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  • 301.
    Carlsson, Tommy
    et al.
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Melander Marttala, Ulla
    Department of Scandinavian Languages, Uppsala University, Uppsala, Sweden.
    Mattsson, Elisabeth
    Department of Public Health and Caring Sciences, Uppsala University; Department of Health Care Sciences, Ersta Sköndal University College, Stockholm, Sweden.
    Ringnér, Anders
    Umeå University, Faculty of Medicine, Department of Nursing.
    Experiences and preferences of care among Swedish immigrants following a prenatal diagnosis of congenital heart defect in the fetus: A qualitative interview study2016In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 16, article id 130Article in journal (Refereed)
    Abstract [en]

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

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

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

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

  • 302.
    Cartaxo, Elisabeth
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hansson, Kornelia
    Umeå University, Faculty of Medicine, Department of Nursing.
    Upplevelsen av mötet med skolsköterskan: Hbtq-ungdomars erfarenheter och förväntningar2017Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

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

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

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

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

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

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

  • 303.
    Cedering, Signe
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Emilsson, Julia
    “Vad har man med sig i bagaget och hur kan jag, ja, ge bästa bemötande. Det är ju mycket dethandlar om när man möts såhär två, ja, ansikte mot ansikte”: Barnmorskors upplevelse av mötet med nyanlända kvinnor i norra Sverige.2016Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

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

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

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

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

  • 304.
    Choowattanapakorn, Tassana
    et al.
    Faculty of Nursing, Chulalongkorn University, Bangkok, Thailand.
    Aléx, Lena
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lundman, Berit
    Umeå University, Faculty of Medicine, Department of Nursing.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing.
    Nygren, Björn
    Umeå University, Faculty of Medicine, Department of Nursing.
    Resilience among women and men aged 60 years and over in Sweden and in Thailand2010In: Nursing and Health Sciences, ISSN 1441-0745, E-ISSN 1442-2018, Vol. 12, no 3, p. 329-335Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to compare the level of resilience of people aged > or = 60 years in Sweden and Thailand. In a randomized sample of 422 people in Sweden and a convenience sample of 200 people in Thailand, the level of resilience was measured by using the Resilience Scale. A chi(2)-analysis was used for the differences between proportions. The relationships between the background variables and the resilience scores were analyzed by using stepwise multiple linear regression. The mean scores of resilience were 144 for the Swedish participants and 146 for the Thai participants. The two samples differed in their background characteristics. The Thai participants were more likely to be women, to be widowed, and to have more children, while among the Swedish participants, more women were married and more participants were aged > or = 80 years. Despite different background characteristics, the Swedish and the Thai participants' scores were almost the same on the Resilience Scale. More studies are necessary to address aspects of gender and ethnicity in relation to resilience.

  • 305.
    Christianson, Monica
    Umeå University, Faculty of Medicine, Department of Nursing.
    "Not Used But Almost…"-A Gender and Agency Analysis of the Grey Zone Between Consensual and Nonconsensual Sexual Intercourse2015In: Health Care for Women International, ISSN 0739-9332, E-ISSN 1096-4665, Vol. 36, no 7, p. 768-783Article in journal (Refereed)
    Abstract [en]

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

  • 306.
    Christianson, Monica
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Aléx, Lena
    Umeå University, Faculty of Medicine, Department of Nursing.
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Lundman, Berit
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sex and gender traps and springboards: a focus group study among gender researchers in medicine and health sciences2012In: Health Care for Women International, ISSN 0739-9332, E-ISSN 1096-4665, Vol. 33, no 8, p. 739-755Article in journal (Refereed)
    Abstract [en]

    We explored the difficulties that gender researchers encounter in their research and the strategies they use for solving these problems. Sixteen Swedish researchers, all women, took part in focus group discussions; the data were analyzed using qualitative content analysis. The problems reported fell into four main categories: the ambiguity of the concepts of sex and gender; traps associated with dichotomization; difficulties with communication; and issues around publication. Categories of suggested problem-solving strategies were adaptation, pragmatism, addressing the complexities, and definition of terms. Here the specific views of gender researchers in medicine and health sciences-"medical insiders"-bring new challenges into focus.

  • 307.
    Christianson, Monica
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Berglin, Björn
    Johansson, Eva E
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    "It should be an ordinary thing": a qualitative study about young people´s experiences of taking the HIV-test and getting the test result2010In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 24, no 4, p. 678-683Article in journal (Refereed)
    Abstract [en]

    Aim:  Increased HIV-testing has public health benefits, but for youth there is a multitude of barriers against the test. The aim of this study is to explore how young women and men in Sweden experience HIV-testing within primary healthcare.

    Method:  Six focus-group interviews were tape recorded, transcribed verbatim and analysed according to qualitative content analysis.

    Results:  Three themes emerged, describing how the informants were met before, during and after testing; ‘Obstacles accessing the clinic’– describes their perceptions on how to overcome different barriers and enter into primary health care. ‘Quick and easy testing’– describes perceptions of the testing procedure and ‘Conflicting and unclear information about test results’– describes inconsistencies concerning communication of the test result and a concern about ‘what would happen’ in the event of an HIV-positive finding. Most of these youth preferred the HIV-test ‘quick and easy’ and preferred a telephone referral of the test result. A minority of them worried about HIV, and they thought that the staff seemed to be unprepared for an HIV-positive test result.

    Conclusion:  According to these youth, a quick and easy testing procedure together with a short pretest discussion may be sufficient and may also help normalising the testing practice. In a Swedish context, it may be common to see heterosexual youth as a risk-free population, and this perception may act as a barrier for HIV-testing and increase missed opportunities for early diagnose of HIV within primary care.

  • 308.
    Christianson, Monica
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Boman, Jens
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Essén, Birgitta
    'Let men into the pregnancy': men's perceptions about being tested for Chlamydia and HIV during pregnancy2013In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 29, no 4, p. 351-358Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate how to prevent transmission of HIV and Chlamydia trachomatis (CT) by exploring whether screening of men during pregnancy may be an innovative way to reach men, to increase detection, and to avoid the present gendered responsibility.

    DESIGN: An explorative research strategy with in-depth interviews and an analysis informed by grounded theory principles was used.

    SETTING: The northern part of Sweden.

    PARTICIPANTS: Twenty men/becoming fathers in their twenties and early thirties were offered CT and HIV testing and were interviewed about their perceptions about being tested during pregnancy.

    FINDINGS: Six categories emerged that concerned the men's risk perceptions, reasons for not testing men, benefits and negative consequences associated with being tested, incentive measures for reaching men and the optional time for testing men during pregnancy. The majority of the men perceived their own risk for having CT or HIV to be close to zero, trusted their stable partner, and did not see men as transmitters. They did not understand how men could play a role in CT or HIV transmission or how these infections could negatively affect the child. However, few informants could see any logical reasons for excluding men from testing and the majority was positive towards screening men during the pregnancy.

    KEY CONCLUSIONS: Men's sexual health and behaviour on social and biological grounds will affect the health of women and their children during pregnancy and childbirth. As long as expectant fathers do not count in this 'triad', there is a risk that CT and HIV infections in adults and infants will continue to be an unsolved problem.

    IMPLICATIONS FOR PRACTICE: Knowledge from this research can contribute to influencing the attitudes among health-care providers positively, and inspiring policy changes.

  • 309.
    Christianson, Monica
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Eriksson, Carola
    Umeå University, Faculty of Medicine, Department of Nursing.
    Acts of Violence- Midwives experiences and attitudes to virginity control and hymen (re)constructions2014In: British journal of midwifery, ISSN 0969-4900, E-ISSN 2052-4307Article in journal (Refereed)
    Abstract [en]

    AbstractGlobally, midwives are often at the forefront of promoting and improvingwomen’s sexual and reproductive health. It is important to develop agender perspective in midwifery education, one that addresses thefact that virginity control and hymen (re)constructions are unscientificand may cause great harm to women worldwide. This study aimedto investigate the experience and attitudes of an international groupof midwives regarding virginity control and hymen (re)constructions.An online questionnaire was emailed to midwives who attended theInternational Confederation of Midwifery (ICM) Congress in Glasgow.The respondents (n=480) represented five continents. Ten percent ofthe midwives reported professional experience of requests concerningvirginity examinations and hymen (re)constructions. The majority statedthat these practices are unjustifiable, and amount to acts of violenceagainst women, whereas a minority responded that these practices canbe acceptable. Almost two-thirds stated that it is the responsibility ofmidwives to work against these practices

  • 310.
    Christianson, Monica
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Eriksson, Carola
    Umeå University, Faculty of Medicine, Department of Nursing.
    Acts of violence: virginity control and hymen (re)construction2014In: British journal of midwifery, ISSN 0969-4900, E-ISSN 2052-4307, Vol. 22, no 5, p. 344-352Article in journal (Refereed)
    Abstract [en]

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

  • 311.
    Christianson, Monica
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Eriksson, Carola
    Umeå University, Faculty of Medicine, Department of Nursing.
    Acts of violence: Virginity controland hymen (re)construction2014In: British journal of midwifery, ISSN 0969-4900, E-ISSN 2052-4307Article in journal (Refereed)
    Abstract [en]

    AbstractGlobally, midwives are often at the forefront of promoting and improvingwomen’s sexual and reproductive health. It is important to develop agender perspective in midwifery education, one that addresses thefact that virginity control and hymen (re)constructions are unscientificand may cause great harm to women worldwide. This study aimedto investigate the experience and attitudes of an international groupof midwives regarding virginity control and hymen (re)constructions.An online questionnaire was emailed to midwives who attended theInternational Confederation of Midwifery (ICM) Congress in Glasgow.The respondents (n=480) represented five continents. Ten percent ofthe midwives reported professional experience of requests concerningvirginity examinations and hymen (re)constructions. The majority statedthat these practices are unjustifiable, and amount to acts of violenceagainst women, whereas a minority responded that these practices canbe acceptable. Almost two-thirds stated that it is the responsibility ofmidwives to work against these practices.

  • 312.
    Christianson, Monica
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Eriksson, Carola
    Umeå University, Faculty of Medicine, Department of Nursing.
    Myths and misconceptions: Midwives´ perception of the vaginal opening or hymen and virginity2013In: British journal of midwifery, ISSN 0969-4900, E-ISSN 2052-4307, Vol. 21, no 2, p. 108-115Article in journal (Refereed)
    Abstract [en]

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

  • 313.
    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'.

  • 314.
    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.

  • 315.
    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.

  • 316.
    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)
  • 317.
    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.

  • 318.
    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.

  • 319. 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.

  • 320.
    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.

  • 321.
    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.

  • 322.
    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.

  • 323.
    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.

  • 324.
    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.

  • 325.
    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.

  • 326.
    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.

  • 327.
    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)
  • 328.
    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.

  • 329.
    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)
  • 330.
    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.

  • 331.
    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.

  • 332.
    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.

  • 333.
    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.

  • 334.
    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.

  • 335.
    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

     

     

     

     

     

     

  • 336. 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)
  • 337.
    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.

  • 338.
    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.

  • 339.
    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.

  • 340.
    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. 

  • 341.
    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.

  • 342.
    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.

  • 343.
    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. 

  • 344.
    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.

  • 345.
    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.

  • 346.
    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.

  • 347.
    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.

  • 348.
    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.

  • 349.
    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.

  • 350.
    Dyborn, Julia
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Mella, Josefine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Åtgärder för att minska stråldoser till patient vid interventionell radiologi: - En litteraturöversikt2018Independent thesis Basic level (degree of Bachelor), 180 HE creditsStudent thesis
    Abstract [en]

    Abstract

    Measures aiming to reduce the radiation doses to patients undergoing interventional radiology – A literature review

     

    Background: It's important during radiological procedures that the advantages outweighs the risks. Patients should only be exposed by radiation that can be motivated. The responsability to optimize the radition dose lays with the radiographer and methods to reduce the dose should therefore be researched.

     

    Aim: To describe measures aiming to reduce the radiation doses to patients undergoing an examination within interventional radiology.

     

    Method: The aim was met through a literature review with ten quantitative studies. The search for literature was done in two databases.

     

    Results: The results were organized in two domains; measures that could be done before examination and measures that could be done during examination. Five categories were formulated; upgrade of software and hardware, upgrade of control panel, use of techniques with predetermined programs, use of Dynamic Trace Digital Angiography (DTDA) and spot flouroscopy and use of low-dose parameters.

     

    Conclusion: The results showed that an upgrade of equipment and use of different techniques may reduce the radiation dose. Through this literature review and more research within this area the radiographer may be helped with optimizing the dose.

                                                         

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