av vårdpersonals förmåga till bemötande, Visual Analog Scale som mäter tillfredsställelsen med senaste interaktionstillfället med vårdpersonal och Hospital and Anxiety Scale som mäter självskattad depression och ångest.Resultat:Majoriteten av patienterna rapporterade att de var nöjda med bemötandet från vårdpersonalen. Därtill var faktorer som utbildningsnivåoch ålderassocierade med en självrapporterad nöjdhet av bemötandet. Slutsats:Resultaten från studien antyder att det finns både sociodemografiska och patientkarakteristiska faktorer som kan vara relaterade till patientens upplevelse av vårdpersonals bemötande. Detta kan indikera effekter av ojämlik vård och bör ytterligare belysas ur såväl vetenskapligt som samhälleligt perspektiv

  • 49.
    Andersson, Sofia
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Årestedt, Kristofer
    Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.
    Lindqvist, Olav
    Umeå University, Faculty of Medicine, Department of Nursing. Department of Learning, Informatics, Management and Ethics/MMC, Karolinska Institutet, Stockholm.
    Fürst, Carl Johan
    The Institute for Palliative Care, Faculty of Medicine, Department of Clinical Science, Lund University and Region Skåne, Lund, Sweden.
    Brännström, Margareta
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Arctic Research Centre at Umeå University. Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg.
    Factors associated with symptom relief in end-of-life care in residential care homes: a national register-based study2018In: Journal of Pain and Symptom Management, ISSN 0885-3924, E-ISSN 1873-6513, Vol. 55, no 5, p. 1304-1312Article in journal (Refereed)
    Abstract [en]

    Context: Residential care homes (RCHs) are a common place of death. Previous studies have reported a high prevalence of symptoms such as pain and shortness of breath among residents in the last week of life.

    Objectives: The aim of the study was to explore the presence of symptoms and symptom relief and identify factors associated with symptom relief of pain, nausea, anxiety, and shortness of breath among RCH residents in end-of-life care.

    Methods: The data consisted of all expected deaths at RCHs registered in the Swedish Register of Palliative Care (N = 22,855). Univariate and multiple logistic regression analyses were conducted.

    Results: Pain was reported as the most frequent symptom of the four symptoms (68.8%) and the one that most often had been totally relieved (84.7%) by care professionals. Factors associated with relief from at least one symptom were gender; age; time in the RCH; use of a validated pain or symptom assessment scale; documented end-of-life discussions with physicians for both the residents and family members; consultations with other units; diseases other than cancer as cause of death; presence of ulcers; assessment of oral health; and prescribed pro re nata injections for pain, nausea, and anxiety.

    Conclusion: Our results indicate that use of a validated pain assessment scale, assessment of oral health, and prescribed pro re nata injections for pain, nausea, and anxiety might offer a way to improve symptom relief. These clinical tools and medications should be implemented in the care of the dying in RCHs, and controlled trials should be undertaken to prove the effect.

  • 50.
    Andersson, Veronica
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Samuelsson, Jannike
    Umeå University, Faculty of Medicine, Department of Nursing.
    Äldres hälsa i glesbygd och stad: Skiljer sig äldres hälsa på särskilt boende?2016Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Syfte: Syftet med denna studie var att jämföra hälsotillstånd bland äldre människor bosatta på särskilt boende i glesbygd respektive stad.

    Bakgrund: Världens befolkning förväntas öka kraftigt samtidigt som vi lever längre. Detta ställer i sin tur höga krav på hälso- och sjukvården. Det finns skillnader i tillgänglighet och möjlighet till vård i glesbygd och stad trots Hälso- och sjukvårdslagens förordning om jämlik vård. Det förekommer bristfällig forskning gällande äldres hälsa på särskilda boenden i glesbygd och i stad. Med hänsyn till den förväntade befolkningsutvecklingen som tenderar i fler äldre och fler multisjuka är det av vikt att ta reda på vad som är hälsa för denna grupp, för att kunna utveckla en god äldreomsorg i takt med samhällsutvecklingen.

    Metod: En kvantitativ tvärsnittsstudie genomfördes under en vecka i maj 2013. Äldre (n=1544) boende på särskilt boende i glesbygd och i stad blev skattade av vårdpersonal. Multi-Dimensional Dementia Assessment Scale användes som instrument i studien och det insamlade materialet analyserades i SPSS Statistics.

    Resultat: Resultatet visade på skillnader i de äldres hälsotillstånd beroende på om de var bosatta på särskilt boende i glesbygd eller i stad. I glesbygd hade de äldre en lägre grad av kognitiv svikt, högre ADL-förmåga, fick oftare besök och var oftare utomhus självständigt. I glesbygd förekom mer smärta och de tenderade till att vara mer förstoppade. I stad hade en högre andel fått en läkemedelsgenomgång senaste året och fler hade egna tänder jämfört med i glesbygd. I stad förekom begränsningsåtgärd i form av sänggrindar oftare, fler hade sväljsvårigheter och fler var i behov av hjälp av vårdpersonal på morgonen. Av vårdpersonal skattades den psykiska vårdtyngden som högre i stad jämfört med i glesbygd, däremot sågs ingen skillnad gällande den fysiska vårdtyngden.

    Konklusion: Resultatet visar att det skiljer sig gällande hälsostatus bland äldre vid särskilda boenden i glesbygd och stad, och det fanns både positiva och negativa aspekter bland de äldre både i glesbygd och i stad. Vidare forskning inom området är av vikt för att utforska vad som orsakar dessa skillnader, och på vilka sätt distriktssköterskor kan lära av varandra och implementera nya arbetssätt i sitt arbete på särskilda boenden. 

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