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  • 301.
    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'.

  • 302.
    Claesson Lingehall, Helena
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Delirium in older people after cardiac surgery: risk factors, dementia, patients’ experiences and assessments2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background:

    Delirium is common in older people undergoing cardiac surgery. Delirium is an acute or subacute neuro-psychiatric syndrome, characterized by a change in cognition, disturbances in consciousness; it fluctuates, develops over a short period of time and always has an underlying cause. It is associated with a disturbance in psychomotor activity, and is classified according to different clinical profiles such as hypoactive, hyperactive and mixed delirium. Delirium after cardiac surgery is not harmless, it increases the risk of complications such as prolonged stay in hospital, falls, reduced quality of life, reduced cognitive function and increased mortality.

    Aim:

    The overall aim of this thesis was to investigate postoperative delirium in older people undergoing cardiac surgery with Cardiopulmonary Bypass (CPB), focusing on risk factors, dementia and patients’ experiences; and to evaluate an assessment for screening delirium.

    Methods:

    This thesis compromises four studies. All participants (n=142) were scheduled for cardiac surgery with use of CPB at the Cardiothoracic Surgery Department, Heart Centre, Umeå University Hospital, Sweden, between February and October 2009. Six structured interviews were conducted preoperatively, day one and day four postoperatively, and in home visits, one, three and five years after surgery (2010, 2012 and 2014). The assessment scales used in Studies I, II and IV were: the Mini-Mental State Examination (MMSE) for cognition, the Organic Brain Syndrome Scale (OBS) for delirium, Geriatric Depression Scale 15 (GDS-15) for depression, Katz staircase with Activities of Daily Living (ADL) for participants’ functional status and the Numerical Rating Scale (NRS) for pain. During the hospital stay, nursing staff used the Swedish version of the Nursing Delirium Screening Scale (Nu-DESC) to assess delirium. Semi-structured interviews were also carried out (III) in the one-year follow up. Delirium, dementia and depression were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders (DSM IV TR).

    Results:

    Out of 142 participants 54.9% (78/142) developed delirium after cardiac surgery (I). Independent risk factors, predisposing and precipitating, associated with delirium were: age, diabetes, gastritis/peptic ulcer, volume load during operation, longer time on ventilator in intensive care, increased temperature and plasma sodium concentration in the intensive care unit. Out of 114 participants thirty (26.3%) developed dementia within the five years of follow-up. It was shown that a lower preoperative MMSE score and postoperative delirium were factors independently associated with development of dementia (II). One year after cardiac surgery, participants diagnosed with postoperative delirium described in detail feelings of extreme vulnerability and frailty. Despite this, the participants were grateful for the care they had received (III). Hypoactive was the most common symptom profile for delirium. The Swedish version of Nu-DESC showed high sensitivity in detecting hyperactive delirium, but low sensitivity in detecting hypoactive delirium (IV).

    Conclusion:

    Delirium was common among older patients undergoing cardiac surgery. Both predisposing and precipitating factors contributed to postoperative delirium. Preventive strategies should be considered in future randomized studies. It might also be suggested that cognitive function should be screened for preoperatively and patients who develop delirium should be followed up to enable early detection of symptoms of dementia. Whether prevention of postoperative delirium can reduce the risk of future dementia remains to be studied. To minimise unnecessary suffering, patients and next of kin should be informed about and prepared for the risk of delirium developing during hospitalization. The Swedish version of Nu-DESC should be combined with cognitive testing to improve detection of hypoactive delirium, but further research is needed. Healthcare professionals need knowledge concerning postoperative delirium in order to prevent, detect and treat delirium so as to avoid and relieve the suffering it might cause.

  • 303.
    Claesson Lingehall, Helena
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Cardiothoracic Surgery Division, Heart Center.
    Smulter, Nina
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Cardiothoracic Surgery Division, Heart Center.
    Engström, Karl Gunnar
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Cardiothoracic Surgery Division, Heart Center.
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Olofsson, Birgitta
    Umeå University, Faculty of Medicine, Department of Nursing. Department of Nursing, The Strategic Research Programme in Care Sciences, Umeå University and Karolinska Institutet, Department of Surgical and Perioperative Science, Orthopedic Surgery, University of Umeå.
    Validation of the Swedish version of the Nursing Delirium Screening Scale used in patients 70 years and older undergoing cardiac surgery2013In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 22, no 19-20, p. 2858-2866Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES: Validation of the Swedish version of the Nursing Delirium Screening Scale as a screening tool for nurses to use to detect postoperative delirium in patients 70 years and older undergoing cardiac surgery.

    BACKGROUND: Delirium is common among old patients after cardiac surgery. Underdiagnosis and poor documentation of postoperative delirium is problematic, and nurses often misread the signs.

    DESIGN: A prospective observational study.

    METHODS: Patients (n = 142) scheduled for cardiac surgery were assessed three times daily by the nursing staff using the Nursing Delirium Screening Scale. Nursing Delirium Screening Scale was compared with the Mini Mental State Examination and the Organic Brains Syndrome Scale, evaluated day one and day four postoperatively. Delirium was diagnosed according to Diagnostic and Statistical Manual of Mental Disorders - DSM-IV-TR criteria.

    RESULTS: A larger proportion of patients were diagnosed with delirium according to the Mini Mental State Examination and Organic Brains Syndrome Scale compared with the Nursing Delirium Screening Scale, both on day one and day four. The Nursing Delirium Screening Scale protocol identified the majority of hyperactive and mixed delirium patients, whereas several with hypoactive delirium were unrecognised.

    CONCLUSIONS: The Swedish version of the Nursing Delirium Screening Scale was easily incorporated into clinical care and showed high sensitivity in detecting hyperactive symptoms of delirium. However, in the routine use by nurses, the Nursing Delirium Screening Scale had low sensitivity in detecting hypoactive delirium, the most prevalent form of delirium after cardiac surgery. Nursing Delirium Screening Scale probably has to be combined with cognitive testing to detect hypoactive delirium.

    RELEVANCE TO CLINICAL PRACTICE: Nurses play a key role in detecting delirium. The Nursing Delirium Screening Scale was easy incorporated instrument for clinical practice and identified the majority of hyperactive and mixed delirium, but several of the patients with hypoactive delirium were unrecognised. Training of assessment and cognitive testing seems to be necessary to detect hypoactive delirium.

  • 304.
    Claesson Lingehall, Helena
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Smulter, Nina
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Lindahl, Elisabeth
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lindkvist, Marie
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Engström, Karl Gunnar
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Olofsson, Birgitta
    Umeå University, Faculty of Medicine, Department of Nursing.
    Dementia after postoperative delirium in older people who have undergone cardiac surgery: a longitudinal cohort studyManuscript (preprint) (Other academic)
  • 305.
    Claesson Lingehall, Helena
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Smulter, Nina
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences. Cardiothoracic Surgery Division, Heart Center.
    Lindahl, Elisabeth
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lindkvist, Marie
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Engström, Karl Gunnar
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Gustavsson, Yngve
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Olofsson, Birgitta
    Umeå University, Faculty of Medicine, Department of Nursing.
    Preoperative Cognitive Performance and Postoperative Delirium Are independently Associated With Future Dementia in Older People Who Have Undergone Cardiac Surgery: A Longitudinal Cohort Study2017In: Critical Care Medicine, ISSN 0090-3493, E-ISSN 1530-0293, Vol. 45, no 8, p. 1295-1303Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate if postoperative delirium was associated with the development of dementia within 5 years after cardiac surgery.

    Design: Longitudinal cohort study.

    Setting: Cardiothoracic Division, Umeå University Hospital, Sweden.

    Patients: Patients aged 70 years old or older (n = 114) scheduled for routine cardiac procedures with cardiopulmonary bypass without documented dementia were enrolled in 2009.

    Intervention: Structured assessments were performed preoperatively, 1 and 4 days after extubation, and 1, 3, and 5 years postoperatively.

    Measurements and Main Results: Patients were assessed comprehensively, including cognitive and physical function, coexisting medical conditions, demographic characteristics, and medications. Diagnoses of delirium, depression, and dementia were made according to Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision criteria. During the 5-year period, 30 of 114 participants (26.3%) developed dementia. Postoperative delirium had occurred in 87% of those who later developed dementia. A multivariable logistic regression model showed a lower preoperative Mini-Mental State Examination score (p < 0.001; odds ratio, 0.68; 95% CI, 0.54–0.84) and the occurrence of postoperative delirium (p = 0.002; odds ratio, 7.57; 95% CI, 2.15–26.65) were associated with dementia occurrence.

    Conclusions: Our findings suggest that older patients with reduced preoperative cognitive functions or who develop postoperative delirium are at risk of developing dementia within 5 years after cardiac surgery. Cognitive functions should be screened for preoperatively, those who develop postoperative delirium should be followed up to enable early detection of dementia symptoms, and management should be implemented.

  • 306.
    Claesson Lingehall, Helena
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Smulter, Nina
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Olofsson, Birgitta
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lindahl, Elisabeth
    Umeå University, Faculty of Medicine, Department of Nursing.
    Experiences of undergoing cardiac surgery among older people diagnosed with postoperative delirium: one year follow-up2015In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 14, article id 17Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Cardiovascular disease is common among old people and many undergo cardiac surgery. Scientific knowledge is available on cardiac surgery from several perspectives. However, we found few studies focusing on older patients' experiences of cardiac surgery. The aim of this study was to illuminate experiences of undergoing cardiac surgery among older people diagnosed with postoperative delirium, a one year follow-up.

    METHODS: Qualitative interviews were conducted with 49 participants (aged ≥70 years) diagnosed with delirium after cardiac surgery. Data were collected in Sweden during 2010 through individual, semi-structured interviews in participants' homes one year after surgery. The interviews were analyzed using qualitative content analysis.

    RESULTS: Four themes with sub-themes were formulated: Feeling drained of viability includes having a body under attack, losing strength and being close to death. Feeling trapped in a weird world describes participants having hallucinations, being in a nightmare and being remorseful for their behavior. Being met with disrespect includes feeling disappointed, being forced, and feeling like cargo. On the other hand, Feeling safe, including being in supportive hands and feeling grateful, points to participants' experiences of good care and the gift of getting a second chance in life.

    CONCLUSIONS: Even one year after cardiac surgery, participants described in detail feelings of extreme vulnerability and frailty. They also had felt completely in the hands of the health care professionals. Participants described experiences of hallucinations and nightmares during hospitalization. Cardiac surgery was a unique, fearful, traumatic and unpleasant experience yet could also include pleasant or rewarding aspects. It seems that health care professionals need deeper knowledge on postoperative delirium in order to prevent, detect and treat delirium to avoid and relieve the suffering these experiences might cause.

  • 307. Cleeve, Helena
    et al.
    Tishelman, Carol
    Macdonald, Alastair
    Lindqvist, Olav
    Umeå University, Faculty of Medicine, Department of Nursing. Karolinska Institutet, LIME, MMC, Innovative Care research group, Stockholm, Sweden.
    Goliath, Ida
    Not just things: the roles of objects at the end of life2018In: Sociology of Health and Illness, ISSN 0141-9889, E-ISSN 1467-9566, Vol. 40, no 4, p. 735-749Article in journal (Refereed)
    Abstract [en]

    While the study of objects in care contexts is an emerging research field, it is largely overlooked in end of life (EoL) care. In this study, we empirically and inductively explore the roles of objects at the EoL from the perspective of bereaved family members. Open individual interviews were conducted with 25 family members recruited from palliative in-patient and homecare units, as well as residential care facilities. After verbatim transcription, the interviews were analysed thematically. Based on these interviews, we conceptualise the roles of objects as relating to temporality, transformations of the everyday, and care. Through analysis we offer two main insights, the first relating to interdependency between objects and people, and the second to the recognition of objects as simultaneously flexible and stable in this interdependent relationship. The capacity and challenge of objects as part of EoL care lies in their ability to encompass various viewpoints and relationships simultaneously. This might provide valuable insights for staff caring for dying persons and their families. We propose that staff's ability to navigate objects in care practices could be meaningful in supporting the relationships between individuals in EoL situations.

  • 308.
    Cole, Frida
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Öberg, Julia
    Umeå University, Faculty of Medicine, Department of Nursing.
    Åldersbedömningar baserat på undersökningar med datortomografi och magnetisk resonanstomografi av mediala nyckelbensepifysen2016Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Titel: Åldersbedömningar baserat på undersökningar med datortomografi och magnetisk resonanstomografi av mediala nyckelbensepifysen.

    Bakgrund: Barn och ungdomar som flytt från krig saknar ofta offentliga handlingar. Dessa individer kan därför erbjudas en medicinsk åldersbedömning. I asylprocesser spelar åldern 18 år en stor roll och vid åldersbedömningar av dessa individer rekommenderar Study Group on Forensic Age Diagnostics en röntgenundersökning av nyckelbenen.

    Syfte: Syftet med denna litteraturstudie var att beskriva åldersvariationerna inom nyckelbenets olika utvecklingssteg vid undersökning med datortomografi respektive magnetisk resonanstomografi vid åldersbedömmande processer.

    Metod: En litteraturstudie genomfördes med 11 artiklar med kvantitativ ansats. Artiklarnas resultat granskades, analyserades och sammanställdes.

    Resultat: Åldersvariationerna inom utvecklingsstegen varierade i större och mindre grad dock tycktes det inte föreligga några större skillnader mellan modaliteterna. Överlappen mellan utvecklingsstegen tenderade att vara större för MRT än för DT. Resultaten visade ett positivt samband mellan kronologisk ålder och utvecklingsstegen samt att medelåldern generellt ökade med utvecklingsstegen.

    Konklusion: Det förekom stora åldersvariationer inom utvecklingsstegen samt stora överlapp mellan utvecklingsstegen vilket indikerade på precisionsproblem och osäkerheter, för både DT och MRT. Sett till den kliniska tillgängligheten, kostnader, tid, smidighet och upplevelser för patienten tyder DT på att vara en bättre metod än MRT.

  • 309.
    Conradsson, Mia
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Rosendahl, Erik
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Littbrand, Håkan
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Olofsson, Birgitta
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lövheim, Hugo
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Usefulness of the Geriatric Depression Scale 15-item version among very old people with and without cognitive impairment2013In: Aging & Mental Health, ISSN 1360-7863, E-ISSN 1364-6915, Vol. 17, no 5, p. 81p. 638-645Article in journal (Refereed)
    Abstract [en]

    Objectives: The aim of this population-based study was to investigate the usefulness of the Geriatric Depression Scale 15-item version (GDS-15) to assess depressive symptoms among very old people with differing levels of cognitive function.

    Methods: The 834 participants were aged 85 and over. Feasibility of GDS-15 was evaluated as the proportion of people who completed the scale. Concurrent criterion validity was evaluated by calculating correlations between GDS-15 and Philadelphia Geriatric Center Morale Scale (PGCMS). PGCMS measures psychological wellbeing which is closely related with depressive symptoms. Correlations were calculated within groups according to cognitive function assessed with Mini-Mental State Examination (MMSE); 0-4, 5-9, 10-14, 15-19, 20-24, 25-27, and 28-30, using Pearson's two-sided correlation and compared using Fisher r-to-z transformation. Internal consistency of the GDS-15 was evaluated by calculating Cronbach's in each group.

    Results: In total, 651 (78%) of the 834 participants completed the GDS-15. For the two MMSE-groups with scores of <10, the proportion who completed GDS-15 were 1% and 42%, respectively, compared to 65-95% in the MMSE-groups with scores of 10. Cronbach's in each MMSE-group ranged from 0.636 (MMSE 28-30) to 0.821 (MMSE 5-9). The level of correlation between GDS-15 and PGCMS did not significantly differ between MMSE-groups with scores of 5-27 compared to the MMSE-group with scores of 28-30.

    Conclusions: The GDS-15 seems to have an overall usefulness to assess depressive symptoms among very old people with an MMSE score of 10 or more. More studies are needed to strengthen the validity of GDS-15 among older people with MMSE scores of 10-14. For older people with MMSE scores lower than 10, there is a need to develop and validate other measurements.

  • 310.
    Dacke, Niklas
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Malm, Malm
    Umeå University, Faculty of Medicine, Department of Nursing.
    Är det svårt att hålla mask eller?: Anestesisjuksköterskans erfarenheter av oväntat svåra luftvägar i samband med anestesi2016Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Managing the airway of a patient during anesthesia is one of anesthesia

    nurse's main tasks. When an unexpected difficult airway occurs, the high demands in

    terms of competence of the nurse anesthetist. Previous research has small extent

    focused on the nurse anesthetist experiences of this complex situation. It is therefore

    desirable to perform further studies on this subject, focusing on experience.

    Aim: The aim was to illustrate anesthetic nurses experiences of the unexpected

    difficult airway associated with anesthesia.

    Method: The study was conducting using qualitative approach. Data were collected

    through semi-structured interviews with ten anesthetic nurses employed in two

    different surgical departments in Sweden. The interviews were transcribed and

    analyzed by content analysis.

    Result: The analysis revealed four categories that describe anesthetic nurses

    experiences of the unexpected difficult airway associated with anesthesia; experiences

    of working under pressure, to work in teams, the importance of feeling safe in their

    professional capacity and the value reflection

    Conclusion: Anesthetic nurses shared experiences suggest a consensus that when

    these situations occur they requested more training together. This is partly to facilitate

    cooperation and also to take advantage of others' experiences and strategies to solve

    similar situations in the future.

    Keywords: Nurse anesthetist, unexpected difficult airways, experiences, feelings.

  • 311.
    Dahlgren, Marie
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Holm, Eva
    Umeå University, Faculty of Medicine, Department of Nursing.
    Nutritionsbedömning är viktigt men få patienter bedöms: En litteraturstudie om sjuksköterskors uppfattning om nutritionsbedömning av vuxna inom hälso- och sjukvård2016Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Nutritionsbedömning är viktigt men få patienter bedöms

    En litteraturstudie om sjuksköterskors uppfattning om nutritionsbedömning för vuxna i hälso- och sjukvård

    Marie Dahlgren Eva Holm

    Abstrakt

    Bakgrund: Många framför allt äldre människor lider av undernäring. Tillståndet uppmärksammas sällan därför att nutritionsbedömning inte rutinmässigt genomförs vid kontakt med hälso- och sjukvård. Undernäring får negativa konsekvenser för den enskilde och ger ökade samhällskostnader genom de komplikationer som uppstår. Med obligatorisk nutritionsbedömning för alla patienter kan tillståndet tidigt identifieras och behandlas. I bedömningsprocessen har sjuksköterskor en central roll och deras inställning till arbetsuppgiften är av stor betydelse för genomförandet.

    Syfte: Att belysa sjuksköterskors uppfattning om nutritionsbedömning av vuxna i hälso-och sjukvård.

    Metod: En litteraturstudie innehållande 10 artiklar; fem med kvalitativmetod och fem medkvantitativmetod som ansats. Artiklarna söktes i databaserna Cinahl, Pub Med och Medline. Efter kvalitetsgranskning analyserades innehållet i valda artiklar.

    Resultat: I materialet ingick 1872 sjuksköterskor. Sjuksköterskorna var i huvudsak positiva till nutritionsbedömning men osäkra på hur den skulle utföras. De önskade utbildning och träning samt goda förutsättningar i arbetsmiljön.

    Konklusion: Kunskapsbrist och organisatoriska strukturer utgjorde de största hindren för obligatorisk bedömning. Förbättringsåtgärder krävs och kostnaderna för detta ligger sannolikt på mycket lägre nivå än kostnaden för de komplikationer som undernäring orsakar.

  • 312.
    Dahlheim Englund, Ann-Charlotte
    et al.
    Umeå University, Faculty of Medicine, Nursing.
    Hartman, Jan
    Segesten, Kerstin
    Assisting teens with asthma to take command.2006In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 20, no 2, p. 193-201Article in journal (Refereed)
    Abstract [en]

    To meet and work with teenagers may be a challenge for caregivers as adolescence is a period when youths try to establish autonomy. Although asthma is an increasing problem worldwide, few studies have addressed professional caregivers' motives and actions. Therefore, the aim of this study was to describe professional caregivers' strategies in their work with teenagers with asthma. Grounded theory, inspired by Glaser, was used to uncover the phenomenon. The informants were seven professional caregivers who worked at an eight-day asthma camp for teenagers in Sweden. Participant observations and interviews were used, and the first author collected the data and participated in the activities. Findings show that professional caregivers' core concern is to assist teenagers with asthma to take command. This core concern gives rise to five strategies: showing respect, being at hand, promoting own responsibility, promoting to exceed boundaries and promoting reflections. In professional caregivers' attempt to assist teenagers to take command some differences are seen in the way they support boys and girls. One conclusion drawn from our study is that the provisional theory of 'Assisting teenagers with asthma to take command' is not only suitable for professional caregivers working at asthma camps; it may, in some degree, also be used as a source of inspiration for professional caregivers in other settings.

  • 313.
    Dahlheim-Englund, Ann-Charlotte
    et al.
    Umeå University, Faculty of Medicine, Nursing.
    Rydström, Ingela
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Nursing.
    Being the parent of a child with asthma.2001In: Pediatric Nursing, ISSN 0097-9805, Vol. 27, no 4, p. 365-373Article in journal (Refereed)
    Abstract [en]

    The aim of this study is to describe what it means to be parents of a child with asthma. Unstructured interviews were carried out with 12 mothers and 12 fathers of children with asthma living in Sweden. The parents' accounts were analyzed using a phenomenological-hermeneutic approach. The results revealed that parents were living a strenuous life and their actions involved both protecting and liberating. Parents also reported feelings of sadness and acceptance. In most cases, mothers acted in a protecting manner and expressed feelings of sadness; fathers acted in a liberating manner and expressed feelings of acceptance. To gain a deeper understanding of the parents' actions and feelings, study results were interpreted through philosophical perspectives described by Ruddick (1989), Mayeroff (1965), and Hegel (1975). These interpretations show that the feelings and actions of these parents exist in a dialectical relation with one another. Results emphasize the importance of a good partnership between the parents and the nurse, where the nurse shows consideration for the parents' unique actions and feelings and understands and supports parents in the care of their child with asthma.

  • 314.
    Dahlqvist, Vera
    Umeå University, Faculty of Medicine, Department of Nursing.
    Samvete i vården: att möta det moraliska ansvarets röster2008Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The overall aim of this thesis is twofold: first, to develop and validate questionnaires that could be used for investigating relationships between perceptions of conscience, moral sensitivity and burnout and second, to describe patterns of self-comfort used to ease stress and illuminate meanings of living with a troubled conscience. The thesis comprises five studies and is based on both quantitative and qualitative data.

    In study I, a questionnaire was constructed to assess perceptions of conscience; the Perceptions of Conscience Questionnaire (PCQ). This 15 item-questionnaire was distributed to 444 care providers. Statistical analyses of responses showed sufficient distribution and a stable six factor solution congruent with reviewed literature. The six factors were labelled: ‘the voice of authority’, ‘warning signal’, ‘demanding sensitivity’, ‘asset’, ‘burden’ and ‘depending on culture’. The findings suggest that the PCQ is a valid questionnaire. The aim of study II was further development of an existing questionnaire assessing care providers’ moral sensitivity, enabling its use in various care contexts. The revised nine-item questionnaire, the Moral Sensitivity Questionnaire Revised version (MSQ-R), was distributed to 278 care providers with various professional backgrounds. Statistical analyses of responses showed sufficient distribution and a three-factor solution congruent with reviewed literature. The three factors were labelled: ‘sense of moral burden’, ‘sense of moral strength,’ and ‘sense of moral responsibility.’ The findings suggest that MSQ-R is valid for use in various healthcare contexts. In study III, the PCQ, the MSQ-R and the Maslach Burnout Inventory (MBI) were distributed to a population of psychiatric care providers (n=101) to investigate relationships between perceptions of conscience and moral sensitivity and levels of burnout. The hierarchical cluster analysis shows two clusters with Pearson’s r >.50. Cluster A comprising items such as: being sensitive, interpreting and following the voice of conscience that warns us against hurting other or ourselves and developing as human beings was labelled ‘experiencing a sense of moral integrity’. Cluster B comprising items such as: feeling inadequate, doing more than one has strengths for, feeling always responsible, having difficulties to deal with wearing feelings, perceiving that conscience gives wrong signals and express social values, having to deaden one’ conscience, were all related to scores of the MBI subscales emotional exhaustion (EE) and depersonalisation (DP). Cluster B was labelled ‘experiencing a burdening accountability’. The results show that levels of ‘experiencing a burdening accountability’ are closely related to levels of being at risk of burnout.

    The aim of study IV was to describe patterns of self-comforting measures used to ease stress. The written accounts of 168 care providers and healthcare students were analysed by means of qualitative content analysis. The findings disclose two dimensions: an ability to use early learned measures to take care of oneself (ingression) and an ability to feel intimately related to life, other human beings and universe or God (transcendence). The findings provide valuable knowledge about self-comfort as a coping strategy. The aim of study V was to illuminate meanings of living with a troubled conscience. Ten psychiatric care providers, respondents of study III with various perceptions of conscience were interviewed. The interviews were interpreted using a phenomenological - hermeneutical method. The findings show that one meaning of living with a troubled conscience is being confronted with inadequacy and struggling to view oneself as ‘good enough.’ The comprehensive understanding indicates that inadequacy, both one’s own and that of organization one represents, infuse feelings of shame rather than feelings of guilt. Shame concerns one’s identity and need of reconciliation.

    Conclusions: The results reveal two ways of encountering a troubled conscience. One is being unable to interpret the ethical demand from a troubled conscience. This is indicated by connections between levels of moral burden and levels of burnout. The other way is being able to interpret the ethical demand and using one’s troubled conscience to develop practical wisdom. This means facing shame of feeling inadequate, reconciling images of the ideal self and self-contempt, and becoming realistic about what one can do. In this process comfort seems to be a mediator of reconciliation.

  • 315.
    Dahlqvist, Vera
    et al.
    Umeå University, Faculty of Medicine, Omvårdnad.
    Eriksson, S
    Lützén, K
    Söderberg, A
    Norberg, A
    Perceptions of conscience, moral sensitivity and burnout among psychiatric staffManuscript (Other academic)
  • 316.
    Dahlqvist, Vera
    et al.
    Umeå University, Faculty of Medicine, Nursing.
    Eriksson, Sture
    Umeå University, Faculty of Medicine, Community Medicine and Rehabilitation, Geriatric Medicine. Geriatrik.
    Glasberg, Ann-Louise
    Umeå University, Faculty of Medicine, Nursing.
    Lindahl, Elisabeth
    Umeå University, Faculty of Medicine, Nursing.
    Lützén, Kim
    Strandberg, Gunilla
    Umeå University, Faculty of Medicine, Nursing.
    Söderberg, Anna
    Umeå University, Faculty of Medicine, Nursing.
    Sørlie, Venke
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Nursing.
    Development of the perceptions of conscience questionnaire.2007In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 14, no 2, p. 181-193Article in journal (Refereed)
    Abstract [en]

    Health care often involves ethically difficult situations that may disquiet the conscience. The purpose of this study was to develop a questionnaire for identifying various perceptions of conscience within a framework based on the literature and on explorative interviews about perceptions of conscience (Perceptions of Conscience Questionnaire). The questionnaire was tested on a sample of 444 registered nurses, enrolled nurses, nurses' assistants and physicians. The data were analysed using principal component analysis to explore possible dimensions of perceptions of conscience. The results showed six dimensions, found also in theory and empirical health care studies. Conscience was perceived as authority, a warning signal, demanding sensitivity, an asset, a burden and depending on culture. We conclude that the Perceptions of Conscience Questionnaire is valid for assessing some perceptions of conscience relevant to health care providers.

  • 317.
    Dahlqvist, Vera
    et al.
    Umeå University, Faculty of Medicine, Omvårdnad.
    Söderberg, Anna
    Umeå University, Faculty of Medicine, Omvårdnad.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Omvårdnad.
    Dealing with stress: Patterns of self-comfort among healthcare students.2008In: Nurse Education Today, ISSN 0260-6917, Vol. 28, no 4, p. 476-584Article in journal (Refereed)
  • 318.
    Dahlqvist, Vera
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Söderberg, Anna
    Umeå University, Faculty of Medicine, Department of Nursing.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing.
    Facing inadequacy and being good enough: psychiatric care providers' narratives about experiencing and coping with troubled conscience2009In: Journal of Psychiatric and Mental Health Nursing, ISSN 1351-0126, E-ISSN 1365-2850, Vol. 16, no 3, p. 242-247Article in journal (Refereed)
    Abstract [en]

    The aim of this study is to illuminate the meaning of encounters with a troubled conscience among psychiatric therapists. Psychiatric care involves ethical dilemmas which may affect conscience. Conscience relates to keeping or losing a sense of personal integrity when making judgments about one's actions. Ten psychiatric therapists were interviewed in June 2006. The interviews were tape-recorded, transcribed verbatim and interpreted using a phenomenological-hermeneutic method. Two themes 'Facing inadequacy' and 'Struggling to view oneself as being 'good enough'' are presented. In the therapists interviewed, awareness of their use of power, a sense of powerlessness and a sense of blame gave rise to feelings of betrayals and shameful inadequacy. By sharing their inadequacy with co-workers, they managed to endure the sense of their inadequacy which otherwise would have threatened to paralyse them. Finding consolation in sharing wearing feelings, becoming realistic and attesting their worthiness, they reached reconciliation and found confirmation of being good enough. The findings are interpreted in light of Lögstrup's ethics of trust, according to which conscience alerts us to silent but radical ethical demand and the risk of self-deception.

  • 319.
    Dahlroth, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Enström, Jessica
    Umeå University, Faculty of Medicine, Department of Nursing.
    Föräldrars upplevelse av vård i samband med barnens behandling för läpp-, käk- och gomspalt2015Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Syfte: Syftet med denna studie var att belysa föräldrars upplevelse av vård i samband med barnens behandling för läpp,- käk- och gomspalt.

    Bakgrund: Läpp-, käk- och gomspalt är en av de vanligaste medfödda missbildningarna i Sverige och det föds mellan 150-200 barn med denna missbildning varje år. Dessa barn kommer tidigt i livet att behöva genomgå kirurgisk behandling för sin missbildning och följas upp med kontroller fram till vuxen ålder och sammantaget innebär detta en påfrestning för hela familjen.

    Metod: Nio föräldrar deltog i denna intervjustudie inspirerad av tematisk narrativ metod. Intervjuerna spelades in, skrevs ut ordagrant och textmassan har analyserat med tematisk narrativ analys.

    Resultat: Föräldrarnas upplevelser fångades i två huvudteman; ”en resa som trots allt gått bra” och ”en kamp som präglades av osäkerhet”. Föräldrarnas upplevelser varierar från positiva till negativa. De som har positiva upplevelser vittnar om ett bra bemötande, en strukturerad organisation samt tillräcklig information. De föräldrar som har negativa upplevelser har berättat om känslor av att bli ifrågasatt som förälder, att bli skuldbelagd för sitt barns missbildning, falla mellan stolarna samt att få otillräcklig information

    Slutsats: Denna studie tydliggör vikten av att planera och skapa en trygg vård kring dessa familjer och på det sättet kunna möjliggöra ett gott föräldraskap. För att ytterligare få förståelse för dessa föräldrars upplevelse krävs ytterligare forskning.

  • 320.
    Dalheim Englund, Ann-Charlotte
    Umeå University, Faculty of Medicine, Nursing.
    Skydda och frigöra: en studie av föräldrar till barn med astma och av professionella vårdare2005Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Aim: The overall aim of this thesis is, from the point of view of parents of a child with asthma, to describe meanings of being a parent, parents’ quality of life, and to describe how family relations are influenced by their child’s disease. The aim is also to increase the understanding of what strategies professional caregivers use in their work with teenagers suffering from asthma.

    Methods: Informants in the three qualitative studies were 29 parents (17 mothers and 12 fathers) of children with asthma and 7 professional caregivers. Informants in a quantitative quality of life study were 371 parents. The data collections were undertaken by means of interviews, observations and a questionnaire. The data was analysed by means of a phenomenological-hermeneutic method, grounded theory and statistics.

    Results: A meaning of being a parent of a child with asthma is to live a strenuous life and to fear that the child might die during a severe asthma attack. The parents’ actions involve both protecting and liberating and their feelings involve sadness as well as acceptance. Mostly the mothers act in a protecting manner and express feelings of sadness. The fathers mostly act in a liberating manner and express feelings of acceptance. The core concern in families of a child with asthma was found to be disease-engendered uncertainty. The mothers describe that feelings of uncertainty always are present owing to the unpredictability of the disease. These feelings make the mothers more or less available for family members. For the child with asthma the mothers’ experience that they are always available. Thus, control and tight bonds characterize the mother-child relationships. The mothers’ constant availability for the child with asthma is experienced to lead to a decreased availability for other family members and theses relationships are characterised by feelings of forsakenness and lack of understanding. However, when parents of children with asthma estimate their quality of life by a questionnaire, they estimate it as comparatively high. In the same family the parents scoring of separate items was to a large extent similar. The result also shows that professional caregivers’ central concern is to assist teenagers with asthma to conquer life. This gives rise to five strategies: showing respect, being at hand, promoting personal sense of responsibility, promoting exceeding boundaries, and promoting reflections. In professional caregivers’ attempt to assist teenagers to conquer life some differences are seen in the way they support boys and girls.

    Conclusion: One conclusion drawn from this thesis is that being a parent of a child with asthma involves feelings of uncertainty. In meeting the parents in question, caregivers should reflect upon these feelings and consider how the parents could be assisted. As mothers and fathers describe different attitudes in relation to the care of the child, it is also important to reflect upon how professional caregivers can assist the balance between the mothers’ protecting and the fathers’ liberating attitudes. It is also important for professional caregivers to reflect upon how they meet teenage girls and boys with asthma respectively, and to take their needs and understanding of the situation into consideration.

  • 321.
    Dalheim-Englund, Ann-Charlotte
    et al.
    Umeå University, Faculty of Medicine, Nursing.
    Rydström, Ingela
    Umeå University, Faculty of Medicine, Nursing.
    Rasmussen, Birgit Holritz
    Umeå University, Faculty of Medicine, Nursing.
    Möller, Christian
    Sandman, Per-Olof
    Umeå University, Faculty of Medicine, Nursing.
    Having a child with asthma: quality of life for Swedish parents2004In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 13, no 3, p. 386-395Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Asthma is the most common chronic childhood disease. Childhood asthma contributes significantly to morbidity among children and has a significant impact on the quality of life (QoL) and daily routines of both the children and their parents. AIM AND OBJECTIVE: The purpose of this study was to investigate how Swedish parents of children with asthma experience their QoL, and to investigate whether there were differences concerning QoL between parents within the same family. The purpose was also to investigate possible connections between their QoL and background variables. METHOD: A total of 371 parents of children with asthma (57% mothers and 43% fathers) participated in the study. The Paediatric Asthma Caregiver's Quality Of Life Questionnaire (PACQLQ) was used to measure the parents' QoL, i.e. how the child's asthma interferes with the parents' normal activities and how it has made them feel. RESULTS: The findings show that most parents of children with asthma evaluated their QoL as close to the positive end of the scale, and there was close agreement in the scoring between parents within the same family. Significant associations were found between parents' lower QoL outcome and living in the North of Sweden. There were also significant associations between fathers' lower QoL outcome and having a child younger than 13 years of age and mothers' lower QoL outcome and having a child with severe asthma. Although the result shows that a child's asthma did not influence the parents' QoL to a greater degree, it is still important for healthcare workers to help these parents to sustain and improve their well-being. CONCLUSIONS: The fact that they just evaluated their QoL during the preceding week only, and did so at the time when their children were being treated with asthma medication, might have influenced the results in a positive direction.

  • 322.
    Danielsson, Lina
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lundgren, Emma
    Hälsosamtal kan vara såväl stärkande som stjälpande: Patienters upplevelser av hälsosamtal med distriktssköterskan inom ramen för Västerbottens hälsoundersökningar (VHU)2018Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Aim: To shed light on patients' experiences of health conversations with primary health care nurses in the context of Västerbotten Intervention Programme (VIP).

    Background: Since 1995, 40-, 50- and 60-year-olds are offered health conversations at health centers in Västerbotten County. Health conversations aim at improving patients’ health by acquiring awareness of their health risks and being motivated for lifestyle changes. There are no published studies of patients’ experiences of health conversations within in the context of the VIP.

    Design: We chose a qualitative approach for our study. Method:  During 2017 we conducted interviews with seven individuals that had been attending a health conversation at three health centers in the inland of Västerbotten county. In order to analyze the data obtained, we used qualitative content analysis.

    Results: The result showed that patients experienced that health conversations can be supporting as well as the reversed. The health conversation could be described as empowerment support, person centered, informative and educational as it was felt to be strengthening. In contrast to this, the result showed that if the health conversation was described as paternalistic, it could counteract a successful outcome of the health conversation.

    Conclusion: Our conclusion is that primary health care nurses should work in a  person centered manner and possess knowledge of concepts such as empowerment and health literacy when conducting health conversations. Furthermore to ensure person centered care (PCC) in the context of health promotion, the process of professional role development for the primary health care nurses are important as well as organizational improvements.

  • 323.
    Degent, Sandra
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. 1994.
    Strålberg, Evelina
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sjuksköterskans erfarenheter av mötet med kvinnor utsatta för våld i nära relationer.: En litteraturstudie2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    ABSTRAKT

    Titel: Sjuksköterskans erfarenheter av mötet med kvinnor utsatta för våld i nära relationer.

    Bakgrund: Våld i nära relationer är idag ett globalt folkhälsoproblem. En tredjedel av världens kvinnor har någon gång utsatts för fysiskt eller sexuellt våld i en nära relation och det är stor sannolikhet att man som sjuksköterska kommer möta dessa våldsutsatta kvinnor. Sjuksköterskan har en viktig roll i mötet med utsatta kvinnor och befinner sig i en unik position när det gäller att identifiera våld i nära relation och för att ge en adekvat omvårdnad.                                                                                                                                                                                                                      Syfte: Syftet med studien var att beskriva sjuksköterskans erfarenheter av mötet med kvinnor utsatta för våld i nära relationer.                                                                                                                                                                                Metod: Studien var en litteraturstudie som baserades på en kvalitativ innehållsanalys med 10 artiklar som låg till grund för resultatet.                                                                                                                                                                         Resultat: Tre domäner och nio underkategorier identifierades. Domänerna innefattade: Förhållningssätt i mötet, Känslor som uppstår i mötet och Behov av kunskap och stöd.                                                                                                                                                   Konklusion: Behovet av utbildning tydliggjordes då mer kunskap möjliggör för ett bättre bemötande och bättre hantering av de känslorna som sjuksköterskorna upplevde i mötet med de utsatta kvinnorna och kan därmed möjliggöra för en adekvat vård. 

    Nyckelord: Våld i nära relationer, Sjuksköterskans erfarenheter, Våldsutsatta kvinnor

     

     

     

     

     

     

  • 324. Degerfält, J. E.
    et al.
    Sjöstedt, S.
    Fransson, Per
    Umeå University, Faculty of Medicine, Department of Nursing.
    Kjellén, E.
    Werner, M. U.
    E-learning programs in oncology: a nationwide experience from 2005 to 20142016In: International Journal of Radiation Oncology, Biology, Physics, ISSN 0360-3016, E-ISSN 1879-355X, Vol. 96, no 2, p. E413-E414Article in journal (Refereed)
  • 325.
    Degerfält, Tilda
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    sundqvist, Sara
    Umeå University, Faculty of Medicine, Department of Nursing.
    Kvinnors erfarenheter av att vara utsatta för våld i nära relation: en litteraturstudie2013Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Introduktion:

    Våld mot kvinnor i en nära relation är ett växande samhällsproblem i hela världen och en av de vanligaste orsakerna till att kvinnor skadas allvarligt.

    Syfte:

    Syftet med denna litteraturstudie var att belysa kvinnors erfarenheter av att vara utsatta för våld i en nära relation.

    Metod:

    En litteraturstudie har genomförts. En sammanställning av 11 kvalitativa vetenskapliga artiklar genomfördes och artiklarnas resultat bearbetades med inspiration av innehållsanalys.

    Resultat:

    Det fanns tydliga mönster som visade att mannens maktutövande och kontrollerande beteende ledde till allvarliga konsekvenser för kvinnan. Detta kunde yttra sig som dålig självkänsla, en nedbruten personlighet och våldet genererar ett allmänt lidande. För att uthärda ett liv av misshandel anpassade sig kvinnorna och de utformade olika hanteringsstrategier, dock kunde inpräntade normer utgöra hinder för kvinnorna i deras beslutningsprocesser.

    Slutsats:

    För att kunna bemöta och behandla våldsutsatta kvinnor är det viktigt att sjukvårdpersonal förstår dynamiken i hur det kan vara att leva med våld i en nära relation så att dessa problem uppmärksammas. Resultatet i denna litteraturstudie kan leda till en ökad kunskap och en djupare förståelse hos sjukvårdpersonal och därmed förhoppningsvis kan detta leda till ett bättre bemötande och en mer adekvat omvårdnad.

  • 326.
    Domeij, Emelie
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Kljajic, Karolina
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sjuksköterskors erfarenheter och strategier av att vårda barn som inte talar svenska.: - En intervjustudie.2017Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Title: Nursing's experiences and strategies of caring for children who do not speak Swedish. An interview study.

     

    Abstract

    Aim: To describe nurses' experiences and strategies of communicating with children who do not speak Swedish. Background: As immigration in Sweden has increased greatly in recent years nurses have experienced caring for children who do not speak Swedish highlighted due to communication in healthcare being essential to provide good care. Design: The study has a descriptive design with a qualitative approach. Method: Ten nurses were interviewed in January and February 2017. The experience of the nurses was at least 2 years of experience in the children's ward. Semi-structured interviews were conducted in two different hospitals, then the interviews were analyzed using qualitative content analysis which resulted in three categories and ten subcategories.

    Result: Based on the experiences and strategies of nurses, three main categories were created: Consequences of communication difficulties, Individualization based on patient needs and The use of various aids. These categories are then divided in to ten subcategories.

    Conclusion: Being unable to communicate adequately with the children creates frustration and concern among nurses. There are several different strategies that can be implemented for communication, such as body language, images and interpreters.

  • 327.
    Doohan, Isabelle
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Arctic Research Centre at Umeå University.
    Björnstig, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Östtlund, Ulrika
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Arctic Research Centre at Umeå University.
    Exploring Injury Panorama, Consequences, and Recovery among Bus Crash Survivors: A Mixed-Methods Research Study2017In: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 32, no 2, p. 165-174Article in journal (Refereed)
    Abstract [en]

    Objective The aim of this study was to explore physical and mental consequences and injury mechanisms among bus crash survivors to identify aspects that influence recovery. Methods The study participants were the total population of survivors (N=56) from a bus crash in Sweden. The study had a mixed-methods design that provided quantitative and qualitative data on injuries, mental well-being, and experiences. Results from descriptive statistics and qualitative thematic analysis were interpreted and integrated in a mixed-methods analysis. Results Among the survivors, 11 passengers (20%) sustained moderate to severe injuries, and the remaining 45 (80%) had minor or no physical injuries. Two-thirds of the survivors screened for posttraumatic stress disorder (PTSD) risk were assessed, during the period of one to three months after the bus crash, as not being at-risk, and the remaining one-third were at-risk. The thematic analysis resulted in themes covering the consequences and varying aspects that affected the survivors' recoveries. The integrated findings are in the form of four core cases of survivors who represent a combination of characteristics: injury severity, mental well-being, social context, and other aspects hindering and facilitating recovery. Core case Avery represents a survivor who had minor or no injuries and who demonstrated a successful mental recovery. Core case Blair represents a survivor with moderate to severe injuries who experienced a successful mental recovery. Core case Casey represents a survivor who sustained minor injuries or no injuries in the crash but who was at-risk of developing PTSD. Core case Daryl represents a survivor who was at-risk of developing PTSD and who also sustained moderate to severe injuries in the crash. Conclusion The present study provides a multi-faceted understanding of mass-casualty incident (MCI) survivors (ie, having minor injuries does not always correspond to minimal risk for PTSD and moderate to severe injuries do not always correspond to increased risk for PTSD). Injury mitigation measures (eg, safer roadside material and anti-lacerative windows) would reduce the consequences of bus crashes. A well-educated rescue team and a compassionate and competent social environment will facilitate recovery.

  • 328.
    Doohan, Isabelle Marie
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Gyllencreutz, Lina
    Umeå University, Faculty of Medicine, Department of Nursing.
    Björnstig, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Nursing.
    Survivors' experiences of consequences and recovery five years after a major bus crashManuscript (preprint) (Other academic)
    Abstract [en]

    Rationale: There is a lack of long-term follow-up studies focused on injured and uninjured survivors’ experiences of the recovery process after major traffic crashes.

    Aim/objective: To explore survivors’ experiences of long-term physical and psychological consequences and recovery five years after a major bus crash.

    Methodological design and justification: A qualitative design was used to explore experiences in a 5-year follow-up study.

    Research methods: Participants were 54 survivors of a bus crash with 56 survivors and six fatalities. Telephone interviews were analyzed with qualitative content analysis.

    Results: The theme overarching the categories is “visible and existential marks in everyday life” and it represents the range of the crash’s influence in the survivors’ lives. The first category, “health consequences in daily life,” has four subcategories covering quick recovery, suffering in daily life, distress in traffic situations, and long-term pain. Described reasons for quick recovery among survivors were previous crisis experiences, traveling alone, being uninjured, and not being exposed to traumatic impressions. For the other survivors, being reminded of the crash caused disturbing reactions, such as sweating, anxiety, and flashbacks. Survivors avoided going by bus if they could. A group of the injured survivors were still suffering from limiting and painful injuries. The second category, “oneself and social connection,” has three subcategories that include self-awareness, impact on relationships, and connectedness. Survivors developed a stronger bond to their significant other or separated from their partner within the first couple of years. Friendships and a sense of connectedness among survivors were sources of long-lasting comfort and support.

    Conclusion: There is a need for more information about disruptive long-lasting consequences, such as travel anxiety, and available treatments. Initially, health-promoting connectedness can be facilitated by treating survivors as a group of people who belong together, from the day of the crash and throughout the recovery process. 

  • 329.
    Doohan, Isabelle
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Centre for Research and Development in Disaster Medicine, Umeå University.
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Impact on life after a major bus crash - a qualitative study of survivors' experiences2014In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 28, no 1, p. 155-163Article in journal (Refereed)
    Abstract [en]

    Background Crashes occur regularly throughout the world and can result in multiple fatalities and many injuries. Research into how survivors experience a crash is very limited. AimTo describe and analyse the nonphysical consequences of a multifatality bus crash in Sweden and the subsequent effect on the surviving passengers' lives. MethodThe participants were all (n=56) of the survivors of a major bus crash. The passengers were interviewed approximately one month after the bus crash. The interviews were analysed using a qualitative content analysis. ResultsPrior to the arrival of rescue personnel at the crash site, helpfulness emerged among the passengers. Further, the crash generated an impact on the surviving passengers' lives from a short-term perspective. The passengers displayed a diverse need for crisis support; informal support from family and friends was essential for the early healing process. Sleep difficulties and a change in travel routines were the most common consequences. Lastly, passengers sought closure in order to move on with their lives. ConclusionThe passengers' reactions to and behaviour following a crash offer an insight into the, relatively unexplored, interaction between people experiencing a major road traffic crash. It is necessary to have a flexible crisis support system, and the vital role of family support ought to be upgraded.

  • 330.
    Doohan, Isabelle
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Umeå University, Faculty of Medicine, Department of Nursing.
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Arctic Research Centre at Umeå University.
    Need for compassion in prehospital and emergency care: a qualitative study on bus crash survivors' experiences2015In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 23, no 2, p. 115-119Article in journal (Refereed)
    Abstract [en]

    Aim: To explore the survivors' experiences after a major bus crash. Background: Survivors' experiences of emergency care after transportation related major incidents are relatively unexplored, with research involving survivors mainly focused on pathological aspects or effects of crisis support. Methods: Semi-structured telephone interviews were conducted with 54 out of 56 surviving passengers 5 years after a bus crash in Sweden. Interviews were analyzed using qualitative content analysis. Results: Prehospital discomfort, lack of compassionate care, dissatisfaction with crisis support and satisfactory initial care and support are the categories. Lack of compassion in emergency departments was identified as a main finding. Lack of compassion caused distress among survivors and various needs for support were not met. Survivors' desire to be with their fellow survivors the day of the crash was not facilitated after arriving at emergency departments. Conclusions: Connectedness among survivors ought to be promoted upon arrival at emergency departments. There is a need for emergency department professionals to be sufficiently educated in compassionate care.

  • 331.
    Dorell, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Tröst genom hälsostödjande familjesamtal: upplevelser och effekter av en familjecentrerad intervention2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Aim: The overall aim of this thesis was to evaluate the experiences of nurses and families participated in Family Health Conversations (FamHC) and the effects of this intervention on those families with a family member living in a residential home for older people. Methods: This thesis comprises four studies. The FamHC were structured as three conversations held at two-week intervals and a closing letter. In two of the studies (I and II), group interviews with family members were interpreted using qualitative content analysis. A mixed-method research design was used in study three (III). Data were collected through group interviews with families and by using the instruments FHI and SWED-QUAL completed by the family members. The qualitative and quantitative data were analyzed and then integrated. In the fourth study (IV), registered nurses who had performed the FamHC participated in individual interviews after they had completed four conversation series each. The RNs also wrote diary notes about what they experienced directly after conducting each conversation. The interviews and diary notes were interpreted with qualitative content analyses. Result: The findings from study I one month after participating in the conversations showed that the families felt alleviated from guilty consciences. The FamHC gave the family members confirmation that they were, indeed, good enough. Study II showed that, six months after participating in the conversations, the families had experienced the FamHC as healing because the sharing and reflections through dialogue within the conversations mediated confirmation, which made the families feel consoled. Study III revealed that the families’ emotional wellbeing had increased six months after participating in the FamHC. The families also showed an improved ability to work together. In study IV, the nurses reported that the FamHC was a useful care action in their work with families. Conclusion: The overall conclusion from the findings is that the families were consoled by participating in the FamHC. The conversations offered an arena for families to listen to each other’s narration which provided a better relationship and cooperation within the family and a greater sense of well-being for the family members. 

  • 332.
    Dorell, Åsa
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Bäckström, Britt
    Ericsson, Marie
    Johansson, Maria
    Östlund, Ulrika
    Sundin, Karin
    Umeå University, Faculty of Medicine, Department of Nursing.
    Experiences With Family Health Conversations at Residential Homes for Older People2016In: Clinical Nursing Research, ISSN 1054-7738, E-ISSN 1552-3799, Vol. 25, no 5, p. 560-582Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to highlight family members' experiences of participating in Family Health Conversation (FamHC), based on families in which a family member was living in a residential home for older people. A total of 10 families and 22 family members participated in evaluating family interviews 1 month after participating in FamHC. The interviews were analyzed by qualitative content analysis. The main finding was being a part of FamHC increased family members' insights, understanding, and communication within the family. Getting confirmation from nurses was essential to cope with the new life situation, which also meant that they felt comfortable to partly hand over the responsibility for the older person who moved to the residential home. By being open and expressing their feelings, a bad conscience could be relieved. These findings showed that FamHC could be helpful for family members in adapting to this novel situation.

  • 333.
    Dorell, Åsa
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Isaksson, Ulf
    Umeå University, Faculty of Medicine, Department of Nursing.
    Östlund, Ulrika
    Centre for Research & Development, Uppsala University/ Region Gävleborg, Gävle.
    Sundin, Karin
    Umeå University, Faculty of Medicine, Department of Nursing.
    Family Health Conversations have positive outcomes on families: A mixed method studyArticle in journal (Refereed)
    Abstract [en]

    Background: A Family Systems Nursing intervention, “Family Health Conversations” (FamHC) was conducted in order to strengthen the health of families having relatives at residential home for older people. Having a family member living in a residential home affects the entire family and can be hard to handle. Family members require encouraging and open communication support from nurse during and after relocation to a residential home.

    Objectives: The aims of this study were to evaluate the responses to and effects of the Family Health Conversations in families with a member living at a residential home for older people and to integrate the empirical results with a theoretical assumption upon which the intervention was based.

    Methods: A mixed method research design was used. The Swedish Health-Related Quality of Life Survey and the Family Hardiness Index were administered before and 6 months after the intervention. Qualitative data was collected by semi-structured interviews with each family 6 months post-intervention. The sample included families of residents, a total of 10 families comprising 22 family members.

    Result: Main finding was that FamHCs helped family members process their feelings about having a member living at a residential home and made it easier for them to deal with their own situations. FamHCs helped to ease their consciences, improve their emotional well-being, and change their beliefs about their own insufficiency and guilt. Seeing problems from a different perspective facilitated the families’ thinking in a new way.

    Conclusion: These findings showed that FamHC can be an important type of intervention to improve family functioning and enhance the emotional well-being.

  • 334.
    Dorell, Åsa
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sundin, Karin
    Umeå University, Faculty of Medicine, Department of Nursing.
    Becoming visible: Experiences from families participating in Family Health Conversations at residential homes for older people2016In: Geriatric Nursing, ISSN 0197-4572, E-ISSN 1528-3984, Vol. 37, no 4, p. 260-265Article in journal (Refereed)
    Abstract [en]

    Having a sick family member living at a residential home for older people can be difficult for families, who as a result often suffer from feelings of forsakenness and powerlessness. In response, the purpose of this study was to illuminate family members' experiences with participating in Family Health Conversations at residential homes for older persons 6 months after concluding the conversation series. Twenty-two family members who participated in the conversations later took part in group interviews, the texts of which were analyzed according to qualitative content analysis. Findings showed that participating in Family Health Conversations mediated consolation, since within such a liberating communicative interaction, family members for the first time felt visible as persons with individual significance. Family members reported a positive experience involving both being open to each other and speaking and listening to each other in a new, structured way. As a result, families were able to discover their family members' problems and suffering, as well as to identify their family's resources and strengths.

  • 335.
    Dorell, Åsa
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Östlund, Ulrika
    Sundin, Karin
    Umeå University, Faculty of Medicine, Department of Nursing.
    Nurses' perspective of conducting family conversation2016In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 11, article id 30867Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Nurses are in a prime position to manage to support families that have a family member living in a residential home for older people. Nurses' attitudes about meeting patients' family members vary. Studies describe that some nurses consider family members as a burden. But some nurses consider family members a resource and think it is important to establish good relationships with them.

    AIM: The aim of this study was to describe how registered nurses (RNs) experienced to participate in and conduct the intervention Family Health Conversations (FamHCs) with families in residential homes for older people.

    METHODS: The intervention FamHC was accomplished at three residential homes for older people. FamHC is a family systems nursing (FSN) intervention developed to support families facing the ill health of someone in the family. One RN from each residential home conducted the conversations. The RNs wrote diary notes directly after each conversation. The RNs were also interviewed 1 month after they had each conducted four FamHCs. The diary notes and the interviews were analysed separately by qualitative content analysis, and the findings were then summarized in one theme and further discussed together.

    FINDINGS: The main findings were that the RNs experience the conversations as a valuable professional tool involving the whole family. The RNs grasped that silence can be a valuable tool and had learned to attentively listen to what the families were saying without interrupting, allowing them and the families to reflect upon what the family members said.

    CONCLUSION: The findings show that the FamHC can be helpful for RNs in their work, helping them to perceive and understand the needs and desires of the families.

  • 336.
    Dunhäll, Lisa
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Fossland, Ulrika
    Umeå University, Faculty of Medicine, Department of Nursing.
    En resa där toppas och dalar bör undvikas: En litteraturstudie om ungdomars upplevelse av att leva med sjukdomen typ 1-diabetes.2015Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: In Sweden, around 7000-8000 children and adolescents live with type 1- diabetes. Youth is a period of constant turmoil, confusion and alienation. To have an illness at that age can be perceived as a life readjustment since the disease makes great demands on the capacity to self-management. Purpose: The purpose of this study was to elucidate adolescent’s experience of living with type 1-diabetes. Method: Study search was performed in the databases CINAHL, PubMed, Scopus and ub.umu's search engine together with manual search. The literature study compiled of eight qualitative empirical studies. The studies were analyzed with ‘analysis of content’ based on Friberg analysis. The young people in the trials were between 12-18 years. Results: Adolescent’s experience of living with type 1 diabetes is individual and diverse. The experiences can switch between manageability and hopelessness, feeling normal and different and also experience of the possibilities and limitations. Adolescent’s varied also between a sense of confidence in their own abilities over their treatment, and frustration, guilt, anxiety and uncertainty about the lack of own capacity. Conclusion: Adolescents' experiences demonstrate the need for person-centered care and a greater knowledge of their situation in life. The authors believe that there is further need for the nurse's insight that approach may impact on adolescence´s quality of life. The literature study may contribute to increased understanding of the need for further research into young people's experience of living with type 1- diabetes and how the nurse's attitude can have effects on young people's quality of life.

    Keywords: Adolescenc*. Life experience. Type 1-diabetes. Nursing care.

  • 337.
    Duzgun, Ramazan
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Mohammad, Sonia
    Umeå University, Faculty of Medicine, Department of Nursing.
    Unga och vuxna kvinnors upplevelser av att leva med Anorexia Nervosa.- En litteraturstudie2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Eating disorders has become more common and an increase occurs among all ethnic’s groups. Anorexia nervosa is recognized by the fact that the persons has a false image of themselves and a fear of getting fat.Aim: The aim of this study was to illustrate young and adult women’s experiences of living with anorexia nervosa.Method: A literature review based on eight qualitative studies where the result has been quality audited, analyzed and compiled. The databases which have been used to find different studies are CINAHL, PsycINFO and PubMed.Result: The main results of the study shows that the anorexia nervosa causes lots of pain and suffering for women's and that there is an ambivalence to recover from the disorder. The limitations of living with anorexia nervosa, often came with a price of isolation, shame and feelings of guilt.Conclusion: Anorexia nervosa provides control, stability and was a way for the women to cope with negative emotions.

  • 338.
    Edholm, Angelique
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Nyberg, Peter
    Umeå University, Faculty of Medicine, Department of Nursing.
    Vårdpersonalens följsamhet till riktlinjer för handhygien: En litteraturstudie2015Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Vårdrelaterade infektioner är vanligt förekommande över hela världen.Det innebär en hög kostnad, ökat lidande och medför fler vårddygn för patienten.God handhygien är den viktigaste påverkbara faktorn för att minska vårdrelateradeinfektioner. Det är sjuksköterskans ansvar att säkerställa rutiner för en godhandhygien.

    Syfte: Syftet är att beskriva vårdpersonalens följsamhet till riktlinjer för handhygien.

    Metod: En litteraturstudie där datainsamlingen valdes att göra från 10 olikakvantitativa studier. Genom analysen gjordes en sammanställning av de resultat somsvarade på vårt syfte och frågeställningar.

    Resultat: Resultatet redovisas i tre stapeldiagram med tillhörande text. Förstarubriken är följsamhet till riktlinjer för handhygien medel %. De två andradiagrammen är följsamhet till riktlinjer för handhygien före och efter patientkontaktsamt sjuksköterskor och läkares följsamhet till riktlinjer för handhygien. Huvudfynden i litteraturstudien visade att följsamhet till handhygien varierar i allastudier och att det är statistiskt säkerställt att fler vårdpersonal utför handhygienefter patientkontakt än före samt att fler sjuksköterskor än läkare följde riktlinjer förhandhygien.

    Konklusion: Det finns brister i följsamhet till handhygien. Kunskapen omsmittspridning och handhygien mellan olika arbetsmoment i den patientnära vårdenär otillräcklig. Ytterligare forskning behövs och alla länder måste sträva efter sammamål.

  • 339.
    Edholm, Miriam
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Westin, Lisett
    Umeå University, Faculty of Medicine, Department of Nursing.
    Anhörigas upplevelser när en familjemedlem flyttar till ett särskilt boende för äldre: Relatives’ experiences when a family member move to a residential home for older people2016Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Omorganisation inom vården ställer högre krav på anhöriga då fler vårdas i hemmet. Därför behövs mer kunskap om anhörigas situation för att stärka familjehälsan. Syfte: Syftet med studien var att belysa hur anhöriga upplever sin situation i flyttprocessen före, under och efter flytten av en vårdbehövande familjemedlem till ett särskilt boende för äldre, vilket framkom vid hälsostödjande familjesamtal.

    Metod: Åtta familjer deltog i en samtalsserie av tre samtal. Samtalen analyserades med kvalitativ innehållsanalys.

    Resultat: Huvudresultatet visade på att före flytten upplevdes livssituationen som ohållbar med ett krävande ansvar. Under flytten upplevdes både känslor av frid och frustration. Efter flytten upplevdes sorg, varierat förtroende för boendet, att de anhöriga ville behålla relationen med den vårdbehövande och en förändrad familjesituation.

    Slutsats: Anhörigas upplevelser var varierande under flyttprocessen. Distriktsköterskan bör vara synlig och finnas som stöd.

  • 340.
    Edin, Karolina
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Westerholm, Moa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Patienters erfarenheter av att vårdas för anorexia nervosa inom slutenvård: En litteraturstudie2015Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Anorexia nervosa is a disease where self-starvation leads to underweight. People with the disease have a disturbed body image which affects their self-esteem. Symptoms include low body weight, excessive weight loss, mental illness and absent periods. Treatment includes prevention along with acute psychiatric and somatic interventions. Anorexia nervosa can be treated in outpatient care, day care or inpatient care. Aim: The aim of this study was to describe individuals’ experiences of being treated for anorexia nervosa in inpatient care. Method: A literature review based on eight qualitative research articles. A literature search was conducted in CINAHL with Full Text and PubMed. Searches were also conducted in Medline, PsycINFO and AMED but no further hits were found. Results: The analyze identified three major themes and eight subthemes. The themes were “Loss of control and a desire for participation”, “Equal relationships and support” and “Responsibility and learning for life”. Conclusion: Anorexia nervosa is a complex disease to be treated for. Nursing staff must understand patients’ experiences of care to be able to give the best care possible. This understanding can contribute to a patient-centered care in the meeting with these patients.

  • 341.
    Edin, Kerstin
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS). Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Nilsson, Bo
    Umeå University, Faculty of Arts, Department of culture and media studies. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Between desire and rape - narratives about being intimate partners and becoming pregnant in a violent relationship2013In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 6, p. 20984-Article in journal (Refereed)
    Abstract [en]

    Background: Women subjected to intimate partner violence (IPV) experience different forms of abuse. Sexual violence is often under-reported because physically abused women, in particular, might see forced sex as an obligatory part of the sexual interplay. Accordingly, abused women have less sexual autonomy and experience unplanned pregnancies more often than other women. Objective: To describe and analyse nine Swedish women's retrospective stories about IPV with a focus on power and coping strategies as intimate partners, particularly regarding experiences of sex, contraception, and becoming pregnant. Design: Nine qualitative interviews were carried out with women who had been subjected to very severe violence in their intimate relationships and during at least one pregnancy. The stories were analysed using 'Narrative method' with the emphasis on the women's lived experiences. Results: Despite the violence and many contradictory and ambivalent feelings, two of the women described having sex as desirable, reciprocal and as a respite from the rest of the relationship. The other seven women gave a negative and totally different picture, and they viewed sex either as obligatory or as a necessity to prevent or soothe aggression or referred to it as rape and as something that was physically forced upon them. The women's descriptions of their pregnancies ranged from being carefully planned and mostly wanted to completely unwelcome and including flawed contraceptive efforts with subsequent abortions. Conclusions: Women subjected to IPV have diverse and complex experiences that have effects on all parts of the relationship. Intimacy might for some turn into force and rape, but for others sex does not necessarily exclude pleasure and desire and can be a haven of rest from an otherwise violent relationship. Accordingly, women may tell stories that differ from the ones expected as 'the typical abuse story', and this complexity needs to be recognized and dealt with when women seek healthcare, especially concerning contraceptives, abortions, and pregnancies.

  • 342.
    Edin, Kerstin
    et al.
    Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS). Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Medicine, Department of Nursing.
    Nilsson, Bo
    Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS). Umeå University, Faculty of Arts, Department of culture and media studies.
    Men's violence: narratives of men attending anti-violence programmes in Sweden2014In: Women's Studies: International Forum, ISSN 0277-5395, E-ISSN 1879-243X, Vol. 46, p. 96-106Article in journal (Refereed)
    Abstract [en]

    The efficacy of batterer-intervention programmes for men has frequently been questioned, inviting additional research and development. Men inclined to violence have multifaceted problems but are frequently squeezed into ‘one-size-fits-all’ programmes with high ambitions for change that often show little evidence of effectiveness. Some research even indicates that any changes in men's violent behaviour might result from factors not at all linked to the programmes.

    For this study, ten interviews were carried out with men who had attended anti-violence programmes within the Swedish Probation Service. The overall aim was to analyse gendered identity constructions in the narratives of men attending the programmes — how men articulate the course of violent events and in what way they talk about themselves and the programmes.

    According to our results, men defended themselves by making excuses, explanations and victim positions. Furthermore, the men's gendered identity constructions collided with the programmes' ambitions of changing men's conceptions and behaviour.

  • 343.
    Edin, Kerstin
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. MRC/ Wits Rural Public Health & Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
    Nilsson, Bo
    Umeå University, Faculty of Arts, Department of culture and media studies.
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. MRC/ Wits Rural Public Health & Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
    Kinsman, John
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Norris, Shane A
    Kahn, Kathleen
    Umeå University, Faculty of Arts, Department of culture and media studies. MRC/ Wits Rural Public Health & Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana.
    Perspectives on intimate relationships among young people in rural South Africa: the logic of risk2016In: Culture, Health and Sexuality, ISSN 1369-1058, E-ISSN 1464-5351, Vol. 18, no 9, p. 1010-1024Article in journal (Refereed)
    Abstract [en]

    This paper explores how young people in rural South Africa understand gender, dating, sexuality and risk-taking in adolescence. The empirical material drawn upon consists of 20 interviews with young men and women (aged 18-19) and reflects normative gender patterns characterised by compulsory heterosexuality and dating as obligatory, and representing key symbols of normality. However, different meanings of heterosexual relationships are articulated in the interviews, for example in the recurring concept of 'passing time', and these meanings show that a relationship can be something arbitrary: a way to reduce boredom and have casual sex. Such a rationale for engaging in a relationship reflects one of several other normative gender patterns, which relate to the trivialisation of dating and sexual risk-taking, and which entail making compromises and legitimising deviations from the 'ideal' life-script and the hope of a better future. However, risks do not exclusively represent something bad, dangerous or immoral, because they are also used as excuses to avoid sex, HIV acquisition and early pregnancy. In conclusion, various interrelated issues can both undermine and/or reinforce risk awareness and subsequent risk behaviour. Recognition of this tension is essential when framing policies to support young people to reduce sexual risk-taking behaviour.

  • 344.
    Edin, Marina
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Vallner, Kristina
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Psykosocial arbetsmiljö och förutsättningar att bedriva systematiskt arbetsmiljöarbete för första linjens chefer i primärvården2016Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Cheferna inom vård och omsorg i offentliga organisationer har hög arbetsbelastning och ett komplext uppdrag. Ofta finns rutiner för det systematiska arbetsmiljöarbetet, men de är bristfälliga och används inte. Syftet var att undersöka hur första linjens chefer i primärvården upplevde sin psykosociala arbetsmiljö samt deras förutsättningar att bedriva systematiskt arbetsmiljöarbete. En tvärsnittsstudie där samtliga 126 första linjens chefer från fyra landsting i primärvården deltagit, med svarsfrekvens 51%. I studien har enkät QPS Nordic 34+ använts samt 10 kompletterande frågor om systematiskt arbetsmiljöarbete. Analys delvis med referensdata och Pearsons korrelation. Cheferna hade en hög arbetsbelastning och arbetet tenderade att hopa sig. I jämförelse med referensdata 3,2 var chefernas medelvärde 4,02. De upplevde gott stöd, bra klimat och hade goda kunskaper för arbetsuppgifterna, men 32,8% av cheferna ansåg att de inte alls eller bara lite var insatt i AFS 2015:4. Avseende om arbetsbelastningen gav utrymme för att bedriva systematiskt arbetsmiljöarbete svarade fyra femtedelar av alla chefer inte alls eller i viss mån. Trots det goda stöd som cheferna upplevde är det viktigt att förebygga hög arbetsbelastning, då varaktig stress kan leda till ohälsa. Förutsättningar att bedriva systematiskt arbetsmiljöarbete begränsas också av deras arbetsbelastning och kan innebära negativa konsekvenser för medarbetarna.

  • 345.
    Edin-Liljegren, Anette
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Västerbottens läns landsting.
    Daerga, Laila
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Västerbottens läns landsting.
    Sahlén, Klas-Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Institutionen för omvårdnad.
    Jacobsson, Lars
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Psychosocial Perspectives on Working Conditions among Men and Women in Reindeer Breeding in Sweden2017In: Journal of Northern Studies, ISSN 1654-5915, Vol. 11, no 2, p. 31-47Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this project was to describe the work organisation in the Sami communities and in reindeer-herding work and to explore the range of female duties and compare how men and women experience their psychosocial working conditions. Design: A kind of intervention study was performed by means of a questionnaire sent out to 200 individuals from seven Sami communities. Questions were asked about work organisation, communication, personal relations, solitary work, support, participation and appreciation from colleagues and women's tasks. Meetings and discussions were held about what was perceived as being important in the life of the Sami communities. Notes from 16 group discussions were written down and analysed according to themes of topics relating to how men and women in the Sami communities experience their lives. Results: Communication and relations were described as being inadequate and some respondents experienced a heavy workload. The women reported more troubled relations, less participation in decision-making and less appreciation from colleagues. Positive issues reported were the Sami identity and a strong connection to the reindeer and to nature. Conclusions: This study indicates a need for a more systematic study of the psychosocial work conditions in the Sami communities in Sweden. Measures should be taken to develop the organisation of work, e.g. through developing communication strategies and conflict management, which has been requested by several Sami communities.

  • 346.
    Edin-Liljegren, Anette
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sahlen, Klas-Göran
    Umeå University, Faculty of Medicine, Department of Nursing.
    Jacobsson, Lars
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Daerga, Laila
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Reindeer-herding Sami experiences of seeking care in the mainstream society2016In: International Journal of Circumpolar Health, ISSN 1239-9736, E-ISSN 2242-3982, Vol. 75, no 33200Article in journal (Refereed)
  • 347.
    Edlund, Anette
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Holmström, Frida
    Umeå University, Faculty of Medicine, Department of Nursing.
    M-hälsa i behandlingen av ungdomar med självskadebeteende2014Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Abstract

    Background: In Sweden self-harm behaviors among young people have been a difficult area to handle in psychiatric care. From the government's efforts have been made to synchronize the knowledge and experience from the local level aiming to prevent, reduce and faster identify self-harm among young people. M-Health refers to technology such as smartphones, notebooks and mobile phones provide.  These mobile devices have come to revolutionize aspects of health care perhaps mostly among young people, live their digital lives by these electronic media.

    Aim: To illuminate the use of m-Health in the treatment of mental illness and to present a draft of a mobile application that helps professionals in work with young people active in a mild to moderate self-injury.

    Method: A literature review based on an analysis of twelve scientific articles with qualitative and quantitative approach. We searched in November 2013-January 2014 Ebsco and PubMed databases. 

    Results: The literature review is presented as gains and losses in use of m-Health in the treatment of mental illness. The focus has been on what is possible to achieve with a mobile application in this area of concern. It appeared that young people show positive attitudes to using an application in monitoring of psychiatric symptoms and gained more control mental health. The professionals sees advantage in terms of more truthful symptom monitoring in real time in comparison with retrospective self-monitoring, expedited handling processes and better treatment outcomes.

    Conclusion: We interpret the results of the studies about m-Health as an opportunity for nurses to meet young people, active in a mild to moderate self-harm. An m- Health intervention based on an application for young people could make it easier for nurses to improve their communication and treatment outcomes. Care initiatives and relevant actions can then be tailored to young people's cultural values, beliefs and lifestyle.

  • 348.
    Edlund, Susanna
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Chefer Portin, Julia
    Umeå University, Faculty of Medicine, Department of Nursing.
    Skillnader i uppfattning av säkerhetskultur2015Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Våra värderingar, uppfattningar, beteenden samt de oskrivna regler som medarbetare styrs av är grunden till säkerhetskulturen på en arbetsplats, d.v.s. när medarbetare i en organisation har gemensamma attityder, förhållningssätt och normer gällande säkerhet och risker. Det har visats sig i tidigare studier att en god säkerhetskultur bland personalen har inverkan på patientsäkerheten. Att intensivvårdspersonal effektivt arbetar mot ett gemensamt mål har visats medföra positiva resultat vad gäller patientsäker vård och arbetstillfredsställelse. Syfte: Syftet med studien var att jämföra skillnader i uppfattningar om säkerhetskultur mellan grupper av sjuksköterskor som arbetar vid olika typer av intensivvårdsavdelningar. Metod: En pilotstudie med kvantitativ och jämförande design genomfördes vid två intensivvårdsenheter vid ett svenskt sjukhus under hösten 2015. Den översatta enkäten, The Safety Attitudes Questionnaire (SAQ)–ICU, användes där sex subskalor ”samarbetsklimat, säkerhetsklimat, arbetstrivsel, stressmedvetenhet, uppfattning om arbetsledning samt arbetsförhållanden” analyserades med hjälp av programmet Statistical Package for the Social Sciences (SPSS 23,0). Resultat: Bland de 56 deltagarna i grupperna påvisades generellt relativt hög uppfattning av säkerhetskulturen, men där en enhet skattade signifikant högre på samarbetsklimat och arbetsförhållanden. Slutsats: Det fanns tillfredsställande säkerhetsattityder vid båda enheterna, men vissa skillnader förelåg dock mellan grupperna av sjuksköterskor från de olika intensivvårdsenheterna när det handlar om samarbetsklimat och arbetsförhållanden. Dessa skillnader kan bero på olika arbetssätt mellan enheterna. 

  • 349.
    Edström, Emelie
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Simmons, Ella
    Umeå University, Faculty of Medicine, Department of Nursing.
    Avvikelserapportering: En möjlighet och skyldighet men finns förutsättningarna?: En kvalitativ intervjustudie om sjuksköterskors erfarenheter av avvikelserapportering2016Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

     

    Bakgrund: Tio procent av de patienter som vårdas på svenska sjukhus drabbas av en vårdskada. Avvikelserapportering är en av hörnstenarna i patientsäkerhetsarbetet som syftar till att undvika uppkomst av vårdskador. Att arbeta patientsäkert är en del av sjuksköterskans kärnkompetenser och utöver det är sjuksköterskor enligt patientsäkerhetslagen skyldiga att rapportera händelser, som har eller hade kunnat resultera i en vårdskada.

    Syfte: Syftet med studien var att beskriva sjuksköterskors erfarenheter av avvikelserapportering.

    Metod: En kvalitativ intervjustudie utfördes. Sex yrkesverksamma sjuksköterskor som arbetade på ett större sjukhus i norra regionen i Sverige intervjuades.

    Resultat: Sjuksköterskornas främsta motiv till att skriva avvikelserapporter var att belysa fel i verksamheten. Det fanns flera hinder för skriva avvikelserapporter. Dessa var hög arbetsbelastning, tidsbrist, organisatoriska problem och att det av olika skäl kan vara känsligt att skriva en avvikelserapport. Samtliga sjuksköterskor hade erfarenheter av återkoppling men ansåg att den återkoppling som brukade ges var undermålig och de ansåg även att avvikelserapporterer sällan leder till någon förändring i verksamheten.

    Konklusion: Det finns flera faktorer som försämrar sjuksköterskors förutsättningar för att skriva avvikelserapporter. Ökad kunskap inom området skulle kunna generera att fler avvikelserapporter skrivs. Det skulle i sin tur bidra till en patientsäkrare vård.

  • 350.
    Edström, Margareta
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Jacobsson, Catrine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Oja, Britt-Mari
    Umeå University, Faculty of Medicine, Department of Nursing.
    The use of e-meetings in distance education in nursing, Umea university, Sweden2006In: Consumer-centered computer-suppported care for healthy people, Amsterdam: IOS Press, 2006, p. 831-831Conference paper (Refereed)
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