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  • 251.
    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.

  • 252.
    Burlin, Therese
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Rosell, Anna
    "Flexibel arbetstid och trygga föderskor måste vara ett vinnande koncept": En kvantitativstudie om intresset för caseloadvård hos barnmorskor i Sverige.2019Independent thesis Advanced level (degree of Master (One Year)), 60 credits / 90 HE creditsStudent thesis
    Abstract [en]

    Background: In recent years, it has been reported that midwives "are fleeing" from thematernity care. In several places in Sweden, caseload care is introduced as a complementto the traditional maternity care. Caseload means that the pregnant woman has the samemidwife/midwives during pregnancy, childbirth and aftercare.

    Motive: International studies have shown that there are several advantages of caseloadcare.

    Aim: The aim of the study was to investigate the interest in caseload care among midwivesin Sweden.

    Methods: A cross-sectional study with a self-designed questionnaire. The questionnairewas posted on a closed midwife forum on a social media platform. The responses wereentered into SPSS version 25 and the results were analyzed with descriptive andcomparative statistics.

    Result: The main result showed that 85.2% are interested in caseload care and 71.6% areinterested in working within a caseload model.The group (14.8%) who were not interested in caseload care saw no benefits from workingaccording to a caseload model.

    Discussion: Caseload care can mean that the midwife feels strengthened in herprofessional role. Work within a caseload model contributes to less burnout and increasedjob satisfaction.

    Conklusion: The result is interpreted as that midwives in Sweden are interested incaseload care and that the interest in working within a caseload model is high. Moreresearch is needed in this area.

  • 253.
    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.

  • 254.
    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.

  • 255.
    Burström, Maja
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lindholm, Nils
    Patienters erfarenheter av vårdmiljön inom psykiatrisk heldygnsvård2018Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Aim: To describe patients experiences of the ward environment within psychiatric inpatient care.

    Background: The environment has historically played a major part in psychiatric care and treatment, however that changed towards the end of the twentieth century. The prevalence of psychiatric illness in Sweden is increasing. Patients within psychiatric inpatient care are more often than in the case with somatic inpatients experiencing poor reception, being less informed and to be less included. Earlier research shows that the ward environment plays a significant part in the time the patient spend on the ward and that the patients often can describe how they are not satisfied with the environment they are experiencing at the psychiatric wards.

    Method: We used a qualitative method with an inductive approach. Four focus group interviews were conducted at four different psychiatric wards. A total of 11 patients took part as interviewees. The data collection took place between December 2015 and February 2016. The transcribed interviews have been analyzed using qualitative content analysis.

    Result: The result showed that the patients often had clear views about what constitutes a good ward environment but that they often were displeased with what actually was case. Three categories were identified: the physical environment sets the frame, relationships are crucial, and activity promotes health. The ward environment was described as a possible obstacle to mental recovery in different ways, the physical environment was negative, lacked space for being by oneself and could make the patients feel trapped. The patients affected each other in both positive and negative ways whilst the staff often were described as being uninterested in the environment of the wards. The patients could describe how they lacked meaningful activities and that the existence of such activities could have played a part in the promotion of their mental health.

    Conclusion: Our study shows that patients often carries with them clear views and expectations of what constitutes a good ward environment. As they are admitted as patients these expectations are often not met by the actual environment on the wards. This study can help staff at psychiatric wards to increase their knowledge of the patient experience regarding the care environment of psychiatric wards and therefore can help improve the care within that context. Further research could deal with question of which care type of requirements have to be put on the care environment of psychiatric wards in order to further effectiveness when it comes to mental rehabilitation and in what physical shape it should take place.

    Key words:experiences, patients, psychiatric inpatient care, psychiatric nursing, ward environment.

  • 256.
    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.

  • 257. Burström, Åsa
    et al.
    Mora, Mariela Acuna
    Öjmyr-Joelsson, Maria
    Sparud-Lundin, Carina
    Rydberg, Annika
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Hanseus, Katarina
    Frenckner, Björn
    Nisell, Margret
    Moons, Philip
    Bratt, Ewa-Lena
    Parental uncertainty about transferring their adolescent with congenital heart disease to adult care2019In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 75, no 2, p. 380-387Article in journal (Refereed)
    Abstract [en]

    Aims: To study parent's levels of uncertainty related to the transfer from pediatric to adult care in adolescents with congenital heart disease (CHD) and to identify potentially correlating factors. Background: Parents acknowledge that during transition they struggle with finding ways of feeling secure in handing over the responsibility and letting go of control. Well-prepared and informed parents who feel secure are most likely better skilled to support their adolescent and to hand over the responsibility. Design: A cross-sectional study. Methods: Overall, 351 parents were included (35% response rate). Parental uncertainty was assessed using a Linear Analogue Scale (0-100). Data were collected between January - August 2016. Potential correlates were assessed using the readiness for transition questionnaire and sociodemographic data. Results: The mean parental uncertainty score was 42.5. Twenty-four percent of the parents had a very low level of uncertainty (score 0-10) and 7% had a very high level (score 91-100). Overall, 26% of the mothers and 36% of the fathers indicated that they had not started thinking of the transfer yet. The level of uncertainty was negatively associated with the level of perceived overall readiness. Adolescents' age, sex, CHD complexity, and parental age were not related to uncertainty. Conclusion: A wide range in the levels of uncertainty was found. Parents who were less involved in the care, or perceived their adolescent as readier for the transition, felt less uncertain. Still, thirty percent of the parents had not started to think about the transfer to adult care.

  • 258.
    Byenfeldt, Marie
    Umeå University, Faculty of Medicine, Department of Nursing.
    Ultraljuds-baserad shear wave elastografi- En kvantitativ studie av faktorer som kan påverka tillförlitligheten i mätresultatet vid gradering av leverfibros2016Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Aim: The aim of this study was to investigate factors that may affect the reliability of measurement result with ultrasound-based shear wave elastography, when scoring liver fibrosis, among patients with chronic liver disease.

    Background: Chronic liver disease may develop liver fibrosis, and in worst cases cancer of the liver. Today, there is antiviral treatment and among the non-invasive methods that have been developed to score liver fibrosis, there is ultrasound-based shear wave elastography. This new method started in 2014 at Östersunds Hospital x-ray department and in cases when the measurements result does not correlate with the clinical findings, problems emerge.

    Design: The study has been performed as a descriptive quantitative study with retrospective design, at the level of Master’s degree in the radiography science at Umeå University.

    Method: Measurements from 132 individuals, which have been examined with Philips iU22 ElastPQ shear wave elastography, was analyzed.  The measurements was divided into two groups, using the inter quartile range as a cut-off; obtaining one study group and one control group. Logistic regression analysis has been performed to investigate the relationship to either group.

    Results: The following factors showed significant correlation to less accurate measurement result: age, the length of disease, steatosis, antiviral-and/or cardiovasckular medicine, AST och ALT and distance between probe surface and liver capsule. With bivariate regression analysis the significant findings were: age (p=0.002), the disease length (p=0.039), steatosis (p=0.001), antivirale- and/or cardiovascular medicine (p=0.045), AST (p=0.001), ALT (p=0.038) and distance between probe surface and liver capsule (p=0.000). Using the multivariate regression analysis the following significant findings remained: antivirale- and/or cardiovascular medicine (p=0.049) and increased distance between probe surface and liver capsule (p=0.003).

    Conclusion: When scoring liver fibrosis with the method ultrasound-based shear wave elastography, and the distance between probe surface and liver capsule are increased, the measurements may, according to the study´s main finding, imply less accurate measurements result. The patient may for that reason advantageously lie in left decubitus position during the examination, to obtain decreased distance to the liver capsule. There is still need for further research of variables that may affect the reliability of measurement result and which quality parameters that should be used for liver elastography with ARFI technology.

  • 259.
    Byenfeldt, Marie
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Elvin, Anders
    Fransson, Per
    Umeå University, Faculty of Medicine, Department of Nursing.
    Influence of Probe Pressure on Ultrasound-Based Shear Wave Elastography of the Liver Using Comb-Push 2-D Technology2019In: Ultrasound in Medicine and Biology, ISSN 0301-5629, E-ISSN 1879-291X, Vol. 45, no 2, p. 411-428Article in journal (Refereed)
    Abstract [en]

    It has been postulated that in the liver, applying increased probe pressure during ultrasound-based shear wave elastography (SWE) might lead to a false increase in the SWE result. We aimed to determine the influence of increased intercostal probe pressure when performing SWE of the liver. We also investigated the number of measurements required to achieve technically successful and reliable SWE examinations. This prospective, clinical study included 112 patients and 2240 SWE measurements of the liver. We applied probe pressure intercostally, to reduce the skin-to-liver capsule distance (SCD), which could stabilize the SWE signal and thus increase the number of technically successful measurements. We performed 10 measurements with maximum probe pressure and 10 with normal pressure in each patient. Thus, two analysis groups were compared for differences. Compared with normal pressure, maximum probe pressure significantly reduced the SCD (p < 0.001) and significantly increased the number of technically successful measurements from 981 to 1098, respectively (p < 0.001). The SWE results with normal and maximum probe pressure were 5.96 kPa (interquartile range: 2.41) and 5.45 kPa (interquartile range: 1.96), respectively (p < 0.001). In obese patients, a large SCD poses a diagnostic challenge for ultrasound SWE. We found that maximum intercostal probe pressure could reduce the SCD and increase the number of technically successful measurements, without falsely increasing the SWE result. Only three measurements were required to achieve technically successful and reliable SWE examinations.

  • 260.
    Byenfeldt, Marie
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Elvin, Anders
    Fransson, Per
    Umeå University, Faculty of Medicine, Department of Nursing.
    On patient related factors and their impact on ultrasound-based shear wave elastography of the liver2018In: Ultrasound in Medicine and Biology, ISSN 0301-5629, E-ISSN 1879-291X, Vol. 44, no 8, p. 1606-1615Article in journal (Refereed)
    Abstract [en]

    The aim of the study was to investigate patient-related factors associated with either reliable or poorly reliable measurement results of ultrasound-based shear wave elastography (SWE) of the liver. A total of 188 patients were analyzed prospectively with binary logistic regression using the interquartile range/median as cutoff to define two groups based on reliable and poorly reliable SWE results. SWE results correlated significantly with liver biopsy. Factors associated with reliable SWE results (i.e., no negative impact on measurements) were age, sex, cirrhosis, antiviral and/or cardiovascular medication, smoking habits and body mass index. Factors associated with poorly reliable SWE results were increased skin-to-liver capsule distance (odds ratio = 3.08, 95% confidence interval: 1.70-5.60) and steatosis (odds ratio =2.89, 95% confidence interval: 1.33-6.28). These findings indicate that the interquartile range/median as a quality parameter is useful in avoiding poorly reliable SWE results. How best to examine patients with increased skin-to-liver capsule distance is a matter of some controversy, as the incidences of obesity, diabetes and metabolic syndrome are increasing worldwide; however, our results indicate that reliable SWE results can be obtained in this group of patients by using ultrasound-based SWE. (Email: marie.byenfeldt@umu.se, Marie.byenfeldt@aleris.se ) 

  • 261.
    Byggmark, Malin
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Edlund, Karin
    Umeå University, Faculty of Medicine, Department of Nursing.
    Att leva med ett nytt organ: En litteraturstudie2014Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    ABSTRACT

    Background: A new organ is a lifesaving treatment for patients living with chronicle illness in heart or liver. To be transplanted implicates a big change in life, from living with a chronicle illness to be living with a new organ. After the transplantation the aim for the patient is to go back to living a normal life again. Aim: The aim of this literature review was to elucidate the transplanted patient perspective of living with a new organ. Method: In this literature review ten qualitative studies were viewed and analysed. The articles were searched in CINAHL, PubMed and PsycInfo.  Result: The result identified three main categories: ”Changed body”, ”Emotional rollercoaster” and ”To manage to keep living”. From these categories eight sub categorize were identified. Conclusion: To be transplanted is a life changing experience that changes the life forever. It is important for the nurse to be aware of the patient perspective to be able to offer a good and suitable care for the patient. Though the transplantation is followed by a difficult recovery, both physical and psychological, to be transplanted gives you a second chance in life and hope of a better future.

    Keywords: Organ transplantation, patient perspective, nursing

  • 262.
    Bylund, Jennie
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Johansson, Charlotte
    Umeå University, Faculty of Medicine, Department of Nursing.
    Kan ullfrotté lindra de strålrelaterade hudbiverkningarna vid behandling av bröstcancer? 2015Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

     

     

    Aim. To compare the radiation-related skin reactions among a group of women who used a newly developed a bra containing wool terry, and a group of women who had not used the bra and undergone radiation treatment for breast cancer.

    Background. Breast cancer is the most common cancer diagnosed in women worldwide, where treatment mainly consists of surgery with complimentary chemotherapy and radiotherapy. One of the most common side effects of radiotherapy is skin reactions.

    Design. Quantitative descriptive cross-sectional study.

    Methods. Questionnaire survey study with a quantitative approach which included breast cancer patients undergoing radiotherapy, two groups were compared at two hospitals in the Northern Region in Sweden (n = 31). The analysis was done with Fisher´s Exact Test and Mann Whitney U Test.

    Results. The results showed that the majority of the women in this study were affected by skin reactions. The women were well informed and no significant differences were found between the groups regarding information about any skin reactions. The comparison between the groups showed significant differences over time regarding the development of radiation-related skin reactions side effects. We found that the side effects redness and itching were later developed by the participants in the intervention group.

    Conclusion. The results of the study showed that the newly developed product, consisting of wool terry containing lanolin with the anti-inflammatory and antimicrobial properties, may have delayed the development of radiation-related skin reactions. Further research is needed.

     

    Keywords: radiotherapy, breast cancer, skin toxicity, side effects

     

     

  • 263.
    Bylund, Sara
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sundén, Anna
    Umeå University, Faculty of Medicine, Department of Nursing.
    Magnetfältstyrkans betydelse för personer med multipel skleros eller kliniskt isolerat syndrom: en litteraturstudie2016Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Title: The importance of magnetic field strength for people with multiple sclerosis or clinically isolated syndrome - a literature study. Background: Multiple sclerosis (MS) is an autoimmune demyelinating disease of the central nervous system debuting mostly in young adults. MS is diagnosed based on clinical and radiological findings according to the McDonald criteria where no requirements are placed on which field strength that should be used. Magnetic resonance imaging (MRI) scanners with higher field strengths are however becoming more common. Objective: To investigate whether higher field strength (Tesla, T) gave better detection of lesions at MRI examinations of people with MS or clinically isolated syndrome. Methods: In this literature study searches were made in the databases PubMed, Web of Science and Scopus between the 8th and 11th of March 2016. Ten quantitative articles were examined and analyzed to finally be compiled under the results. Results: The results are presented under four main headings and twelve sub- headings. The main headings are the differences between field strengths, field strength and anatomical regions, field strength and pulse sequences and artifacts and image quality. Conclusion: 3T and 7T are better than 1,5T and 7T is usually better than 3T at detecting lesions. However other aspects need to be taken into account because many parameters come into play during MRI examinations. Further studies regarding optimization of pulse sequences and field strength and patients’ experiences of ultrahigh field strength are recommended, among others. 

  • 264.
    Byström, Sara
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Olofsson, Linn
    Umeå University, Faculty of Medicine, Department of Nursing.
    Skillnader och likheter mellan magnetresonanstomografi och datortomografi vid undersökning av barns hjärnor: En litteraturstudie2014Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Skillnader och likheter mellan magnetresonanstomografi och datortomografi vid undersökning av barns hjärnor

    - En litteraturstudie

     

     

    Sara Byström

    Linn Olofsson

     

    Vårterminen 2014

    Självständigt arbete, 15 hp

    Röntgensjuksköterskeprogrammet, 180 hp

    Handledare: Ulf Isaksson, Universitetslektor, Institutionen för omvårdnad

    Abstrakt

    Bakgrund: Användandet av magnetresonanstomografi och datortomografi har ökat under åren. Det finns skillnader och likheter mellan dessa som bör finnas i åtanke vid val av undersökningsmetod. En magnetresonanstomografi är den bästa undersökningen för att se mjukvävnadskontraster. Datortomografens korta undersökningstid och dess lättillgängliget gör den kostnadseffektiv. En skillnad är att patienten utsätts för joniserande strålning vid en datortomografiundersökning, även om den är lättillgänglig och kostnadseffektiv gör den också skada. Barn är extra strålkänsliga och nyttan med att utföra undersökningen måste vägas mot riskerna. Syfte: Belysa skillnader och likheter mellan magnetresonanstomografi och datortomografi vid undersökning av barns hjärnor vid tre olika tillstånd. Metod: Tolv kvantitativa vetenskapliga artiklar granskades och analyserades av författarna. Artiklarna söktes fram via databaserna CINAHL, EBSCOhost, Pubmed samt med hjälp av manuell sökning. Resultat: Resultatet visade att både magnetresonanstomografi och datortomografi är ett radiologiskt verktyg för avbildning av barns hjärnor. Magnetresonanstomografi visade på bättre bilddiagnostik, dessutom utsätter magnetresonanstomografi inte patienten för joniserande strålning. Användandet av sedering visad sig dock vara frekventare vid magnetresonanstomografiundersökningar. Konklusion: Vid huvudtrauma, huvudvärk och krampanfall var magnetresonanstomografi den undersöknings metod att föredra. Den korta undersökningstiden för datortomografen visade sig kunna vara livsavgörande och en stor fördel vid akuta huvudtrauman.

    Nyckelord: MR, DT, barn, skillnad, likhet

     

     

     

     

     

     

     

    Abstract

    Background: The utilization of magnetic resonance imaging and computed tomography has increased over the years. There are differences and similarities between these imaging techniques that should be considered when selecting method of examination. Magnetic resonance imaging is the technique to prefer to view the soft tissue contrast. The short examination time and the accessibility make the computed tomography cost-effective. Although, one difference is that the patient is exposed to ionizing radiation during a computed tomography scan that may lead to harmful effects. Children are particularly sensitive to radiation exposure and the benefits of performing the examination must be weighed against the risks. Aim: Illuminate differences and similarities between magnetic resonance imaging and computed tomography in the examination of children’s brains for three different conditions. Method: Twelve quantitative scientific articles were reviewed and analyzed. Searched was done in the databases CINAHL, EBSCOhost, Pubmed and by manual search. Results: The results showed that both magnetic resonance imaging and computed tomography is a radiological tool for imaging of children’s brains. Magnetic resonance imaging showed better diagnostic imaging. Additionally this method does not expose the patient to ionizing radiation. Sedation shows to be more frequently used during a magnetic resonance examination. Conclusion: Magnetic resonance imaging was the method to prefer when examining head trauma, headache and seizures. The short examination time for computed tomography proved to be life changing and a great benefit for acute head trauma.

  • 265.
    Bäck, Lisette
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sjuksköterskors upplevelse av informations- och kommunikationsteknik i omvårdnad: En litteraturstudie2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: E-health is a general term of different kinds of digital technology,information- and communication technology is one kind, witch can be used forstorage and transfering of data and communication and nursing at a distance.Worldwide large amounts of mony is invested in dfferent kinds of e-health andusing new technology is a part of a nurse daily work.

    Aim: The aim was to describe nurses´ experience of using information- andcommunication technology in nursing.

    Method: Literature review based on nine qualitative articles. The articles havebeen reviewed, analyzed and compiled. Searches were maed in Cinahl andPubMed.

    Result: Implementation of new technology has a large impact on the nurese dailywork and nursing.The result of this study identified three main categories:implementation of new technology, role of the nurse and caring relationship.

    Conclusion: Implementation of new technology has a big impact on nursing andlarge resourses is put in new technology, but technology can never replace thenurse patient meeting.

  • 266.
    Bäcke, My
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lindström, Ida
    Umeå University, Faculty of Medicine, Department of Nursing.
    Delirium - En litteraturstudie om äldre patienters upplevelser i samband med delirium2015Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
  • 267.
    Bäckman, Håkan
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Helena, Grundberg
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hur agerar vi när vi ser?: En studie om sjuksköterskors anmälningsbenägenhet gällande barn som far eller riskerar att fara illa2016Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Syfte. Syftet med studien var att kartlägga sjuksköterskors anmälningsbenägenhet angående barn som far illa samt jämföra anmälningsbenägenhet avseende arbetsplats, erfarenhet och ålder inom primärvården. Bakgrund. Trots rådande anmälningsplikt gällande barn som far eller riskerar att fara illa anmäls endast en bråkdel av de fall där misstanke finns. Riktlinjer för tillvägagångssätt saknas ofta och sjuksköterskor utrycker bristande stöd från arbetsgivare och kollegor vid en orosanmälan. Osäkerhet och en vilja att bibehålla goda relationer med föräldrarna leder till minskad benägenhet att anmäla. Design. Tvärsnittsstudie med enkäter. Metod. 39 sjuksköterskor, barnsjuksköterskor och distriktssköterskor inom primärvården i Västerbotten, Sverige besvarade enkäten. Bakgrundsvariabler och skattning av intervention efter läst fallbeskrivning användes i studien och analyserades med frekvenser, genomsnittsmått, spridningsmått. Gruppjämförelser utfördes med hjälp av Mann-Whitney U-test. Resultat. Sjuksköterskor med lång erfarenhet har högre grad av anmälningsbenägenhet jämfört med sjuksköterskor med kort erfarenhet. De avvaktade i lägre grad samt tillfrågade verksamhetschefen i lägre grad jämfört med sjuksköterskor med kort erfarenhet. Resultatet visar även att yngre sjuksköterskor i högre grad avvaktar och ser hur det utvecklas jämfört med äldre sjuksköterskor. Konklusion. Skillnader i hanteringssätt av orosanmälan hos sjuksköterskor visar att vem barnet möter har betydelse. Sammantaget ser resultatet av studien ut att peka mot att lång erfarenhet och hög ålder är betydelsefulla variabler när sjuksköterskor handhar ett ärende som berör barn som far illa. 

  • 268.
    Bäckman, Jenny
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Nyman, Nyman
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sjuksköterskor och skötares upplevelser av möten i psykiatrisk öppenvård: En intervjustudie2016Independent thesis Advanced level (degree of Master (One Year)), 40 credits / 60 HE creditsStudent thesis
    Abstract [en]

    The aim of this study was to investigate the nurses and assisted nurse mentals experiences of encounters with patients in psychiatric outpatient care.

     

    Background – In psychiatric outpatient care nurses and assisted nurse mentals meets many different people with individual needs. Since previous research has shown that patients' sense of security generated by factors such as staff attitude and empathy. The relationship between staff and patients is important for the patient's feeling of being taken seriously and to be confirmed. For people living with mental illness, it is important to have a long-term relationship based on trust and transparency. A good relationship can be built if the staff can be at the patient level and make the patient feel important and significant. A working alliance takes time to develop, but it then forms a good basis for a good working relationship and has good effects on mental health.

     

    Design – A qualitative design with a phenomenological approach was used.

     

    Method – 8 interviews were conducted with nurses and assisted nurse mentals in psychiatric outpatient care in three outpatient clinics in northern Sweden during December 2015 - February 2016 and analyzed using qualitative content analysis.

     

    Results – In psychiatric outpatient care the relationship between caregiver and patient was considered as a significant basis, and above all that it was a secure relationship. This security could, among other things be created by carers’ availability to patients. Four categories were identified; Meet patients, Make the right assessments, Be in the patient's home environment and Work in outpatient care.

     

    Conclusion – The work that nurses and assisted nurse mentals carrying through in their meetings with patients in psychiatric outpatient care is important for so many people with mental illness. By getting the benefit of carers’ experiences it may contribute to a better understanding of their importance to the patients’ psychological being. But at the same time their vulnerability as they can be placed in problematic situations. The results can therefore contribute to relevant educations and initiatives can be identified and hopefully implemented in the clinics.

     

     

  • 269.
    Bäckström, Britt
    et al.
    Mid-Sweden University, Sundsvall, Sweden.
    Asplund, Kenneth
    Mid-Sweden University, Sundsvall, Sweden; University of Tromsö, Tromsö Norway.
    Sundin, Karin
    Umeå University, Faculty of Medicine, Department of Nursing.
    The meaning of middle-aged female spouses' lived experience of the relationship with a partner who has suffered a stroke, during the first year postdischarge2010In: Nursing Inquiry, ISSN 1320-7881, E-ISSN 1440-1800, Vol. 17, no 3, p. 257-268Article in journal (Refereed)
    Abstract [en]

    Stroke consequences present a great long-term challenge to the spouses of the stroke sufferer. A longitudinal study with a phenomenological hermeneutic approach was used to illuminate the meanings of middle-aged female spouses' lived experience of their relationship with a partner who has suffered a stroke, during the first year postdischarge. Four middle-aged female spouses of stroke sufferers participated in the study. Narrative interviews were conducted 1, 6 and 12 month postdischarge (total of 12 interviews), audio-taped and transcribed verbatim to a text and interpreted by a phenomenological hermeneutic method inspired by Ricoeur. The findings showed a process over time during which spouses come to know, recognize and acknowledge the residual changes in their partners' cognitive and emotional conditions and the impact on their relationship. Spouses showed grief due to the loss of the marital relationship they once had and anxiety that they would not be able to continue in an undesired relationship in the future. Even if the partner is still alive, there is a loss to grieve and to be understood, an important meaning of the transition process in the relationship during the first year after the partner's discharge.

  • 270. Bäckström, Britt
    et al.
    Sundin, Karin
    Umeå University, Faculty of Medicine, Department of Nursing.
    The experience of being a middle-aged close relative of a person who has suffered a stroke: six months after discharge from a rehabilitation clinic2010In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 24, no 1, p. 116-124Article in journal (Refereed)
    Abstract [en]

    The experience of being a middle-aged close relative of a person who has suffered a stroke - six months after discharge from a rehabilitation clinicBeing a close relative brings with it a large number of consequences, with the life situation changing over time. The aim of this study was to illuminate the experiences of being a middle-aged close relative of a person who has suffered a stroke 6 months after being discharged from a medical rehabilitation clinic. Narrative interviews were conducted with nine middle-aged close relatives and analysed using a content analysis with a latent approach. The analysis revealed that being close to someone who had suffered a stroke 6 months after discharge meant; a struggling for control and a renewal of family life in the shadow of suffering and hope. The middle-aged close relatives began to perceive the changed reality. They were struggling to take on something new, become reconciled and find a balance in their family life. Their ability to work, relief from caring concerns and having support and togetherness with others seemed to be essential for the close relatives in their efforts to manage their life situation and maintain their well-being. Having reached the 'halfway point' in their lives and still with half of their life in front of them created worries. They felt dejected about their changed relationships and roles, experience a sense of loss of shared child responsibilities, a negative impact on their marital relationships and sexual satisfaction. They felt trapped in a caring role and they worried about how to endure in the future. The middle-aged close relatives' experiences were of being alone and neglected, in an arduous and complex life situation filled with loss and grief. The findings highlights that health professionals need to see and listen to the close relatives' experiences of transition in order to provide appropriate support adjusted to their varying needs during a time of renewal.

  • 271.
    Bäckström, Frida
    Umeå University, Faculty of Medicine, Department of Nursing.
    ”Ni dricker ju kaffe, då måste ju vi få dricka någonting också”: Skolsköterskors erfarenheter av högstadieelevers konsumtion av energidrycker2016Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Barn och ungdomar är de största konsumenterna av energidrycker inom EU. Energidryckens huvudingrediens är koffein, vilket kan vara skadligt i höga doser. Vanliga biverkningar av koffein är hjärtklappning och huvudvärk. Konsumtionen bland barn och ungdomar har ökat drastiskt på sistone, och ingen lag på åldersgräns finns i Sverige. Forskare på Världshälsoorganisationen (WHO) anser att den höga konsumtionen kan vara ett hot mot folkhälsan. 

    Syfte: Syfte med föreliggande studie är att beskriva skolsköterskans erfarenheter av energidryckskonsumtion bland högstadieelever i Västerbotten.

    Metod: Kvalitativ metod med semistrukturerade intervjuer. Intervjuerna analyseras med hjälp av innehållsanalys med induktiv ansats.

    Resultat: Sammanlagt åtta skolsköterskor deltog i studien. Från analysen av resultaten framkom sju kategorier: ute efter effekter, påverkade av marknadsföringen, könsskillnader, utsatta elever dricker mer, leder till problem i skolan, okunskap hos elever och vuxna, samt konsumtionen minskar.

    Slutsats: Resultatet visar att skolsköterskor känner oro kring elevers energidryckskonsumtion och dess konsekvenser. Studien belyser skolsköterskors erfarenheter av energidryckskonsumtion bland elever vilket kan leda till ökad förståelse och möjligheter att förebygga ohälsa hos elever. Fler och större studier behövs för djupare förståelse.

  • 272.
    Bäckström, Linnea
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Bohlin, Emelie
    Umeå University, Faculty of Medicine, Department of Nursing.
    Spelar det någon roll med TOF?: En korrelationsstudie som undersöker samband mellan TOF-ratio, tid på uppvakningsavdelning och respiratorisk svikt2019Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: In general anaesthesia non-depolarising muscle relaxants (NDMR) areoften used, and it is therefore important that the anesthesia nurse has sufficient knowledgeto be able to continuously evaluate the effect of these drugs. Evaluation is usually done byusing train-of-four (TOF), where the TOF ratio is a way to assess how relaxed the patientis. The patient is considered to suffer from postoperative residual curarization (PORC) ifTOF ratio <0.9. Studies show that PORC increase the risk of postoperative respiratorycomplications and may prolong the time spent in the postoperative recovery unit (PACU).Motive: Previous studies that investigate the relationship between TOF ratio and timespent in the PACU or TOF ratio and respiratory complications have not investigated theassociation of the NDMR rocuronium.

    Aim: To investigate whether there is a relationship between TOF ratio and time spent inthe PACU, and TOF ratio and respiratory complications for patients undergoing colonresection where rocuronium is used perioperatively.

    Methods: The study was a descriptive correlation study performed retrospectively byjournal review.

    Results: Out of the 54 patients included in the study, 16 patients (29.6 %) suffered fromPORC. No significant relationship could be detected between TOF ratio and time spent inthe PACU or TOF ratio and respiratory complications.

    Discussion: Previous studies where significant relationship between PORC, the timespent in the PACU and postoperative respiratory complications have a lower mean age anda greater proportion of healthy patients, as defined by ASA classification. Patientsundergoing colon resection are generally older and have more diseases, which may haveaffected the outcome of our study. A weakness in this study is the relatively limitedselection, only 54 patients were included.

    Conclusion: Our study can’t demonstrate a significant correlation between PORC and thepostoperative care for patients undergoing colon resection.

  • 273.
    Bådner, Malin
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Kassberg, Melinda
    Umeå University, Faculty of Medicine, Department of Nursing.
    Vägen tillbaka: En litteraturstudie om kvinnors upplevelser av att leva med bröstcancer efter avslutad behandling.2017Independent thesis Basic level (degree of Bachelor), 180 HE creditsStudent thesis
    Abstract [en]

    Background: Breast cancer is the most common cancer among women. Early diagnosis and treatment increase the chance of surviving breast cancer. In the process of ending treatment and moving on in life, psychological and physical experiences can affect women's daily lives, and in this context they may experience a continuing need for support.  

    Aim: To describe women’s experiences of living with breast cancer after completed treatment.

    Methods: A literature study with qualitative approach where 12 studies were chosen that responded to the aim. A qualitative analysis was made of the material and then compiled into 4 categories and 10 subcategories.

    Results: The result shows that women have different physical and psychological experiences after completed breast cancer treatment that affects them in everyday life. Four main categories were identified: Restrictions, concerns about the future, need for support and new life perspective.

    Conclusion: The knowledge of women's experiences and needs after completed breast cancer treatment should be noted in the formation of personalized care. This can facilitate the everyday lives of women and increase their well-being.  

    Keywords: Breast cancer, women, experiences, completed treatment, support. 

  • 274.
    Bånghammar, Anders
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Severin, Ann-Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hudvård- och sårbehandling till patienter i samband med extern strålbehandling. En litteraturstudie.2015Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Strålbehandling är en vanlig behandlingsform vid cancersjukdom och hälften av alla cancerpatienter får någon form av strålbehandling, antingen extern eller intern strålbehandling. Hudreaktioner vid strålbehandling kan inte undvikas men med rätt omvårdnadsåtgärder kan man minska symptomen. Hudbiverkningar kan vara till stort besvär och förorsaka obehag hos patienten. Det finns fortfarande oklarheter i hur dessa bäst kan förebyggas och, när de uppstår, bäst lindras. Syfte: Syftet var att sammanställa och beskriva effekter av olika hudvårdsåtgärder och sårbehandlingar relaterat till strålbehandling. Metod: Studien är en litteraturstudie där artiklarna söktes från databaserna CINAHL och PubMed. 11 kvantitativa artiklar granskades och analyserades. Sökord som användes var; radiotherapy, nursing, skin care, radiodermatitis, self care och skin cream. Resultat: Resultatet delades in 4 kategorier enligt följande; fuktgivande- och mjukgörande krämer, naturläkemedel, steroider och förband-sårbehandling. Slutsats: Resultatet visar att det inte finns skäl till att rekommendera den ena fuktgivande/mjukgörande krämen framför den andra som åtgärd för prevention. Studier visar dock att användning av potent steroid skulle kunna rekommenderas i avsikt att få kontroll på akuta hudbiverkningar. Absorptionsförband anses vara fördelaktigare och effektivare än gentiana violett vid sårbehandling. Onkologisjuksköterskan bör vara medveten om evidens och bristen på evidens då hudvårdprodukter rekommenderas och information ges till egenvård.

    Nyckelord: strålbehandling, hudbiverkan, hudvård och sårbehandling.

  • 275.
    Båtsman, Emma
    Umeå University, Faculty of Medicine, Department of Nursing.
    Farmakologisk smärtlindring till nyfödda barn i samband med insättning av thoraxdränage – en journalgranskningsstudie2014Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Abstrakt

    Syfte. Att beskriva vilken farmakologisk smärtlindring barnen på en neonatal

    intensivvårdsavdelning erhåller inför och efter insättning av thoraxdränage, samt att jämföra

    detta mot avdelningens lokala anvisningar för smärtbehandling.

    Bakgrund. Smärta hos nyfödda barn är historiskt sett underskattad och underbehandlad.

    Barn som vårdas på neonatal intensivvårdsavdelning utsätts för många smärtsamma

    procedurer dagligen, och en av de mest smärtsamma procedurerna är insättning av

    thoraxdränage. Det finns anvisningar för hur procedursmärta ska behandlas hos nyfödda

    barn, men det finns inga studier som visar att dessa anvisningar följs i praktiken.

    Design. Studien är en retrospektiv journalgranskningsstudie som utförts med kvantitativ

    metod.

    Metod. Studien genomfördes på den neonatala intensivvårdsavdelningen vid Norrlands

    Universitets Sjukhus i Umeå. Barn som hade vårdats på avdelningen med ett eller flera

    thorax dränage, mellan åren 2008-2013 inkluderades i studien. Trettiotre journaler och

    totalt 67 procedurer granskades.

    Resultat. Vid de flesta av procedurerna användes någon form av smärtlindring inför

    insättningen av thoraxdränage. Morfin var det läkemedel som användes vid flest tillfällen.

    Vid 75 procent av procedurerna gavs en opioidinjektion innan insättningen av dränaget.

    Morfin gavs inom fyra timmar efter proceduren vid 96 procent av tillfällena. Avdelningens

    lokala anvisningar följdes dock endast vid fyra procent av procedurerna. Lokalbedövning

    hade använts vid sex procent av procedurerna.

    Konklusion. Smärtlindring hade använts i större utsträckning på den granskade avdelningen

    än vad litteraturen beskriver. Ändå var det få av procedurerna som utfördes enligt de lokala

    anvisningarna, och vid fyra tillfällen (6 %) gavs ingen smärtlindring alls innan insättningen av

    dränaget.

    Nyckelord. Nyfödd, Smärtlindring, Procedur smärta, Thoraxdränage, Omvårdnad

  • 276.
    Båtsman, Tina
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Holmner, Magdalena
    Umeå University, Faculty of Medicine, Department of Nursing.
    Omvårdnadsmetoder för att lindra oro och smärta vid nålstick på barn.: En litteraturstudie2015Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Every year more than 200 000 children make a visit to the emergency department in Sweden. Painful procedures are not unusual and the unfamiliar environment cause the children to feel stress, anxiety and fear. Both children and their parents agree that needlestick and venipuncture is one of the most stressful and painful procedures that children need to undergo during a hospital stay. When in hospital, many children’s biggest fear is to feel pain or having an injection. Aim: The aim of this literature review was to illuminate methods that can ease pain and anxiety in children undergoing needlestick during a hospital visit. Method: In this literature review sixteen quantitative articles were complied and analysed, inspired by meta-synthesis and descriptive synthesis were made. The search for articles were conducted in Pub Med, CINAHL and Academic Search Elite. Articles were also searched manually. Result: The analyse resulted in three categories with two sub-categories each. The categories were: Psychological pain relief, Local pain relief and Safety giving factors. Conclusion: The pain and anxiety children experience in association with needlestick can be eased by simple methods at a low cost. For a successful needlestick, the nurse need to choose methods based on the child’s age and mental development.Keywords: Children, pain, anxiety, needlestick, venipuncture, distraction, nursing, literature review.

  • 277.
    Bölenius, Karin
    Umeå University, Faculty of Medicine, Department of Nursing.
    Improving venous blood specimen collection practices: method development and evaluation of an educational intervention program2014Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: About 60%–80% of decisions regarding diagnosis and treatment are based on laboratory test results. Low adherence to venous blood specimen collection (VBSC) guidelines may lead to erroneous or delayed test results, causing patient harm and high healthcare costs. Educational intervention programs (EIPs) to update, improve and sustain VBSC practices are seldom evaluated. After testing a self-reported venous blood sampling questionnaire, the overall aim of this thesis was to evaluate the impact of a large-scale EIP on healthcare personnel’s VBSC practices.

    Methods: The study settings were primary healthcare centres (PHCs) in northern Sweden. Participants were VBSC personnel. Data consisted of a VBSC questionnaire of self-reported practices, records of low-level haemolysis index in serum samples (specimen quality indicator), and interviews reflecting VBSC practices. First, experts on questionnaires and VBSC were consulted, and test-retest statistics were used when testing the VBSC questionnaire for validity and reliability. Thereafter, we evaluated the impact of a short, large-scale EIP with a before-after approach comparing self-reported VBSC questionnaire of two county councils. The personnel of the county councils (n = 61 PHCs) were divided into an intervention group (n = 84) and a corresponding control group (n = 79). In order to test changes in blood specimen quality we monitored haemolysis in serum samples (2008, n = 6652 samples and 2010, n = 6121 samples) from 11 PHCs. Finally, 30 VBSC personnel from 10 PHCs reported their experiences. The interview questions were open-ended with reflective elements and the interviews were analysed by qualitative content analysis.

    Results: The VBSC questionnaire was found to be valid and could be used to identify risk of errors (near misses) and evaluate the impact of an EIP emphasising VBSC guideline adherence. The intervention group demonstrated several significant improvements in self-reported practices after the EIP, such as information search, patient rest, test request management, patient identification, release of venous stasis, and test tube labelling. The control group showed no significant improvements. In total, PHCs showed minor differences in blood specimen quality. Interviews summarized VBSC personnel experiences in the overall theme: education opened up opportunities for reflection about safety.  

    Conclusion: This thesis is, to our knowledge, the first to evaluate the impacts of a large-scale EIP on VBSC practices. The VBSC questionnaire and monitoring for low-level haemolysis reflected VBSC practices. The frequently occurring near-miss markers made it possible to compare and benchmark VBSC practices down to the healthcare unit and hospital ward. The short, general EIP opened up opportunities for reflection about safety and improved VBSC practices in PHCs with larger deviations from guidelines. EIPs that provide time for reflection and discussion could improve VBSC further. Directed EIPs focused on specific VBSC flaws might be more effective for some near misses in VBSC practices, while some near misses must be changed at a different level in the system.

    Clinical relevance: Our results indicate that monitoring and counteracting the near misses in VBSC practices is a well-functioning preventive action. We propose that the VBSC monitoring instruments (VBSC questionnaire & haemolysis index) we used and the EIP strategy proposed should be tested in additional countries with different healthcare settings. It is suggested that a national program intended to identify near misses and prevent VBSC errors be developed in the healthcare system. General e-learning programs may be cheaper than, and as effective as, the EIP program and may be performed everywhere and any time. Systematic planning, useful for reflection and with focus on the specific elements in a skill, together with VBSC guidelines, could probably increase improvements. Our studies have led to deeper and extended knowledge of the impact of an EIP on VBSC practices. Our results can be used when considering future VBSC practice interventions. Using a model for practical skills in nursing to describe VBSC in a more holistic and less technical way might highlight VBSC as a practical nursing skill.

  • 278.
    Bölenius, Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hällgren Graneheim, Ulla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Personnel's Experiences of Phlebotomy Practices after Participating in an Educational Intervention Programme2014In: Nursing Research and Practice, ISSN 2090-1429, E-ISSN 2090-1437, p. 1-8, article id 538704Article in journal (Refereed)
    Abstract [en]

    Background. Blood specimen collection is a common procedure in health care, and the results from specimen analysis have essential influence on clinical decisions. Errors in phlebotomy may lead to repeated sampling and delay in diagnosis and may jeopardise patient safety. This study aimed to describe the experiences of, and reflections on, phlebotomy practices of phlebotomy personnel working in primary health care after participating in an educational intervention programme (EIP). Methods. Thirty phlebotomists from ten primary health care centres participated. Their experiences were investigated through face-to-face interviews. Findings were analysed using qualitative content analysis. Results. The participants perceived the EIP as having opened up opportunities to reflect on safety. The EIP had made them aware of risks in relation to identification procedures, distractions from the environment, lack of knowledge, and transfer of information. The EIP also resulted in improvements in clinical practice, such as a standardised way of working and increased accuracy. Some said that the training had reassured them to continue working as usual, while others continued as usual regardless of incorrect procedure. Conclusions. The findings show that EIP can stimulate reflections on phlebotomy practices in larger study groups. Increased knowledge of phlebotomy practices improves the opportunities to revise and maximise the quality and content of future EIPs. Educators and safety managers should reflect on and pay particular attention to the identification procedure, distractions from the environment, and transfer of information, when developing and implementing EIPs. The focus of phlebotomy training should not solely be on improving adherence to practice guidelines.

  • 279.
    Bölenius, Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hällgren Graneheim, Ulla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Personnel’s experiences of venous blood specimen collection practices after participating in an educational intervention programmeManuscript (preprint) (Other academic)
    Abstract [en]

    Aim: The aim of this study was to describe primary healthcare personnel’s experiences of venous blood specimen collection practices after participating in an educational intervention programme.

    Background: Venous blood specimen collection is one of the most frequent procedures in healthcare, and the results from specimen analysis have essential influence on clinical decisions. Errors in specimen collection may lead to repeated sampling and delay in diagnosis, and may jeopardise patient safety.

    Design: This is a qualitative, descriptive study based on individual interviews subjected to qualitative content analysis.

    Methods: A convenient sample of 30 venous blood specimen collection personnel from ten primary healthcare centres participated in this study. Their experiences were investigated through face-to-face interviews and analysed using qualitative content analysis.

    Results: In this study we found that the participants experienced that the education opened up opportunities for reflections on safety. They became aware of risks in relation to identification procedures, environmental disturbances, lack of knowledge and transfer of information. They had also achieved improvements in clinical practice such as standardised ways of working and increased accuracy. However, some described that they felt strengthened in working as usual and worked as usual in a correct way or as usual in an incorrect way.

    Conclusions: Our findings indicate that a short educational programme opens up opportunities for reflections about safety. Education is needed to improve and maintain a good quality of venous blood specimen collection practices.

    Relevance to clinical practice: Developers of education should reflect on and pay attention to the identification procedure, environmental disturbances, and transferral of information, when developing educational intervention programmes, and not focus solely on improving adherence to guideline practices.

  • 280.
    Bölenius, Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lämås, Kristina
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sandman, Per-Olof
    Umeå University, Faculty of Medicine, Department of Nursing. Division of Caring Sciences, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing. School of Nursing and Midwifery, La Trobe University.
    Effects and meanings of a person-centred and health-promoting intervention in homecare services: a study protocol of a non-randomised controlled trial2017In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 17, article id 57Article in journal (Refereed)
    Abstract [en]

    Background: The literature indicates that current home care service are largely task oriented with limited focus on the involvement of the older people themselves, and studies show that lack of involvement might reduce older people's quality of life. Person-centred care has been shown to improve the satisfaction with care and quality of life in older people cared for in hospitals and nursing homes, with limited published evidence about the effects and meanings of person-centred interventions in home care services for older people. This study protocol outlines a study aiming to evaluate such effects and meanings of a person-centred and health-promoting intervention in home aged care services. Methods/design: The study will take the form of a non-randomised controlled trial with a before/after approach. It will include 270 older people >65 years receiving home care services, 270 relatives and 65 staff, as well as a matched control group of equal size. All participants will be recruited from a municipality in northern Sweden. The intervention is based on the theoretical concepts of person-centredness and health-promotion, and builds on the four pedagogical phases of: theory apprehension, experimental learning, operationalization, and clinical supervision. Outcome assessments will focus on: a) health and quality of life (primary outcomes), thriving and satisfaction with care for older people; b) caregiver strain, informal caregiving engagement and relatives' satisfaction with care: c) job satisfaction and stress of conscience among care staff (secondary outcomes). Evaluation will be conducted by means of self-reported questionnaires and qualitative research interviews. Discussion: Person-centred home care services have the potential to improve the recurrently reported sub-standard experiences of home care services, and the results can point the way to establishing a more person-centred and health-promoting model for home care services for older people.

  • 281.
    Bölenius, Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Nilsson, Karin
    Umeå University, Faculty of Medicine, Department of Nursing.
    Variations in the system influencing venous blood specimen collection practices: sources of pre-analytical errors2018In: Journal of Laboratory and Precision Medicine, ISSN 2519-9005, Vol. 3, article id 39Article, review/survey (Refereed)
    Abstract [en]

    Incorrect venous blood specimen collection (VBSC) practices might influence results from blood analyses and thus jeopardize patient safety. A large amount (60–80%) of important decisions in diagnosis, administration and medication are based on laboratory test results, therefore correct VBSC is of most importance. A harmonization of VBSC can lead to accurate collection procedures, rapid and correct diagnosis, and treatment. Correct test results contribute to increased patient safety and enhanced healthcare economy. VBSC errors might be consequences of both human mistakes and cultural factors in relation to the overall system. Variations in the system influencing VBSC practices might originate from international and national structures, local organizational and work cultures, and humans working in the frontline. In order to succeed in reducing sources of errors, it is of utmost importance that leaders and managers take the whole system into consideration when planning interventions in their mission to enhance practice. Thus, the aim of this article was to discuss variation in VBSC practices and how the variation might be a source of VBSC errors.

  • 282.
    Bölenius, Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Söderberg, Johan
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Clinical chemistry.
    Hultdin, Johan
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Clinical chemistry.
    Lindkvist, Marie
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Grankvist, Kjell
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Clinical chemistry.
    Minor improvement of venous blood specimen collection practices in primary health care after a large-scale educational intervention2013In: Clinical Chemistry and Laboratory Medicine, ISSN 1434-6621, E-ISSN 1437-4331, Vol. 51, no 2, p. 303-310Article in journal (Refereed)
    Abstract [en]

    Background: Venous blood specimen collection is a common health care practice that has to follow strict guidelines, non-compliance among sampling staff may compromise patient safety. We evaluated a large-scale 2 h educational intervention that emphasised guideline adherence to assess possible improvements of venous blood specimen collection practices.

    Methods: Blood specimen haemolysis is usually caused by inadequate venous blood specimen collection and handling, reflecting overall pre-analytical handling. We monitored haemolysis of serum samples with haemolysis index corresponding to ≥150 mg/L of free haemoglobin for specimens sent from 11 primary health care centres and analysed on a Vitros 5,1 clinical chemistry analyser before (2008, n=6652 samples) and after (2010, n=6121 samples) the intervention.

    Results: The total percentage of haemolysed specimens was 11.8% compared to 10.5% (p=0.022) before the intervention. As groups, rural primary health care centres demonstrated a significant reduction [Odds ratios (OR)=0.744] of haemolysed specimens after intervention, whereas urban primary health care centres demonstrated a significant increase (OR=1.451) of haemolysis.

    Conclusions: A large-scale 2 h educational intervention to make venous blood specimen collection staff comply with guideline practices had minor effects on collection practices. Educational interventions may be effective in wards/care centres demonstrating venous blood specimen collection practices with larger deviations from guidelines.

  • 283.
    Bölenius, Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Vestin, Christin
    Umeå University, Faculty of Medicine, Department of Nursing.
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Nursing.
    Gyllencreutz, Lina
    Umeå University, Faculty of Medicine, Department of Nursing.
    Validating a questionnaire - prehospital preparedness for pediatric trauma patients2017In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 34, p. 2-6Article in journal (Refereed)
    Abstract [en]

    In recent decades, prehospital emergency care has undergone extensive development. Today, prehospital emergency nurses (PENs) are well trained and provide advanced care to patients of all ages. Caring for pediatric trauma patients is considered to be particularly demanding. However, in Sweden and internationally, there is a lack of research regarding PENs' preparedness for caring for pediatric trauma patients.

    Objective: The development and testing of a questionnaire on self-reported preparedness among PENs caring for pediatric trauma patients in a prehospital emergency setting.

    Methods: Questionnaire development included face and content validity tests resulting in 38 questions. Eighteen of these questions were analyzed by test-retest. The content of the questionnaire was statistically analyzed.

    Results: Fifteen questions were considered valid after reliability and validity tests. Three questions did not fulfill the stability criteria. The content analyses show a low degree of experience with pediatric trauma patients and half of the participants reported stress symptoms when responding to such alarms.

    Conclusion: The questionnaire assessing PENs preparedness caring for pediatric trauma patients in Sweden is considered to be suitable for research and clinical practice to improve the care of pediatric trauma patients and the health of PENs, although further testing of the questionnaire is required.

  • 284.
    Börlin, Emma
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Randleff, Jessica
    Umeå University, Faculty of Medicine, Department of Nursing.
    Biverkningar vid administrering av gadoliniumkontrastmedel vid MRT-undersökningar2015Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Inom röntgenverksamhet används kontrastmedel som ett hjälpmedel för att påvisa skillnader mellan vävnader i kroppen. Gadoliniumbaserade kontrastmedel används till större delen vid MR undersökningar. Biverkningar anses ovanliga, men de förekommer och kan innebära allvarliga konsekvenser. Röntgensjuksköterskor behöver kunskap om dessa biverkningar för att kunna ge en patientsäker vård.  Syfte: Studien har således som syfte att undersöka biverkningar som kan uppstå vid administrering av gadoliniumkontrastmedel vid MRT undersökningar. Metod: En litteraturstudie med artikelsökningar i tre databaser PubMed, CinAhl samt Scopus. Tolv kvantitativa artiklar användes och bearbetades till att bilda kategorier och underkategorier genom innehållsanalys. Resultat: Utifrån artiklarna bildades kategorin Cirkulationssystem och luftvägar med underkategorier hjärtpåverkan och andningsproblem, kategorin Mag- tarmkanalen och bukorgan med underkategorier GI-systemet samt njurar, urinvägar och lever, kategorin Ändrade sinnesförnimmelser med underkategorier ögat, förnimmelser från smak och lukt, hudpåverkan och temperaturförnimmelser samt kategorin Påverkan av kommunicerbarhet och obehag med underkategorier medvetandepåverkan och obehagsupplevelse. Konklusion: De allvarligaste biverkningarna involverade hjärtpåverkan, andningsproblem, njurproblem samt medvetandepåverkan. De vanligaste biverkningarna förknippades med GI-systemet, Hudreaktioner och Obehagsupplevelser. Eftersom biverkningar var otroligt sällsynta vid administrering av Gadoliniumkontrastmedel finns det risk att vårdpersonal inte känner till biverkningarna och därmed inte är uppmärksamma.

  • 285.
    Callenås, Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Bexell, Bim
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sjuksköterskors erfarenheter av andvändandet av pre- och postoperativa omvårdnadsåtgärder hos barn.2018Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: För att uppnå en god vård för barn har det visats att en kombination av farmakologisk behandling och omvårdnadsåtgärder är väsentligt. Omvårdnadsåtgärder används dock inte i praktiken i den utsträckning som önskas.

    Motiv: Studera sjuksköterskors erfarenheter av användandet av pre- och postoperativa omvårdnadsåtgärder hos barn, eftersom forskning visar att användningen av omvårdnadsåtgärder många gånger brister i praktiken.Syfte: Syftet med studien var att belysa sjuksköterskors erfarenheter av användandet av pre- och postoperativa omvårdnadsåtgärder för att underlätta det postoperativa förloppet hos barn.

    Metod: En kvalitativ intervjustudie med induktiv ansats där tio sjuksköterskor intervjuades våren 2018. Det insamlade materialet analyserades sedan enligt Hsieh och Shannons konventionella innehållsanalys.

    Resultat: I studien framkom det att sjuksköterskorna upplevde att barnen många gånger var rädda och oroliga inför olika procedurer. För att underlätta det postoperativa förloppet hos barnen ansågs pre- och postoperativa omvårdnadsåtgärder som förberedelser, information, delaktighet i vården och föräldrarnas roll som betydande faktorer. Det framkom även att sjuksköterskorna önskade mer utbildning för att öka sin kunskap kring utförandet av omvårdnadsåtgärder, och tidsbrist nämndes som ett hinder för att kunna utföra dessa i praktiken.

    Diskussion: Studiens resultat bekräftar vad tidigare forskning beskriver för att skapa ett bra postoperativt vårdförlopp för barnen. Med hjälp av omvårdnadsåtgärder och olika copingstrategier hanterar barnen sitt vårdförlopp betydligt bättre.

    Konklusion: Kunskapen kring pre- och postoperativa omvårdnadsåtgärder finns men sjuksköterskorna önskade ändå mer utbildning för att öka sin kunskap ytterligare. Sjuksköterskorna ansåg även att det inte alltid finns tid för att hinna använda sig av omvårdnadsåtgärder i praktiken i den mån de önskar

  • 286.
    Campo Rodriguez, Juan Carlos
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sjöström, Annelie
    Umeå University, Faculty of Medicine, Department of Nursing.
    Vårdpersonals attityder till missbrukare: En litteraturstudie2014Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Alcohol and drug abuse is a worldwide health problem and health care professionals should maintain an ethical approach to all patients. People with substance abuse problems experience poor health care delivery, partly because of the attitudes of health care professionals.

    Aim: To examine the attitudes of health care professionals towards people with substance abuse problems.

    Method: A literature study where 8 qualitative research articles were quality reviewed and analyzed.

    Results: The attitudes of the majority of health care professionals towards people with substance abuse were negative. People with substance abuse were considered to lack will, to be hopeless cases, to be manipulative with rapid mood swings and were seen only on the basis of their addiction problems. There was also a reluctance to work with these patients. Among the few positive attitudes that emerged were that the health care professionals wanted to show respect, understanding and a willingness to support people with substance abuse. Lack of knowledge and skills is fundamental to the negative attitudes of health care professionals.

    Conclusion: Negative attitudes towards people with substance abuse were evident among health care professionals who tended to see them based only on their addiction problems. These negative attitudes can affect the care provided to these patients so that they do not receive adequate care. Education is needed to change the negative attitudes.

     

    Keywords: Attitudes, health care professionals, people with substance abuse

  • 287. Carlbo, Adam
    et al.
    Claesson, Hanna Persic
    Åström, Sture
    Umeå University, Faculty of Medicine, Department of Nursing.
    Nurses' experiences in using physical activity as complementary treatment in patients with schizophrenia2018In: Issues in Mental Health Nursing, ISSN 0161-2840, E-ISSN 1096-4673, Vol. 39, no 7, p. 600-607Article in journal (Refereed)
    Abstract [en]

    Introduction: Schizophrenia is a common disease with a high risk of comorbidity in both psychiatric and somatic diseases. Physical activity is proven effective in reducing symptoms of schizophrenia and increasing overall health. Still it is not used systematically in the care of persons with schizophrenia.

    Aim: The aim of this study is to describe nurses' experience, including personal motivation, in using physical activity as complementary treatment in patients with schizophrenia.

    Method: Interviews in three focus groups with 12 participating nurses were conducted. Qualitative content analysis was used to analyze data.

    Results: Physical activity was commonly used. Although several nurses signaled positive patient response, i.e. less anxiety and better quality of sleep, the overall consensus was an uncertainty regarding the benefits. It was perceived as non-evidence based form of intervention.

    Conclusion: The uncertainty of the benefits of physical activity is evident in nursing staff and poses a resistance to implement systematic physical activity as a complementary treatment in schizophrenia. A new awareness of evidence based nursing is suggested to promote a wider and more receptive attitude to reduce patient vulnerability in persons with schizophrenia.

  • 288.
    Carlsson, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Eriksson, Erika
    Umeå University, Faculty of Medicine, Department of Nursing.
    Patienters upplevelser av strålrelaterade biverkningar vid behandling av huvud och halscancer-en litteraturstudie2016Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Flera studier har visat att cancer i huvud- och halsområdet och omvårdnaden runt dessa patienter är komplex och omfattande. De flesta patienter får kvarstående biverkningar långt efter behandlingens slut och känner sig lämnade utan ståd från sjukvården. Det behövs fler studier kring hur patienter upplever sin situation under och efter strålbehandling.

    Syfte: Syftet med studien var att belysa patienters upplevelser av strålrelaterade biverkningar vid behandling av huvud- och halscancer.

    Metod: En litteraturstudie med hjälp av innehållsanalys har gjorts på ett urval av tretton stycken kvalitativa, vetenskapliga artiklar.

    Resultat: Resultatet presenteras med fyra kategorier; Fysiska förändringar, psykiska förändringar, sociala förändringar och se det positiva i livet. Kategorierna resulterade i ett genomgående tema; Fortsätta livet trots nya förutsättningar.

    Konklusion: Ur resultatet framkom att upplevelserna av att genomgå strålbehandling mot HH-cancer ger upphov till att livet fortsätter med helt nya förutsättningar under och efter strålbehandling. För att sjuksköterskor ska kunna vårda denna patientgrupp krävs det stor förtåelse för biverkningarna och kunskap i hur man hanterar dessa. Vården av dessa patienter bör utformas på ett personcentrerat sätt för att göra den mer holistisk.

  • 289.
    Carlsson, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sanna, Vallmark
    Umeå University, Faculty of Medicine, Department of Nursing.
    När kroppen förändras och hoppet om en framtid sviktar.: En litteraturstudie om kvinnors upplevelser i samband med att leva med diagnostiserad bröstcancer.2015Independent thesis Basic level (university diploma), 10 credits / 15 HE creditsStudent thesis
  • 290.
    Carlsson, Rasmus
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Järvholm, Karin
    Umeå University, Faculty of Medicine, Department of Nursing.
    Ambulanssjuksköterskors upplevelse av utmaningar i vården av äldre patienter.2014Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
  • 291. Carlsson, Sigrid
    et al.
    Drevin, Linda
    Loeb, Stacy
    Widmark, Anders
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Franck Lissbrant, Ingela
    Robinson, David
    Johansson, Eva
    Stattin, Pär
    Fransson, Per
    Umeå University, Faculty of Medicine, Department of Nursing.
    Population-based study of long-term functional outcomes after prostate cancer treatment2016In: BJU International, ISSN 1464-4096, E-ISSN 1464-410X, Vol. 117, no 6B, p. E36-E45Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To evaluate long-term urinary, sexual and bowel functional outcomes after prostate cancer treatment at a median follow-up of 12 years (IQR 11-13).

    PATIENTS AND METHODS: In this nationwide, population-based study, we identified from the National Prostate Cancer Register, Sweden, 6,003 men diagnosed with localized prostate cancer (clinical local stage T1-2, any Gleason score, prostate specific antigen < 20 ng/mL, NX or N0, MX or M0) between 1997 and 2002 who were ≤70 years at diagnosis. 1,000 prostate cancer-free controls were selected, matched for age and county of residence. Functional outcomes were evaluated with a validated self-reported questionnaire.

    RESULTS: Responses were obtained from 3,937/6,003 cases (66%) and 459/1,000 (46%) controls. Twelve years post diagnosis, at a median age of 75 years, the proportion of cases with adverse symptoms was 87% for erectile dysfunction or sexually inactive, 20% for urinary incontinence and 14% for bowel disturbances. The corresponding proportions for controls were 62%, 6% and 7%, respectively. Men with prostate cancer, except those on surveillance, had an increased risk of erectile dysfunction, compared to control men. Radical prostatectomy was associated with increased risk of urinary incontinence (odds ratio; OR 2.29 [95% CI 1.83-2.86] and radiotherapy increased the risk of bowel dysfunction (OR 2.46 [95% CI 1.73-3.49]) compared to control men. Multi-modal treatment, in particular including androgen deprivation therapy (ADT), was associated with the highest risk of adverse effects; for instance radical prostatectomy followed by radiotherapy and ADT was associated with an OR of 3.74 [95 CI 1.76-7.95] for erectile dysfunction and OR 3.22 [95% CI 1.93-5.37] for urinary incontinence.

    CONCLUSION: The proportion of men who suffer long-term impact on functional outcomes after prostate cancer treatment was substantial.

  • 292.
    Carlsson, Tommy
    et al.
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Melander Marttala, Ulla
    Department of Scandinavian Languages, Uppsala University, Uppsala, Sweden.
    Mattsson, Elisabeth
    Department of Public Health and Caring Sciences, Uppsala University; Department of Health Care Sciences, Ersta Sköndal University College, Stockholm, Sweden.
    Ringnér, Anders
    Umeå University, Faculty of Medicine, Department of Nursing.
    Experiences and preferences of care among Swedish immigrants following a prenatal diagnosis of congenital heart defect in the fetus: A qualitative interview study2016In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 16, article id 130Article in journal (Refereed)
    Abstract [en]

    Background: Immigrants experience significant challenges when in contact with healthcare and report less satisfaction with maternity care compared to native Swedes. Research that gives voice to pregnant immigrant women and their partners following a prenatal diagnosis of a fetal anomaly is scarce. Thus, the aim of this study was to explore experiences and preferences of care following a prenatal diagnosis of congenital heart defect among Swedish immigrants.

    Methods: Pregnant immigrants and their partners were consecutively recruited following a prenatal diagnosis of a congenital heart defect in the fetus. Nine respondents were interviewed in five interviews, four with the aid of a professional interpreter. The material was analyzed using manifest qualitative content analysis.

    Results: The analysis resulted in five categories: 1) “Trustworthy information”, 2) “Language barriers”, 3) “Psychosocial situation”, 4) “Peer support”, and 5) “Religious positions”.

    Conclusion: The potential need for interpreter services, visual information, psychosocial support, coordination with welfare officers, and respect for religious positions about termination of pregnancy are all important aspects for health professionals to consider when consulting immigrants faced with a prenatal diagnosis of fetal anomaly in the fetus. Peer support within this context needs to be further explored in future studies.

  • 293.
    Cartaxo, Elisabeth
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hansson, Kornelia
    Umeå University, Faculty of Medicine, Department of Nursing.
    Upplevelsen av mötet med skolsköterskan: Hbtq-ungdomars erfarenheter och förväntningar2017Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    The feeling of the meeting with the school nurse – LGBTQ-youths experiences and expectations

    Aim: To describe experiences of and expectations on support from school nurses by young LGBTQ people.

    Background: Research shows that school nurses may lack knowledge and have negative attitudes towards sexual minorities. Studies also show that students did not feel safe talking to the school nurse about sexuality.

    Method: Unstructured narrative interviews were conducted with 10 youths who identified themselves as LGBTQ. The interviews were analyzed with qualitative content analysis.

    Results: The study shows that youths who identify themselves as LGBTQ have had both positive and negative experiences in interactions with their school nurse. Youths who have had positive experiences with their school nurse felt that the nurse listened with respect and mediated safety. The negative experiences are due to the school nurse not being well versed in the subject of LGBTQ as well as seeming heteronormative. The expectations of the youths were to be treated equally, given the opportunity for active call support, a trustworthy relationship and a competent response from school nurses.

    Conclusion: A school nurse needs to be compentent and possess knowledge in LGBTQ to properly interact with LGBTQ-youths. 

  • 294.
    CEDERBLAD, THERES
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    LJUNGQVIST, TINA
    Umeå University, Faculty of Medicine, Department of Nursing.
    Att vårda en döende familjemedlem: -Anhörigas erfarenheter av palliativ vård i hemmet2019Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Palliative care at home is going to increase for the years to come. When practicing palliative care at home family caregivers have a very important roll. Previous studies show that the health of family caregivers that are practicing palliative care can be negatively affected. As professionals it is important to have an understanding of the experience of family providing palliative care at home and see the family as a unit. This, to give the family needed support and care.

    Aim: To illuminate the family caregivers’ experiences of taking care of a dying family member at home with support of professionals.

    Method: A literature study based on previous empirical studies. Database queries were carried out in PubMed, Cinahl, Scopus. The results are based on 8 qualitative studies which were reviewed, analyzed and compiled.

    Result: The result is put together into 3 categories: To being a family caregiver, The relation to professionals and existential challenges.

    Conclusion: Family caregivers experience of palliative care at home can be affected of the relationship to professionals. Family caregivers put their own needs aside which leads to an influence on the health of relatives. Professionals have an important role in identifying insufficiencies and needs of support for the family caregivers. When palliative care takes place in the home, it is important that the professionals take the focus from the dying family member and look to the whole family.

  • 295.
    Cedering, Signe
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Emilsson, Julia
    “Vad har man med sig i bagaget och hur kan jag, ja, ge bästa bemötande. Det är ju mycket dethandlar om när man möts såhär två, ja, ansikte mot ansikte”: Barnmorskors upplevelse av mötet med nyanlända kvinnor i norra Sverige.2016Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Objective: The aim of the study was to explore from a transcultural perspective, how midwives within Swedish maternity care units experienced meetings with newly arrived women.

    Methods: A qualitative interview study was conducted with six midwives in northern Sweden and analyzed with the help of content analysis. Nine subcategories, three categories and one theme emerged.

    Results: The results of the project were summarized in three categories: Midwifes balance between the personal and professional commitment in the meeting with newly arrived women. Language barriers and time constraints provide other conditions which may affect care and The fusion of different cultures was appreciated but contributes to clashes in the encounter between midwifes and newly arrived women. The majority of these midwives expressed a desire to work with these women and actively sought ways to develop their skills.

    Conclusion: Cultural differences affect the meeting between midwives and newly arrived women. Newly arrived women does not have the same opportunity to benefit from healthcare and may be at greater risk for illness. There is a great need for professional interpreters in Sweden. More education, time and resources would probably ease the midwives' frustration and increase the health benefits for newly arrived women.

  • 296.
    Christianson, Monica
    Umeå University, Faculty of Medicine, Department of Nursing.
    "Not Used But Almost…"-A Gender and Agency Analysis of the Grey Zone Between Consensual and Nonconsensual Sexual Intercourse2015In: Health Care for Women International, ISSN 0739-9332, E-ISSN 1096-4665, Vol. 36, no 7, p. 768-783Article in journal (Refereed)
    Abstract [en]

    Rape is a widespread but underreported problem among women. In this article I explore the complexities surrounding the fine line between consensual and nonconsensual sexual intercourse, by studying a rape through which a young woman was infected with HIV. I provide an analysis of how to understand and interpret this episode by applying a gender perspective based on patriarchy-namely, women's submissive position in heterosexual situations compared with men-and the concept of agency, that is, the individual's own decision-making ability, own choices, and different courses of action available, to outline the frame of action available to the informant. The inclusion of agency and a gender perspective offers new dimensions on how to understand and give meaning to narratives that are seldom told.

  • 297.
    Christianson, Monica
    et al.
    Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Eriksson, Carola
    A Girl Thing: Perceptions Concerning the Word "Hymen" Among Young Swedish Women and Men2011In: Journal of midwifery & women's health, ISSN 1526-9523, E-ISSN 1542-2011, Vol. 56, no 2, p. 167-172Article in journal (Refereed)
    Abstract [en]

    Methods: Students answered an open-ended question: What do you think about when you hear the word hymen? The answers were analyzed by using content analysis.

    Results: In total, 198 students, aged 17 to 18 years, answered the question. The theme "a fragile biological structure in the female body" described how the vast majority of the girls and 57% of the boys associated the hymen with a thin membrane that breaks during first vaginal intercourse. The theme "a symbol and manifestation of feminine virginity" described the symbolic meanings of having or not having a hymen. The theme "questioning the existence of the hymen" revealed the doubts that some had about its existence.

    Discussion: Most of the students associated the hymen with a breakable membrane. This is problematic. It may lead to misunderstandings about virginity or about bleeding during sexual intercourse. Changing these views about the hymen is important to correct such misunderstanding but may be a significant challenge. In modern medical discourse, in health care, and in popular speech, there are few discussions about the hymen as a social construct, indicating that more gender research concerning hymen-related issues is needed.

  • 298.
    Christianson, Monica
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Eriksson, Carola
    Umeå University, Faculty of Medicine, Department of Nursing.
    Acts of violence: virginity control and hymen (re)construction2014In: British journal of midwifery, ISSN 0969-4900, E-ISSN 2052-4307, Vol. 22, no 5, p. 344-352Article in journal (Refereed)
    Abstract [en]

    Globally, midwives are often at the forefront of promoting and improving women’s sexual and reproductive health. It is important to develop a gender perspective in midwifery education, one that addresses the fact that virginity control and hymen (re)constructions are unscientific and may cause great harm to women worldwide. This study aimed to investigate the experience and attitudes of an international group of midwives regarding virginity control and hymen (re)constructions. An online questionnaire was emailed to midwives who attended the International Confederation of Midwifery (ICM) Congress in Glasgow. The respondents (n=480) represented five continents. Ten percent of the midwives reported professional experience of requests concerning virginity examinations and hymen (re)constructions. The majority stated that these practices are unjustifiable, and amount to acts of violence against women, whereas a minority responded that these practices can be acceptable. Almost two-thirds stated that it is the responsibility of midwives to work against these practices.

  • 299.
    Christianson, Monica
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Eriksson, Carola
    Umeå University, Faculty of Medicine, Department of Nursing.
    Myths and misconceptions: Midwives´ perception of the vaginal opening or hymen and virginity2013In: British journal of midwifery, ISSN 0969-4900, E-ISSN 2052-4307, Vol. 21, no 2, p. 108-115Article in journal (Refereed)
    Abstract [en]

    Ideas and misconceptions about the vaginal opening, hymen and virginity are widely held in many societies. The aim of this study was to investigate the perceptions of the vaginal opening, the hymen and its connection with bleeding, sexual intercourse, physical activity and virginity verification among an international group of midwives. An online questionnaire about the topic was emailed to midwives who attended the International Confederation of Midwives' (ICM) Congress in Glasgow. The respondents (n=480) represented five continents with European delegates dominating the attendees. Two thirds (66%) of the respondents believed that girls are born with a covering membrane that breaks during the first vaginal intercourse and 52% thought that the membrane breaks during physical activities. Fifteen percent connected bleeding with the first vaginal intercourse and 21% stated that virginity can be verified by a gynecological examination. Midwives play a significant role in improving the sexual and reproductive health of women, thus in order to challenge long-held biomedical 'truths', midwives must become conscious and knowledgeable about how the myths surrounding the hymen contribute to gender inequalities and health disparities in women. A first step is to implement gender perspectives in midwifery education.

  • 300.
    Christianson, Monica
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Eriksson, Carola
    Umeå University, Faculty of Medicine, Department of Nursing.
    Promoting women's human rights: A qualitative analysis of midwives' perceptions about virginity control and hymen 'reconstruction'2015In: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 20, no 3, p. 181-192Article in journal (Refereed)
    Abstract [en]

    Objectives To explore midwives' perceptions regarding virginity control and hymen 'reconstructions', and how these practices can be debated from a gender perspective. Methods An international group of 266 midwives answered an open-ended question in a Web survey. The great majority came from the Western world, among them, the majority were from Europe. Data were analysed using qualitative content analysis. Results Three themes emerged: misogynistic practices that cement the gender order, which revealed how the respondents viewed virginity control and hymen 'reconstructions'; raising public awareness and combatting practices that demean women, which were suggested as strategies by which to combat these practices; and promoting agency in women and providing culturally sensitive care, which were considered to improve health care encounters. Conclusions Virginity control and hymen 'reconstructions' are elements of patriarchy, whereby violence and control are employed to subordinate women. To counter these practices, macro and micro-level activities are needed to expand women's human rights in the private and the public spheres. Political activism, international debates, collaboration between sectors such as health care and law-makers may lead to increased gender equality. A women-centred approach whereby women are empowered with agency will make women more capable of combatting virginity control and hymen 'reconstruction'.

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