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  • 201.
    Boman, Erika
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Department of Nursing, Åland University of Applied Sciences, Finland.
    Häggblom, Anette
    Lundman, Berit
    Umeå University, Faculty of Medicine, Department of Nursing.
    Nygren, Björn
    Umeå University, Faculty of Medicine, Department of Nursing.
    Santamäki Fischer, Regina
    Umeå University, Faculty of Medicine, Department of Nursing. Department of Nursing, Åland University of Applied Sciences, Finland.
    Identifying variables in relation to health-related quality of life among community-dwelling older women: knowledgebase for health-promoting activities2016In: Nordic journal of nursing research, ISSN 2057-1585, E-ISSN 2057-1593, Vol. 36, no 1, p. 20-26Article in journal (Refereed)
    Abstract [en]

    The aim of the present study was to explore health-related quality of life (HRQoL) and associated variables among all community-dwelling older women (565 years) (n¼2724) on A ° land, a Finnish self-governing island community. A total of 1023 women participated (mean age 72.96.8 years). Absence of depression, absence of diagnosed disease(s), having the opportunity to engage in meaningful leisure activities, and never or seldom feeling lonely explained, together with socioeconomic control variables (i.e. age, education and economic situation), 34.4% of the variation in physical health. Absence of depression, strong inner strength, and never or seldom feeling lonely explained, together with socio-economic control variables, 27.7% of the variation in mental health. HRQoL was rated as relatively good, although special attention should be paid to women aged 80þ years. To promote HRQoL, interventions aimed at preventing, detecting and treating depression should be prioritised. In addition, interventions aimed at reducing feelings of loneliness are also recommended in order to enhance overall HRQoL.

  • 202.
    Boman, Erika
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lundman, B
    Nygren, Björn
    Umeå University, Faculty of Medicine, Department of Nursing.
    Årestedt, K
    Santamäki Fischer, Regina
    Umeå University, Faculty of Medicine, Department of Nursing.
    Inner strength and its relationship to healththreats in ageing – a cross-sectional studyamong community-dwelling older womenManuscript (preprint) (Other academic)
  • 203. Boman, Erika
    et al.
    Lundman, Berit
    Umeå University, Faculty of Medicine, Department of Nursing.
    Nygren, Björn
    Umeå University, Faculty of Medicine, Department of Nursing.
    Årestedt, Kristofer
    Santamäki Fischer, Regina
    Umeå University, Faculty of Medicine, Department of Nursing. Faculty of Education and Welfare Studies, Åbo Akademi University, Vasa, Finland.
    Inner strength and its relationship to health threats in ageing: a cross-sectional study among community-dwelling older women2017In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 73, no 11, p. 2720-2729Article in journal (Refereed)
    Abstract [en]

    Aim: To explore the relationship between inner strength and health threats among community-dwelling older women. Background: Inner strength is described as a resource that promotes experiences of health, despite adversities. Inner strength and its dimensions (i.e. connectedness, creativity, firmness and flexibility) can be assessed using the Inner Strength Scale (ISS). Exploring attributes of weaker inner strength may yield valuable information about areas to focus on in enhancing a person's inner strength and may ultimately lead to the perception of better health. Design: Cross-sectional questionnaire survey. Methods: The study is based on responses from 1270 community-dwelling older women aged 65 years and older; these were collected in the year 2010 and describe the situation that still exists today for older women. The questionnaire included the ISS, background characteristics and explanatory variables known to be health threats in ageing. Data were analysed using descriptive and inferential statistics. Results: Poorer mental health was related to weaker inner strength in total and in all the dimensions. Symptoms of depressive disorders and feeling lonely were related to three of the dimensions, except firmness and creativity respectively. Furthermore, poor physical health was associated with the dimensions firmness and flexibility. Other health threats were significantly related to only one of the dimensions, or not associated at all. Conclusion: Mental ill health has overall the strongest association with weaker inner strength. Longitudinal studies are recommended to confirm the results. However, the ISS does not only estimate inner strength but can also be a tool for discovering where (i.e. dimension) interventions may be most profitable.

  • 204.
    Boman, Hanna
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Bergström, Malin
    Umeå University, Faculty of Medicine, Department of Nursing.
    Stor vikt vid vikten: En litteraturstudie om sjuksköterskors sätt att arbeta med patienter med fetma inom primärvården2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Antal personer med fetma i världen har dubblerats mellan åren 1980 - 2014. I Sverige lever nu 14% av befolkningen med fetma. Enligt Folkhälsomyndigheten är fetma en av de sjukdomar som ökar mest i vårt samhälle. Detta är en patientgrupp som är och kommer bli större inom vården. I dagens samhälle finns det en smalhetsnorm där personer med fetma anses som avvikande och det har negativa konsekvenser för primärvården.

    Syfte: Syftet med denna studie är att undersöka sjuksköterskors sätt att arbeta med patienter med fetma inom primärvården.

    Metod: Litteraturstudien innehåller 8 artiklar med kvalitativ ansats. Databaserna som har använts är främst Cinahl och PubMed. Respektive artikel har granskats, analyserats och sammanställts med inspiration av innehållsanalys.

    Resultat: Sjuksköterskornas sätt att arbeta grundade sig i många olika aspekter. Litteraturstudiens resultat har sammanställts i 3 huvudkategorier: samhällsnormens inverkan på sjuksköterskans roll, sjuksköterskans individuella uppgifter och när resurserna inte räcker till.

    Konklusion: Sjuksköterskorna i primärvården beskriver svårigheter i arbetet med patientgruppen och detta resulterar i en försämrad vård. Ökad utbildning och implementering av riktlinjer i primärvården hade stärkt sjuksköterskornas roll i deras arbetssätt.

    Nyckelord: fetma, arbetssätt, sjuksköterska, primärvård. 

  • 205.
    Boman, Kurt
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Olofsson, Mona
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Bergman, Ann-Charlotte R.
    Brännström, Margareta
    Umeå University, Faculty of Medicine, Department of Nursing.
    Anaemia, but not iron deficiency, is associated with clinical symptoms and quality of life in patients with severe heart failure and palliative home care: a substudy of the PREFER trial2017In: European journal of internal medicine, ISSN 0953-6205, E-ISSN 1879-0828, Vol. 46, p. 35-40Article in journal (Refereed)
    Abstract [en]

    Background: To explore the relationships between anaemia or iron deficiency (ID) and symptoms, quality of life (QoL), morbidity, and mortality.

    Methods: A post-hoc, non-prespecified, explorative substudy of the prospective randomized PREFER trial. One centre study of outpatients with severe HF and palliative need managed with advanced home care. Associations between anaemia, ID, and the Edmonton Symptom Assessment Scale (ESAS), Euro QoL (EQ-5D), Kansas City Cardiomyopathy Questions (KCCQ) were examined only at baseline but at 6months for morbidity and mortality.

    Results: Seventy-two patients (51 males, 21 females), aged 79.2±9.1years. Thirty-nine patients (54%) had anaemia and 34 had ID (47%). Anaemia was correlated to depression (r=0.37; p=0.001), anxiety (r=0.25; p=0.04), and reduced well-being (r=0.26; p=0.03) in the ESAS; mobility (r=0.33; p=0.005), pain/discomfort (r=0.27; p=0.02), and visual analogue scale of health state (r=-0.28; p=0.02) in the EQ-5D; and physical limitation (r=-0.27; p=0.02), symptom stability; (r=-0.43; p<0.001); (r=-0.25; p=0.033), social limitation;(r=-0.26; p=0.03), overall summary score; (r=-0.24, p=0.046) and clinical summary score; (r=-0.27; p=0.02) in the KCCQ. ID did not correlate to any assessment item. Anaemia was univariably associated with any hospitalization (OR: 3.0; CI: 1.05-8.50, p=0.04), but not to mortality. ID was not significantly associated with any hospitalization or mortality.

    Conclusion: Anaemia, but not ID, was associated although weakly with symptoms and QoL in patients with advanced HF and palliative home care.

  • 206.
    Bonivart, Robin
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Åhl Lundström, Emma
    Umeå University, Faculty of Medicine, Department of Nursing.
    Efter att en stroke slagit till: En litteraturstudie om upplevelserna av livet efter en stroke2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Titel: After a stroke strikes - A literature study about the experiences of life after a stroke

    Background: Stroke is a disease that affects approximately 26,500 people annually and leaves the survivors with cognitive, physical, emotional difficulties.

    Aim: The purpose of this literature study is to highlight experiences of life after stroke.

    Method: Eight studies were identified in CINAHL and PubMed searches, they were quality-reviewed, analyzed for similarities and differences and compiled.

    Result: We report the results into three categories with five subcategories. The three categories consist of meeting difficult challenges, the way back and managing new challenges.

    Conclusion: A stroke leads to a changed vision of life with new priorities and values. The victims find that support from family and friends is important in order to maintain good health. Loss of activity due to lost confidence in their body has generated a more passive life and lost relationships.

  • 207.
    Borglund, Jenny
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Jansson, Isabell
    Umeå University, Faculty of Medicine, Department of Nursing.
    Triagering i ambulanssjukvården: Sjuksköterskors följsamhet till beslutsstöd2019Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Triage is a dynamic process in which the patient is assessed and prioritized based on symptoms and vital signs with the goal of getting the right patient to the right level of treatment early in the care chain. High medical competence in the ambulance care means that assessment and triage to the appropriate level of care is performed already pre- hospital to optimize the resources. Motive: Factors for quality monitoring in ambulance care are, among other things, the modelling of and adherence to decision guidelines. There is currently no information on whether existing decision guidelines for the execution of triage to treatment level is sufficiently clear, and whether nurses in Skåne's ambulance healthcare are following these. Purpose: The purpose of the study is to investigate whether nurses in Region Skåne's ambulance care services are triaging to the appropriate level of care, and to study adherence to decision guidelines. Method: A prospective cross- sectional study was conducted with an anonymous web poll. The survey was conducted on nurses working in the ambulance care in Region Skåne. 191 complete questionnaires were analyzed. The significance was ensured by a Chi2 – test. Results: 85.9% of the nurses strive to always triage the patient to the appropriate level of treatment. 74.3% of the nurses always consult RLS for triage to another level of treatment. 43.5% state that they never use TH as support for decision making. RETTS is always used by 62.8% of the nurses. Discussion: Although the TH is a support for decision making for triage to the level of care, it is used only by few nurses. This could be because Region Skåne is not clear in the directive that TH should be used. Instead, it is clear from the directives that RLS should always be consulted at triage to another level of care, which the majority of respondents state that they do. A majority of the nurses was comfortable with triage even though the liability issue is unclear. The directives do not show how triage should be implemented and who is responsible for it. Conclusion: Region Skåne needs to review the directive for ambulance care to the appropriate level of care.

  • 208.
    Borndalen, Adam
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Jakobsson, Anton
    Umeå University, Faculty of Medicine, Department of Nursing.
    Vårdtagares erfarenheter av att genomgå en magnetkameraundersökning: en litteraturstudie inom radiografi.2016Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Title: Patients experience of undergoing a magnetic resonance imaging examination – a literature study in radiography. Background: In the 1980s the MRI was introduced in diagnostic radiology. Examinations with MRI are well suited for imaging of the body´s soft tissue. A requirement for this is that the patient is still during the image acquiring process because movements affect the quality of the diagnostic material. Mixed feelings are present among patients during the examination and the radiographer is there to provide good nursing. Aim: The aim of this literature review was to describe the experiences of patients undergoing an MRI- examination. Method: A literature review of adult patients, over 18, undergoing an MRIexamination with a qualitative approach. Analysis and processing of data was inspired by Friberg. Result: Presented in six main categories, preliminary information, anxiety and nervousness, the perceived impact of the room, the interaction with personnel, unexpected occurrences and mixed emotions after completed examination. Results show that the experience of undergoing an MRI-examination was affected by a several factors. Conclusion: The radiographer is the patients contact with the radiology department, he/she is responsible for the communication with the patient. Therefor he/she can affect the experience of undergoing a magnetic resonance imaging examination in a positive way.

  • 209.
    Boström, Eva
    Umeå University, Faculty of Medicine, Department of Nursing.
    Personcentrerad vård fungerar men kan upplevas obekväm2014In: Diabetesvård : tidning för Svensk förening för sjuksköterskor i diabetesvård, ISSN 1652-697X, no 2-3, p. 10-11Article in journal (Other academic)
    Abstract [sv]

    Inledning:Diabetessjuksköterskans roll och de utmaningar som ligger i att praktisera personalcentrerad vård behöver tydliggöras.

  • 210.
    Boström, Eva
    Umeå University, Faculty of Medicine, Department of Nursing.
    Personcentrerad vård innebär en förändrad professionell roll för diabetssjuksköterskor2014In: Best Practice, ISSN 1329-1874, no 10, p. 16-18Article in journal (Refereed)
    Abstract [sv]

    Diabetessjuksköterskor innom primärvården har en viktig uppgift i att stödja personer med typ 2 diabetes så att de kan bibehålla  en tillfredsställande livskvalitet och fördröja sjukdomens progression. Ett personcentrerat förhållningssätt förespråkas idag och innebär att den enskilda personen ses med unika egenskaper, preferenser och förmågor som tas tillvara och vars medbestämmande får betydelse vid upprättande av behandlingsmål.

  • 211.
    Boström, Eva
    Umeå University, Faculty of Medicine, Department of Nursing.
    Proximity and distance: challenges in person-centred care for diabetes specialist nurses in primary health care2013Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background Type 2 diabetes demands self-management over time, to maintain health and reduce the risk for diabetes complications. However, despite efforts, many persons with type 2 diabetes are not reaching the treatment targets. In diabetes, person-centred care and group education are recommended. Diabetes specialist nurses (DSNs) working in primary healthcare have an important role in supporting patients with type 2 diabetes in their self-management to adapt to the demands of the disease in everyday life. Therefore, it is important to explore the DSNs’ professional role and their experiences of practising person-centred care. The overall aim of the thesis was to explore the professional role of DSNs in primary healthcare, and to describe their experiences of person-centred diabetes care.

    Methods The thesis includes three studies with qualitative, and one with a quantitative, approach. Data collection consisted of focus group interviews, individual interviews, observations, and questionnaires. Qualitative content analysis and statistics were used in the analysis. In studies I and II, 29 and 31 DSNs participated, respectively. In study III, 10 DSNs and 44 persons with type 2 diabetes participated. Lastly, in study IV, 10 DSNs participated.

    Results The results in the thesis showed that DSNs have a complex and multifaceted professional role that entails striving to be an expert, a fosterer, a leader, an executive, and a role model, which they found challenging. The DSNs perceived high job demands, such as decision-making and learning. The thesis also showed that the interaction between DSNs and persons with type 2 diabetes shifted from empowerment to authority struggles during group support sessions based on person-centred care. The experience of person-centred care was described as enriching, but DSNs also expressed ambivalence, related to an altered professional role.

    Conclusion There is a desire by DSNs to be close to persons with type 2 diabetes, although they have several challenges to fulfil, which makes it difficult to uphold a relation with proximity; thus, distance is also present. Even though person-centred care is recommended in healthcare, and despite DSNs’ efforts to practise PCC, the result of this thesis shows that it also implies an altered professional role for DSNs that has to be addressed.

  • 212.
    Boström, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hörnsten, Asa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lundman, Berit
    Umeå University, Faculty of Medicine, Department of Nursing.
    Stenlund, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Isaksson, Ulf
    Umeå University, Faculty of Medicine, Department of Nursing.
    Role clarity and role conflict among Swedish diabetes specialist nurses2013In: Primary care diabetes, ISSN 1878-0210, Vol. 7, no 3, p. 207-212Article in journal (Refereed)
    Abstract [en]

    AIM: To explore diabetes specialist nurses (DSNs)' perceptions of their role in terms of clarity, conflict and other psychosocial work aspects.

    METHODS: A cross-sectional study was conducted among DSNs in a county in northern Sweden. The DSNs answered the Nordic Questionnaire of Psychological and Social Factors at Work (QPS Nordic) about psychosocial aspects of their work. Statistical analysis compared DSNs with a reference group of different health professionals. Correlations between role clarity, role conflict, and other variables were analysed.

    RESULTS: The DSNs perceived more, and higher, job demands, including quantitative, decision-making and learning demands, but also more positive challenges at work compared with the reference group. Role clarity correlated with experiences of health promotion, perception of mastery, co-worker support, and empowering leadership, while role conflict correlated with quantitative and learning demands.

    CONCLUSIONS: The DSNs perceived high demands but also positive challenges in their work. Their role expectations correlated with several psychosocial work aspects. It is important that DSNs should be presented with positive challenges as meaningful incentives for further role development and enhanced mastery of their work.

  • 213.
    Boström, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Persson, Chatrin
    Umeå University, Faculty of Medicine, Department of Nursing.
    Rising, Inger
    Santamäki Fischer, Regina
    Umeå University, Faculty of Medicine, Department of Nursing.
    Clinical challenges and ongoing role changes for primary health-care nurses2012In: British Journal of Community Nursing, ISSN 1462-4753, E-ISSN 2052-2215, Vol. 17, no 2, p. 68-74Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate the perceptions of primary health-care nurses (PHNs) about clinical demands and future challenges.

    METHOD: Qualitative content-analysis of open questions from a questionnaire. A total of 121 PHNs from health-care districts in northern Sweden filled in a questionnaire during a mandatory educational day.

    RESULTS: Key issues that were raised included: defending the specific professional role of the PHNs; strengthening their self-governance and authority; and ensuring adequate care in the future through education that focuses more on nursing practice than on academic work.

    CONCLUSION: To ensure that the role of the PHN continues to develop, it is necessary to enable them to articulate, discuss, and evaluate their profession and to learn, in concrete forms, how to implement science in clinical practice.

  • 214.
    Boström, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Isaksson, Ulf
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lundman, Bent
    Umeå University, Faculty of Medicine, Department of Nursing.
    Graneheim, Ulla H.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Interaction between diabetes specialist nurses and patients during group sessions about self-management in type 2 diabetes2014In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 94, no 2, p. 187-192Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this study was to explore the interaction between diabetes specialist nurses (DSNs) and patients with type 2 diabetes (T2D) during group sessions about self-management. Methods: Ten DSNs and 44 patients were observed during group sessions about self-management, and thereafter the observations were analyzed using qualitative content analysis. Results: The interaction was characterized by three themes: becoming empowered, approaching each other from different perspectives, and struggling for authority. The interaction was not a linear process, but rather a dynamic process with distinct episodes that characterized the content of the sessions. Conclusion: It is important to achieve an interaction that is patient-centered, where the DSN is aware of each patient's individual needs and avoids responding to patients in a normative way. A satisfying interaction may strengthen patients' self-management, and also may strengthen the DSNs in their professional performance. Practice implications: Authority struggles between patients and DSNs could be a prerequisite for patients to become autonomous and decisive in self-management. DSNs might benefit from an increased awareness about this issue, because they can better support patients if they do not perceive authority struggles as threats to their professional role. (C) 2013 Elsevier Ireland Ltd. All rights reserved.

  • 215.
    Boström, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Isaksson, Ulf
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lundman, Berit
    Umeå University, Faculty of Medicine, Department of Nursing.
    Egan Sjölander, Annika
    Umeå University, Faculty of Arts, Department of culture and media studies.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Diabetes specialist nurses' perceptions of their multifaceted role2012In: European Diabetes Nursing, ISSN 1551-7853, E-ISSN 1551-7861, Vol. 9, no 2, p. 39-44Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to explore diabetes specialist nurses' (DSNs') perceptions of their professional role in diabetes care.

    Exploratory interviews were used to elicit DSNs' perceptions of their professional role. Twenty-nine DSNs working in 23 primary health care centres in northern Sweden were interviewed in focus groups. Data were analysed using qualitative content analysis.

    The DSNs described their profession as encompassing five major roles: ‘expert’, ‘fosterer’, ‘executive’, ‘leader’, and ‘role model’. Challenges interpreted as role ambiguities included feeling uninformed, fragmented, resigned, pressed for time, and self-reproachful.

    The profession of DSN was interpreted as multifaceted, with various roles and role ambiguities. Patient-centred care and empowerment, which are recommended in diabetes care, can be difficult to achieve when DSNs experience role ambiguity.

    Lack of clarity about role demands and difficulty in reconciling different roles may have a negative impact on DSNs' attitudes in clinical encounters and could inhibit patient-centred care. The development of the DSN profession requires improved awareness of the DSN's professional role in the clinical encounter, not only to improve the care of patients with diabetes, but also to retain these professionals.

  • 216.
    Boström, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Öresland, Stina
    The (in)visible ‘mother’: Diabetes specialist nurses in Swedish primary healthcare2019In: Nordic journal of nursing research, ISSN 2057-1585, E-ISSN 2057-1593, Vol. 39, no 1, p. 29-37Article in journal (Refereed)
    Abstract [en]

    This study aimed to explore how diabetes specialist nurses (DSNs) discursively construct and reconstruct their professional position in their working relationships with physicians and thereby the relation with patients in primary healthcare in Sweden. Twenty-nine DSNs working in diabetes care from 21 primary healthcare centres were included in focus-group interviews. The interviews were analysed using discourse analysis. From a social constructionist perspective, findings showed that the working relationship between the DSNs, physicians and thereby the relation with patients was discursively constructed as a relationship within a gendered discourse. The DSNs constructed their subject position metaphorically as ‘mothers’ in this relationship. The construction of doing gender implies that the DSNs became visible as biological women, but invisible in being perceived as competent, well-educated professionals, because skills such as multitasking and versatility are often associated with female abilities.

  • 217.
    Boström, Josefine
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hörsing, Ida
    Umeå University, Faculty of Medicine, Department of Nursing.
    Patienters upplevelser av att vårdas på låst avdelning och avskiljas från andra.2016Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
  • 218.
    Bracin, Lana
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Persson, Linnéa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Huvudpina.: En litteraturstudie om att vara ung med migrän.2014Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Migraine is a chronic disaese, often described as a growing publich health problem. One of the suffering groups are adolescents and the prevalence of the migraine is one of the most common reasons why school based health clinics are contacted. The state is related to an extensive, physical and psychological suffering. Objectives: The aim with the presented study was to illuminate the experienced life situation of the adolescent migraineurs. Method: The exploration of articles were done with restriction in databases as Pubmed, CINAHL and psycINFO. The 13 chosen articles were viewed, analyzed and compiled in four different categories with eight sub-categories. Results: The presented outcome reveals that migraine effects the life of adolescents in four different dimensions. The state impacts negatively on the physical and psychological well-being. Furthermore it influences school and leisure of the suffered group. A tendency of isolation and denial is seen as a repeated behaviour in the adolescent migraineurs. Conclusion: Embracement and acceptance ought to be present for the possibility, to create and develop an individual lasting coping strategy. This way of thinking might improve the life situation of the adolescent migraineurs. Keywords: Migraine, adolescents, life changing events, coping strategies, effects.

  • 219.
    Brandt, Andreas
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Anders, Engberg
    Umeå University, Faculty of Medicine, Department of Nursing.
    Mobila egenvårdsstöd vid diabetes: Mobial egenvårdsapplikationer och dess effekter på Hba1c: en litteraturstudie2015Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Ny teknik förändrar förutsättningar för hur information sprids och används i samhället. Den enskilde individen kan i stor utsträckning samla data om sig själv och sin omgivning. I vården kan denna förändring medföra en förskjutning av roller där patienten intar en roll som söker partnerskap och delaktighet snarare än undervisning och riktade beslut. Parallellt med en snabb teknisk utveckling har idag även livsstils relaterade sjukdomar växt fram, däribland diabetes.  Sjukdomen kräver en hög grad av egenvård och information. Stöd för patienten erbjuds idag via ett flertal mobila applikationer, specifikt riktade till patienter med Diabetes. Syfte: Syftet med studien var att beskriva likheter och skillnader mellan mobila egenvårdsstöd för patienter med diabetes. Fokus riktades även mot förändring av HBA1c (metabol balans) knutet till användandet av mobila egenvårdstöd. Metod: Litteraturstudie, där åtta vetenskapliga artiklar med kvantitativ ansats granskades. Databaserna CINAHL, PubMed och PsychInfo användes. Resultat: Analysen resulterade i två kategorier och två sub-kategorier. Den första kategorin var Likheter och skillnader mellan applikationer och den andra var HbA1c. Konklusion: Forskning pekar på positiva trender gällande metabol balans vid användning av mobila applikationer vid diabetes. Dock saknar dessa applikationer ofta viktiga komponenter. Mer studier krävs inom området då forskningen inom fältet är begränsad.

  • 220. Bratt, E. L.
    et al.
    Burström, Å.
    Hanseus, K.
    Rydberg, Annika
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Berghammer, M.
    Do not forget the parents: Parents' concerns during transition to adult care for adolescents with congenital heart disease2018In: Child Care Health and Development, ISSN 0305-1862, E-ISSN 1365-2214, Vol. 44, no 2, p. 278-284Article in journal (Refereed)
    Abstract [en]

    Background: Growing up with congenital heart disease (CHD) often means transfer to adult care and lifelong medical follow-up. An optimal transition process usually involves a multipart collaboration between the patient, their parents and other family members, and the healthcare providers. Taking an active role while knowing when it is time to step aside can be difficult for all the concerned parties, even the healthcare professionals. The aim of the present study therefore, was to explore parents' expectations and needs during their adolescent's transition to adult care.

    Method: Semi-structured interviews were conducted with 18 parents of 16 adolescents (aged 13-18years) with CHD in 4 pediatric cardiology settings in Sweden. The interviews were analysed with qualitative content analysis.

    Results: The analysis resulted in 2 main themes: (a) Feeling securethe importance of being prepared and informed. This theme focused on the need to be prepared and informed about transition and future transfer to adult care. (b) Recognizing when to hand over at the right time. This theme addressed the process of handing over the responsibility from the parent to the adolescents and contained handing over from pediatric care to adult care.

    Conclusion: Being prepared and informed about the upcoming transition process was essential. The parents underlined the importance of being involved in the transition planning for gradually handing over responsibility to the adolescent. They also considered establishing contact with the adult healthcare team before transfer as important and needed to be assured that CHD-related information of importance for the young person's daily life would be given.

  • 221.
    Bredberg, Pettter
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Engfors Nyqvist, Mathilda
    Umeå University, Faculty of Medicine, Department of Nursing.
    Erfarenheter av livet ett år efter hjärtoperation hos personer med postoperativt delirium2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Experience of life one year after cardiac surgery in people diagnosed with postoperative delirium.

    Abstract Background: Cardiovascular diseases are common among older people and many have to undergo cardiac surgery. A frequent complication after cardiac surgery is delirium, a complex syndrome that can have serious consequences in both short and long term. Few studies have investigated the long term follow-up among those who develops delirium. Aim: The aim of the study was to illuminate the experience of life, one year after heart surgery in people diagnosed with postoperative delirium. Method: Semi-structured interviews had been conducted on participants (aged ≥70 years) one year after cardiac surgery. Qualitative content analysis was used to analyse the 20 interviews included in the study. Results: Three themes with eight subthemes were formulated: The physical impact includes somatic dysfunction and the ability to perform activities. Mental impact includes the ability to reminisce, to experience hallucinations and nightmares and the impact of the mood. The affected quality of life includes belonging to a social context, to be socially limited and the importance of health. Conclusion:  One year after cardiac surgery there were participants that experienced a lowered quality of life and some had still not recovered. Others experienced that their memory were impaired and that they had become more emotional. To reduce suffering for people, who have undergone cardiac surgery and have been diagnosed with postoperative delirium, more research is needed on postoperative follow-ups, an improved rehabilitation process and an individualized care that takes patients risks and resources in consideration in the context of postoperative recovery.

    Keywords: Cardiac surgery, Delirium, Lived experience, Nursing, Patients’ experience, Follow-up, Older people

     

  • 222.
    Brinkman, Johan
    Umeå University, Faculty of Medicine, Department of Nursing.
    Förebyggande metoder och behandlingar för Posttraumatiskt stressyndrom (PTSD):: Systematisk litteraturstudie2012Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Aim: The aim of this study was to describe the impact of debriefing, brief eclectic psychotherapy, cognitive behavioral therapy and EMDR therapy for PTSD and other stress-like reactions in emergency personnel. Background: In 1980, PTSD got a name and a place in the modern psychiatric diagnosis. Interest in the treatment and prevention of PTSD has increased over the past 20 years. Responders (ambulance, police and firefighters) are professionals who often meet human pain and suffering and are thus at risk for developing PTSD. Method: A literature search was made in the databases SocINDEX, PsycINFO, CINAHL and PubMed to identify relevant articles based on the purpose. A total of 556 articles were identified after consideration for inclusion and exclusion criteria and finally, it was 11 articles that were included in the results. Results: The effects of debriefing was found to have no significance in the prevention of PTSD. The effect of pre-traumatic vaccination showed good results in the prevention of PTSD, while the effects of brief eclectic therapy,cognitive behavioral therapy and eye movement desensitization and reprocessing therapy showed good results in the treatment of PTSD.

    Keyword: PTSD, traumatic event, ambulance, police, firefighter, prevention and treatment.

  • 223.
    Broman, Johan
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Edlund, Jörgen
    Umeå University, Faculty of Medicine, Department of Nursing.
    Anestesi-, intensivvårds- och operationssjuksköterskans förståelser och erfarenheter av katastrofberedskap: En kvalitativ intervjustudie2016Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Syfte: Syftet med föreliggande studie är att beskriva anestesi-, intensiv – och operationssjuksköterskans förståelser och erfarenheter av allvarliga händelser och katastrofer.

    Bakgrund: Att arbeta inom operation eller intensivvård kräver förberedelser inför komplexa situationer som kan ändras med tvära kast. Det senaste decenniet har Europa sett ett flertal attentat riktat mot allmänheten som fått förödande konsekvenser. Detta tillsammans med ett överhängande klimathot ställer höga krav på specialistsjuksköterskans förmåga att hantera katastrofer.

    Metod: En kvalitativ intervjustudie. Under hösten 2016 genomfördes 15 intervjuer på anestesi, - intensivvårds, - och operationssjuksköterskor på tre sjukhus i norra Sverige. Intervjuerna analyserades med kvalitativ innehållsanalys.

    Resultat: Berättelserna vittnade om svag förberedelse inför eventuella katastrofsituationer. Brister i katastrofberedskap, organisation samt utbildnings, - och övningsmöjligheter ansågs vara negativa faktorer som spelade in i personalens upplevelse av den egna katastrofberedskapen. Informanterna kände att de hade dålig uppfattning vad det egentligen innebar att vara förberedda på katastrofer, både i fall med olyckshändelser men även antagonistiska våldshändelser. De berättade också om en oro för en förändrad samhällsbild som med stor risk kan komma att sätta dem i situationer som inbegriper katastrofer i framtiden.

    Slutsats: Anestesi, - intensivvårds och operationssjuksköterskor känner sig generellt dåligt förberedda på eventuella katastroflägen. En allmän känsla av att det inte finns resurser att tillgodose en god beredskap även om de upplever en allmän oro inför en förändrad samhällsbild.

  • 224.
    Bruce, Elisabeth
    Umeå University, Faculty of Medicine, Department of Nursing.
    Erfarenheter av stöd bland föräldrar till barn med medfödda hjärtfel2014Doctoral thesis, comprehensive summary (Other academic)
    Abstract [sv]

    Bakgrund. Antalet överlevande barn som diagnostiserats med medfött hjärtfel (CHD) har ökat markant de senaste 15 åren, vilket har bidragit till en växande grupp av barn och familjer som behöver specialiserat stöd, eftersom familjelivet påverkas och begränsas av CHD. Studier har visat att föräldrar till barn med CHD har en ökad risk för psykosocial sjuklighet i jämförelse med föräldrar till barn med andra sjukdomar eller föräldrar till friska barn. Få studier har belyst föräldrars erfarenheter av stöd när de har barn med CHD. Därför fokuseras denna avhandling på föräldrarnas perspektiv av fenomenet stöd, för att öka förståelsen för vad stöd innebär för föräldrar till barn med CHD.

    Syfte. Avhandlingens syfte är att belysa innebörder i den levda erfarenheten av stöd, hos föräldrar till barn med CHD samt att till svensk kontext anpassa och validera ett familjecentrerat instrument för föräldrars skattning av stöd till hela familjen från sjuksköterskor.

    Metoder. Avhandling består av fyra delstudier. I tre av dessa (I, II, III) genomfördes datainsamlingen genom narrativa intervjuer, som tolkades genom fenomenologisk hermeneutisk tolkningsmetod. I den fjärde delstudien gjordes en översättning och psykometrisk testning av det isländska instrumentet ICE-FPSQ till svensk kontext. Dessutom beskrevs föräldrars skattning av uppfattat stöd från sjuksköterskor till familjer som har barn med CHD.

    Resultat. Fynden från delstudie I visade att innebörder i den levda erfarenheten av stöd hos föräldrar till tonåringar med CHD var stöd för att själva kunna vara stödjande för sin familj, men också för andra personer i tonåringens omgivning. Delstudie II visade att innebörder i den levda erfarenheten av stöd för mödrar till yngre barn med CHD var att få stöd så att de själva kunde hantera sin egen oro och sitt familjeliv. Delstudie III visade att innebörder i den levda erfarenheten av stöd för fäder till yngre barn med CHD var önskan att få stöd genom delande relationer med familjen och att bli involverad i vården av sitt barn. Den fjärde delstudien (IV) visade att den svenska versionen av instrumentet ICE-FPSQ var valid och reliabel i svensk kontext. Föräldrarnas skattningar av uppfattat familjecentrerat stöd till familjen från sjuksköterskor visade sig vara lågt.

    Slutsats. En övergripande slutsats från de tre första delstudierna pekar mot att innebörder i stöd för föräldrarna är stöd genom att ha goda, interaktiva relationer med vårdpersonalen, bli mött som en hel familj med unika och individuella behov samt inkluderade i vårdprocessen för att kunna stödja varandra inom familjen. Dessa fynd pekar mot familjecentrerad pediatrisk omvårdnad som sannolikt är lämplig för att, på ett mångfacetterat sätt, möta varje familjs behov av att bli bemött som en unik helhet. Det Isländska instrumentet ICE-FPSQ är designad utifrån teorin om familjecentrerad omvårdnad. I delstudie IV visade resultaten på acceptabla psykometriska egenskaper för den svenska versionen av instrumentet. Fynden visade även att föräldrarna inte skattade höga nivåer av familjecentrerat stöd från sjuksköterskor.

  • 225.
    Bruce, Elisabeth
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Dorell, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lindh, Viveca
    Umeå University, Faculty of Medicine, Department of Nursing.
    Erlingsson, Christen
    Lindkvist, Marie
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Sundin, Karin
    Umeå University, Faculty of Medicine, Department of Nursing.
    A translation into Swedish and psychometric analysis of the Icelandic instrument “ICE-Family Perceived Support Questionnaire”, and parents’ estimations of support to families from nursesManuscript (preprint) (Other academic)
    Abstract [en]

    Aims and objectives. Testing the psychometric properties, reliability, and validity of a cross-cultural translation into Swedish of the Icelandic instrument “ICE-Family Perceived Support Questionnaire” and, furthermore, reporting estimations of support given by nurses to families in a sample of parents of children with congenital heart defects.

    Background. Parents of children with congenital heart (CHD) defects often experience greater psychosocial morbidity than parents of children with other medical conditions. In order to design and evaluate interventions with family-centered support, a suitable instrument for measuring family members’ perceived support is required for the Swedish context.

    Design. A translation and psychometric testing of the instrument ICE-FPSQ.

    Methods. A sample of 97 parents, including both fathers and mothers, of children with CHD selected in year 2012. A translation of the ICE-FPSQ into Swedish was done, and reliability and validity were tested for the Swedish version.

    Results. Parents scored low on perceived family support from nurses on the ICE-FPSQ scale. The Swedish version of the ICE-FPSQ was found to be reliable and valid in this context. Reliability was tested by analyzing internal consistency through Cronbach’s α for the entire scale and the two subscales. Test-retest was performed by calculating intra-class correlation, and the results showed satisfactory scale stability over time. The results from the validity test illustrated an acceptable model fit of the Swedish version.

    Conclusion. This study, by psychometrically testing an instrument for Swedish conditions, has provided an instrument for measuring families’ experience of cognitive and emotional support from nurses to families in Sweden. Additionally, the present study found while testing this instrument that nurses at four pediatric cardiac outpatient clinics only sparingly offered family-centered care to the parents.

    Relevance to clinical practice. The Swedish version of ICE-FPSQ can be considered useful to measure the effects of family-centered support interventions in the future. 

  • 226.
    Bruce, Elisabeth
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Dorell, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lindh, Viveca
    Umeå University, Faculty of Medicine, Department of Nursing.
    Erlingsson, Christen
    Linnaeus University, Kalmar, Sweden.
    Lindkvist, Marie
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sundin, Karin
    Umeå University, Faculty of Medicine, Department of Nursing.
    Translation and Testing of the Swedish Version of Iceland-Family Perceived Support Questionnaire With Parents of Children With Congenital Heart Defects2016In: Journal of Family Nursing, ISSN 1074-8407, E-ISSN 1552-549X, Vol. 22, no 3, p. 298-320Article in journal (Refereed)
    Abstract [en]

    There is a need for a suitable instrument for the Swedish context that could measure family members' perceptions of cognitive and emotional support received from nurses. The purpose of this study was to translate and test the psychometric properties of the Swedish version of the Iceland-Family Perceived Support Questionnaire (ICE-FPSQ) and, further, to report perceptions of support from nurses by family members of children with congenital heart defects (CHDs). A sample of 97 parents of children with CHD, living in Sweden, completed the Swedish translation of ICE-FPSQ. The Swedish version of ICE-FPSQ was found to be reliable and valid in this context. Parents scored perceived family support provided by nurses working in pediatric outpatient clinics as low, which suggests that nurses in these outpatient contexts in Sweden offered family nursing only sparingly.

  • 227.
    Bruce, Elisabeth
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Institutionen för omvårdnad i Örnsköldsvik.
    Lilja, Catrine
    Umeå University, Faculty of Medicine, Department of Nursing. Institutionen för omvårdnad i Örnsköldsvik.
    Sundin, Karin
    Umeå University, Faculty of Medicine, Department of Nursing. Institutionen för omvårdnad i Örnsköldsvik.
    Mothers' lived experiences of support when living with young children with congenital heart defects2014In: Journal for specialists in pediatric nursing, ISSN 1744-6155, 1539-0136, Vol. 19, no 1, p. 54-67Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The purpose of this study was to illuminate the meanings of support as disclosed by mothers of children with congenital heart defects (CHD).

    DESIGN AND METHOD: Narrative interviews were conducted with 10 mothers of children with CHD. A phenomenological-hermeneutic method was used for interpretation of the transcribed interviews.

    RESULTS: The comprehensive understanding of mothers' lived experiences of support emerged as the experiences of receiving good support, receiving "poor support," and absence of support.

    PRACTICE IMPLICATIONS: Mothers receiving person-centered and family-centered care feel more supported and are more likely to adapt to the stresses of parenting a child with CHD.

  • 228.
    Bruce, Elisabeth
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lindh, Viveca
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sundin, Karin
    Umeå University, Faculty of Medicine, Department of Nursing.
    Fathers' experiences when having a child with heart defectsManuscript (preprint) (Other academic)
    Abstract [en]

    The purpose of the study was to illuminate the meanings of the lived experiences of support as disclosed by fathers of children with CHD. Narrative interviews were conducted individually with five fathers of children diagnosed with a CHD. A phenomenological-hermeneutic method was used to interpret the verbatim transcribed narrative interviews. The meanings of the lived experiences of support for the fathers were identified in two themes and illustrate the fathers’ feelings of being supported when being in a shared relationship with others. A third theme illustrates the situation when support is absent. Our findings pointed to that support for fathers of children with a CHD might be best promoted by the philosophy of family-centered care.

  • 229.
    Bruce, Elisabeth
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Umea Univ, Dept Nursing, Örnskoldsvik, Sweden.
    Lindh, Viveca
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sundin, Karin
    Umeå University, Faculty of Medicine, Department of Nursing. Umea Univ, Dept Nursing, Örnskoldsvik, Sweden.
    Support for Fathers of Children With Heart Defects2016In: Clinical Nursing Research, ISSN 1054-7738, E-ISSN 1552-3799, Vol. 25, no 3, p. 254-272Article in journal (Refereed)
    Abstract [en]

    The purpose of the study was to illuminate the meanings of the lived experiences of support as disclosed by fathers of children with congenital heart defect (CHD). Narrative interviews were conducted individually with five fathers of children diagnosed with CHD. A phenomenological-hermeneutic method was used to interpret the verbatim transcribed narrative interviews. The meanings of the lived experiences of support for the fathers were identified in two themes and illustrate the fathers' feelings of being supported when being in a mutual relationship with others. A third theme illustrates the situation when support is absent. Our findings indicate that support for fathers of children with CHD might be best promoted by the philosophy of family-centered care.

  • 230.
    Bruce, Elisabeth
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sundin, Karin
    Umeå University, Faculty of Medicine, Department of Nursing.
    Experience of support for parents of adolescents with heart defects: supported to be supportive2012In: Journal of Pediatric Nursing: Nursing Care of Children and Families, ISSN 0882-5963, E-ISSN 1532-8449, Vol. 27, no 4, p. 366-374Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to illuminate the meanings of the lived experience of support for parents of adolescents with heart defects. Narrative interviews were conducted with four mothers and two fathers of adolescents with heart defects. Interviews were interpreted using a phenomenological-hermeneutic method. The interpretation revealed that parents, themselves, attempt to be very supportive. They support their adolescent children, the rest of their families, the staffs of their children's schools, and others around their children. The sense of gratification and contentment that parents receive from fulfilling supportive functions is, in turn, influenced by the support that they, themselves, receive from care providers.

  • 231.
    Bruce, Elisabeth
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sundin, Karin
    Umeå University, Faculty of Medicine, Department of Nursing.
    Pediatric nurses' perception of support for families with children with congenital heart defects2018In: Clinical Nursing Research, ISSN 1054-7738, E-ISSN 1552-3799, Vol. 27, no 8, p. 950-966Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to illuminate pediatric nurses' (PNs) perceptions of support for families with a child with a congenital heart defect. The study used a qualitative design with narrative interviews with eight PNs in Northern Sweden, and the interview data were analyzed with content analysis. The analysis revealed that the nurses perceive that letting the parents be involved in their child's care is of great importance in supporting the families. Although they have a paternalistic attitude to the families, they also stated that nurses should inform the parents about the care of the child, create a good relationship with the family, and build trust among all parties involved.

  • 232.
    Brunzell, Ida
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sundström, Hannelore
    Umeå University, Faculty of Medicine, Department of Nursing.
    Att leva med hiv: En litteraturstudie om personers upplevelser av att leva med en stigmatiserad sjukdom.2016Independent thesis Basic level (degree of Bachelor), 180 HE creditsStudent thesis
    Abstract [sv]

    Titel: Att leva med hiv - En litteraturstudie om personers upplevelser av att leva med en stigmatiserad sjukdom. Bakgrund: Idag lever ca 7000 personer med hiv i Sverige och årligen upptäcks ca 450 nya sjukdomsfall. Sjukdomen behöver inte längre leda till en för tidig död då effektiv bromsmedicin funnits sedan 1996. Hiv är dock fortfarande en stigmatiserande sjukdom som dessutom förknippas med andra stigmatiserande attribut. Att leva med hiv har en stor inverkan i personers liv då allmänhetens syn fortfarande försvårar möjligheten att vara öppen om hivsamt att vårdpersonals ovilja påverkar vårdkvaliteten. Syfte: Syftet med denna litteraturstudie var att belysa hiv-smittade personers erfarenheter av att leva med hiv. Metod: En litteraturstudie genomfördes baserad på nio vetenskapliga artiklar med kvalitativ ansats. Resultat: Resultatet presenteras i tre huvudkategorier och totalt 8 underkategorier: “Livet påverkas av hiv”; - Att hantera en förändrad livssituation, - Att behöva ta läkemedel varje dag, “Att prata om hiv”; - Att välja att vara öppen, - En möjlighet till stöd genom att prata med någon, - Valet att hålla hiv hemligt, “Att leva med stigmatiserande sjukdom”; - En påverkad syn på sig själv, - Samhället och omgivningens syn, - Erfarenheter från möten med vården. Konklusion: Att leva med hiv kan orsaka flera svårigheter i de drabbades liv och de behöver stöd kring beslutet att vara öppna om sin hiv. Sjuksköterskor kan behöva mer kompetens inom området för att kunna ge bästa möjliga vård. Fler studier om vårdpersonals kunskapsläge och attityd är önskvärt.

  • 233.
    Bryntesson, Kristin
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Jansson, Niklas
    Umeå University, Faculty of Medicine, Department of Nursing.
    Anestesisjuksköterskans erfarenheter av att identifiera och lindra oro i det perioperativa mötet med patienter2017Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Purpose The aim with this study was to explore the nurse anesthetist´s experiences of identifying and relieve anxiety during the perioperative meeting with patientsBackground Preoperative anxiety is a common problem. Patients can be anxious about the anesthesia or not to be able to wake up after the surgery. Nurse anesthetist´s meet this patient category in her daily work, and has as a challenge, the task of nursing for them and create a feeling of safety before the upcoming surgery.Method The selection of participants was eleven experienced nurse anesthetists. The interviews took place in the autumn of 2017. Participants was chosen from a convenience sample, the head of the department was allowed to choose participants by the writers inclusion- and exclusion criteria. The collection of data was made by semi structured interviews with nurse anesthetists at two hospitals in the western part of Sweden. The transcribed information was analyzed with qualitative content analysis.Results The material resulted in two domains, to identify and to alleviate anxiety. The result showed how the nurse anesthetist used her ”clinical look” to read the patients mood. In the domain “Alleviate anxiety”, three categories arose, with six subcategories. Our study showed how the nurse anesthetist could alleviate anxiety by creating a relationship to the patient through active listenening and confirmation of the patient. And used different nursinginterventions such as playing music and physical touch.Conclusion The nurse anesthetists who were interviewed had a “clinical look” which they used to identify the anxious patient, and could interpret different physiological parameters and the patient´s bodily reactions of anxiety. The informants had good knowledge about different types of nursing actions to use when needed, and felt comfortable using drugs as a complement.

  • 234.
    Brännholm, Åsa
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Bergkvist, Anna
    Umeå University, Faculty of Medicine, Department of Nursing.
    Livet efter en hjärtinfarkt: En litteraturstudie2015Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: The most common cause of death in Sweden is coronary heart disease, which can imply myocardial infarction. Risk factors for myocardial infarction are low physical activity, high blood lipids, smoking, low income and poor levels of education. A myocardial infarction occurs when a fatty, calcified plaque has ruptured and formed a trombosis. Aim: The aim of this literature study is to examine women and men’s experiences after a myocardial infarction. Method: Nine qualitative scientific studies were analyzed according to Friberg’s model for literature review. Results: The results were complied into three categories named Restrictions in daily life, Support or lack of support from the community, Altered life vision. Conclusion: The people who have suffered a myocardial infarction often sustain health problems such as fatigue in the aftermath. Lifestyle changes may be difficult to adopt and above all to maintain. Healthcare professionals should be well informed of what life after a myocardial infarction can implicate and give good support to those affected. Lifestyle changes should be carried out a few at a time rather than all at once to make them sustainable in the long term.

  • 235.
    Brännman, Sanna
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Moliis, Matilda
    Umeå University, Faculty of Medicine, Department of Nursing.
    Att skapa en bubbla: Anestesi- och operationssjuksköterskors erfarenheter av att vårda vaken patient under operation i regional anestesi2018Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: The development of efficient methods for anesthesia has increased the number of surgery in regional anesthesia where the patient is awake. Being awake during surgery can be worrisome and frightening for the patient. The perioperative nurse therefore has a responsibility in supporting the patient throughout the course of the operation. Studies have shown that close contact, consideration and professionalism from healthcare professionals increase the patients well-being and at the same time reduce postoperative rehabilitation time.

    Purpose: To describe nurse anesthetists’ and operating theatre nurses’ experiences of nursing of awake patients during surgery in regional anesthesia.

    Design: An interview study with a qualitative approach.

    Method: During the spring of 2018 semi-structured interviews with twelve nurse anesthetists and operating theatre nurses were conducted. The material was analyzed with a content qualitative analysis.

    Result: The result was summarized into three main categories with nine subcategories. In the main category, the conscious dialogue, nurse anesthetists and operating theatre nurses adapted the language between each other and were wary of how they expressed themselves not to worry the patient. In the main category person before patient the participants reflected upon the patient’s experience and how a relationship could be established during a short period of time. In the main category the caring room the participants created a safe space for the patient with different nursing care measures. The participants were well aware of how they were perceived and changed their behavior according to the atmosphere in the operating room.

    Conclusion: The main results showed that the two professions changed their communication, their way of working and their behavior in the operating room between each other and to the patient being awake. To care for a patient who was awake during surgery could be both challenging and fulfilling, depending on how the nurse perceived the patient. This study can hopefully supply a more profound understanding of how it might be to nurse for a patient being awake during surgery.

  • 236.
    Brännström, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Gustavsson, Lisa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Omvårdnad av patienter med venösa bensår - en intervjustudie som beskriver distriktsköterskors strategier vid bensårsbehandling2015Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Syfte: Syftet med denna studie var att beskriva distriktssköterskors strategier vid behandling av venösa bensår.Bakgrund: Svårläkta sår är ett stort problem som orsakar försämrad livskvalitet för de som drabbas. Svårläkta sår innefattar venösa bensår som distriktssköterskan har ett stort eget ansvar för i primärvårdens verksamhet. Behandlingen är dock komplex och kan vara frustrerande både för patienter och personal då läkning uteblir. Viktiga delar i behandlingen är kontinuitet, helhetsperspektiv, utredning och förståelse för orsaken bakom såret.Design: Kvalitativ design med semistrukturerade intervjuer.Metod: Kvalitativ innehållsanalys med induktiv ansats. Data insamlades september-oktober 2015.Resultat: Resultatet visar på att distriktssköterskorna använder strategier som liknar omvårdnadsprocessen. Fem kategorier identifierades, anamnes, bedömning, åtgärder, dokumentation och uppföljning. Vissa strategier är genomgående hos alla distriktssköterskor medan andra varierar. Deltagarna lade mer tyngdpunkt på vissa delar i omvårdnadsprocessen, där de fokuserade mycket på bedömning och åtgärder och mindre på anamnes och uppföljning.Slutsats: Distriktssköterskan utför självständigt behandlingen av patienter med venösa bensår men behöver ibland konsultera kollegor, allmänläkare och specialistsjukvården. Avsaknaden av skriftliga rutiner och behandlingsriktlinjer kan bidra till skillnader i behandlingen då den i nuläget baseras på beprövad erfarenhet. Det framträdde att alla distriktssköterskor har en strategi vid behandling av venösa bensår som liknar omvårdnadsprocessen.

  • 237.
    Brännström, Margareta
    Umeå University, Faculty of Medicine, Omvårdnad.
    Ett liv i berg och dalbana: innebörder av att leva med svår kronisk hjärtsvikt i palliativ avancerad hemsjukvård utifrån patienters, närståendes och sjuksköterskors berättelser2007Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The overall purpose of this thesis is to illuminate meanings of living with severe chronic heart failure (CHF) in palliative advanced home care (PAHC) as disclosed through patients’, close relatives’ and nurses’ narratives. This thesis comprises four papers that illuminate the phenomenon from various perspectives and with different focus. In paper I four patients with severe CHF in PAHC were interviewed. In paper II three of their close relatives were interviewed. In paper III one man and his wife in PAHC were interviewed at 3-5 month intervals over a 4.5-years period. In paper IV 11 nurses in PAHC were interviewed. In all papers narrative interviews were conducted and the text was interpreted using a phenomenological-hermeneutic method. The result shows that meanings of living with severe CHF in PAHC is to be ‘knocking on death’s door’ yet surviving. This means never knowing what to expect of tomorrow as one suffers from a complex array of unpredictable, interwoven symptoms. The course of the illness forces sufferer to ride a symbolical ‘roller coaster’, an ongoing oscillation between ‘ups and downs’. Being offered a safety belt in the ‘roller coaster’ by the PAHC team means feelings of safety (I). Meanings of being a close relative of a person with severe CHF in PAHC is to be following the life- threatening ups and downs that the ill person goes through. It is like being a fellow passenger on the ‘roller coaster’ ride that is their loved one’s disease, with burdensome responsibility for easing the ‘downs’ and supporting the ‘ups’. This means being on primary call, always on standby to mediate security and pleasure. In the deepest downs it is also to call for the back-up call i.e. the PAHC team (II). Meanings of living the ‘ups and downs’ over time is being captive in a roller-coaster ride, side by side, with the ‘ups and downs’ caused by the illness. Living close to death is inescapable when recurrent periods of deepest ‘downs’ force one to face that one’s life together is coming to an end. The relationship between the spouses is severely tested but seems to withstand the strain and meaning is found in togetherness in life. Sharing the safety belt on the ‘roller coaster’, offered by the PAHC team, evokes feelings of security. However, the safety belt is adjusted to the man with severe CHF leaving the wife partly without comfort and at times uncertain, especially in the deepest ‘downs’ (III). Meanings of being a palliative nurse for patients with severe CHF in PAHC is being firmly rooted and guided by the values of palliative culture. Being a facilitator for the patient with CHF to live his/her everydaylife in the best way possible is difficult, challenging but overall positive. The nurses get into a tight corner when palliative culture values clash and do not correspond to nurses’ interpretation of what is good for the patient with severe CHF. There is a limit to nurses’ pliability to patients’ and close relatives’ will, as they are strongly convinced that resuscitation is not an option. Nurses have already made up their mind about that they do not perform heart- lung resuscitation (IV). The comprehensive understanding is that meanings of living with severe CHF in PAHC is being captive in a ‘roller-coaster’ life with varying periods between unpredictable improvement and deterioration of the body, for the rest of life. Living with the unpredictable, deteriorated body means to oscillate between enduring the suffering in ‘downs’ and enjoying life in ‘ups’ (I-III). Living with death so close over and over again i.e. being in a limit situation evokes feelings of uncertainty (I-IV) and confidence (I-III). Being positive dependent on PAHC facilitates a life as normal as possible in togetherness at home (I-IV). The comprehensive understanding of the four papers (I-IV) are discussed in the light of a theoretical framework from the German psychiatrist and philosopher Karl Jaspers thoughts about limit situation, the Danish philosopher K.E Lögstrup thoughts about the ethical demand, palliative theories and relevant empirical studies.

  • 238.
    Brännström, Margareta
    Umeå University, Faculty of Medicine, Department of Nursing.
    Livet med svår hjärtsvikt2013In: Palliativ vård: begrepp & perspektiv i teori och praktik / [ed] Birgitta Andershed, Britt-Marie Ternerstedt, Cecilia Håkanson, Studentlitteratur AB, 2013, 1, p. 359-368Chapter in book (Other academic)
  • 239.
    Brännström, Margareta
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Boman, Kurt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    A new model for integrated heart failure and palliative advanced homecare: rationale and design of a prospective randomized study2013In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 12, no 3, p. 269-275Article in journal (Refereed)
    Abstract [en]

    Background: Guidelines have concluded that there is a great need for new models of integrated care, e.g. heart failure and palliative care, in order to facilitate equality of care for dying patients, regardless of diagnosis. We found no evidence in the literature concerning the advantages and effects of integrated heart failure and palliative advanced home care for patients with severe chronic heart failure.

    Aim: The primary aim is to study the effects of integrated Palliative advanced homecarRE and heart FailurE caRE (PREFER) on patients' symptom burden, quality of life, and activities of daily living (ADL) as compared to usual care.

    Method: Prospective, randomized study with an open-evaluation PROBE design. Optimally treated outpatients with chronic heart failure of varying aetiologies in New York Heart Association classes III-IV will be eligible to participate.

    Conclusion: The PREFER study is designed to investigate whether a new concept of managing patients with severe chronic heart failure by integrating palliative homecare and active heart failure treatment will reduce symptom burden, increase quality of life and ADL, and reduce the number of hospitalizations in patients with severe chronic heart failure.

  • 240.
    Brännström, Margareta
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.
    Fischer Grönlund, Catarina
    Umeå University, Faculty of Medicine, Department of Nursing.
    Zingmark, Karin
    Söderberg, Anna
    Umeå University, Faculty of Medicine, Department of Nursing.
    Meeting in a ‘free-zone’: Clinical ethical support in integrated heart-failure and palliative care2019In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953Article in journal (Refereed)
    Abstract [en]

    Background: Integrating heart-failure and palliative care combines expertise from two cultures, life-saving cardiology and palliative care, and involves ethically difficult situations that have to be considered from various perspectives. We found no studies describing experiences of clinical ethical support (CES) in integrated cardiology and palliative care teams.

    Objective: Our aim is to describe experiences of CES among professionals after a period of three years working in a multidisciplinary team in integrated heart-failure and palliative homecare.

    Method: The study design was descriptive qualitative, comprising interviews with seven professionals from one integrated heart-failure and palliative care team who received CES over a three-year period. The interview data were subjected to qualitative content analysis.

    Results: The CES was found to offer possibilities for meeting in an ethical ‘free-zone’ where the participants could relate to each other beyond their various professional roles and specialties. The trust within the team seemed to increase and the participants were confident enough to express their points of view. Together they developed an integrated understanding, and acquired more knowledge and a comprehensive view of the ethically difficult situation of concern. The CES sessions were considered a means of becoming better prepared to deal with ethical care issues and developing action strategies to apply in practice, from shared standpoints.

    Conclusion: Participating in CES was experienced as meeting in an ethical ‘free-zone’ and seemed to be a means of facilitating integration of palliative and heart-failure care.

  • 241.
    Brännström, Margareta
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Forssell, Anna
    Pettersson, Berit
    Physicians' experiences of palliative care for heart failure patients2011In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 10, no 1, p. 64-69Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Although heart disease is the single most common cause of death knowledge about palliative care for this group of patients is deficient.

    AIM: The aim of this study was to describe physicians' experiences of palliative care for heart failure patients.

    METHODS: Fifteen physicians at a medical geriatrics clinic were interviewed. The interviews were analysed using thematic content analysis.

    RESULTS: The results show that the physicians are confronted with patients with an unpredictable disease trajectory, including patients with severe symptoms, uncertainty about anticipating the course of dying and encountering close relative's anxiety and frustration. The physicians face difficult situations regarding whether to continue or withdraw care and medical treatment which means deciding concerning 'active' medical treatment, cardio pulmonary resuscitation and an implantable cardioverter-defibrillator (ICD). The physicians acknowledge the necessity for better structured follow-ups and cooperation with outpatient settings. They recognize that there is a lack of follow-ups and continuity of care and treatment at the hospital, involving their passing on or retaining responsibility for the patients' medical care.

    CONCLUSION: From the physicians' view clarification of who is principally responsible for the patient's medical care, being involved throughout the disease trajectory and cooperating more closely with palliative care services are necessary to further improve the way in which care is delivered to patients dying of heart failure.

  • 242.
    Brännström, Margareta
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Fürst, Carl Johan
    Tishelman, Carol
    Petzold, Max
    Lindqvist, Olav
    Umeå University, Faculty of Medicine, Department of Nursing. Medical Management Centre (MMC), Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
    Effectiveness of the Liverpool care pathway for the dying in residential care homes: An exploratory, controlled before-and-after study2016In: Palliative Medicine: A Multiprofessional Journal, ISSN 0269-2163, E-ISSN 1477-030X, Vol. 30, no 1, p. 54-63Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Clinical pathways aim to ensure that individuals receive appropriate evidence-based care and interventions, with the Liverpool Care Pathway for the Dying Patient focusing on end of life. However, controlled studies of the Liverpool Care Pathway for the Dying Patient, particularly outside of cancer settings, are lacking.

    AIM: To compare the effects of the Liverpool Care Pathway for the Dying Patient and usual care on patients' symptom distress and well-being during the last days of life, in residential care homes.

    DESIGN: Exploratory, controlled before-and-after study. During a 15-month baseline, usual care was carried out in two areas. During the following 15-months, usual care continued in the control area, while residential care home staff implemented Liverpool Care Pathway for the Dying Patient use in the intervention area. The intervention was evaluated by family members completing retrospective symptom assessments after the patient's death, using the Edmonton Symptom Assessment System and Views of Informal Carers - Evaluation of Services.

    SETTINGS/PARTICIPANTS: Patients who died at all 19 residential care homes in one municipality in Sweden.

    RESULTS: Shortness of breath (estimate = -2.46; 95% confidence interval = -4.43 to -0.49) and nausea (estimate = -1.83; 95% confidence interval = -3.12 to -0.54) were significantly reduced in Edmonton Symptom Assessment System in patients in the intervention compared to the control area. A statistically significant improvement in shortness of breath was also found on the Views of Informal Carers - Evaluation of Services item (estimate = -0.47; 95% confidence interval = -0.85 to -0.08).

    CONCLUSION: When implemented with adequate staff training and support, the Liverpool Care Pathway for the Dying Patient may be a useful tool for providing end-of-life care of elderly people at the end of life in non-cancer settings.

  • 243.
    Brännström, Margareta
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hägglund, Lena
    Umeå University, Faculty of Medicine, Department of Nursing.
    Fürst, Carl Johan
    Boman, Kurt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Unequal care for dying patients in Sweden: a comparative registry study of deaths from heart disease and cancer2012In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 11, no 4, p. 454-459Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The Swedish Palliative Registry is a nationwide quality registry aimed at facilitating improvement in end-of-life care. The goal is for the registry to list and report quality indicators related to care during the last week of life in all cases expected death in Sweden.

    AIM: To examine the quality of care during the last week of life as reported to the registry for patients with heart disease compared to those with cancer.

    METHOD: A retrospective registry study.

    RESULTS: Patients dying of heart disease compared to those dying from cancer had more shortness of breath, fewer drugs prescribed as needed against the usual symptoms and often died alone. Furthermore, they and their close relatives received less information about the imminence of death and bereavement follow-up was less common. The healthcare personnel were less aware of the heart disease patients' symptoms and less often knew about where they wished to die.

    CONCLUSION: Great differences were found in registered end-of-life care suggesting that the care given to patients with heart disease and cancer was unequal even after adjustment for age, sex and setting at the time of death. If our observational findings are confirmed in future studies there is obviously a need for new models for end-of-life management in order to facilitate the provision of equal care to dying patients regardless of diagnosis.

  • 244.
    Brännström, Margareta
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Jaarsma, Tiny
    Faculty of Health Sciences, Linköping University.
    Struggling with issues about cardiopulmonary resuscitation (CPR) for end-stage heart failure patients2015In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 29, no 2, p. 379-385Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Integrating heart failure and palliative care teams combines unique expertise from both cardiology and palliative care. However, professionals from the two arenas of life-saving cardiology and palliative care may well have different experiences with and approaches to patient care. Little is known how to optimally discuss cardiopulmonary resuscitation with patients and their relatives and what challenges are for healthcare providers.

    OBJECTIVE: The aim of this study was to describe the experiences and thoughts of members of an integrated heart failure and palliative care team concerning talking about CPR with end-stage heart failure patients.

    METHOD: We used a descriptive qualitative design, conducting group interviews during 2011 with professionals from different disciplines working with heart failure patients over a 1-year period. A qualitative content analysis was performed to examine the interview data.

    RESULTS: Professional caregivers in integrated heart failure and palliative homecare are struggling with the issue of CPR of end-stage heart failure patients. They wrestle with the question of whether CPR should be performed at all in these terminally ill patients. They also feel challenged by the actual conversation about CPR with the patients and their relatives. Despite talking them about CPR with patients and relatives is difficult, the study participants described that doing so is important, as it could be the start of a broader end-of-life conversation.

    CONCLUSION: Talking with patient and relatives about CPR in end-stage heart failure, as suggested in the current heart failure guidelines, is a challenge in daily clinical practice. It is important to discuss the difficulties within the team and to decide whether, whom, how and when to talk about CPR with individual patients and their relatives.

  • 245.
    Brännström, Margareta
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Niederbach, Camilla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Rödin, Ann-Charlotte
    Experiences of surviving a cardiac arrest after therapeutic hypothermia treatment: an interview study2018In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 36, p. 34-38Article in journal (Refereed)
    Abstract [en]

    Background: Cardiac arrest (CA) is often associated with high mortality. In Sweden, it is reported that 13–52 per 100,000 people suffer out-of-hospital CA, and survival to one month is 2–14%.

    Objective: This study aimed to describe people’s experiences of surviving a CA after therapeutic hypothermia treatment.

    Method: A descriptive qualitative design was used. Data were collected through individual interviews with seven CA survivors. The collected data were analyzed using qualitative content analysis.

    Results: The analysis resulted in six subthemes and three emerging themes. The themes were “Dealing with issues of mortality”, “Living a changed life”, and “Being confident with health care and family members”.

    Conclusion: Surviving a CA after therapeutic hypothermia treatment means having to deal with issues of mortality, and these patients face a turning point in life. The near-death event can create regression or progression in ethos among these patients.

    Relevance to clinical practice: This study implies that persons who have survived a CA need support to cope. One way to provide support might be to initially establish an individualized health care plan, including bringing up existential issues and involving family members in such conversations.

  • 246.
    Bränström, Camilla
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Andersson, Lisa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Närståendes behov och erfarenheter av stöd när en familjemedlem diagnostiseras med en primär malign hjärntumör2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: A primary brain tumor occurs in the brain and gives varyingsymptoms depending on where in the brain the tumor grows. The symptoms affectthe patient, but also their relatives whose situation changes. Relatives assumesgreater responsibility to cope with everyday life together with the sick person. InSweden in 2015 approximately about 1300 people diagnosed whit brain tumor.

    Aim: To describe the needs and experiences of support of relatives to adult patient’swhit primary malignant brain tumors.

    Method: The results from eight studies whit a qualitative approach and ethicalapproval have been compiled. The analysis has been conducted with inspiration ofcontent analysis in which categories and subcategories have been created. The articleresearch was conducted in Cinahl, PubMed and PsykINFO.

    Results: Relatives experience support needs from family and friends and fromhealthcare, whit emotional support, practical support and information. The resultalso shows that the fulfillment of the support-needs is insufficient.

    Conclusion: Support to relatives from family and friends, but also from healthcareprofessionals, needs to be improved to fulfill the support-needs of relatives. Supportand communication needs to be individually adapted.

  • 247.
    Bråbäck, Lennart
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Vogt, H.
    Hjern, A.
    Migration and asthma medication in international adoptees and immigrant families in Sweden2011In: Clinical and Experimental Allergy, ISSN 0954-7894, E-ISSN 1365-2222, Vol. 41, no 8, p. 1108-1115Article in journal (Refereed)
    Abstract [en]

    Background Studies of asthma in migrant populations illustrate the effects of environmental changes. Objective In this register study we investigated the importance of exposure to a western lifestyle in different phases of development in Swedish residents with an origin in regions in the world where asthma usually is less prevalent. Methods The study population comprised 24 252 international adoptees, 47 986 foreign-born and 40 971 Swedish-born with foreign-born parents and 1 770 092 Swedish-born residents with Swedish-born parents (age 6-25 years). Purchased prescribed inhaled corticosteroids (ICS) during 2006 were used as an indicator of asthma. Results International adoptees and children born in Sweden by foreign-born parents had three-to fourfold higher rates of asthma medication compared with foreign-born children. The odds ratios (ORs) of asthma medication declined persistently with age at immigration. For adoptees the ORs compared with infant adoptees were 0.78 [95% confidence interval (CI) 0.71-0.85] for those adopted at 1-2 years, 0.51 (0.42-0.61) at 3-4 years and 0.35 (0.27-0.44) after 5 or more years of age. Corresponding ORs for foreign-born children with foreign-born parents immigrating at 0-4 years, at 5-9 years, at 10-14 years and at 15 years or more were 0.73 (0.63-0.86), 0.56 (CI 0.46-0.68) and 0.35 (CI 0.28-0.43), respectively. The ORs were only marginally affected by adjustment for region of birth and socio-economic indicators. Conclusions and Clinical Relevance Age at immigration is a more important determinant of purchased ICS than population of origin. This indicates the importance of environmental factors for asthma in schoolchildren and young adults.

  • 248.
    Bråndal, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Eriksson, Marie
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Glader, Eva-Lotta
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Department of Clinical Sciences, Karolinska Institute, Danderyd hospital, Stockholm, Sweden.
    Effect of early supported discharge after stroke on patient reported outcome based on the Swedish Riksstroke registry2019In: BMC Neurology, ISSN 1471-2377, E-ISSN 1471-2377, Vol. 19, article id 40Article in journal (Refereed)
    Abstract [en]

    Background: The efficacy of early supported discharge (ESD) has not been tested in current stroke care setting, which provide relatively short hospital stays, access to hyper-acute therapies and early carotid stenosis interventions. This study aimed to compare patient-reported outcome measures (PROM) among patients with stroke that received modern stroke unit care with or without ESD.

    Methods: Observational study of 30,232 patients with first-ever stroke registered in the Riksstroke registry in Sweden, between 1 January 2010 and 31 December 2013. Patient characteristics were collected from the Riksstroke and Statistics Sweden databases. The primary outcome was satisfaction with the rehabilitation at 3 months after discharge. Secondary outcome were information about stroke provided, tiredness/fatigue, pain, dysthymia/ depression, general health status and dependence in activities of daily living (mobility, toileting and dressing) at 3 months after the stroke. We used separate multivariable logistic regression models for each PROM variable to analyze associations between PROMs and ESD/no ESD.

    Results: The ESD group comprised 1495 participants: the control group comprised 28,737 participants. Multivariable logistic regression models of PROMs showed that, compared to controls, the ESD group was more satisfied with rehabilitation after discharge (OR: 1.78, 95% CI: 1.17–2.49), experienced less dysthymia/depression (OR: 0.68, 95% 0.55–0.84) and showed more independence in mobility (OR: 1.50, 95% CI: 1.17–1.92), toileting (OR: 1.30, 95%CI: 1.05–1.61), and dressing (OR: 1.23, 95%CI: 1.02–1.48).

    Conclusion: In the setting of modern stroke unit care, ESD appeared to have positive effects on stroke rehabilitation, in the subacute phase.

  • 249.
    Brömster, Therése
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Karin, Hoffman
    Umeå University, Faculty of Medicine, Department of Nursing.
    Självkänsla hos extremt prematurfödda barn - en kvantitativ tvärsnittsstudie2015Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Vården av extremt prematurfödda barn (EPB) har gått mycket framåt och i olika länder är de olika aktiva i omhändertagandet vid födseln av dessa barn. Omvårdnaden har stor betydelse för hur dessa barn ska klara sig utan svåra men. The Newborn Individualized Developmental Care and Assessment Program (NIDCAP) är en strategi för hur EBP bör skötas i förhållande till vad de klarar av och har visat sig ha betydelse för att skydda dessa barns känsliga hjärna. God smärtlindring är också viktigt då smärtan är skadlig för hjärnans utveckling både på kort och lång sikt. Barnets anknytning till sina föräldrar har betydelse för deras självkänsla. Självkänsla hos extremt prematurfödda barn är inte så väl studerat varför syftet med studien är att undersöka självskattad självkänsla hos extremt prematurfödda barn.

    Metod: Urvalet bestod i en totalpopulation av EPB födda i Sverige mellan mars 1990-april 1992 och en kontrollgrupp bestående av barn födda på samma sjukhus, med samma kön och så nära födelsedatum som möjligt i fullgången tid och med en normal födelsevikt. Alla barn har fyllt i självskattningsformuläret ”Jag tycker jag är”. Chi2-test, t-test och Mann-Whitney U-test har utförts för att jämföra grupperna. Signifikansnivån var satt till p=0,050.

    Resultat: EPB skattade sig lägre jämfört med barnen i kontrollgruppen förutom inom domänen relationer till familjen där de skattar sig högre. De EPB med intraventrikulär hemorragi (IVH) grad III-IV/PVL skattade sin självkänsla signifikant lägre än de EPB utan. Mellan EPB med socioekonomiska risker och utan socioekonomiska risker fanns inga signifikanta skillnader vad gäller självskattning för självkänsla, medan det fanns signifikanta skillnader inom flera domäner för barnen i kontrollgruppen mellan barnen med och utan socioekonomiska risker.

    Slutsats: De flesta EPB skattar sin självkänsla inom normalvariationen dock skattar de den lägre inom flera domäner jämfört med kontrollgruppen. Troligtvis har både omvårdnaden och föräldrar inverkan på hur barnen skattar sin självkänsla. 

  • 250.
    Buchberger, Andreas
    Umeå University, Faculty of Medicine, Department of Nursing.
    Ansvar och utmaning: En litteraturstudie om sjuksköterskors erfarenheter av arbete inom kommunal äldreomsorg2019Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Introduction: Sweden’s average population is getting older and is in need of more advanced care, this creates more challenges and greater demands for nurses working within elderly care.

    Methods: A literary study performed with the usage of eight qualitative research papers, the data was collected via content analysis. The search was performed in three databases; CINAHL, PubMED and PsycINFO.

    Results: The results were sorted in three categories; Responsibility for safe care and nursing with subcategories Holistic care, Patient safety as an important aspect, Safe drug management, and Competence in different areas with subcategories Advanced knowledge requirements, Knowledge lack as a problem, Leadership - Between Accessibility and Powerlessness, Communication as an important factor, and Challenge in daily work with subcategories Lack of Organization and resource shortage, Independent and Lonely, Development as a positive factor

    Conclusions: Nurses perceive their work as complex with elderly people in the centre and with staff and relatives in mind. Lack of knowledge, unclear organization and lack of resources are factors that the nurse felt stressed and dissatisfied with. Functional communication is a key role for daily work and contributes to a qualitatively good person-centered care and increased patient safety and requires extended research in the future

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