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  • 1801. Wisnuwardani, Ratih Wirapuspita
    et al.
    De Henauw, Stefaan
    Androutsos, Odysseas
    Forsner, Maria
    Umeå University, Faculty of Medicine, Department of Nursing. School of Education, Health and Social Sciences, Dalarna University, Falun, Sweden.
    Gottrand, Frédéric
    Huybrechts, Inge
    Knaze, Viktoria
    Kersting, Mathilde
    Le Donne, Cinzia
    Marcos, Ascensión
    Molnár, Dénes
    Rothwell, Joseph A.
    Scalbert, Augustin
    Sjöström, Michael
    Widhalm, Kurt
    Moreno, Luis A.
    Michels, Nathalie
    Estimated dietary intake of polyphenols in European adolescents: the HELENA study2019In: European Journal of Nutrition, ISSN 1436-6207, E-ISSN 1436-6215, Vol. 58, no 6, p. 2345-2363Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Knowledge about polyphenols intakes and their determinants among adolescents might be helpful for planning targeted prevention strategies at an early age.

    METHODS: In the European multicenter cross-sectional HELENA study of 2006-2007, 2428 subjects (47% boys) had data on dietary intake of polyphenols from 2 non-consecutive 24 h recalls via linking with the Phenol-Explorer database. Differences by sex, age, country, BMI, maternal education, paternal education, family affluence, smoking status, alcohol use, and physical activity were explored by linear regression.

    RESULTS: Median, lower and upper quartiles of polyphenol intakes were 326, 167 and 564 mg/day, respectively. Polyphenol intake was significantly higher in the oldest (16-17.49 years), girls, non-Mediterranean countries, lowest BMI, highest paternal education, and alcohol consumers. Main food contributors were fruit (23%, mainly apple and pear, i.e., 16.3%); chocolate products (19.2%); and fruit and vegetable juices (15.6%). Main polyphenol classes were flavonoids (75-76% of total) and phenolic acids (17-19% of total). The three most consumed polyphenols were proanthocyanidin polymers (> 10 mers), hesperidin, and proanthocyanidin 4-6 oligomers.

    CONCLUSION: The current study provided for the first time numbers on the total polyphenol intake and their main food sources in a heterogeneous group of European adolescents. Major differences with adult populations are the lower polyphenol consumption and the major food sources, such as chocolate and biscuits. The discussed determinants and polyphenol types already point to some important population groups that need to be targeted in future public health initiatives.

  • 1802. Wisnuwardani, Ratih Wirapuspita
    et al.
    De Henauw, Stefaan
    Forsner, Maria
    Umeå University, Faculty of Medicine, Department of Nursing. School of Education, Health and Social Sciences, Dalarna University, Falun, Sweden.
    Gottrand, Frédéric
    Huybrechts, Inge
    Knaze, Viktoria
    Kersting, Mathilde
    Le Donne, Cinzia
    Manios, Yannis
    Marcos, Ascensión
    Molnár, Dénes
    Rothwell, Joseph A.
    Scalbert, Augustin
    Sjöström, Michael
    Widhalm, Kurt
    Moreno, Luis A.
    Michels, Nathalie
    Polyphenol intake and metabolic syndrome risk in European adolescents: the HELENA study2019In: European Journal of Nutrition, ISSN 1436-6207, E-ISSN 1436-6215Article in journal (Refereed)
    Abstract [en]

    Purpose: The role of polyphenol intake during adolescence to prevent metabolic syndrome (MetS) is little explored. This study aimed to evaluate the association between intake of total polyphenols, polyphenol classes and the 10 most consumed individual polyphenols with MetS risk in European adolescents.

    Methods: Of the cross-sectional HELENA study, 657 adolescents (54% girls; 14.8% overweight; 12.5–17.5 year) had a fasting blood sample and polyphenol intake data from two non-consecutive 24-h recalls matched with the Phenol-Explorer database. MetS was defined via the pediatric American Heart Association definition. Multilevel linear regressions examined the associations of polyphenol quartiles with MetS components, while logistic regression examined the associations with MetS risk.

    Results: After adjusting for all potential confounders (socio-demographics and nine nutrients), total polyphenol intake, polyphenol classes and individual polyphenols were not associated with MetS risk. From all MetS components, only BMI z-score was modestly inversely associated with total polyphenol intake. Further sub analyses on polyphenol classes revealed that flavonoid intake was significantly associated with higher diastolic blood pressure and lower BMI, and phenolic acid intake was associated with higher low-density cholesterol. For individual polyphenols, the above BMI findings were often confirmed (not independent from dietary intake) and a few associations were found with insulin resistance.

    Conclusion: Higher intakes of total polyphenols and flavonoids were inversely associated with BMI. No consistent associations were found for other MetS components.

  • 1803.
    Wode, Kathrin
    et al.
    Umeå University, Faculty of Medicine, Department of Radiation Sciences. Umeå University, Faculty of Medicine, Department of Nursing. Regional Cancer Center Stockholm Gotland, Stockholm, Sweden; Department for Upper Gastrointestinal Cancer, K42, Karolinska University Hospital, Stockholm, Sweden.
    Henriksson, Roger
    Umeå University, Faculty of Medicine, Department of Radiation Sciences. Regional Cancer Center Stockholm Gotland, Stockholm, Sweden.
    Sharp, Lena
    Stoltenberg, Anna
    Nordberg, Johanna Hök
    Cancer patients' use of complementary and alternative medicine in Sweden: a cross-sectional study2019In: BMC Complementary and Alternative Medicine, ISSN 1472-6882, E-ISSN 1472-6882, Vol. 19, article id 62Article in journal (Refereed)
    Abstract [en]

    Background: Access to and advice on Complementary and Alternative Medicine (CAM) are uncommon within Swedish conventional cancer care and little is known about cancer patients' own use of CAM. The aim of this cross-sectional study was to explore Swedish cancer patients patterns of CAM use, their experiences and preferences.

    Methods. Questionnaires were distributed consecutively to 1297 cancer patients at a university hospital's out-patient oncology units. The response rate was 58% (n=755). Descriptive statistics were used to analyze the survey data. A logistic regression model was used to investigate the association between CAM use and gender, age and level of education. Open-ended responses were analyzed, using qualitative content analysis.

    Results: Lifetime CAM use was reported by 34% (n=256), and 26% (n=198) used CAM after cancer diagnosis. Being female, younger and having higher education predicted CAM use. Most commonly used methods were natural products including vitamins and mineralsand relaxation. Main reasons for CAM use were improvement of physical, general and emotional wellbeing and increasing the body's ability to fight cancer. Satisfaction with CAM usage was generally high. Reported adverse effects were few and mild; 54% of users spent <50 Euro a month on CAM. One third had discussed their CAM use with cancer care providers. More than half of all participants thought that cancer care providers should be able to discuss (58%) and to consider (54%) use of CAM modalities in cancer care.

    Conclusions: Despite limited access and advice within conventional cancer care, one fourth of Swedish cancer patients use CAM. The insufficient patient-provider dialogue diverges with most patients' wish for professional guidance in their decisions and integration of CAM modalities in conventional cancer care. Concurrent and multimodal CAM use implies challenges and possibilities for cancer care that need to be considered.

  • 1804.
    Wrede (fd. Petersén), Ida
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Karlstedt, Maria
    Umeå University, Faculty of Medicine, Department of Nursing.
    Föräldrars upplevelser av delaktighet och tillgänglighet inom barnsjukvården: – En intervjustudie2017Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: The study is based on answers from the National Patient Survey from spring 2016. There were questions about participation and accessibility. A region in southern Sweden had difficulties to understand the answers to these questions. Was the questions misunderstood or was their experience of participation and accessibility bad? Aim: To describe how parents of children with chronic bowel disease experienced participation and accessibility to health care. Design: The study has a qualitative approach. Method: Semistructured interviews were conducted with parents who have a child with chronic intestinal disease. The interviews were analyzed on the basis of a qualitative content analysis. Results: The material from the interviews was divided into participation and accessibility. Parents perceived that participation in child care was important. It gave the parents a sense of security, trust and control. When the participation burst, it gave parents botheration as they did not experience being seen or believed. It was also worrying to lack knowledge. The parents experienced a good accessibility when they received sincere information, continuity and support of care. Inadequate availability is symbolized by insufficient contact with care, sufficient information or access to a network with other parents in similar situations. Conclusion: It's important to keep listening to parents to make them feel participant. In order for parents to experience good accessibility, it´s important to give them information, let them meet like-minded and gain access to cross-professional contacts. Appropriate personnel should be informed of the results regarding participation and availability so improvement measures can be implemented.

  • 1805.
    Wredlert, André
    Umeå University, Faculty of Medicine, Department of Nursing.
    Samband mellan prestation i fystester och prestation på basketplan hos svenska ungdomslandslagsspelare i basket2016Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Fysprofilen är Sveriges Olympiska Komittés (SOK) verktyg för att testa deras topp- och talangidrottare. Tidigare studier har visat att man kan förutspå basketprestation med olika typer av fystester där aerob kapacitet och styrka i både nedre och övre extremitet var signifikanta prediktorer. Dock har ingen studie undersökt om Fysprofilens tester samvarierar med prestation. Syfte: Syftet med denna studie var att undersöka samband mellan basketprestation på spelplan med prestation i testbatteriet Fysprofilen som används regelbundet för unga landslagsspelare. Ytterligare ett syfte var att undersöka hur prestationen i Fysprofilen förändras med stigande ålder.         Metod: Fysprofilen inkluderar tester inom aerob och anerob förmåga, power och styrka och genomförs på samtliga ungdomslandslagsspelare. Basketprestation definieras som speltid/match och poäng/match i Europamästerskapen i basket som genomförs varje år. Resultat: Linjära regressionsanalyser visade att Fysprofilens index för aerob kapacitet verkar vara den variabel som bäst kan förutspå prestation men att övriga tester/index i Fysprofilen inte samvarierar med speltid/match och poäng/match för ungdomslandslagsspelare i basket. ANOVA och efterföljande post hoc-test visade att det fanns skillnader mellan åldersgrupperna för samtliga index förutom det aeroba indexet. För styrke-, power och anaerobic index såg man ingen skillnad mellan 18- och 19- och 20-åringar varken för män eller kvinnor. Slutats: Förutom indexet för aerob kapacitet verkar Fysprofilens ingående tester/index inte kunna prediktera prestation i form av speltid/match eller poäng/match. Ungdomslandslagsspelare verkar inte utveckla sin kondition mellan 16-20 års ålder.

  • 1806.
    Wändin, Ellenor
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Anundsson, Maria
    Umeå University, Faculty of Medicine, Department of Nursing.
    Distriktssköterskans upplevelse och erfarenhet av att vårda patienter med nedsatt psykisk hälsa inom hemsjukvård: -En intervjustudie2014Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Syfte: Syftet med studien var att beskriva distriktssköterskans upplevelse och erfarenhet av att vårda patienter med nedsatt psykisk hälsa inom hemsjukvård.

    Bakgrund: Hemsjukvård är idag ett av de snabbaste växande områdena inom hälso- och sjukvård. Distriktssköterskorna som arbetar inom hemsjukvård möter många olika patientgrupper och har ett brett omvårdnadsansvar. Den psykiska ohälsan i Sverige har kommit att räknas som ett av de verkligt stora folkhälsoproblemen. Distriktssköterskan inom hemsjukvård har en viktig roll att förebygga och hantera hemsjukvårdspatienter med nedsatt psykisk hälsa. 

    Metod: Semistrukturerade intervjuer med åtta distriktssköterskor utfördes. Intervjumaterialet transkriberades och analyserades med kvalitativ innehållsanalys.

    Resultat: Analysen resulterade i två kategorier: Ensam och maktlös samt Göra ett bra arbete och vara tillfreds. Under dessa kategorier formades åtta subkategorier: Otillräcklighet och frustration, Bristande samarbete, Att sakna stöd, Att se patienten, Att skapa förtroende och tillit, Att våga ställa rätt frågor, Att känna stöd och En fungerande hemtjänst.

    Slutsats: Det är betydelsefullt distriktssköterskan ser hemsjukvårdspatienten ur ett helhetsperspektiv och tar del av dennes upplevelser. Resultatet indikerar även att samarbete med andra yrkesgrupper är av stor relevans för distriktssköterskan och det är önskvärt att skapa förutsättningar för detta, både inom hemsjukvårdens yrkesgrupper men även gentemot andra instanser. Vidare visar resultatet att rutiner för och användandet av screeninginstrument omkring bedömning av psykisk nedsatt hälsa saknas, och är något som kan förbättras inom framtida hemsjukvård.

  • 1807.
    Wänstedt, Pernilla
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Örnberg, Ida
    Umeå University, Faculty of Medicine, Department of Nursing.
    Distriktssköterskors och sjuksköterskors upplevelse av att i glesbygd vårda patienter de känner från situationer utanför arbetet2017Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Few studies are performed within the area of the district nurses and the registered nurses experiences of working in rural areas. There are even less studies focusing on the district nurses and the registered nurses experiences of working in rural areas where there is a possibility that you already know the patient from situations outside of work.Aim: To illustrate the district nurses and the registered nurses experiences of in rural areas care for patients they already know from situations form outside of work. Design: Qualitative interview study.Method: Through semi-structured interviews the data was collected during autumn of 2017 from district nurses and registered nurses who worked in rural areas within Västerbottens county, Sweden. Collected data was analyzed by a qualitative content analysis. Result: The results of the study are based on data from seven interviews. The analysis of data resulted in three categories; factors affecting interaction with the patient; to have knowledge of the patient; to be professional with dual identities. Conclusion: All district nurses and registered nurses described positive and negative experiences of in rural areas caring for patients they already know. The result of this study illustrated district nurses and registered nurses experiences of caring for patients they already know, and demonstrate important factors that can contribute to future work and strengthening the profession. There is need for further research on nursing in rural areas because there are few studies, and deeper knowledge is needed to better understand the district nurses and registered nurses occupation.

  • 1808. Wästberg, Birgitta A.
    et al.
    Sandström, Boel
    Pooremamali, Parvin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    A Turning Point Towards Recovery: An Interview Study with Participants in the Culture and Health Programme for Clients with Long-Term Mental Health Disorders in Sweden2019In: Issues in Mental Health Nursing, ISSN 0161-2840, E-ISSN 1096-4673, Vol. 40, no 5, p. 373-381Article in journal (Refereed)
    Abstract [en]

    The study aimed to explore participants' perceptions and experiences of the Culture and Health programme in Sweden for clients with long-term mental health disorders. A qualitative approach with interviews was applied. Grounded Theory guided the analysis and selection of informants. A total of 15 informants were interviewed. A core category 'A turning point in dealing with everyday life beyond the mental illness' with three categories: inner life, social life and occupational life emerged. A theory indicating the importance of asking clients about their expectations, was formulated. Further studies are warranted, including studies of effects.

  • 1809.
    Ylikangas, Malin
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Edström, Josefin
    Umeå University, Faculty of Medicine, Department of Nursing.
    Förekomst och faktorer av relevans gällande sexuella trakasserier inom operationssjukvården2019Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Sexual harassment is a common problem among healthcare professionals and has become more noticeable because of the #metoo movement. Studies show that women are more vulnerable than men, and the harassment affected nurses to perform nursing care and suffer from physical and mental problems.

    Motive: Since sexual harassment can affect the workforce's working capacity, it is important to increase the knowledge of the prevalence and factors of relevance among perioperative nurses.

    Aim: The purpose of the study was to investigate the prevalence of and factors of relevance to sexual harassment among perioperative nurses in Northern Sweden.

    Methods: The study was conducted as a quantitative cross-sectional study with deductive approach. Data was collected via a web-based survey with response options. The study was carried out at two selected hospitals in Northern Sweden and the participants were perioperative nurses. A total of 116 questionnaires were distributed and 42 (36%) of them were answered. VAS scale was used as an instrument and an average value was calculated for each question. Meanvalues <8 were considered to be in need of action.

    Result: The study's results show that 4.7% of respondents have been subjected to sexual harassment at their workplace. The result shows by calculation with Mann-Whitney test, no statistical relationship between groups based on age and professional experience regarding the issues with mean <8. Of the 19 questions asked in the questionnaire, 9 questions had averages <8.

    Discussion: Gender, norms and hierarchy are important for the prevalence of sexual harassment and the phenomenon can be used to exercise power. To aim for a learning organization can mean development of the organization and bring about changes with increased knowledge about sexual harassment. Perioperative nurses who receive education about sexual harassment can reduce the risk of inappropriate behavior being normalized and accepted as part of the work culture.

    Conclusion: More research is needed in Sweden on sexual harassment and the results of this study show a need for improvements at the workplace.

  • 1810. Yoon, Ju Young
    et al.
    Roberts, Tonya
    Grau, Bruce
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing. School of Nursing and Midwifery, La Trobe University, Australia.
    Person-centered Climate Questionnaire-Patient in English: A psychometric evaluation study in long-term care settings2015In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 61, no 1, p. 81-87Article in journal (Refereed)
    Abstract [en]

    Background: There is increasing evidence that person-centered care improves nursing home residents' quality of life. Despite the clear focus of person-centered care on enhancing care for residents and engaging residents in care, there are few options available for measuring person-centered care from the perspective of the elder residents. Objective: The aim of this study was to assess the psychometric properties of the English version of the Person-centered Climate Questionnaire-Patient (PCQ-P) in U.S. long-term care settings. Methods: A total of 189 older adults from six nursing homes in the Midwestern United States were included. Convergent validity and known-group comparison were examined for construct validity. Exploratory factor analysis and second-order confirmatory factor analysis were utilized to examine the factor structure. Reliability was tested using Cronbach's alpha values for internal consistency. Results: This study demonstrated a substantial convergent validity of the PCQ-P in English as higher scores correlated significantly with higher resident life satisfaction (r = 0.459), and the satisfactory construct validity as evidenced by a significantly higher mean PCQ-P score from residents in higher quality nursing homes. Factor analysis demonstrated that the PCQ-P had three factors (hospitality, safety, and everydayness) in U.S. nursing home residents. The PCQ-P showed satisfactory internal consistency reliability (alpha = 0.89). Conclusion: The English version of the PCQ-P is a valid and reliable tool to directly measure the perceptions of the person-centered climate in the U.S nursing homes. The simple and straightforward PCQ-P items are easy to administer to nursing home residents. Consequently, clinical staff can utilize the PCQ-P to assess the unit climate, and evaluate outcomes of person-centered interventions.

  • 1811.
    Zdunek, Eliza
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Demir, Lorin
    Umeå University, Faculty of Medicine, Department of Nursing.
    Tecken på barnmisshandel: En litteraturstudie om radiologiska fynd som kan indikera barnmisshandel2017Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Swedish health care professionals’ knowledge about child abuse has lately been criticized. The radiographer is obligated to report on suspected child abuse and therefore needs to be able to identify these cases.

    Aim: The aim was to describe radiological findings that might indicate child abuse.

    Method: The studies in this literature review were quality assessed, analyzed and processed to compile the results. The results consisted of ten quantitative studies. PubMed and CINAHL were used as search databases.

    Results: The results were presented in three categories: brain injuries and hemorrhages, fractures and ligamentous injuries.

    Conclusion: Common radiological findings that might indicate child abuse are subdural hemorrhages, rib fractures and long bone fractures. Continued research should be conducted to investigate the prevalence of fractures in hands and feet, and also ligamentous injuries of the cervical spine in suspected child abuse.

  • 1812. Zhou, Bin
    et al.
    Bentham, James
    Di Cesare, Mariachiara
    Bixby, Honor
    Danaei, Goodarz
    Cowan, Melanie J.
    Paciorek, Christopher J.
    Singh, Gitanjali
    Hajifathalian, Kaveh
    Bennett, James E.
    Taddei, Cristina
    Bilano, Ver
    Carrillo-Larco, Rodrigo M.
    Djalalinia, Shirin
    Khatibzadeh, Shahab
    Lugero, Charles
    Peykari, Niloofar
    Zhang, Wan Zhu
    Lu, Yuan
    Stevens, Gretchen A.
    Riley, Leanne M.
    Bovet, Pascal
    Elliott, Paul
    Gu, Dongfeng
    Ikeda, Nayu
    Jackson, Rod T.
    Joffres, Michel
    Kengne, Andre Pascal
    Laatikainen, Tiina
    Lam, Tai Hing
    Laxmaiah, Avula
    Liu, Jing
    Miranda, J. Jaime
    Mondo, Charles K.
    Neuhauser, Hannelore K.
    Sundstrom, Johan
    Smeeth, Liam
    Soric, Maroje
    Woodward, Mark
    Ezzati, Majid
    Abarca-Gomez, Leandra
    Abdeen, Ziad A.
    Rahim, Hanan Abdul
    Abu-Rmeileh, Niveen M.
    Acosta-Cazares, Benjamin
    Adams, Robert
    Aekplakorn, Wichai
    Afsana, Kaosar
    Aguilar-Salinas, Carlos A.
    Agyemang, Charles
    Ahmadvand, Alireza
    Ahrens, Wolfgang
    Al Raddadi, Rajaa
    Al Woyatan, Rihab
    Ali, Mohamed M.
    Alkerwi, Ala'a
    Aly, Eman
    Amouyel, Philippe
    Amuzu, Antoinette
    Andersen, Lars Bo
    Anderssen, Sigmund A.
    Angquist, Lars
    Anjana, Ranjit Mohan
    Ansong, Daniel
    Aounallah-Skhiri, Hajer
    Araujo, Joana
    Ariansen, Inger
    Aris, Tahir
    Arlappa, Nimmathota
    Aryal, Krishna
    Arveiler, Dominique
    Assah, Felix K.
    Assuncao, Maria Cecilia F.
    Avdicova, Maria
    Azevedo, Ana
    Azizi, Fereidoun
    Babu, Bontha V.
    Bahijri, Suhad
    Balakrishna, Nagalla
    Bandosz, Piotr
    Banegas, Jose R.
    Barbagallo, Carlo M.
    Barcelo, Alberto
    Barkat, Amina
    Barros, Aluisio J. D.
    Barros, Mauro V.
    Bata, Iqbal
    Batieha, Anwar M.
    Baur, Louise A.
    Beaglehole, Robert
    Ben Romdhane, Habiba
    Benet, Mikhail
    Benson, Lowell S.
    Bernabe-Ortiz, Antonio
    Bernotiene, Gailute
    Bettiol, Heloisa
    Bhagyalaxmi, Aroor
    Bharadwaj, Sumit
    Bhargava, Santosh K.
    Bi, Yufang
    Bikbov, Mukharram
    Bjerregaard, Peter
    Bjertness, Espen
    Bjokelund, Cecilia
    Blokstra, Anneke
    Bo, Simona
    Bobak, Martin
    Boeing, Heiner
    Boggia, Jose G.
    Boissonnet, Carlos P.
    Bongard, Vanina
    Braeckman, Lutgart
    Brajkovich, Imperia
    Branca, Francesco
    Breckenkamp, Juergen
    Brenner, Hermann
    Brewster, Lizzy M.
    Bruno, Graziella
    Bueno-de-Mesquita, H. B. (as)
    Bugge, Anna
    Burns, Con
    Bursztyn, Michael
    de Leon, Antonio Cabrera
    Cameron, Christine
    Can, Gunay
    Candido, Ana Paula C.
    Capuano, Vincenzo
    Cardoso, Viviane C.
    Carlsson, Axel C.
    Carvalho, Maria J.
    Casanueva, Felipe F.
    Casas, Juan-Pablo
    Caserta, Carmelo A.
    Chamukuttan, Snehalatha
    Chan, Angelique W.
    Chan, Queenie
    Chaturvedi, Himanshu K.
    Chaturvedi, Nishi
    Chen, Chien-Jen
    Chen, Fangfang
    Chen, Huashuai
    Chen, Shuohua
    Chen, Zhengming
    Cheng, Ching-Yu
    Dekkaki, Imane Cherkaoui
    Chetrit, Angela
    Chiolero, Arnaud
    Chiou, Shu-Ti
    Chirita-Emandi, Adela
    Cho, Belong
    Cho, Yumi
    Chudek, Jerzy
    Cifkova, Renata
    Claessens, Frank
    Clays, Els
    Concin, Hans
    Cooper, Cyrus
    Cooper, Rachel
    Coppinger, Tara C.
    Costanzo, Simona
    Cottel, Dominique
    Cowell, Chris
    Craig, Cora L.
    Crujeiras, Ana B.
    Cruz, Juan J.
    D'Arrigo, Graziella
    d'Orsi, Eleonora
    Dallongeville, Jean
    Damasceno, Albertino
    Dankner, Rachel
    Dantoft, Thomas M.
    Dauchet, Luc
    De Backer, Guy
    de Gaetano, Giovanni
    De Henauw, Stefaan
    De Smedt, Delphine
    Deepa, Mohan
    Dehghan, Abbas
    Delisle, Helene
    Deschamps, Valerie
    Dhana, Klodian
    Di Castelnuovo, Augusto F.
    Dias-da-Costa, Juvenal Soares
    Diaz, Alejandro
    Dickerson, Ty T.
    Do, Ha T. P.
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    Donfrancesco, Chiara
    Donoso, Silvana P.
    Doering, Angela
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    Eggertsen, Robert
    Ekelund, Ulf
    El Ati, Jalila
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    Foo, Leng Huat
    Forslund, Ann-Sofie
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Forsner, Maria
    Umeå University, Faculty of Medicine, Department of Nursing. Högskolan Dalarna.
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    Herqutanto,
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    Janszky, Imre
    Jasienska, Grazyna
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    Jiang, Chao Qiang
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    Juolevi, Anne
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    Koziel, Slawomir
    Kristensen, Peter Lund
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    Luksiene, Dalia
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    Maria Navarrete-Munoz, Eva
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    Sarrafzadegan, Nizal
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    Söderberg, Stefan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Solfrizzi, Vincenzo
    Sonestedt, Emily
    Song, Yi
    Sorensen, Thorkild I. A.
    Jerome, Charles Sossa
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    Sung, Yn-Tz
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    Tang, Xun
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    Topor-Madry, Roman
    Jose Tormo, Maria
    Torrent, Maties
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    Trichopoulou, Antonia
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    Verstraeten, Roosmarijn
    Victora, Cesar G.
    Viet, Lucie
    Viikari-Juntura, Eira
    Vineis, Paolo
    Vioque, Jesus
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    Viswanathan, Bharathi
    Vollenweider, Peter
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    Vrijheid, Martine
    Wade, Alisha N.
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    Walton, Janette
    Mohamud, Wan Nazaimoon Wan
    Wang, Ming-Dong
    Wang, Qian
    Wang, Ya Xing
    Wannamethee, S. Goya
    Wareham, Nicholas
    Wederkopp, Niels
    Weerasekera, Deepa
    Whincup, Peter H.
    Widhalm, Kurt
    Widyahening, Indah S.
    Wiecek, Andrzej
    Wijga, Alet H.
    Wilks, Rainford J.
    Willeit, Peter
    Williams, Emmanuel A.
    Wilsgaard, Tom
    Wojtyniak, Bogdan
    Wong, Tien Yin
    Wong-McClure, Roy A.
    Woo, Jean
    Wu, Aleksander Giwercman
    Wu, Frederick C.
    Wu, Shou Ling
    Xu, Haiquan
    Yan, Weili
    Yang, Xiaoguang
    Ye, Xingwang
    Yiallouros, Panayiotis K.
    Yoshihara, Akihiro
    Younger-Coleman, Novie O.
    Yusoff, Ahmad F.
    Zambon, Sabina
    Zdrojewski, Tomasz
    Zeng, Yi
    Zhao, Dong
    Zhao, Wenhua
    Zheng, Yingffeng
    Zhu, Dan
    Zimmermann, Esther
    Zuniga Cisneros, Julio
    Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19.1 million participants2017In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 389, no 10064, p. 37-55Article in journal (Refereed)
    Abstract [en]

    Methods: For this analysis, we pooled national, subnational, or community population-based studies that had measured blood pressure in adults aged 18 years and older. We used a Bayesian hierarchical model to estimate trends from 1975 to 2015 in mean systolic and mean diastolic blood pressure, and the prevalence of raised blood pressure for 200 countries. We calculated the contributions of changes in prevalence versus population growth and ageing to the increase in the number of adults with raised blood pressure.

    Findings: We pooled 1479 studies that had measured the blood pressures of 19·1 million adults. Global age-standardised mean systolic blood pressure in 2015 was 127·0 mm Hg (95% credible interval 125·7–128·3) in men and 122·3 mm Hg (121·0–123·6) in women; age-standardised mean diastolic blood pressure was 78·7 mm Hg (77·9–79·5) for men and 76·7 mm Hg (75·9–77·6) for women. Global age-standardised prevalence of raised blood pressure was 24·1% (21·4–27·1) in men and 20·1% (17·8–22·5) in women in 2015. Mean systolic and mean diastolic blood pressure decreased substantially from 1975 to 2015 in high-income western and Asia Pacific countries, moving these countries from having some of the highest worldwide blood pressure in 1975 to the lowest in 2015. Mean blood pressure also decreased in women in central and eastern Europe, Latin America and the Caribbean, and, more recently, central Asia, Middle East, and north Africa, but the estimated trends in these super-regions had larger uncertainty than in high-income super-regions. By contrast, mean blood pressure might have increased in east and southeast Asia, south Asia, Oceania, and sub-Saharan Africa. In 2015, central and eastern Europe, sub-Saharan Africa, and south Asia had the highest blood pressure levels. Prevalence of raised blood pressure decreased in high-income and some middle-income countries; it remained unchanged elsewhere. The number of adults with raised blood pressure increased from 594 million in 1975 to 1·13 billion in 2015, with the increase largely in low-income and middle-income countries. The global increase in the number of adults with raised blood pressure is a net effect of increase due to population growth and ageing, and decrease due to declining age-specific prevalence.

    Interpretation: During the past four decades, the highest worldwide blood pressure levels have shifted from high-income countries to low-income countries in south Asia and sub-Saharan Africa due to opposite trends, while blood pressure has been persistently high in central and eastern Europe.

  • 1813. Ziebland, Sue
    et al.
    Rasmussen, Birgit
    MacArtney, John
    Hajdarevic, Senada
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sand Andersen, Rikke
    How wide is the Goldilocks Zone in your health system?2019In: Journal of Health Services Research and Policy, ISSN 1355-8196, E-ISSN 1758-1060, Vol. 24, no 1, p. 52-56Article in journal (Refereed)
    Abstract [en]

    In astrophysics, the 'Goldilocks Zone' describes the circumstellar habitable zone, in which planets, sufficiently similar to Earth, could support human life. The children's story of Goldilocks and the Three Bears, one of the most popular fairy tales in the English language, uses this metaphor to describe conditions for life that are neither too hot nor too cold and neither too close to the sun nor too far from its warmth. We propose that the 'Goldilocks Zone' also offers an apt metaphor for the struggle that people face when deciding if and when to consult a health care provider with a possible health problem. Drawing on decades of research in Denmark, England and Sweden on people's accounts of their experiences of accessing health care, this essay considers the ambivalence of health care seeking that individuals face in identifying when it is 'just right' to consult a general practitioner and the steps that health systems and individual clinicians might take to widen the zone.

  • 1814.
    Zingmark, Lisa
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Holmqvist, Anna-Sara
    Umeå University, Faculty of Medicine, Department of Nursing.
    ”Jag försöker att vara som en syster för dem”: Kulturdoulans erfarenheter av att möta nyanlända kvinnor före, under och efter förlossning2017Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Objective: To illuminate the cultural doula’s experiences of meeting newly arrived women before, during and after childbirth. Design: A qualitative method with inductive approach was used. Data was collected through qualitative semistructured interviews and analyzed by qualitative content analysis.

    Settings: The womens clinic in a city in northern Sweden. Participants: Cultural doulas who continuously participated in childbirth. Findings: The analysis resulted in three main categories: The influence of culture, A driving force to help and wanting to develop oneself, The cultural doula is a link between language and emotions Key conclusions: According to the cultural doula, she is a link between language and culture. It is common that the cultural doula has given birth her self as well as assisted other in childbirth. Through her own experience and education she has good knowledge of care during childbirth. This combined with being able to talk several languages and being present throughout the the childbirth creates a sense of safety for the woman according to the cultural doula. She always take sides with the woman and does the utmost for her to have a positive experience. The cultural doula can often fill the role of a close female relative or friend. Implications for practice: The number of asylum seekers in Sweden is expected to remain at a high level. This will mean that midwives will meet many women born outside of Nordic countries from different cultures. The maternety mortality in Sweden is low, however, of those affected, women born abroad are in majority, which has been shown to be caused mostly by language barriers. The cultural doula project is relatively new and local but will hopefully expand to include the antenatal care and the period after the childbirth and to be more widely distributed nationally. 

  • 1815. Zoffmann, Vibeke
    et al.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Storbaekken, Solveig
    Graue, Marit
    Rasmussen, Bodil
    Wahl, Astrid
    Kirkevold, Marit
    Translating person-centered care into practice: a comparative analysis of motivational interviewing, illness-integration support, and guided self-determination2016In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 99, no 3, p. 400-407Article in journal (Refereed)
    Abstract [en]

    Objective: Person-centred care [PCC] can engage people in living well with a chronic condition. However, translating PCC into practice is challenging. We aimed to compare the translational potentials of three approaches: motivational interviewing [MI], illness integration support [IIS] and guided self-determination [GSD]. Methods: Comparative analysis included eight components: (1) philosophical origin; (2) development in original clinical setting; (3) theoretical underpinnings; (4) overarching goal and supportive processes; (5) general principles, strategies or tools for engaging peoples; (6) health care professionals' background and training; (7) fidelity assessment; (8) reported effects. Results: Although all approaches promoted autonomous motivation, they differed in other ways. Their original settings explain why IIS and GSD strive for life-illness integration, whereas MI focuses on managing ambivalence. IIS and GSD were based on grounded theories, and MI was intuitively developed. All apply processes and strategies to advance professionals' communication skills and engagement; GSD includes context-specific reflection sheets. All offer training programs; MI and GSD include fidelity tools. Conclusion: Each approach has a primary application: MI, when ambivalence threatens positive change; IIS, when integrating newly diagnosed chronic conditions; and GSD, when problem solving is difficult, or deadlocked. Practice Implications: Professionals must critically consider the context in their choice of approach. (C) 2015 Elsevier Ireland Ltd. All rights reserved.

  • 1816.
    Älander, Martin
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Arvidsson, Anton
    Umeå University, Faculty of Medicine, Department of Nursing.
    Det sexuella orosmolnet: Finns det ett samband mellan oro/ångest/nedstämdhet och sexuell aktivitet samt hur det påverkar den upplevda sexualfunktionen bland män med prostatacancer?2015Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Prostate cancer is the most common form of cancer among men in Sweden. Many people that are diagnosed or going through treatment for the disease experiences negative side effects. It´s not uncommon with side effects that give problems with sexual health.

    Aim: The objective of the study is to investigate the connection between problems with worry/anxiety/depression and sexual activity and perceived sexual function for men with prostate cancer.

    Method: This study was conducted as a quantitative cross-sectional study, as part of a larger ongoing study, with data collected from members in the SPCF (Svenska Prostatacancer Förbundet) with help of questionnaires. Data collected from 3165 men who regardless of treatment and age were analyzed and studied by division into two groups.

    Results: The results showed that men who has problems with any form of worry/anxiety/depression are less sexually active than men who not had problems. It also shows that men with less sexual activity think themselves as less satisfied than men with no problems.

    Conclusion: The study shows that there is a connection between worry/anxiety/depression and sexual activity and perceived sexual function on men with prostate cancer. Various finds have been discovered in the study and knowledge gaps have been illustrated. Nurses can use the schedule as a help whit their work about the sexual health.

  • 1817.
    Åberg Zingmark, Ida
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Larsson, Susanna
    Umeå University, Faculty of Medicine, Department of Nursing.
    Stöd, kunskap och inre resurser: En kvalitativ litteraturstudie om vad som främjar egenvården för personer med diabetes typ 22019Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Diabetes type 2 is a worldwide growing public disease. In order to avoid complications and maintain good health, a functioning self management is required. There are many barriers to self management, but the promotion aspects of self management should also be highlighted in order to increase the conditions for good disease control. This will gain health care professionals more knowledge about how to meet individual needs in the future.

    Objective: The aim of this study was to highlight experienced self management facilitators among people with type 2 diabetes.Method: A qualitative literature study which included 11 studies was conducted. A quality review was made, and the results of all studies were analyzed and compiled.

    Result: The experienced facilitators in self management among people with type diabetes was presented in three main categories: Support, Knowledge and Internal resources. Support included support from family and significant others, healthcare professionals, fellow patients, assistive devices and belief. Knowledge was based on group education and information, while internal resources consisted of attitude and driving forces.

    Conclusion: Support, knowledge and internal resources was identified as self management facilitators among people with type 2 diabetes. Self management is acomplex individual phenomenon that changes during the patients’ course of life. To be able to meet their needs, a person-centered approach is therefore recommended for health care professionals.

    Keywords: Diabetes type 2, experiences, facilitators, self management, support.

  • 1818.
    Ågren, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Burland, Cecilia
    Umeå University, Faculty of Medicine, Department of Nursing.
    Vågar jag berätta?: Kvinnors upplevelser i mötet med vårdpersonal efter att de utsatts för våld i en nära relation – En litteraturstudie2016Independent thesis Basic level (university diploma), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Vågar jag berätta?

    Kvinnors upplevelser i mötet med vårdpersonal efter att de utsatts för våld i en nära relation – En litteraturstudie

    Abstrakt

    Bakgrund: Våld i nära relationer (IPV) är ett globalt problem som påverkar såväl individ som samhälle. Mörkertalet är stort. Kvinnors möte med vårdpersonal innebär en unik möjlighet att identifiera våldsutsatthet.

    Syfte: Att belysa kvinnors upplevelser i mötet med vårdpersonal efter att de blivit utsatta för IPV.

    Metod: En litteraturstudie bestående av åtta kvalitativa studier analyserades och sammanställdes genom manifest innehållsanalys. Databassökning genomfördes i databaserna PubMed, Cinahl och PsycINFO.

    Resultat: Fyra kategorier och fjorton underkategorier identifierades:“Att delge våldsutsatthet” - Tillit till vårdpersonal, Stöd från vårdpersonal.“Hinder att delge våldsutsatthet” - Bristande tillit till vårdpersonal, Bristande stöd från vårdpersonal, Att inte tillfrågas om våld, Rädsla för förövaren och inte bli betrodd. “Bristfällig vårdrelation” - Anklagad av vårdpersonal, Ignorerad av vårdpersonal, Fokus ligger på fysiska skador, Bristande information. “Gynnsam vårdrelation” - Empatisk och icke-dömande förhållningssätt, Bekräftelse från vårdpersonal, Hjälp att nå insikt, Trygg omgivning.

    Konklusion: Våldsutsatta kvinnors vårdbehov blev ofta förbisedda. Vårdpersonalens förhållningssätt hade stor inverkan på kvinnors benägenhet att avslöja våldsutsatthet. Kunskap om kvinnors upplevelse av en stödjande vårdrelation kan främja upptäckt av våldsutsatthet, vilket ger ökad förutsättning för god omvårdnad.

    Nyckelord: Våld i nära relationer, kvinnor, upplevelse, vårdpersonal.

  • 1819.
    Ågren, Caroline
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Troeng, Sofia
    Umeå University, Faculty of Medicine, Department of Nursing.
    Intubationstidens betydelse för utveckling av delirium hos CABG opererade patienter: En kvantitativ registerstudie2019Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Delirium is a common complication after heart surgery that can cause suffering to the patient and lead to short-and long-term consequences such as increased mortality and risk for dementia. Delirium increases health care costs. As a specialized nurse in an intensive care unit you have an important task in preventing delirium by regarding triggering factors.

    Motive: The development of delirium after heart surgery is a growing problem. The relationship between intubation time and developing delirium is poorly studied. Aim: The aim of the study was to examine if there was a relation between intubation time and the development of delirium in CABG operated patients.

    Methods: The study was performed as a register study with a quantitative design and a consecutive selection from the register Carath. 303 participants were included in the study. The studied variables were intubation time, age, preoperative hemoglobin, preoperative creatinine, BMI and gender. Data was analyzed in SPSS Statistics and were presented by descriptively with medians and percentages and comparingly with Chi2 for independence and Mann Whitney u-test. A logistic regression was carried out to investigate how large the coefficient of determination was regarding intubation time and development of delirium controlled for other variables.

    Result: There was a relation between intubation time (p=0,0048), age (p=0,006), and the development of delirium after CABG operation. The other variables did not show any correlation of significance.

    Discussion: The result that showed a connection between age, intubation time and delirium can be confirmed in other studies, as well as the non-existing significance between BMI, gender and preoperative hemoglobin. In our study we found that there was no correlation between preoperative creatinine and development of delirium which differs against previous studies.

    Conclusion: The correlation between delirium and intubation time could mean that as a specialized nurse in an intensive care unit you can prevent delirium by extubating the patient earlier. An early extubation saves the patient from long- and short-term complications as well as unnecessary suffering. For us as nurses, a reduced incidence of delirium would lead to less workload and improved work environment. For healthcare and society this could lead to reduced costs.

  • 1820.
    Åhlin, Cecilia
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Taivalsaari, Isabell
    Umeå University, Faculty of Medicine, Department of Nursing.
    Förstoppning hos vårdtagare med kognitiv nedsättning i särskilda boenden2015Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Aim and objectives. The aim of this study was to chart the occurrence of and significant factors of constipation among residents with cognitive impairment that live in residential care settings in Västerbotten.

    Background. Most research on constipation focuses on treatment, causes, costs and how constipation affects the quality of life. Few scientific articles focus on residents with cognitive impairment that suffer from constipation.

    Design. A quantitative cross-sectional study

    Methods. This study was part of a larger cross-sectional study. Data was collected through the instrument Multi-Dimensional Dementia Assessment Scale. A total of 1469 residents met the inclusion criteria for this study. The questions has been answered by a member of the staff who knows the resident best. Constipation in this study is referred to that the staff has determined that the resident has constipation.

    Results. The study revealed that 41% of the total population were constipated. It also showed that a higher proportion in the group with constipation used physical violence (22,1% vs 15,8%), beat other residents(14,5% vs 10,0%) and screamed or shout persistently (21,7% vs 14,3%). It also revealed that a higher proportion in the group with constipation had more pain (63,6% vs 53,5%)  and more severe speech disorders (16,2% vs 8,3%) and often lacked the ability to walk independently (53,2% vs 34%) and were more often subjected to physical restraint (21,6% vs 11,5%). 

    Conclusion and relevance to clinical practice. This study highlights the nurses’ role in interpreting residents’ behavioral symptoms as possible communication about basic needs such as defecation. Our study also illustrates that more research is needed on how residents with cognitive impairment communicate, so that the quality of their care can be improved. This new research could minimize the risk of errors with medicines and decrease physical impairment.

  • 1821.
    Åhlin, Johan
    Umeå University, Faculty of Medicine, Department of Nursing.
    Stress of conscience and burnout among healthcare personnel working in residential care of older people2015Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background This thesis was part of the research programme ‘Stress of Conscience and Burnout among Healthcare Personnel in Elderly Care’ at Umeå University. Relationships have been found between stress of conscience, perception of conscience, burnout, and social support. No longitudinal studies investigating these relationships have been performed previously, thus it was not known how these relationships develop over time. Neither was it known how stress of conscience and other phenomena of importance might vary between organisations because no comparative studies have been performed. It seems important to organize the care of older people in such a way that healthcare personnel can stay healthy at their workplace, especially because the aging population is expected to grow. Studies have shown that stress of conscience is associated with the well being of healthcare personnel and the quality of care they provide. In order to develop measures against stress of conscience, it seems important to gain a deeper understanding of the aspects in daily work that can generate troubled conscience among healthcare personnel.

     

    Aim The overall aim of this thesis was to describe, compare, and investigate longitudinal relationships between stress of conscience, perceptions of conscience, burnout, social support and person-centred care among healthcare personnel working in two different organisations for residential care of older people. Furthermore, the aim was to deepen the understanding of some aspects of importance that generate troubled conscience at each of the two organisations. Based on the emerging knowledge from the research programme and the results from studies І and ІІ, important aspects that can generate troubled conscience among healthcare personnel were shown to be working with guidelines and working during times of downsizing and reorganisation.

    Methods Studies Ι and ΙΙ took quantitative approaches with a longitudinal design (Ι) and a cross-sectional design (ΙΙ), while studies ΙΙΙ and IV were based on a qualitative approach. In study Ι, the participants were healthcare personnel working in an organisation for residential care of older people with a public mode of operation located in a small town in northern Sweden (baseline n = 488, follow-up n = 277). In study ΙΙ, the participants were healthcare personnel working in two different organisations chosen to be as different from each other as possible regarding their characteristics. In this study, an organisation with a private mode of operation and located in a large city in the south of Sweden (n = 98) was compared to the baseline data from the publically run organisation from the small town in study Ι (n = 488). In studies ΙΙΙ (n = 8) and IV (n = 7), the participants were care providers working at the same public organisation (ΙΙΙ) and private organisation (IV) as in studies Ι and ΙΙ. Quantitative data were analysed using partial least square regression with jack-knife approximate t-tests, hierarchical cluster analysis with multiscale bootstrap resampling, descriptive statistics, hypotheses tests, effect size measures, and confidence intervals. Qualitative data were analysed using qualitative content analysis.

    Results The main results showed that the healthcare personnel reported higher levels of stress of conscience than have been reported in other studies. Perceiving one’s conscience as a burden, having high levels of emotional exhaustion and depersonalisation, and noticing disturbing conflicts between co-workers were positively associated with stress of conscience. Associations between stress of conscience and perceiving one’s conscience as a burden and burnout were similar among healthcare personnel despite the differences in the characteristics of the organisations they worked in. Women reported higher levels of stress of conscience and less social support from their co-workers compared to men. This thesis also provides new insights about how working according to guidelines and during times of downsizing and reorganisation can be burdensome issues for care providers and can generate troubled conscience. An overall understanding of care providers experiences of guidelines in daily work was revealed as struggling to do their best; prioritising between arcane guidelines while keeping the residents’ needs in the foreground.  They described experiences that guidelines were coming from above, were controlling and not sufficiently anchored at their workplace. They also described guidelines as stealing time from residents, colliding with each other, lacking practical use and complicating care, and challenging their judgment. An overall understanding of care providers’ experiences of working  during times of downsizing and reorganisation was revealed as perceiving oneself as pinioned in between current circumstances to provide care and what one’s conscience conveyed. They perceived loss of good management, changed working conditions as exhausting and activating their conscience. They also expressed how they perceived troubled conscience when working conditions decreased the quality of care.

    Conclusion The results is reflected on in relation to a nursing care model as it seems important to understand the results from a society- and organizational perspective as well as from an individual perspective. The results of the thesis show that it is important to provide healthcare personnel with opportunities to follow and express what their conscience tells them at their workplace in order to buffer the effects of stress of conscience. Support, knowledge, involvement, time, and additional resources are key issues that can help care providers to work more constructively with guidelines in their daily practice. The results show that in times of downsizing and reorganisation it is important to exercise leadership that promotes care providers’ feelings of involvement, security, and togetherness in order to relieve some of the healthcare personnel’s burdensome experiences. An overall understanding of the results is that it seems important to organize the residential care of older people in such a way that registered nurses and leaders are able to be present in healthcare personnel’s daily practice. Healthcare personnel need attendant and supportive leaders who can help them to solve various forms of work-related problems and to help them make priorities in the daily care of residents. This seems important regardless of whether the priorities are between guidelines and residents’ needs or a consequence of an increasingly stressful work environment during times of downsizing and reorganisation. Further studies are needed in order to investigate the importance of gender in relation to stress of conscience and if different kinds of support are needed for women than for men in order to buffer the effects of stress of conscience. Finally, more longitudinal multilevel studies are needed in order to investigate how organisations’ characteristics and organisational changes affect healthcare personnel’s levels of stress of conscience.

  • 1822.
    Åhlin, Johan
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Ericson-Lidman, Eva
    Umeå University, Faculty of Medicine, Department of Nursing.
    Eriksson, Sture
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing.
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Longitudinal relationships between stress of conscience and concepts of importance2013In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 20, no 8, p. 927-942Article in journal (Refereed)
    Abstract [en]

    The aim of this observational longitudinal cohort study was to describe relationships over time between degrees of stress of conscience, perceptions of conscience, burnout scores and assessments of person-centred climate and social support among healthcare personnel working in municipal care of older people. This study was performed among registered nurses and nurse assistants (n = 488). Data were collected on two occasions. Results show that perceiving one's conscience as a burden, having feelings of emotional exhaustion and depersonalization and noticing disturbing conflicts between co-workers were positively associated with stress of conscience. No significant changes were observed during the year under study, but degrees of stress of conscience and burnout scores were higher than in previous studies, suggesting that downsizing and increased workloads can negatively affect healthcare personnel. Following and expressing one's conscience in one's work, and perceiving social support from superiors are of importance in buffering the effects of stress of conscience.

  • 1823.
    Åhlin, Johan
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Ericson-Lidman, Eva
    Umeå University, Faculty of Medicine, Department of Nursing.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing. Ersta Skondal Univ Coll, Stockholm, Sweden.
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Department of Nursing.
    A comparison of assessments and relationships of stress of conscience, perceptions of conscience, burnout and social support between healthcare personnel working at two different organizations for care of older people2015In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 29, no 2, p. 277-287Article in journal (Refereed)
    Abstract [en]

    AIM: The aim of this cross-sectional, descriptive study was to compare assessments and relationships of stress of conscience, perceptions of conscience, burnout and social support between healthcare personnel (HCP) working in two different organisations for care of older people.

    METHODS: This cross-sectional, descriptive comparative study was performed among Registered Nurses and nurse assistants working in two different organisations (n(1)  = 98, n(2)  = 488) for residential care of older people. The organisations were chosen to be as different as possible, and data were collected using four different questionnaires. Hierarchical cluster analysis with multiscale bootstrap resampling was used to compare the associations between all items in the questionnaires. Descriptive statistics, 95% confidence intervals, chi-squared tests, Cohen's d, Cramer's V and the φ coefficient were all used to judge differences between the organisations.

    RESULTS: The associations between stress of conscience, perceiving one's conscience as a burden, and burnout were similar in both organisations. Perceiving one's conscience as far too strict and having a troubled conscience from being unable to live up to one's standards were associated with stress of conscience and burnout in one organisation. Women had higher levels of stress of conscience and reported lower social support from co-workers compared with men.

    CONCLUSIONS: This study shows that associations between perceptions of conscience, stress of conscience and burnout are common experiences that are similar among HCP despite great differences in the characteristics of organisations. It can be burdensome for HCP to be unable to realise their ambitions to provide good care, and sex/gender can be an important factor to consider in the development of measures against the negative effects of stress of conscience. More studies are needed about how HCP's ambition to provide good care and sex/gender are related to perceptions of conscience, stress of conscience and burnout.

  • 1824.
    Åhlin, Johan
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Ericson-Lidman, Eva
    Umeå University, Faculty of Medicine, Department of Nursing.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing. Department of Health Care Sciences, Ersta Sköndal University College, Stockholm.
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Care providers' experiences of guidelines in daily work at a municipal residential care facility for older people2014In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 28, no 2, p. 355-363Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Guidelines are used as a way of promoting high-quality health care. Most research concerning guidelines has focused on physician behaviour and to improve one specific aspect of care. Care providers working within municipal residential care of older people have described that working with multiple guidelines sometimes exposed them to contradictory demands and trouble their conscience.

    AIM: To describe care providers' narrated experiences of guidelines in daily work at a municipal residential care facility for older people.

    DESIGN: A qualitative descriptive design was adopted.

    METHODS: Interviews with eight care providers were carried out between February and March 2012 and analysed by qualitative content analysis.

    RESULTS: Care providers described experiences that guidelines are coming from above and are controlling and not sufficiently anchored at their workplace. Furthermore, they described guidelines as stealing time from residents, colliding with each other, lacking practical use and complicating care, and challenging care providers' judgment. The overall understanding is that care providers describe experiences of struggling to do their best, prioritising between arcane guidelines while keeping the residents' needs in the foreground.

    CONCLUSION: In order to prevent fragmented use, guidelines have to be coordinated and adapted to the reality of daily practice before implementation. It seems essential to provide opportunities for discussions between care providers, registered nurses and management about how to make guidelines work within their daily practice. Sufficient support, knowledge and involvement are likely key issues that can help care providers to constructively work according to guidelines and thus, by extension, improve the quality of care.

  • 1825.
    Åhlin, Johan
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Ericson-Lidman, Eva
    Umeå University, Faculty of Medicine, Department of Nursing.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing.
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Revalidation of the perceptions of conscience questionnaire (PCQ) and the stress of conscience questionnaire (SCQ)2012In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 19, no 2, p. 220-232Article in journal (Refereed)
    Abstract [en]

    The Perceptions of Conscience Questionnaire (PCQ) and the Stress of Conscience Questionnaire (SCQ) have previously been developed and validated within the 'Stress of Conscience Study'. The aim was to revalidate these two questionnaires, including two additional, theoretically and empirically significant items, on a sample of healthcare personnel working in direct contact with patients. The sample consisted of 503 healthcare personnel. To test variation and distribution among the answers, descriptive statistics, item analysis and principal component analysis (PCA) were used to examine the underlying factor structure of the questionnaires. Support for adding the new item to the PCQ was found. No support was found for adding the new item to the SCQ. Both questionnaires can be regarded as valid for Swedish settings but can be improved by rephrasing some of the PCQ items and by adding items about private life to the SCQ.

  • 1826.
    Åhlin, Johan
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing. Department of Health Care Sciences, Ersta Sköndal University College, Sweden.
    Ternestedt, Britt-Marie
    Ericson-Lidman, Eva
    Umeå University, Faculty of Medicine, Department of Nursing.
    Care providers’ narrated experiences of working in private non-profit residential care for older people during downsizing and reorganisation, focusing on troubled conscience2017In: Nordic journal of nursing research, ISSN 2057-1585, E-ISSN 2057-1593, Vol. 37, no 4, p. 177-185Article in journal (Refereed)
    Abstract [en]

    Knowledge about care providers’ experiences of working in residential care of older people during times of downsizing and reorganisation is scarce, and it is not known whether/how their conscience is influenced by such changes. The aim was to describe care providers’ experiences of working in private residential care for older people during downsizing and reorganisation, focusing on troubled conscience. This study adopted a qualitative descriptive design based on interviews with seven care providers. A qualitative content analysis was used. The overall understanding was revealed as perceiving oneself as pinioned in between current circumstances to provide care and what one’s conscience conveyed. Care providers perceived: deteriorating working conditions as exhausting, downsizing and reorganisation as triggering one’s conscience when collaborating, troubled conscience when downsizing and reorganisation decrease the quality of care, and good management as crucial during downsizing and reorganisation. The results highlight that adequate communication strategies, well-functioning leadership and opportunities to know together and share what one’s conscience tells are aspects that need consideration.

  • 1827.
    Åkerlind, Johanna
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Stål, Lina
    Umeå University, Faculty of Medicine, Department of Nursing.
    Barns erfareneter av att leva med en förälder som lider av psykisk ohälsa.: En litteratur studie.2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    BACKGROUND: Having a parent with mental illness often means increasedresponsibility for the child, for example helping out at home or taking care of siblingsare common tasks. A constant feeling of having to be available in case anythinghappens makes it very unpredictable wich is described stressful by children. In themajority of science the children often falls behind.AIM: To describe a childs experience of living with a parent who suffer from mentalillness.METHOD: The literature consists of 8 articles with qualitative design of wich theresult has been quality examined, analysed and compiled. Searches were made in thedatabases of CINAHL, Pubmed and Scopus.RESULTS: The research emerged three clear categories in the result: Anxiety aboutthe parents mental illness, otherness of the family life and the need of support andinformation. Feelings like sadness, worries, fear, anger and envy was described inmany studies, while the love of the parent was strong despite the illness.CONCLUSION: A child to a parent with mental illness often tend to be neglected.To be able to deal with life and the consequenses of mental illness everyone in thefamily will need support in different ways. Parents and health professionals need tobe better informing the child about the illness, what it does and how it shows.

  • 1828.
    Åkerlund, Britt Mari
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Umeå University, Faculty of Medicine, Department of Nursing.
    Dementia care in an ethical perspective: an exploratory study of caregivers' experiences of ethical conflicts when feeding severely demented patients1990Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The aim of this study was to explore how caregivers caring for severely demented patients experience ethical conflict situations. Feeding patients in a late state of dementia was chosen as focus. Special attention was paid to analyses of the caregivers' experiences with regard to their feelings, use of force, interpretations of the patients' behaviour and their ethical reasoning.

    The study was carried out in five separate parts, presented as five papers. A phenomenological - hermeneutic approach was consistent. Personal interviews, a projective defence mechanism test, the Meta Contrast Technique and an analysis of patient/caregiver behaviour as shown in video taped feeding sessions were the methods used.

    Study participants were forty-one caregivers in psychogeriatric care, registered nurses, licensed practical nurses and nurses' assistants.

    The result indicated that, when facing ethical decisions the caregivers were caught in a double bind conflict due to the contradicting ethical demands "Keep the patient alive!" and "Don't cause the patient suffering!". The difficulty to interpret what the patients experienced and the impossibility to know for sure what actions would be right or wrong were sources of anxiety. They defined force feeding individually, yet a pattern was found. Some caregivers defined force feeding according to the amount of persuasiveness or violence they had to perform. Some regarded force feeding from a patient wish perspective. A majority combined the two dimensions.

    The caregivers' ethical reasoning showed that their decision making was to be regarded as a process grounded on ethical rules. Interdependence in the relation caregiver/patient made them develop their reasoning in a direction of existential reasoning.

  • 1829.
    Åkerman, Lisa
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Holmström, Malin
    Umeå University, Faculty of Medicine, Department of Nursing.
    Vårdpersonals erfarenheter av hot och våld inom psykiatrin: En litteraturstudie2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    ABSTRACT Title: Healthcare professionals experience of threats and violence within the psychiatric care: A literature review Background: During 2014, 78 percent of Swedish nurses in psychiatric care reported that they had been exposed to work-related violence. Systematic overview studies where health professionals 'experiences of threats and violence in psychiatric care have been investigated are missing and can contribute to an increased understanding of the healthcare professionals' experience and can improve nursing work with patients who have demonstrated this behavior. Aim: The aim of the study is to describe health professionals' experiences of threats and violence in psychiatric care. Methods: Nine qualitative articles were examined, analyzed and compiled in a literature review. Searches for relevant studies were done in Cinahl, PubMed and PsycINFO. Results: The analysis resulted in three categories "Emotional distress adversely affect nursing, the individual and personal life", "Need for coping and management strategies" and "Need for organizational and personal support". Conclusions: Results showed that threats and violence lead to negative feelings in healthcare professionals who adversely affect nursing work, privacy and self-esteem. Results showed that healthcare personnel normalize violence and develop strategies for managing and preventing violence. Results showed that healthcare staff experienced insufficient support from managers and colleagues and highlighted the importance of support for recovery. Healthcare professionals could, with increased support and person-centered care, possibly contribute to the prevention of threats and violence and for it to be easier to manage, but more studies are needed.

  • 1830.
    Åkerström, Victoria
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Brodersen, Thomas
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sjuksköterskans attityder och förhållningssätt gentemot personer med benign långvarig smärta.2014Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
  • 1831.
    Ålander, Linda
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Rubensson, Ulrika
    Umeå University, Faculty of Medicine, Department of Nursing.
    Krav, kontroll och socialt stöd i arbetet hos lärare: En enkätstudie2016Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Syfte: Denna uppsats undersökte den psykosociala arbetsmiljön för lärare i en kommun i mellersta Norrland, Sverige, med hjälp av mätinstrumentet, The Swedish Demand Control Support Questionnaire (DCSQ). Metod: En kvantitativ studie som omfattade 56 grundskollärare. DCSQ är en enkät med 17 frågor som behandlar upplevelser av krav, kontroll och socialt stöd på arbetsplatsen. Resultat: Inga signifikanta skillnader kunde påvisas mellan lärare i låg- och mellanstadiet och högstadiet. Dock indikerade siffrorna att lärare i låg- och mellanstadiet upplever högre krav än sina kollegor i högstadiet. Slutsats: Då deltagarantalet var relativt lågt (45,2%), är det svårt att dra slutsatser av resultatet som kan appliceras på hela populationen (124 lärare). Författarna föreslår vidare kvantitativ och kvalitativ forskning med större studiepopulation som även inkluderar frågor kring krav, kontroll och socialt stöd på fritiden. 

  • 1832.
    Ångqvist, Tobias
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Edblom, Eveline
    Umeå University, Faculty of Medicine, Department of Nursing.
    Personalens utsatthet för våldsamt och aggressivt beteende inom psykiatrisk öppenvård: En tvärsnittsstudie2015Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Abstract Background. Aggressive behavior is common in health care, with consequences such as impaired job satisfaction and burnout. The aim of the study is to investigate the relationship between self-rated exposure to aggressive and violent behavior, and job satisfaction, burnout and sick-leave in psychiatric outpatient care. Design. Cross-sectional study with a quantitative approach. Method. Analysis of data collected in autumn 2014 from a total of 129 respondents was performed in SPSS. The result shows that 20.6% of respondents are often exposed to aggressive behavior and 7.3% are often exposed to violent behavior. No association between being exposed and its impact on job satisfaction and burnout. In contrast the results show significance difference in terms of exposure between studied cities. Conclusion The examined groups are rarely exposed to violent behavior, however, there is a high incidence of aggressive behavior. The job satisfaction were estimated high despite the exposure. Keywords:Aggressive behavior, violent behavior, job satisfaction, burnout, psychiatric outpatient.

  • 1833.
    Ångström Brännström, Charlotte
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Dahlqvist, Vera
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing.
    Descriptions of comfort in the social networks surrounding a dying child2014In: Vård i Norden, ISSN 0107-4083, E-ISSN 1890-4238, Vol. 34, no 113, p. 4-8Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to describe how comforters of one dying child were comforted, described by the child's mother and nurse.

    Background: The death of a child is one of the greatest losses parents can sustain and a stressful experience for nurses. Those who provide comfort may also need comfort, yet little is known about how comforters are comforted.

    Method: The interviews with mother and nurse were analysed using content analysis. Persons and activities mentioned as comforting were outlined in a sociogram.

    Findings: The findings show that the mother received comfort from her child and family, the nurse, extended family and others close to the family. She found comfort in being involved in the care and sharing worries with the nurse and in self-comfort. She described that siblings found comfort in each other, in living everyday life, in music and in expressing their feelings in drawings. The nurse gained comfort from sharing hardships with colleagues and a relative and from making a difference to the child.

    Conclusion: The findings provide a picture of interacting comforting social networks surrounding one dying child.

  • 1834.
    Ångström-Brännström, Charlotte
    Umeå University, Faculty of Medicine, Department of Nursing.
    TRÖST: beskriven av långvarigt sjuka barn, föräldrar och en sjuksköterska2010Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The overall aim of the thesis was to describe experiences of comfort for children with chronic illnesses, and who and what comforted children, parents and one nurse. The thesis comprises four studies and is based on interviews with sick children, parents and one nurse. The children also made drawings.

    In study I the aim was to examine how children with chronic illnesses narrate their experiences of being comforted in the hospital. Seven children 4-10 years old described in interviews their experiences of comfort and made drawings. Thematic content analysis revealed four themes: being physically close to one’s family, feeling safe and secure, staff being there for the children, and children being there for parents and siblings. The findings suggest that trusting the staff’s knowledge and professional skills is a prerequisite for children to feel "at home", and safe in hospital. Being close to one’s family was essential for feeling comforted.

    In study II the aim was to describe what parents narrate as comforting them when their child was suffering from cancer. Interviews were performed with nine parents, eight mothers and one father, of children aged 3-9 years, who were admitted to a pediatric oncology ward and had undergone their first treatment. Content analysis revealed five themes: experiencing comfort from being close to the child, deriving comfort from the child’s strength, from feeling at home on the ward, from being a family and being at home, and deriving comfort from support of social networks. In communion with the child and others, the parents built a new normality perceived as being at home in life, despite all their difficulties. Within the frame of communion the parents experienced moments of hope.

    In study III the aim was to describe what comforted a seriously ill and finally dying child, as revealed by the child, his mother and his nurse. Field notes, drawings and interviews were analyzed using content analysis that revealed four themes: expressing feelings and becoming ready for comfort, being in communion, shifting perspective and finding comfort in feeling at home. Based on the findings, comfort for an ill and finally dying child was interpreted as being about having opportunities to express feelings in the way the child chooses, the family being close and involved in care, and achieving feelings of being at home and having a trustful relationship with a special nurse.

    In study IV the aim was to describe who and what comforted the comforters of a seriously ill and ultimately dying child as described by the child’s mother and nurse. Interviews with a mother and a nurse from study III were analyzed by content analysis and a sociogram was outlined. The findings provided a picture of interacting social networks that can exist around a seriously ill child. The difficult situation meant that the child’s family carried a heavy burden. However, surrounded by a comforting network with which they could share both suffering and responsibility, they were able to find comfort and comfort each other.

    The findings from this thesis show that chronically ill children and parents found comfort from sharing suffering with one another. The parents and the nurse found comfort in sharing suffering and responsibility with persons in their social networks. The model of consolation (Norberg et al, 2001) could be used to give structure to the discussion.

  • 1835.
    Ångström-Brännström, Charlotte
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Dahlqvist, Vera
    Ersta Sköndal University College.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing. Ersta Sköndal University College.
    Victor and the Dragon.: A Young Child's Experiences of Discomfort and Comfort, From Diagnosis Until Death2013In: Journal of Hospice and Palliative Nursing, ISSN 1522-2179, E-ISSN 1539-0705, Vol. 15, no 8, p. 464-470Article in journal (Refereed)
    Abstract [en]

    Children with progressive cancer often suffer during treatment and at the end of their life, and they need comfort. This study's aim was to describe a child's experiences of being cared for until death, with a focus on discomfort and comfort. Conversations, field notes, drawings, and interviews with the child and his mother and nurse were content analyzed. The themes enduring unbearable situations, expressing emotional suffering, and finding comfort were constructed. The children's parents and other family members are often a significant source of help for the children to endure discomfort and find comfort. Emotional suffering can be expressed in drawing and crying, but sometimes, a child is inconsolable and must endure discomfort. Comfort for a dying child is enhanced by having the family close, experiencing normal daily activities such as drawing and playing, and feeling at home in life despite approaching death.

  • 1836.
    Ångström-Brännström, Charlotte
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Engvall, Gunn
    Mullaney, Tara
    Umeå University, Faculty of Science and Technology, Umeå Institute of Design.
    Nilsson, Kristina
    Wickart-Johansson, Gun
    Svärd, Anna-Maja
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Nyholm, Tufve
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Lindh, Jack
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Lindh, Viveca
    Umeå University, Faculty of Medicine, Department of Nursing.
    Children Undergoing Radiotherapy: Swedish Parents' Experiences and Suggestions for Improvement2015In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 10, article id e0141086Article in journal (Refereed)
    Abstract [en]

    Approximately 300 children, from 0 to 18 years old, are diagnosed with cancer in Sweden every year. Of these children, 80-90 of them undergo radiotherapy treatment for their cancer. Although radiotherapy is an encounter with advanced technology, few studies have investigated the child's and the parent's view of the procedure. As part of an ongoing multi-center study aimed to improve patient preparation and the care environment in pediatric radiotherapy, this article reports the findings from interviews with parents at baseline. The aim of the present study was twofold: to describe parents' experience when their child undergoes radiotherapy treatment, and to report parents' suggestions for improvements during radiotherapy for their children. Sixteen mothers and sixteen fathers of children between 2-16 years old with various cancer diagnoses were interviewed. Data were analyzed using content analysis. The findings showed that cancer and treatment turns people's lives upside down, affecting the entire family. Further, the parents experience the child's suffering and must cope with intense feelings. Radiotherapy treatment includes preparation by skilled and empathetic staff. The parents gradually find that they can deal with the process; and lastly, parents have suggestions for improvements during the radiotherapy treatment. An overarching theme emerged: that despair gradually turns to a sense of security, with a sustained focus on and close interaction with the child. In conclusion, an extreme burden was experienced around the start of radiotherapy, though parents gradually coped with the process.

  • 1837.
    Ångström-Brännström, Charlotte
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lindh, Viveca
    Umeå University, Faculty of Medicine, Department of Nursing.
    Mullaney, Tara
    Nilsson, Kristina
    Wickart-Johansson, Gun
    Svärd, Anna-Maja
    Nyholm, Tufve
    Lindh, Jack
    Engvall, Gunn
    Parents’ experiences and responses to an intervention for psychological preparation of children and families during the child’s radiotherapy2018In: Journal of Pediatric Oncology Nursing, ISSN 1043-4542, E-ISSN 1532-8457, Vol. 35, no 2, p. 132-148Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to evaluate parents’ experiences and responses to a systematic intervention for psychological preparation of children and families during the child’s radiotherapy (RT) treatment. In this case-control study at 3 pediatric RT centers, an intervention with a preparatory kit, including age-adjusted information on tablets, gift of a stuffed toy or a pair of headphones, a parent booklet, and toy models of the computed tomography and RT machines was implemented. For evaluation, a mixed methods data collection was conducted. A total of 113 parents of children undergoing RT were included—n = 59 in the baseline group and n = 54 in the intervention group. Health-related quality of life was rated low, but parents in the intervention group expressed less anxiety after the RT compared with the baseline group. They found information suitable for their young children, siblings, and friends were involved and the toy models were used for play. Parents expressed positive feelings due to close interaction with staff and each other within the family. The solutions developed within a human-centered design approach and shaped as a systematic family-centered strategy contributed to parents understanding and coping with the child’s RT.

  • 1838.
    Ångström-Brännström, Charlotte
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lindh, Viveca
    Umeå University, Faculty of Medicine, Department of Nursing.
    Nyholm, Tufve
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Lindh, Jack
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Engvall, Gunn
    Staff's Experiences of Preparing and Caring for Children With Cancer and Their Families During the Child's Radiotherapy2018In: Cancer Nursing, ISSN 0162-220X, E-ISSN 1538-9804Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Approximately one-third of children diagnosed with cancer are treated with radiotherapy (RT). Staff experiences of preparing and distracting the children and their families during a child's RT are sparsely described.

    OBJECTIVE: The aim of this study was to describe staff experiences of preparing and caring for children with cancer and their families during the child's RT.

    INTERVENTION/METHODS: Semistructured interviews with staff were performed at 3 Swedish RT centers. The interviews were analyzed using inductive qualitative content analysis.

    RESULTS: The analysis revealed 5 categories summarizing the staff members' experiences. These include the following: experiences of various emotions; care for the child and the child's family; commitments before, during, and after RT; organizational issues; and experiences of the intervention and suggestions for improvement.

    CONCLUSIONS: The preparatory intervention facilitated the ability of staff members to conduct their work, although the intervention should be specifically tailored to each child. Meeting children and their families and providing care to both during RT were challenging. The staff strived to provide optimal care for each child and family. Interdisciplinary teamwork and organizational acceptance for the importance of preparation and distraction were essential.

    IMPLICATIONS FOR PRACTICE: A future challenge will be to provide opportunities for all staff involved in the treatment of children with cancer to develop their skills continuously in order to provide high-quality preparation and distraction to all children undergoing RT, regardless of the geographical location of the RT center.

  • 1839.
    Ångström-Brännström, Charlotte
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing. Palliative Research Centre, Ersta Sköndal University College, Stockholm, Sweden.
    Comforting measures described by staff working in paediatric units2017In: Nursing children and young people, ISSN 2046-2336, Vol. 29, no 4, p. 24-30Article in journal (Refereed)
    Abstract [en]

    Aim: Children with cancer identify staff members, who work with them in paediatric units, as their most important comforters. This study aimed to shed light on how those staff members deliver this comfort.

    Methods: Semi-structured interviews were performed and the content then analysed. Nine families (n=9) and eight staff members (n=8) participated in the study.

    Findings: The staff described caring for the children and the whole family. They implemented certain comforting measures with the child, and described how they provided support to parents. Staff described how they felt comforted by relating to the children they were caring for.

    Conclusion: Staff working in paediatric units develop good relationships with children and parents and comfort them using methods described in the literature. The quality of the staff's positive relationships with the children marked all their actions.

  • 1840.
    Ångström-Brännström, Charlotte
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing.
    Dahlqvist, Vera
    Umeå University, Faculty of Medicine, Department of Nursing.
    Victor's story: a seriously ill child's experiences of discomfort and comfort from being diagnosed with cancer to dyingManuscript (preprint) (Other academic)
    Abstract [en]

    In this case study, the aim was to describe what comforted a seriously ill and finally dying child, here called Victor, as revealed by the child, his mother and his nurse. Content analysis was performed of analyses of conversations, field notes, drawings, interviews and comments on drawings. In the data comfort was often expressed as releasing extreme discomfort Victor experienced and accordingly four themes describing both discomfort and comfort were formulated in the analysis: Expressing feelings and becoming ready for comfort, Being in communion, Shifting perspective and Finding comfort in feeling at home. By expressing feelings through body language, crying and drawings Victor became ready for comfort and found it through feeling close to loved ones while sharing with them whatever was happening; through experiencing a trustful relationship with his nurse, transforming pressure into play, making plans for the future and maintaining his interests in nature; and through being at home, surrounded by his family’s love and concern. Based on these findings comfort for an ill and finally dying child is interpreted as being about providing the child with opportunities to express feelings in the way the child chooses, enabling the family to be close and involved in care, and supporting feelings of being at home and having a trustful relationship with a special nurse.

  • 1841.
    Ångström-Brännström, Charlotte
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing.
    Jansson, Lilian
    Umeå University, Faculty of Medicine, Department of Nursing.
    Narratives of children with chronic illness about being comforted2008In: Journal of Pediatric Nursing: Nursing Care of Children and Families, ISSN 0882-5963, E-ISSN 1532-8449, Vol. 23, no 4, p. 310-316Article in journal (Refereed)
    Abstract [en]

    The aim of the study was to examine how children with chronic illnesses narrate their experience of being comforted in hospital. During interviews, seven children, 4-10 years old described their experiences and made drawings. Thematic content analysis revealed following themes: being physically close to one's family , feeling safe and secure, staff being there for the children, and children being there for the parents and siblings. Mother was identified as the most important comforter. The findings suggest that trusting in the staff's knowledge and professional skills is a prerequisite for the children to feel "at home", and safe in hospital. Being close to one's family is even more important.

  • 1842.
    Ångström-Brännström, Charlotte
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing.
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Dahlqvist, Vera
    Umeå University, Faculty of Medicine, Department of Nursing.
    Comforting the comforters: descriptions of comfort in the social networks surrrounding a seriously ill and ultimately dying childManuscript (preprint) (Other academic)
    Abstract [en]

    The death of a child is considered to be one of the greatest losses a parent can sustain and an extremely stressful experience for nurses. Those who provide comfort, i.e. the comforters, may also need comfort in this difficult situation yet little is known about who and what comforts comforters. The aim of this study was to describe who and what comforted the comforters of a seriously ill and ultimately dying child, as narrated by the child’s mother and nurse. The interviews with mother and nurse were analysed using content analysis. Persons and activities who comforted were outlined in a sociogram (Figure 1). The findings showed that the mother received comfort from her child and family, the nurse, the extended family and others close to the family. She found comfort in being involved in the care and sharing worries with the nurse and other hospital staff and in self-comfort. Siblings found comfort in each other, in living everyday life and in music and making drawings. The nurse gained comfort from sharing hardships with colleagues and a relative and from making a difference to the child. The findings provide a picture of interacting comforting networks that can surround a seriously ill child.

  • 1843.
    Ångström-Brännström, Charlotte
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing.
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Söderberg, Anna
    Umeå University, Faculty of Medicine, Department of Nursing.
    Dahlqvist, Vera
    Umeå University, Faculty of Medicine, Department of Nursing.
    Parents' experiences of what comforts them when their child is suffering from cancer2010In: Journal of Pediatric Oncology Nursing, ISSN 1043-4542, E-ISSN 1532-8457, Vol. 27, no 5, p. 266-275Article in journal (Refereed)
    Abstract [en]

    The aim of the study was to describe parents' narratives concerning what they find comforting when they have a child suffering from cancer. Interviews were conducted with 9 parents--8 mothers and 1 father--of children aged 3 to 9 years who were admitted to a pediatric oncology ward and had undergone their first treatment. The findings showed that the parents derived comfort from being close to their child, perceiving the child's strength, feeling at home in the ward, being a family and being at home, and receiving support from their social network. Comfort experienced in communion with the child and others became important and helped the parents build a new normality perceived as being at home in life despite all their difficulties. Within the frame of communion, the parents seemed to experience moments of hope for their child's recovery and survival.

  • 1844. Årestedt, K.
    et al.
    Alvariza, A.
    Håkansson, C.
    Ohlen, J.
    Boman, Kurt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Goliath, I.
    Furst, C-J
    Brännström, Margareta
    Umeå University, Faculty of Medicine, Department of Nursing.
    Symptom relief and palliative care during the last week of life among patients with heart failure2017In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, p. S58-S59Article in journal (Refereed)
  • 1845. Årestedt, Kristofer
    et al.
    Alvariza, Anette
    Boman, Kurt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine. Research Unit, Medicine-Geriatric, Skellefteå, Sweden.
    Öhlén, Joakim
    Goliath, Ida
    Håkanson, Cecilia
    Fürst, Carl Johan
    Brännström, Margareta
    Umeå University, Faculty of Medicine, Department of Nursing.
    Symptom Relief and Palliative Care during the Last Week of Life among Patients with Heart Failure: a National Register Study2018In: Journal of Palliative Medicine, ISSN 1096-6218, E-ISSN 1557-7740, Vol. 21, no 3, p. 361-367Article in journal (Refereed)
    Abstract [en]

    Background: Heart failure is a disease with high morbidity, mortality, and physical and psychological burden. More knowledge about the care provided for patients with heart failure close to death is needed.

    Objective: The aim was to describe key aspects of palliative care during the last week of life in patients with heart failure, as reported by healthcare professionals.

    Design: This is a national register study.

    Setting/Subjects: The study included 3981 patients with diagnosed heart failure as the underlying cause of death.

    Measurements: Data were obtained from the Swedish Register of Palliative Care, a national quality register that focuses on patients’ last week of life, independent of diagnosis or care setting. The register includes information about care interventions connected with key aspects of palliative care. Data are reported retrospectively by a nurse or physician at the healthcare unit where the patient dies.

    Results: Only 4.2% of patients with heart failure received specialized palliative care. In their last week of life, symptom prevalence was high, validated scales were seldom used, and symptoms were unsatisfactorily relieved. Around one-fifth (17%) of the patients in the study died alone. Less than half of family members had been offered bereavement support (45%). Moreover, one-third (28%) of the patients and more than half (61%) of the family members were reported to have had end-of-life discussions with a physician during the illness trajectory.

    Conclusion: The results indicate inadequate palliative care for patients with heart failure during their last week of life.

  • 1846.
    Åström, Gunilla
    Umeå University, Faculty of Medicine, Department of Nursing.
    The meaning of caring as narrated, lived, moral experience1995Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The purpose of this research was to understand the meaning of caring as narrated, lived, moral experience. Forty-five good nurses experienced in the care of patients in surgical, medical and geriatric wards were interviewed. They described their experience of; caring, caring abilities, the worthwhile of caring, the strength related to caring and narrated situations (n=88) in which they had experienced that their caring had made a difference to the patient. Surgical nurses described care and cure as an integrated whole, medical nurses described care as integrated with the patients' social context and geriatric nurses described care as enhancing the autonomy of patients (I). The nurses' narrated, lived, experiences of caring situations revealed ways of intervening and interacting with the patient including caring actions (II).

    Eighteen good nurses experienced in the care of cancer patients were also interviewed. Their narrated, lived experiences of morally difficult care situations i.e. situations where it had been hard to know what was the right and good thing to do for the patient (n=60), revealed that relationships with their co-workers were very important for their possibility to act according to their moral reasoning and feelings(III). The situations for the nurses were either disclosed as overwhelming or possible to grasp. When narrating about these situations the nurses used different terms about themselves and their co-workers (One, They, I and We). The nurses viewed the patients either as a task to be accomplished or as a valuable unique person. In the latter situations ethical demands were interpreted, judged and acted upon (IV). Interpretations of these nurses' skills in managing morally difficult care situations disclosed two levels; one group of nurses who described positive paradigm cases, liberating maxims and disclosed open minds, while the other group described negative paradigm cases, restrictive maxims and revealed closed minds. The latter nurses were mostly the nurses who disclosed in Paper III that they used the term "one" about themselves and "they" about their co-workers (V).en patients recently cared for at surgical and medical wards were interviewed(IV). They narrated lived experiences of receiving/not receiving the help they needed or wanted when suffering from pain and anxiety/fear. The patients revealed that the most important thing for them to feel cared for in these situations was to be listened to, taken seriously and trusted, if they were not treated in this way the patients revealed that they felt they were in the hands of somebody who was uncaring.

    The findings are interpreted within the framework of Paul Tillich's philosophy concerning love, power, justice and courage, thereby showing the tension between these phenomena in the narrated, lived, moral experience. Light is also thrown on the dynamics of openness, vulnerability, fallibility, forgiveness, affirmation as well as powerlessness, meaninglessness, insufficiency, dissociation and exclusion. Reflections are made concerning practical wisdom.

  • 1847.
    Åström, Sanna
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lind, Diana
    Umeå University, Faculty of Medicine, Department of Nursing.
    Nutritionens betydelse: Näringskomponenternas positiva inverkan på sårläkningsprocessen vid trycksår hos äldre2015Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: En stor andel inneliggande äldre patienter är i riskzonen för att drabbas av trycksår, detta orsakat av en kombination av undernäring samt bristande kunskaper hos sjuksköterskor gällande patienters näringsintag. Trycksår orsakar inte bara ett stort lidande hos den enskilde individen utan är även en stor hälsoekonomisk kostnad. Kunskap om nutritionens betydelse samt dess olika näringskomponenter behövs vid upprättade av individuella behandlingsplaner hos äldre.

    Syfte: Att beskriva näringskomponenternas positiva inverkan på sårläkningsprocessen vid trycksår hos äldre. 

    Metod: Tolv kvantitativa empiriska studier har i litteraturstudien granskats, analyserats och sammanställts. Artikelsökningen genomfördes i databaserna Cinahl, PubMed och Medline och analysprocessen utgick från beskrivande syntes.

    Resultat: I de tolv granskade artiklarna, påvisades vikten av makro- och mikronäringsämnen, så som protein, protein i kombination med kolhydrater och fett, arginin och arginin i kombination med vitamin C och zink samt övriga aminosyrors positiva inverkan på trycksårsläkningen hos äldre.Slutsats: Litteraturstudiens resultat visade att näringskomponenter har en positiv inverkan på trycksårsläkningen. För att inkludera nutrition som en omvårdnadsåtgärd krävs ökad kunskap hos sjuksköterskor gällande betydelsen av rätt nutritionsbehandling och kunskapen att identifiera personer som kan bli hjälpta av den behandlingen, samt vidare forskning inom ämnet.

  • 1848.
    Åström, Sofia
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lindberg, Karolina
    Umeå University, Faculty of Medicine, Department of Nursing.
    Föräldrars upplevelse av intrauterin fosterdöd: en litteraturstudie2015Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
  • 1849.
    Åström, Sture
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Umeå University, Faculty of Medicine, Department of Nursing. Department of Geriatric Medicine, Karolinska Institute, Huddinge Hospital, Huddinge, Sweden.
    Attitudes, empathy and burnout among staff in geriatric and psychogeriatric care1990Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    This study concerned assessments of attitudes towards demented patients among students and nursing staff as well as attitudes towards active euthanasia, wish to transfer to other jobs, ability of empathy and experience of burnout among nursing staff. The study aimed also to relate experience of burnout to attitudes towards demented patients, ability of empathy and experience of work with demented patients. The study was performed by use of questionnaires, scales measuring attitudes towards demented patients, experience of burnout and ability of empathy. Tape-recorded interviews were also included aiming to explore the staffs experience at work.

    The results showed that a majority of the students and staff held positive attitudes towards demented patients. A small proportion intended to work solely with demented patients. Staff working in psychogeriatric care and somatic long-term care held more positive attitudes than staff working in acute medical care. Proportions of staff with positive attitudes varied depending on age, duration of employment, education and place of work. A larger proportion of staff in geriatric care than in acute care reported a wish to transfer to another job. LPN’s in nursing homes to the largest proportion stated this wish to transfer.

    A majority of both students and staff expressed negative attitudes towards active euthanasia to severely demented patients in the finale stage of life. However, most favourable attitudes towards active euthanasia were found among students with shorter health care education and among nurse's aides and LPN’s.

    The staffs empathy was judged as moderately high and there were no differences found in relation to sex, staff category or place of work.

    Experience of burnout /tedium varied with the place of work and category of staff. Largest proportions at risk to develop burnout were found among those working in somatic long-term care and psychogeriatric care. RN’s showed lower burnout scores than nurse's aides and LPN’s.

    Experience of burnout was correlated to attitudes towards demented patients, indicating that the lower burnout score the staff have the more positive are the attitudes. Burnout was also related to the staffs ability of empathy i.e. the lower degree of burnout the higher is the empathie ability. Regression analysis showed that "Experience of feed-back at work” and "Time spent at present place of work" were the most important factors for the staffs experience of burnout.

  • 1850.
    Öberg, Ulrika
    Umeå University, Faculty of Medicine, Department of Nursing.
    Finding a common ground: a pilot implementation of digital self-managment support in Swedish primary health care2019Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Due to an ageing, multi-diseased population, type 2 diabetes (T2D) and other chronic conditions pose a challenge for primary healthcare. To meet such challenges, primary healthcare nurses must adapt to new roles and acquire new skills regarding self-management support. eHealth and digital solutions are suggested to facilitate the increasing need for care in chronic conditions. However, how these solutions are experienced among users has not yet been sufficiently explored. To successful implement new working methods in primary healthcare, it is important to identify prerequisites and barriers that exists.

    Aim: The overall aim of this thesis was to explore perceptions among primary healthcare nurses and patients about digital self-management support in T2D and also to develop and evaluate a digital screening instrument assessing individual needs for self-management support. This thesis is based on four papers. Papers I and II aimed to describe perceptions among primary healthcare nurses and persons with T2D of using eHealth services for self-management support. Paper III aimed to develop and psychometrically test a screening instrument for person-centred guidance and self-management support. Paper IV aimed to describe diabetes specialist nurses’ experiences of a pilot implementation of the instrument labelled the Self-Management Assessment Scale (SMASc) as a basis for person-centred digital self-management support.

    Methods: A combined approach was used to collect and analyse data. Data in the qualitative studies were collected by means of focus group interviews (I) and individual interviews (II, IV) as well as participant observations (IV) were analysed using qualitative content analysis (I, II, IV). Quantitative data in study III were psychometrically tested. The participants in the respective studies were in Paper I primary healthcare nurses (n = 24), in Papers II and III persons with T2D (n = 11; n = 104) and in Paper IV diabetes specialist nurses (n = 5) and persons with T2D (n = 14). All data were collected in a county in northern Sweden.

    Results: The overall results constituted a web of mixed experiences and feelings towards using digital self-management support. Primary healthcare nurses pronounced their ambivalence towards the digital development in healthcare (I). Patients as well had mixed feelings, but they also pronounced benefits and potentials leading to increased involvement and empowerment (II). The psychometric assessment of the screening instrument, SMASc, demonstrated high potential and promising results for clinical assessments on factors affecting self-management behaviours (III). Preliminary results suggest that the SMASc instrument is considered suitable for screening of patients’ needs for self-management support (IV). 

    Conclusion: The results of this thesis suggest that digitalization needs stepwise implementation. Digital tools such as the SMASc instrument can be useful in facilitating identification of patients in need of targeted interventions. However, primary healthcare nurses must be open to discussing patients’ emotional adaptation to the disease as well as the knowledge, sometimes not evidence based, the patients may have obtained from Internet sources. Targeted self-management support including person-centred guidance is suggested to be an effective way to achieve patient.

3435363738 1801 - 1850 of 1876
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