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  • 201.
    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.

  • 202.
    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.

  • 203.
    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.
    Hällgren Graneheim, Ulla
    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 diabetesIn: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134Article in journal (Refereed)
  • 204.
    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.
    Lehuluante, Abraraw
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Patient-centred care in type 2 diabetes: an altered professional role for diabetes specialist nurses2014In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 28, no 4, p. 675-682Article in journal (Refereed)
    Abstract [en]

    Little research has been done to try to understand how patient-centred care is understood and practised by healthcare professionals specialising in patients with diabetes. Experiences from patient-centred practices need to be highlighted as a way of motivating diabetes specialist nurses to take a patient-centred approach. The aim of this study was to describe diabetes specialist nurses' experiences of practising patient-centred care in the context of a type 2 diabetes intervention. The study design was descriptive and used qualitative methods. Focus group interviews complemented by individual semi-structured interviews were analysed by qualitative content analysis. The main theme of the diabetes specialist nurses' experiences of practising patient-centred care was an altered professional role. The main theme was based on two themes: ambivalence towards practising patient-centred care and enriched relationships with the patients. The ambivalence towards practising patient-centred care was based on the three subthemes: a position of withdrawn expertise, inconvenience of changing routines and insights that patient-centred care is difficult but possible. Their experiences of enriched relationships with patients were based on the two subthemes: courage to discuss the severity of diabetes and increased engagement in patients' daily lives. The diabetes specialist nurses' experiences with practising patient-centred care included doubts about their ability to practise in such a way and about the feasibility of such care. At the same time, their enriched relationships with patients were seen as an opportunity to engage in patients' lives. Training and support for practising patient-centred care may improve diabetes specialist nurses skills in patient-centred care and self-management support in type 2 diabetes.

  • 205.
    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
  • 206.
    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.

  • 207.
    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.

  • 208.
    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

     

  • 209.
    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.

  • 210.
    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.

  • 211. Broqvist, Mari
    et al.
    Carlsson, Per
    Jacobsson, Catrine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Karlsson, Erling
    Lund, Karin
    Öppna politiska prioriteringar av hälso- och sjukvård: rapportering från ett seminarium2005Report (Other academic)
  • 212. Browall, Maria
    et al.
    Östlund, Ulrika
    Umeå University, Faculty of Medicine, Department of Nursing.
    Henoch, Ingela
    Wengström, Yvonne
    The course of Health Related Quality of Life in postmenopausal women with breast cancer from breast surgery and up to five years post-treatment2013In: Breast, ISSN 0960-9776, E-ISSN 1532-3080, Vol. 22, no 5, p. 952-957Article in journal (Refereed)
    Abstract [en]

    Background: Previous studies include too few patients over 70 years to be able to assess treatment effects on Health Related Quality Of Life (HRQOL) in the older age group. We aimed to follow HRQOL in postmenopausal women (55-80 years) with breast cancer receiving adjuvant treatment, until five years post-treatment, and compare with a general population. Patients and methods: The patient sample included 150 women (adjuvant CT n - 75 and RT n - 75) and two reference samples from the Swedish SF-36 norm database. Results: Data from baseline showed significantly higher levels of physical functioning and general health among the patients compared to the reference sample, and significantly lower levels of bodily pain, emotional role functioning and mental health. Longitudinal analyses showed significant changes in all scales, and three different patterns (a decrease-stable, a decrease-increase, and a stable-increase pattern) were identified. Conclusion: Postmenopausal women seem to successfully manage the effects of adjuvant treatment on HRQOL. 

  • 213.
    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.

  • 214.
    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. 

  • 215.
    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.

  • 216.
    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.

  • 217.
    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.

  • 218.
    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.

  • 219.
    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.

  • 220.
    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 defects2017In: Clinical Nursing Research, ISSN 1054-7738, E-ISSN 1552-3799Article 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.

  • 221.
    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.

  • 222.
    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.

  • 223.
    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.

  • 224.
    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.

  • 225.
    Brännström, Helene
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Bäckman, Margit
    Umeå University, Faculty of Medicine, Department of Nursing.
    Santamäki Fischer, Regina
    Umeå University, Faculty of Medicine, Department of Nursing.
    Walking on the edge: meanings of living in an ageing body and using a walker in everyday life - a phenomenological hermeneutic study2013In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 8, no 2, p. 116-122Article in journal (Refereed)
    Abstract [en]

    Background.  In order to maintain one’s state of health whilst growing older, the ability to walk is essential.

    Aim and objective.  The aim of this study was to illuminate the meanings of the lived experience of living in an ageing body and using a walker in daily life.

    Methods.  Narrative interviews were performed with seven older persons aged 79–95 years. The transcribed text was analysed using a phenomenological hermeneutic method.

    Results.  The key finding of the study was that the lived experience of living in an ageing body and using a walker in daily life was interpreted as ‘walking on the edge’ based on the themes ‘Being vulnerable and dependent’ and ‘Being confident and independent’.

    Conclusions.  The results highlight the importance of reflecting on this phenomenon as a health care professional while meeting the care needs of older persons who use walkers.

    Implications for practice.  Nurses need to consider the walker as a personal and valued possession of the individual and handle the walker in agreement with the older person, placing the walker close at hand with the brakes locked to give secure support.

  • 226.
    Brännström, Margareta
    Umeå University, Faculty of Medicine, Omvårdnad.
    Att leva med svår kronisk hjärtsvikt i palliativ hemsjukvård: ett liv i berg och dalbana2007In: Primärvårdens Nyheter, no 11/12, p. 18-22Article in journal (Other (popular science, discussion, etc.))
  • 227.
    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.

  • 228.
    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)
  • 229.
    Brännström, Margareta
    Umeå University, Faculty of Medicine, Omvårdnad.
    När livet går i berg- och dalbana2007In: Vårdfacket, Vol. 11, no 31, p. 63-Article in journal (Other (popular science, discussion, etc.))
  • 230.
    Brännström, Margareta
    et al.
    Umeå University, Faculty of Medicine, Nursing.
    Björck, Martin
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Nursing.
    Wanhainen, Anders
    Patients' experiences of being informed about having an abdominal aortic aneurysm: a follow-up case study five years after screening2009In: Journal of Vascular Nursing, ISSN 1062-0303, E-ISSN 1532-6578, Vol. 27, no 3, p. 70-74Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to describe patients' experiences 5 years after being informed about having an abdominal aortic aneurysm (AAA), at screening, in a subgroup of patients who suffered a decrease in quality of life (QoL) 12 months after screening. Of 6 patients with a decreased QoL 12 months after AAA screening, one had died, one declined to participate and one suffered cognitive problems and was therefore excluded. The remaining 3 patients (all men, aged 79-80 years) were interviewed in their homes. The interviews were analysed using thematic content analysis. The result shows that the patients have feelings of security about offered professional care, despite awareness of having an AAA. These feelings include having a relationship of trust with the surgeon; having trust in screening, follow-up checks and the possible treatment for their AAAs; and having awareness of the severity of the disease. Furthermore, the patients experience having an AAA to be symbolically 'like a drop in the ocean.' This means having no physical problems related to AAA, and having more difficulties with other diseases or problems in life overshadows the awareness about the AAA. An observed reduction in QoL among subjects with screening-detected AAA was mainly explained by other diseases or problems that overshadow the AAA. However, the low number of participants indicates a need for extended studies on this topic.

  • 231.
    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.

  • 232.
    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.
    Effects of person-centred and integrated chronic heart failure and palliative home care. PREFER: a randomized controlled study2014In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 16, no 10, p. 1142-1151Article in journal (Refereed)
    Abstract [en]

    AimsWe evaluated the outcome of person-centred and integrated Palliative advanced home caRE and heart FailurE caRe (PREFER) with regard to patient symptoms, health-related quality of life (HQRL), and hospitalizations compared with usual care. Methods and resultsFrom January 2011 to October 2012, 36 (26 males, 10 females, mean age 81.9years) patients with chronic heart failure (NYHA class III-IV) were randomized to PREFER and 36 (25 males, 11 females, mean age 76.6years) to the control group at a single centre. Prospective assessments were made at 1, 3, and 6 months using the Edmonton Symptom Assessment Scale, Euro Qol, Kansas City Cardiomyopathy Questionnaire, and rehospitalizations. Between-group analysis revealed that patients receiving PREFER had improved HRQL compared with controls (57.619.2 vs. 48.524.4, age-adjusted P-value=0.05). Within-group analysis revealed a 26% improvement in the PREFER group for HRQL (P=0.046) compared with 3% (P=0.82) in the control group. Nausea was improved in the PREFER group (2.4 +/- 2.7 vs. 1.7 +/- 1.7, P=0.02), and total symptom burden, self-efficacy, and quality of life improved by 18% (P=0.035), 17% (P=0.041), and 24% (P=0.047), respectively. NYHA class improved in 11 of the 28 (39%) PREFER patients compared with 3 of the 29 (10%) control patients (P=0.015). Fifteen rehospitalizations (103days) occurred in the PREFER group, compared with 53 (305days) in the control group. ConclusionPerson-centred care combined with active heart failure and palliative care at home has the potential to improve quality of life and morbidity substantially in patients with severe chronic heart failure.

  • 233.
    Brännström, Margareta
    et al.
    Umeå University, Faculty of Medicine, Nursing.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Nursing.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Nursing.
    Boman, Kurt
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Medicine. Medicin.
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Nursing.
    Being a palliative nurse for persons with severe congestive heart failure in advanced homecare.2005In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 4, no 4, p. 314-323Article in journal (Refereed)
    Abstract [en]

    Advanced homecare for persons with congestive heart failure is a ‘new’ challenge for palliative nurses. The aim of this study is to illuminate the meaning of being a palliative nurse for persons with severe congestive heart failure in advanced homecare. Narrative interviews with 11 nurses were conducted, tape-recorded, and transcribed verbatim. A phenomenological-hermeneutic method was used to interpret the text. One meaning of being a palliative nurse is being firmly rooted and guided by the values of palliative culture. Being adaptable to the patient's way of life carries great weight. On one hand nurses live out this value, facilitating for the patients to live their everydaylife as good as possible. Being a facilitator is revealed as difficult, challenging, but overall positive. On the other hand nurses get into a tight corner when values of palliative culture clash and do not correspond with the nurses interpretation of what is good for the person with congestive heart failure. Being in such a tight corner is revealed as frustrating and giving rise to feelings of inadequacy. Thus, it seems important to reflect critical on the values of palliative culture.

  • 234.
    Brännström, Margareta
    et al.
    Umeå University, Faculty of Medicine, Nursing.
    Ekman, Inger
    Boman, Kurt
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Medicine. Medicin.
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Nursing.
    Being a close relative of a person with severe, chronic heart failure in palliative advanced home care - a comfort but also a strain.2007In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 21, no 3, p. 338-344Article in journal (Refereed)
    Abstract [en]

    Within previous research on family care of terminally ill people, studies have only rarely been carried out concerning heart failure care. This study aims to illuminate meanings of being a close relative of a person with severe, chronic heart failure (CHF) in palliative advanced home care (PAHC). Narrative interviews were conducted with three close relatives, tape-recorded, transcribed verbatim and a phenomenological-hermeneutic method was used to interpret the text. Meanings of being a close relative is to follow the life-threatening ups and downs, the person with CHF is going through. 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, trusting their ability to show up on time to alleviate in the worst downs i.e. ease suffering. This study reveals that to be the close relative that the ill person is dependent on 24 hours a day is both a comfort and a strain.

  • 235.
    Brännström, Margareta
    et al.
    Umeå University, Faculty of Medicine, Nursing.
    Ekman, Inger
    Boman, Kurt
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Medicine. Medicin.
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Nursing.
    Narratives of a man with severe chronic heart failure and his wife in palliative advanced home care over a 4.5-year period.2007In: Contemporary Nurse, ISSN 1037-6178, Vol. 27, no 1, p. 10-22Article in journal (Refereed)
  • 236.
    Brännström, Margareta
    et al.
    Umeå University, Faculty of Medicine, Nursing.
    Ekman, Inger
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Nursing.
    Boman, Kurt
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Medicine. Medicin.
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Nursing.
    Living with severe chronic heart failure in palliative advanced home care.2006In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 5, no 4, p. 295-302Article in journal (Refereed)
    Abstract [en]

    Background - Living with severe chronic heart failure (CHF) in palliative care has been little studied.

    Aim - The aim of this study is to illuminate meaning of living with severe CHF in palliative advanced home care through patients' narratives.

    Methods-Narrative interviews were conducted with 4 patients, tape-recorded and transcribed verbatim. A phenomenological–hermeneutic method was used to interpret the text.

    Results - Meaning of living with severe CHF in palliative advanced home care emerged as ‘knocking on death's door’ although surviving. The course of the illness forces one to live a ‘roller coaster life,’ with an ongoing oscillation between ups and downs. Making it through the downs breeds a kind of confidence in one's ability to survive and the will to live is strong. Being offered a safety belt in the ‘roller coaster’ by the palliative advanced home care team evokes feelings of security.

    Conclusions - Meaning of living with severe CHF in palliative advanced home care is on one hand, being aware of one's imminent death, on the other hand, making it through the downs i.e. surviving life-threatening conditions, breed confidence in also surviving the current down. Being constructively dependent on palliative advanced home care facilitates everyday life at home.

  • 237.
    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.

  • 238.
    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.

  • 239.
    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.

  • 240.
    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.

  • 241.
    Brännström, Margareta
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Strategic Research Program in Health Care Sciences (SFO-V), "Bridging Research and Practice for Better Health", Karolinska institutet.
    Kristofferzon, Marja-Leena
    Ivarsson, Bodil
    Nilsson, Ulrica G
    Svedberg, Petra
    Thylén, Ingela
    Sexual Knowledge in Patients With a Myocardial Infarction and Their Partners2014In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 29, no 4, p. 332-339Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:: Sexual health and sexual activity are important elements of an individual's well-being. For couples, this topic is often affected after a myocardial infarction (MI). It has become increasingly clear that, after an MI, patients are insufficiently educated on how to resume normal sexual activity. However, sufficient data on the general knowledge that patients and partners have about sexual activity and MI are lacking. OBJECTIVE:: The aims of this study were to explore and compare patients' and partners' sexual knowledge 1 month after a first MI and 1 year after the event and to compare whether the individual knowledge had changed over time. A second aim was to investigate whether patients and their partners report receiving information about sexual health and sexual activity from healthcare professionals during the first year after the event and how this information was perceived. SUBJECTS AND METHODS:: This descriptive, comparative survey study enrolled participants from 13 Swedish hospitals in 2007-2009. A total of 115 patients with a first MI and their partners answered the Sex After MI Knowledge Test questionnaire 1 month after the MI and 1 year after the event. Correct responses generated a maximum score of 75. RESULTS:: Only 41% of patients and 31% of partners stated that they had received information on sex and relationships at the 1 year follow-up. The patients scored 51 ± 10 on the Sex After MI Knowledge Test at inclusion into the study, compared with the 52 ± 10 score for the partners. At the 1-year follow-up, the patients' knowledge had significantly increased to a score of 55 ± 7, but the partners' knowledge did not significantly change (53 ± 10). CONCLUSIONS:: First MI patients and their partners reported receiving limited information about sexual issues during the cardiac rehabilitation and had limited knowledge about sexual health and sexual activity.

  • 242.
    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 study2017In: 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.

  • 243.
    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.

  • 244.
    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. 

  • 245.
    Burbara, Michael
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Bjurinder, Björn
    Umeå University, Faculty of Medicine, Department of Nursing.
    Ambulanssjuksköterskans upplevelser av det prehospitala samarbetet med sjuksköterskor och sjukvårdare.2015Independent thesis Advanced level (degree of Master (One Year)), 40 credits / 60 HE creditsStudent thesis
    Abstract [en]

    Background: Since 2005 it requires at least a nurse in the ambulance crew to administer drugs but the demands on the ambulance crew varies between the Swedish counties. The development within the ambulance service has meant higher skills requirements and that the number of specialized nurses has increased. There is little research on the collaboration between the ambulance crew depending on its composition and very little is researched on specialist trained ambulance nurses' experiences of the pre-hospital collaboration.

    Aim: The aim of this study was to describe the ambulance nurses' experiences of the pre-hospital collaboration with nurses and paramedics.

    Method: In order to capture the phenomenon, a qualitative interview was elected and to deeper describe ambulance nurses' experiences, the data was analyzed with a qualitative content analysis. Interviews were conducted with eight informants from two ambulance stations. Inclusion criteria for the study were registered nurses with specialized training in prehospital care, working in the ambulance service in northern Sweden. The informants would have personal experience of as trained ambulance nurse working with both nurses and paramedics in the ambulance for at least 3 years.

    Results: The results are presented in three main categories; Meaning of competence, Shared responsibility and Quality of care. Seven subcategories; Work experience, Education, Rest and relief, Job rotation, Medical decisions, Patient safety and Good nursing care.

    Conclusion: The informants experienced that working with mainly an inexperienced colleague could have a negative impact on patient management as habitual procedures can’t be followed. Ideally, informants worked with an experienced nurse but preferred an experienced paramedic before an inexperienced nurse. The informants perceive that to be able to toggle role of having the medical responsibility creates a varied and better working environment with the possibility of recovery. Collegial interaction increases the chances for good care.

  • 246.
    Burman, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Säätelä, S.
    Novia University of Applied Sciences, Vasa, Finland.
    Carlsson, Maine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Olofsson, Birgitta
    Umeå University, Faculty of Medicine, Department of Nursing.
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Hörnsten, Carl
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Body Mass Index, Mini Nutritional Assessment, and their Association with Five-Year Mortality in Very Old People2015In: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 19, no 4, p. 461-467Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: to investigate the prevalence of malnutrition and the association between Body Mass Index (BMI), Mini Nutritional Assessment (MNA) and five-year mortality in a representative population of very old (>85 years) people.

    DESIGN: A prospective cohort study.

    SETTING: A population-based study of very old people in northern Sweden and western Finland, living in institutional care or in the community.

    PARTICIPANTS: Out of 1195 potential participants, 832 were included (mean age 90.2±4.6 years).

    MEASUREMENTS: Nutritional status was assessed using BMI and MNA and the association of those two variables with five-year mortality was analyzed.

    RESULTS: The mean BMI value for the whole population was 25.1±4.5 kg/m2, with no difference between genders (P=0.938). The mean MNA score was 22.5±4.6 for the whole sample, and it was lower for women than for men (P<0.001). Thirteen percent were malnourished (MNA<17) and 40.3% at risk of malnutrition (MNA 17-23.5) according to MNA. Also, 34.8% of those with a MNA score <17 still had a BMI value ≥22.2 kg/m2. A BMI value <22.2 kg/m2 and a MNA score<17 were associated with lower survival. The association with mortality seemed to be J-shaped for BMI, and linear for MNA.

    CONCLUSIONS: Malnutrition according to MNA was common, but a substantial portion of those with a low MNA score still had a high BMI value, and vice versa. The association with mortality appeared to be J-shaped for BMI, and linear for MNA. The MNA seems to be a good measurement of malnutrition in very old people, and BMI might be misleading and could underestimate the prevalence of malnutrition, especially in women.

  • 247. Burns, A
    et al.
    Ballard, C
    Banerjee, S
    Calabrese, P
    De Deyn, PP
    Grosberg, G
    Jones, R
    Sandman, PO
    Umeå University, Faculty of Medicine, Omvårdnad.
    Selmes, J
    Vellas, B
    Waldemar, G
    Wilcock, G
    Winblad, B
    Zaudig, M
    The clinical use of memantine.2005In: Research and Practice in Alzheimer's Disease, Vol. 10, p. 205-20Article in journal (Refereed)
  • 248.
    Burström, Johannes
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Wistrand, Emma
    Umeå University, Faculty of Medicine, Department of Nursing.
    Patienters upplevelser av nedre extremitet amputation: En litteraturstudie2015Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Amputation innebär att en extremitet eller ett organ tas bort från kroppen som ett resultat av långvarig sjukdom, fysiskt trauma, tumör eller missbildning. Globalt sett orsakas amputation av ett trauma, men i väst världen är hjärt-kärlsjukdomar den största orsaken till amputation. En traumatisk amputation kan ske oväntat, detta kan leda till förtvivlan och sorg. Människor som har hjärt-kärlsjukdomar eller diabetes kan ha levt med svåra smärtor i extremiteten under en längre tid, då kan amputation lindra smärtan.

    Syfte: Syftet med litteraturstudien var att belysa patienters upplevelser efter amputation av nedre extremitet.

    Metod: För att besvara studiens syfte genomfördes en systematisk litteraturstudie, vilket bygger på granskning och sammanställning av vetenskapliga artiklar. Litteratursökningen genomfördes via databaserna CHINAHL, PubMed, PsycINFO och Scopus. Åtta vetenskapliga artiklar bedömdes relevanta för studiens syfte. Analysmetoden gick ut på att läsa de valda artiklarna och sedan jämföra studiernas resultat för att identifiera likheter och olikheter.

    Resultat: Efter sammanställning av de åtta studierna identifierades tre övergripande rubriker: sociala förändringar, leva med smärta och hantera vardagen.

    Konklusion: Studiens slutsats är att livssituationen förändras på olika sätt för patienter som genomgått amputation av nedre extremitet. Strategier och stöd hjälper patienterna att rehabilitera sig och återfå känsla av självständighet.

  • 249.
    Burström, Marianne
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Boman, Kurt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Manliga patienter med hjärtsvikt och deras erfarenheter av att vara trygga och otrygga2007In: Vård i Norden, ISSN 0107-4083, E-ISSN 1890-4238, Vol. 3, no 27, p. 24-28Article in journal (Refereed)
    Abstract [en]

    To be safe is a basic human need. Although feelings of being unsafe has been identified as a common problem among persons who live with heart failure there are few qualitative studies focusing on the problem. The aim of this study was to describe what it means to be safe or unsafe for men with heart failure. Seven men with heart failure, functional class NYHA II-III, were interviewed in focus groups. The interviews were analysed with content analysis. Threat of sudden death was described as both a source of safety and unsafety, and living with a fear of drowning in their own body fluid was seen as a source of unsafety for the men. In meetings with caregivers and relatives it was of importance to be received as a unique and valuable person. The confidence to the heart specialist was almost supernatural and the specialist nurse was spoken about as valuable for the feeling of being safe. In conclusion, to be seen with respect by physicians and nurses who have good ability to listen to the men's experience of living with heart failure can probably increase the men's feelings of safety. Further, it is important that physicians and nurses have good knowledge about heart failure.

  • 250.
    Burström, Marianne
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Brännström, Margareta
    Umeå University, Faculty of Medicine, Department of Nursing.
    Boman, Kurt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Life experiences of security and insecurity among women with chronic heart failure2012In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 68, no 4, p. 816-825Article in journal (Refereed)
    Abstract [en]

    Aim. This paper is a report of a study illuminating womens experiences of living with chronic heart failure with a focus on feelings of security and insecurity.

    Background. To be secure is a basic human need. Although feelings of being insecure has been found to be a common problem among people who live with chronic heart failure few qualitative studies, particularly among women, have been carried out in the field.

    Method. Eight women took part in focus group interviews during 2006. The data were analysed using qualitative content analysis. Findings. The womens feelings of security include acceptance of the past, everyday life and the future, trusting the self and the body despite the disease, not having to deal with dependency alone, and faith in care and treatment. The womens feelings of insecurity include feeling guilty for being sick and incapacitated, fear of living with a frail and failing body, anxiety about growing dependence on others, loneliness and death and lack of faith in care and treatment.

    Conclusion. The outlook on the past, the present and the view about the future, can be fundamental for the quality of life, and the sense of security and insecurity among women living with chronic heart failure. To support a sense of security it seems essential that nursing staff attempt to understand the womens outlook on life and their personal interpretations of living with chronic heart failure. This can be crucial for enhancing feelings of security in daily life for these women.

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