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  • 51.
    Andersson, Caroline
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Olivia, Carlsson
    Umeå University, Faculty of Medicine, Department of Nursing.
    Kvinnors upplevelser av ofrivillig barnlöshet: En litteraturstudie2015Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: I Sverige är 7-8 % av kvinnorna ofrivilligt barnlösa. Orsakerna till infertilitet kan vara hormonrubbningar, skador på äggledarna, kvinnor senarelägger familjebildningen och livsstilsfaktorer. Infertilitet medför många olika känslomässiga reaktioner. Syfte: Syftet med denna litteraturstudie var att belysa kvinnors upplevelser av ofrivillig barnlöshet. Metod: Artikelsökningen genomfördes i EBSCO som innehåller omvårdnadsinriktade databaser. I litteraturstudien ingick det 12 kvalitativa studier som har analyserats och sammanställts med inspiration av Fribergs analysmetod. Resultat: Resultatet delades in i följande fem kategorier: "Känslomässiga upplevelser", "upplevelsen av förändrad kvinnlighet", "upplevelsen av utanförskap", "upplevelsen av meningen med livet" och "upplevelsen av ett livslångt fenomen". Konklusion: Litteraturstudiens resultat visar att kvinnans upplevelse av ofrivillig barnlöshet är ett komplext fenomen. Kvinnor behöver psykosocialt stöd för att kunna hantera och bearbeta sin situation på bästa sätt. Som sjuksköterskan är det viktigt att ha ett holistiskt synsätt. Mer forskning behövs inom området.

  • 52.
    Andersson, Christer
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Floderus, Y
    Wikberg, Agneta
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lithner, Folke
    The W198X and R173W mutations in the porphobilinogen deaminase gene in acute intermittent porphyria have higher clinical penetrance than R167: a populations-based study2000In: Scandinavian Journal of Clinical and Laboratory Investigation, ISSN 0036-5513, E-ISSN 1502-7686, Vol. 60, no 7, p. 643-648Article in journal (Refereed)
    Abstract [en]

    The biosynthesis of porphyrins is one of the most conserved parthways known, about the same sequence of reactions taking place in all species. By associating different metals, porphyrins give rise to the “pigments of life”: chlorophyll, haem and cobalamin. The unique tetrapyrrolic structure enables it to function in an array of reactions as a single electron carrier and as a catalyst for redox reactions. In this capacity, it constitutes the prosthetic group of enzymes participating in cellular respiration, in conversion reactions involving steroids and lipophilic xenobiotics, in protective mechanisms directed against oxidative stress and in pathways providing central messenger molecules. The formation of haem is accomplished by a sequence of eight dedicated enzymes encoded by different genes, some being active in ubiquitous as well as in erythroid isoforms. Large differences between the participating enzymes with regard to catalytic power, with low capacity steps positioned early in the catalytic chain, constitute a bar against substrate overloading of enzymes processing porphyrins, thus preventing accumulation in the body of these phototoxic compounds under physiological conditions. Most of the haem in the body is produced by the liver and bone marrow, but the mechanisms applied for the control of the synthesis differ between the two organs. The extremely potent hemeprotein enzymes formed in the liver are rapidly turned over in response to current metabolic needs. They have half-lives in the order of minutes or hours and are restored by fast-acting mechanisms for the de novo synthesis, when needed. Uninterrupted and instant availability of the compound is secured by acute deinhibition of the initial enzyme of the synthetic chain, ubiquitous 5-aminolevulinate synthase (ALAS-1), in response to drain of the free cellular haem pool caused by prevailing demands for hemeproteins or by increased catabolism of the compound. In contrast, in the erythroid progenitor cell the haem synthetic machinery is designed for uninterrupted production of huge amounts of haem for combination with globin chains to form hemoglobin at a steady rate. In the erythron the synthesis of the enzymes participating in the formation of haem is under control of erythropoietin, formed under hypoxic conditions. In the absence of iron, to be incorporated in the porphyrin formed in the last step of the synthesis, the mRNA of erythroid 5-aminolevulinate synthase (ALAS-2) is blocked by attachment of an iron-responsive element (IRE) binding cytosolic protein, and transcription of this key enzyme is inhibited. In humans, the genes for each of the haem synthetic enzymes may become the target of mutations that give rise to impaired cellular enzyme activity. Seven of the enzyme deficiencies are associated with accumulation of toxic intermediaries and with disease entities termed porphyrias. The acute porphyrias are characterized by attacks of neuropsychiatric symptoms, which may be due to a toxic surplus of the porphyrin presursor 5-aminolevulinic acid, or a consequence of a deficit of vital hemeproteins resulting from impaired synthesis of haem. In the cutaneous porphyrias, impairment of enzymatic steps where porphyrins are processed gives rise to solar hypersensitivity due to accumulation of phototoxic porphyrins in the skin. Early diagnosis, information to the patient regarding the nature of the illness and counselling aimed at avoidance of triggering factors are cornerstones in the handling of the porphyric diseases. Gene analysis is of incomparable diagnostic reliability in carrier detection, but biochemical methods must be applied in the important task of monitoring porphyric disease activity. In most forms of porphyria the gene carriers run the risk of development of associated diseases in liver or kidneys, a circumstance that prompts application of well-structured surveillance programs.

  • 53.
    Andersson, Christer
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Wikberg, Agneta
    Umeå University, Faculty of Medicine, Department of Nursing.
    Stegmayr, Bernd
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Lithner, Folke
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Renal symtomatology in patients with acute intermitent porphyria2000In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 248, p. 319-325Article in journal (Refereed)
    Abstract [en]

    Objective: Can renal insufficiency in subjects with acute intermittent porphyria (AIP) be due solely to AIP?

    Design: A population-based study.

    Subjects: Subjects with AIP ≥ 18 years of age (n = 386) in the four most northerly counties of Sweden.

    Interventions: Screening with creatinine clearance at 24 h. Patients below the lower reference level underwent a repeat clearance test and, if still low, also chromEDTA clearance.

    Results: 286 (74%) subjects performed the creatinine clearance test and in 57 clearance was low; the second clearance proved normal in 23 who were then excluded. Eighteen subjects with other possible medical reasons for renal insufficiency, ethical reasons or refusing further examinations were also excluded. The 16 remaining subjects with no explanation for their renal insufficiency other than AIP were then studied in detail. All 14 women, mean age 52 years, and two uraemic men, 58 and 67 years, had manifest AIP. Twelve patients had hypertension (HT) and four were normotensive in spite of renal insufficiency. Histological findings of renal biopsies revealed diffuse glomerulosclerotic and interstitial changes with additional ischaemic lesions.

    Conclusion: Protracted vasospasm in attacks of AIP may be a cause of renal lesions. This is discussed.

  • 54.
    Andersson, Elin
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Nilsson, Amanda
    Umeå University, Faculty of Medicine, Department of Nursing.
    Att axla ett vårdaransvar: Att vara anhörig till en närstående med Alzheimers sjukdom - en litteraturstudie2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Alzheimers sjukdom påverkar inte bara den närstående med Alzheimer utan även anhöriga drabbas, både fysiskt och psykiskt då sjukdomen bidrar till stora förändringar i anhörigas livssituation. Därför är det viktigt att öka kunskapen om anhörigas situation för att bättre kunna stödja dem. Syfte: Syftet med denna studie var att beskriva erfarenheter av att vara anhörig till en person med Alzheimer som bor hemma.

    Metod: En litteraturstudie har genomförts och nio kvalitativa artiklar har valts genom sökningar i Cinahl, PubMed och Scopus. Artiklarna har sedan granskats, analyserats och sammanställts.

    Resultat: Anhörigas erfarenheter av att ha en närstående med Alzheimer beskrevs i fyra huvudkategorier; ’Att ställas inför ett vårdaransvar som anhörig’, ’Påfrestningar på den egna hälsan’, ’Behovet av kunskap och stöd’ samt ’Förändrat vardagsliv med närstående’.

    Konklusion: Att vara anhörig till en närstående som har Alzheimers sjukdom är mycket påfrestande både fysiskt och psykiskt. Genom ökad kunskap och ökat stöd kan anhöriga förhoppningsvis bli tryggare i vårdarrollen, förebygga egen ohälsa eller förbättra den.

    Nyckelord: Alzheimers sjukdom, Anhöriga, Erfarenheter

  • 55.
    Andersson, Erika
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sandström, Rosmarie
    Umeå University, Faculty of Medicine, Department of Nursing.
    Att vårda personer med demens på särskilt boende: Vårdpersonalens upplevelser av beteendemässiga och psykiska symtom vid demens2017Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Aim: The aim of the study was to describe nursing staff´s experience of caring for persons with dementia and behavioral and psychological symptoms of dementia (BPSD) in aged care facilities Background: Dementia is common in elderly and often leads to BPSD which puts high demands on nursing staff. The work is affected by the knowledge of the staff and the shape of the organization which could lead to stress of conscience, risk of burn out and that they distanced themselves from the elderly. Design: The study was a qualitative semi-structured interview study. Methods: The participants consisted of enrolled nurses and nursing aides in municipal aged care facilities. 10 interviews were analyzed through inductive content analysis. Findings: Five categories were distinguished in the content analysis – “Knowledge about the elder behind the dementia”, “To meet and validate the reality of the elder”, Commitment to the elderly´s well-being”, “The demands for working cooperation and flexibility”, “Demands for a supportive organization”. Getting to know the person was important to be able to work with persons with BPSD which consisted of different ways to gain information and the staff´s own knowledge about the person. The staff tried to reach the elderly by adapted treatment depending on the situation. The work was seen as challenging and it touched a broad emotional spectrum within themselves when working with the elderly. To work with BPSD put great demands on good cooperation between professions, dialogue, flexibility and to strive towards common goals. Support from the employer and the organization was important. Conclusion: To be able to implement new approaches in the work procedure in the organization the nursing staff needs more education in dementia, support from the employer and the organization.

  • 56.
    Andersson, Gun
    Umeå University, Faculty of Medicine, Department of Nursing.
    Höj-och sänkbara arbetsbord på 1177 sjukvårdsrådgivning och vårdcentral2015Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    AbstractBackgroundOccupations involving more sedentary at work occurs in today´s society to a greater extent, and even in their spare time, several are less physically active. Around 1.2 million acquisition workers felt that their work contained an excessive amount of sedentary.PurposeThe aim of this thesis was to examine the self-assessed work environment amongst medical staff who uses height-adjustable work desks.MethodThe study was conducted as a quantitative survey with validated questionnaires from QPS Nordic- 34 + questions from AFS 2012:2 checklists from the Swedish Work Environment Authority. A convenience sample of 1177 medical counseling and a health center of Uppsala led to 53 completed questionnaires. The study material was analyzed through the development of descriptive statistics and related analysis.ResultThe majority of the 53 respondents had a height- adjustable desk. The group that had height- adjustable desk were able to switch working position frequently during the day. There is no significance between those with and without height- adjustable work desks regarding the questions about the self assessed work.ConclusionThe majority of the staff from both the 1177 medical counseling and the health centers had height- adjustable work desks and were using them.KeywordsOccupational sitting, sit-stand work station, sit-stand desk, height- adjustable workstations, muscle fatigue.

  • 57.
    Andersson, Hillevi
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Israelsson, Frida
    Umeå University, Faculty of Medicine, Department of Nursing.
    Ungdomars upplevelser av att genomgå skolioskirurgi2015Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
  • 58.
    Andersson, Jonas
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Liljekvist, Torkel
    Umeå University, Faculty of Medicine, Department of Nursing.
    Ambulanspersonalens upplevelser av återhämtning mellan uppdragen2015Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Ambulance personnel face daily stress and high workload. This leads to increased risk of health problems among ambulance personnel and risk to affect care.

    Purpose: The purpose of this study was to elucidate the ambulance personnel experiences of recovery between missions.

    Participants: In the study contributed ten employees in prehospital care at two mid-sized cities in Sweden and surrounding rural areas.

    Method: The study was based on ten semi-structured interviews conducted in December 2014. The interviews were recorded and analyzed using qualitative content analysis.

    Results: Four categories emerged: Prerequisites for recovery, Circumstances that provides recovery, Circumstances that impairs recovery and Consequences of lack of recovery. To the four categories 14 subcategories were created. The factors that were considered most important for good recovery is daytime, meals and social interaction. During nighttime sleep was described as the most elementary. It was pointed out that it is difficult to plan for rest and recovery, partly because the workload, partly because of uncertainty about the workshifts progression.

    Conclusion: The result of the study shows that ambulance personnel feel that the most important recovery occurs through sleep, meals and socializing. Prerequisites for rest and recovery has a fundamental role. What may limit the recovery is perceived to be; lack of adequate crisis management, short time for recovery and poor peer support. Which can lead to impaired care and risk of adverse health effects.

  • 59.
    Andersson, Lars
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Larsson, Ida
    Umeå University, Faculty of Medicine, Department of Nursing.
    Tolken som min röst: Sjuksköterskors upplevelser av att arbeta medtolksamtal i asylhälsan2016Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Aims: The aim was to study nurses' experience of working with interpreter conversations inmigrant health.Background: The last years increase in refugees has created rising demands on migranthealth and interpreters in primary healthcare. Lack of communication can hinder nurses' careand knowledge of the experience of interpreter conversations is therefore important,something lacking in research. The National Board of Health and Welfares survey describedproblems of availability of medical interpreters and an unequal situation nationwide.Methods: The study was a qualitative interview study with seven nurses. Interviews wererecorded, transcribed and analyzed with qualitative content analysis.Results: Three main categories were identified: The interpreter’s role affects the conversationdescribed how interpreter professionality could enable or disable the conversation as couldinterpreter sex and culture. The nurses' role affects the conversation described how theprofessionality of the nurse was essential as they needed to find own solutions workwise aswell as the pursuit of a caring conversation with the patient. The organization affects theconversation described a limiting organization with a lack of interpreters, structure andcooperation between healthcare and authorities. Education was stressed as quality-assurance.Conclusions: Nurses need the interpreter as bridge for their voice to enable good care. Thereis need for a systematic way to work with interpreters through education and Nurse-Interpreter training. This would quality-assure healthcare and improve working conditions.Competence in transcultural nursing is important for equal health care in today's multiculturalSweden

  • 60.
    Andersson, Linda
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå universitet.
    Lövström, Jennifer
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå universitet.
    Att leva med bipolär sjukdom: En litteraturstudie om patienters erfarenheter av att leva med bipolär sjukdom2015Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Bipolar disorder is a chronicle disease characterized by changes in the

    patient ́s activity level and mood. These episodes are referred to as mania-,

    hypomania- and depressive episodes. Treatment and care are focused on relieving

    symptoms.

    Aim: The aim of this study was to illuminate patients’ experiences of living with

    bipolar disorder.

    Method: This literature review study used 8 qualitative scientific articles. These

    were compiled and analyzed with the inspiration of a qualitative content analysis.

    When searching for articles, databases like Cinahl, PsycInfo and PubMed were used.

    Results: The result shows that factors affecting living with bipolar disorder was to

    accept or deny the disease. Patients experienced identity change and concern about

    the future. Everyday life is affected in a large extent, especially when regular

    medication and blood sampling was needed in order to control the disease. Varying

    emotion occurred while oscillation in moods. In order to control the disease patients

    describes how important it is to have support, this in order to manage the symptoms

    and being able to identify warning signs. Motivation to change is strengthened by

    good relationships as well as knowledge and understanding, both in patients,

    relatives and health professionals.

    Conclusion: The results of the literature review showed that the diagnosis can

    produce serious consequences for those involved, their family and those related.

    Therefore it requires a lot of support, education and information for all involved.

  • 61.
    Andersson, Maja
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Ebbvik, Caroline
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sjuksköterskan på plats vid en humanitär katastrof: En litteraturöversikt i sjuksköterskors erfarenheter av att tjänstgöra vid humanitära katastrofer2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    ABSTRACT

    Background: The humanitarian needs are on the rise and Sweden has a long tradition of assisting with various types of relief work. Humanitarian relief work aims to save lives and alleviate the people in need affected by natural disasters or armed conflicts. Nurses constitutes the largest work group in the disaster relief and are often assigned leadership on site.

    Aim: To describe nurses' experiences of serving in humanitarian disasters.

    Method: This literature review contains eight articles with qualtitative approach. The result from each article was analyzed and compiled. The databases CINAHL, PubMed and Swemed+ were used.

    Results: The result have been divided into four main categories with eight subcategories. The main categories are: to be insufficient, to face a new environment, to feel an emotional involvement with other people and to find the role as a nurse.

    Conclusion: The result of the literature review shows that nurses could experience feelings of stress and a feeling of being unprepared in the humanitarian disaster work. A disaster can rarely be predicted, therefore it is important with disaster preparedness for all nurses.

    Keywords: disaster medicine, humanitarian disaster, disaster relief, humanitarian aid.

  • 62.
    Andersson, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Nironen, Kristina
    Umeå University, Faculty of Medicine, Department of Nursing.
    Skolsköterskans upplevelser av att hantera mötet med föräldrar till överviktiga barn och motivera till en hälsosam livsstil.2013Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Syftet med studien var att belysa skolsköterskans upplevelser av att hantera mötet med föräldrar till överviktiga/feta barn för att kunna motivera familjen till en mer hälsosam livsstil.Insamlandet av material skedde genom frågeformulär som skickades ut via mail till 30 skolsköterskor i Västra Götalandsregionen. Totalt deltog sju skolsköterskor. Det insamlade materialet analyserades med kvalitativ innehållsanalys. Skolsköterskan upplevde ett flertal hinder i mötet med föräldrar till överviktiga/feta barn. De hinder som upplevdes vara mest förekommandevar föräldrars känsla av att ha blivit kränkta och kritiserade av skolsköterskan samt att det fanns tillfällen där föräldrarna ville klara av problemet med barnens övervikt/fetma själva. Skolsköterskan upplevde även att det fanns möjligheter i arbetet medatt påverka familjerna till en bättre livsstil. Skolsköterskan ansåg att det var viktigt att skapa en bra och tillitsfull relation till familjen. Dessutom ansåg skolsköterskan att ansvaret för barnets övervikt/fetma låg hos föräldrarna och vände sig därmed till dem i första hand för att motivera till en bättre kosthållning och livsstil. Författarna till denna studie uppmärksammade att samtalet mellan skolsköterskan och föräldrarna ofta upplevdes som spänt vilket ibland resulterade i försvårat samarbete. Här spelade ett empatiskt förhållningssätt hos skolsköterskan en mycket stor roll och det kunde vara avgörande för om hon lyckades motivera familjen till livsstilsförändring. Det verkar inte finnas så mycket forskning om huruvida ekonomi försvårar förändringav livsstil eller om en sämre ekonomi påverkar förekomsten av övervikt/fetma hos barn

  • 63.
    Andersson, Sofia
    Umeå University, Faculty of Medicine, Department of Nursing.
    Vård i livets slutskede på särskilt boende för äldre personer: närstående och vårdpersonals skattade och berättade erfarenheter2017Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background Hospital care for older people in Europe is being replaced by other care facilities such as residential care homes (RCHs). RCHs are therefore playing an increasing and important role in end-of-life (EOL) care. The goal of palliative care is to improve quality of life both for persons with life-threating diseases and for their family members. Care pathways such as the Liverpool Care Pathway for the Dying Patient (LCP) are used to improve the quality of EOL care. There is a lack of research focusing on family members’ and care professionals’ perspectives on the use of pathways in EOL care in RCHs. This thesis is part of a larger research project on the implementation of the LCP in RCHs.

    Aim The overall aim of this thesis was to describe family members’ and care professionals’ perspectives on end-of-life care in residential care homes for older people.

    Methods This thesis consists of four studies, two quantitative and two qualitative. The data in Study I were based on the questionnaire, “Views of Informal Carers – Evaluation of Services” (VOICES), filled in by family members (n=189) of older persons who had died in RCHs. Descriptive statistics were used to analyse the data. Study II was based on registered expected deaths in RCHs (n=22 855) reported to the Swedish Register of Palliative Care (SRPC) by care professionals. The data were explored with univariate and multivariate logistic regression analysis. In Study III and IV, a descriptive qualitative design was used. Data in study III were collected through focus groups and individual interviews with care professionals (n=24). The data in Study IV were collected through individual interviews with family members of residents who had died in RCHs (n=15). The data in Studies III and IV were analysed with qualitative content analysis.

    Results The family members in Study I reported that they had been given enough help with nursing such as getting dressings change and with medication, and personal care such as bathing, dressing, help with eating and going to the bathroom, in the last three days of life. They also reported that they were told (86.2%) that the resident was likely to die shortly, and most of them (94.1%) reported that they felt that the resident had died in their preferred place. Just under half of the residents (46.5%) had experienced pain, with the majority (86.4%) receiving treatment for this symptom, and slightly more than half (55.9%) had experienced shortness of breath, with around a third of them (39.7%) receiving treatment for this. Shortness of breath was significantly more common in the younger age group (<85 years; p=0.01) and they were significantly more likely to have received treatment (p=0.006).

    In Study II, the SRPC data revealed high prevalence of pain (68.8%) and anxiety (44.0%). Shortness of breath (14.1%) and nausea (10.2%) were less common. In the multivariate regression analyses, two explanatory factors were significantly associated with symptom relief, of pain, nausea, anxiety and shortness of breath: use of validated pain assessment scales, and assessment of oral health. In both the univariate and multivariate logistic regression analysis, individual presciptions of injections to be administered when required (PRN, pro re nata) for pain, nausea, and anxiety were significantly associated with relief of symptom.

    The care professionals in Study III described several aspects of their experiences of EOL care after implementation of the LCP: they became more confident through a shared approach, they were supported in tailoring the care to the residents’ individual needs, they were supported in involving the family members in decision-making and care, and they had become more aware of the care environment.

    The family members in Study IV also described several aspects of their experiences of care of the dying in RCHs where an EOL care pathway was used: they felt confident in a familiar and warm atmosphere, they were involved or not in the EOL care, and they were consoled by witnessing the care professionals’ endeavours to relieve suffering.

    Conclusion The results described in this thesis indicate a high quality of nursing care and personal care, but also inadequate management of symptom relief in the last days of life for residents in RCHs. Still, despite a high prevalence of symptoms such as pain, shortness of breath, and anxiety, RCHs were described as a natural and appropriate place of death. The results confirm that use of a validated pain assessment scale and medication PRN prescribed could be a way to increase the quality of EOL care. The results also indicate that a standardized care pathway can offer one way to improve the quality of care. The care professionals felt supported in involving the family members in care and decision making, and both family members and care professionals felt supported in the care by the use of the LCP. 

    The full text will be freely available from 2019-01-12 10:00
  • 64.
    Andersson, Sofia
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lindqvist, Olav
    Umeå University, Faculty of Medicine, Department of Nursing. Department of Learning, Informatics, Management and Ethics/MMC, Karolinska Institutet, Stockholm, Sweden.
    Fürst, Carl-Johan
    The Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden.
    Brännström, Margareta
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Arctic Research Centre at Umeå University.
    Care professional's experiences about using Liverpool Care Pathway in end-of-life care in residential care homes2018In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 32, no 1, p. 299-308Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Residential care homes (RCHs) play an important role in end-of-life care, being the most common place of death for elderly people in several European countries. Care pathways such as the Liverpool Care Pathway for the Dying Patient (LCP) are used to improve and ensure quality care at the end of life. There is a lack of scientific evidence supporting the use of care pathways.

    DESIGN: A descriptive qualitative study.

    OBJECTIVE: The aim was to describe care professionals' experiences of using the Liverpool Care Pathway for the Dying Patient in the care of dying residents in residential care homes.

    METHODS: Five focus group interviews and two individual interviews with enrolled nurses (n = 10), Registered Nurses (n = 9) and general practitioners (n = 5) were carried out and analysed using qualitative content analysis.

    RESULTS: Care professionals expressed that they became confident through a shared approach to care, were supported to tailor the care according to the residents' individual needs, were supported to involve family members in decision-making and care and became more aware of the care environment.

    CONCLUSION: The results of this study indicate that the LCP might be a useful tool for care professionals in improving end-of-life care in RCHs through increased attention to the goals of care, the individual needs of residents and family involvement.

  • 65.
    Andersson, Sofia
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lindqvist, Olav
    Umeå University, Faculty of Medicine, Department of Nursing. Department of Learning, Informatics, Management and Ethics/MMC, Karolinska Institutet, Stockholm, Sweden.
    Fürst, Carl-Johan
    Brännström, Margareta
    Umeå University, Faculty of Medicine, Department of Nursing.
    End-of-life care in residential care homes: a retrospective study of the perspectives of family members using the VOICES questionnaire2017In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 31, no 1, p. 72-84Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In Europe, residential care homes (RCHs) are replacing hospitals as the place where death occurs, and they play an important role in end-of-life (EOL) care.

    OBJECTIVE: The aim was to describe the quality of care during the last 3 months and last 3 days of life of those who died in RCHs as reported by family members. We also investigated whether there were differences in the EOL care of younger patients (<85 years) vs. the oldest old patients (≥85 years) as reported by family members.

    DESIGN: A retrospective survey design.

    METHODS: Deaths (n = 189) at 19 RCHs in one municipality in Sweden were included. Family members were sent the VOICES questionnaire 1 month after their elderly relative had died. Descriptive statistics were used.

    RESULTS: In the last 3 days before death, most family members reported there was enough help with nursing (93%) and personal care (78.5%). Among the family members, 86% were told that the resident was likely to die shortly. Most (94.1%) of residents were reported to have died at their preferred place. No significant difference was found between age groups. Family members also reported that about half of the elderly had pain (46.5%) and 86.4% received treatment; 55.9% had breathlessness and 39.7% received treatment. Breathlessness was significantly (p = 0.01) more common in the younger group, and they were treated more often (p = 0.006) than the oldest old.

    CONCLUSION: This study revealed an overall positive picture of personal and nursing care and communication. These findings indicate that the quality of EOL care at RCHs is high. Inadequate management was found for symptom relief the last days of life. This suggests that this subject merits further attention by care professionals. To achieve better quality of EOL care at RCHs, we emphasise the importance of systematically working to improve symptom relief.

  • 66.
    Andersson, Sofia
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lindqvist, Olav
    Umeå University, Faculty of Medicine, Department of Nursing. Department of Learning, Informatics, Management and Ethics/MMC, Karolinska Institutet, Stockholm, Sweden.
    Fürst, Carl-Johan
    The Institute for Palliative Care, Faculty of Medicine, Department of Clinical Science, Lund University and Region Skåne, Lund, Sweden.
    Brännström, Margareta
    Umeå University, Faculty of Medicine, Department of Nursing.
    Family members' experiences of care of the dying in residential care homes where the Liverpool Care Pathway was used2018In: International Journal of Palliative Nursing, ISSN 1357-6321, E-ISSN 2052-286X, Vol. 24, no 4, p. 194-202Article in journal (Refereed)
    Abstract [en]

    Background: Residential care homes (RCHs) are increasingly becoming a common place of death for older people.

    Aim: The aim of this study was to describe family members' experiences of care of the dying in RCHs where the Liverpool care pathway for the dying patient was used.

    Methods: This study had a descriptive qualitative study design. Fifteen (n=15) individual interviews were analysed using qualitative content analysis.

    Results: The analysis resulted in three themes: being confident in a familiar and warm atmosphere, being involved vs not being involved in end-of-life (EoL) care, and being consoled by witnessing the health professional's endeavour to relieve suffering.

    Significance of results: The results indicated that taking part in a care plan seems to increase family members' feelings of involvement in EoL care. This study also highlights the family members' needs for increased possibilities for EoL discussions with the GP.

  • 67.
    Andersson, Sofia
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Vestberg, Maria
    Umeå University, Faculty of Medicine, Department of Nursing.
    Patientens karaktäristika påverkar upplevelsen av vårdpersonalens bemötande2018Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Patientens karaktäristika påverkar upplevelsen av vårdpersonalens bemötandeSyfte:Att undersöka patienters upplevelse av bemötande från vårdpersonal samt om graden av självrapporterad ångest och depression påverkar denna upplevelse. Bakgrund:Den vård som utförs kan spegla både skillnader i tillgång till vård och sociodemografiska faktorer. Bemötande inom psykiatrisk slutenvård är av stor betydelse för hur patienter upplever sin vård. Ett gott bemötande definieras som en upplevelse av att vårdpersonal tar sig tid och att patienten blir sedd samt att patienten erbjuds medverka i den kliniska beslutsprocessen. På individnivå kan ett bristande bemötande bland annat leda till komplikationer som sämre återhämtning för patienten. Sammantaget är det därför angeläget att utvärdera patientens upplevelse av vårdpersonalens bemötande.Design:I denna tvärsnittsstudie användes en kvantitativ design. Metod:Studien genomfördes vid tre psykiatriska slutenvårdsavdelningar i Norra Sverige under januari och februari 2017. Totalt inkluderades 85 patienter. Utfallsmåtten baserades på data från tre separata enkäter; The Caring Professional Scale som mäter patientens upplevelse av vårdpersonals förmåga till bemötande, Visual Analog Scale som mäter tillfredsställelsen med senaste interaktionstillfället med vårdpersonal och Hospital and Anxiety Scale som mäter självskattad depression och ångest.Resultat:Majoriteten av patienterna rapporterade att de var nöjda med bemötandet från vårdpersonalen. Därtill var faktorer som utbildningsnivåoch ålderassocierade med en självrapporterad nöjdhet av bemötandet. Slutsats:Resultaten från studien antyder att det finns både sociodemografiska och patientkarakteristiska faktorer som kan vara relaterade till patientens upplevelse av vårdpersonals bemötande. Detta kan indikera effekter av ojämlik vård och bör ytterligare belysas ur såväl vetenskapligt som samhälleligt perspektiv

  • 68.
    Andersson, Sofia
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Årestedt, Kristofer
    Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.
    Lindqvist, Olav
    Umeå University, Faculty of Medicine, Department of Nursing. Department of Learning, Informatics, Management and Ethics/MMC, Karolinska Institutet, Stockholm.
    Fürst, Carl Johan
    The Institute for Palliative Care, Faculty of Medicine, Department of Clinical Science, Lund University and Region Skåne, Lund, Sweden.
    Brännström, Margareta
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Arctic Research Centre at Umeå University. Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg.
    Factors associated with symptom relief in end-of-life care in residential care homes: a national register-based study2018In: Journal of Pain and Symptom Management, ISSN 0885-3924, E-ISSN 1873-6513, Vol. 55, no 5, p. 1304-1312Article in journal (Refereed)
    Abstract [en]

    Context: Residential care homes (RCHs) are a common place of death. Previous studies have reported a high prevalence of symptoms such as pain and shortness of breath among residents in the last week of life.

    Objectives: The aim of the study was to explore the presence of symptoms and symptom relief and identify factors associated with symptom relief of pain, nausea, anxiety, and shortness of breath among RCH residents in end-of-life care.

    Methods: The data consisted of all expected deaths at RCHs registered in the Swedish Register of Palliative Care (N = 22,855). Univariate and multiple logistic regression analyses were conducted.

    Results: Pain was reported as the most frequent symptom of the four symptoms (68.8%) and the one that most often had been totally relieved (84.7%) by care professionals. Factors associated with relief from at least one symptom were gender; age; time in the RCH; use of a validated pain or symptom assessment scale; documented end-of-life discussions with physicians for both the residents and family members; consultations with other units; diseases other than cancer as cause of death; presence of ulcers; assessment of oral health; and prescribed pro re nata injections for pain, nausea, and anxiety.

    Conclusion: Our results indicate that use of a validated pain assessment scale, assessment of oral health, and prescribed pro re nata injections for pain, nausea, and anxiety might offer a way to improve symptom relief. These clinical tools and medications should be implemented in the care of the dying in RCHs, and controlled trials should be undertaken to prove the effect.

  • 69.
    Andersson, Veronica
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Samuelsson, Jannike
    Umeå University, Faculty of Medicine, Department of Nursing.
    Äldres hälsa i glesbygd och stad: Skiljer sig äldres hälsa på särskilt boende?2016Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Syfte: Syftet med denna studie var att jämföra hälsotillstånd bland äldre människor bosatta på särskilt boende i glesbygd respektive stad.

    Bakgrund: Världens befolkning förväntas öka kraftigt samtidigt som vi lever längre. Detta ställer i sin tur höga krav på hälso- och sjukvården. Det finns skillnader i tillgänglighet och möjlighet till vård i glesbygd och stad trots Hälso- och sjukvårdslagens förordning om jämlik vård. Det förekommer bristfällig forskning gällande äldres hälsa på särskilda boenden i glesbygd och i stad. Med hänsyn till den förväntade befolkningsutvecklingen som tenderar i fler äldre och fler multisjuka är det av vikt att ta reda på vad som är hälsa för denna grupp, för att kunna utveckla en god äldreomsorg i takt med samhällsutvecklingen.

    Metod: En kvantitativ tvärsnittsstudie genomfördes under en vecka i maj 2013. Äldre (n=1544) boende på särskilt boende i glesbygd och i stad blev skattade av vårdpersonal. Multi-Dimensional Dementia Assessment Scale användes som instrument i studien och det insamlade materialet analyserades i SPSS Statistics.

    Resultat: Resultatet visade på skillnader i de äldres hälsotillstånd beroende på om de var bosatta på särskilt boende i glesbygd eller i stad. I glesbygd hade de äldre en lägre grad av kognitiv svikt, högre ADL-förmåga, fick oftare besök och var oftare utomhus självständigt. I glesbygd förekom mer smärta och de tenderade till att vara mer förstoppade. I stad hade en högre andel fått en läkemedelsgenomgång senaste året och fler hade egna tänder jämfört med i glesbygd. I stad förekom begränsningsåtgärd i form av sänggrindar oftare, fler hade sväljsvårigheter och fler var i behov av hjälp av vårdpersonal på morgonen. Av vårdpersonal skattades den psykiska vårdtyngden som högre i stad jämfört med i glesbygd, däremot sågs ingen skillnad gällande den fysiska vårdtyngden.

    Konklusion: Resultatet visar att det skiljer sig gällande hälsostatus bland äldre vid särskilda boenden i glesbygd och stad, och det fanns både positiva och negativa aspekter bland de äldre både i glesbygd och i stad. Vidare forskning inom området är av vikt för att utforska vad som orsakar dessa skillnader, och på vilka sätt distriktssköterskor kan lära av varandra och implementera nya arbetssätt i sitt arbete på särskilda boenden. 

  • 70.
    Andersson Westman, Nina
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Björnström, Anne
    Umeå University, Faculty of Medicine, Department of Nursing.
    Barns och ungdomars erfarenheter av att ha en förälder som drabbats av cancersjukdom: En litteraturstudie2016Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Titel: Barns och ungdomars erfarenheter av att ha en förälder som drabbats av cancersjukdom - en litteraturstudie.

    Bakgrund: Tusentals barn är anhöriga till cancersjuka föräldrar. Sjukdom hos föräldern påverkar barnets tillvaro både känslomässigt och praktiskt. Barn som anhöriga är sårbara på grund av sin beroendeställning till föräldern samt svårigheter att förstå det som händer och bakomliggande orsaker.

    Syfte: Syftet med denna uppsats är att beskriva barns och ungdomars erfarenheter av att ha en förälder som drabbats av cancersjukdom.

    Metod: En litteraturstudie genomfördes på 12 artiklar med kvalitativ ansats. Artiklarna granskades, analyserades och sammanställdes.

    Resultat: Resultatet presenterades i tre huvudkategorier och sammanlagt nio underkategorier. Huvudkategorierna innefattade: behov av kunskap och information, förändringar för hela familjen och en emotionellt svår och krävande situation.

    Konklusion: Sjuksköterskan bör tillämpa ett familjecentrerat förhållningssätt för att uppmärksamma barnens behov när deras vardag förändras. Information och stöd bör anpassas efter barnets utvecklingsnivå och individuella behov och önskemål. Mer forskning i ämnet skulle kunna förbättra bemötandet av barn som anhöriga. 

  • 71.
    Andertun, Sara
    Umeå University, Faculty of Medicine, Department of Nursing.
    Upplevelser från frontlinjen i kampen mot ebola: en kvalitativ studie om riskfyllt arbete2015Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Syfte. Beskriva upplevelser av riskfyllt arbete bland norsk vårdpersonal som arbetat med ebola-patienter i Sierra Leone.

    Bakgrund. Ebolavirus är en ovanlig sjukdom med hög dödlighet, och ett av de mest fruktade virus som man känner till. Vårdpersonal riskerar därmed sitt liv i högre grad än vid andra epidemier. I de få tidigare studier som är gjord har sjuksköterskor beskrivit brist på skyddsutrustning, stigmatisering samt att de upplevt det tungt att vänta och se om de själva blir sjuka. Säker vård är en av sjuksköterskans kärnkompetenser som också handlar om vårdgivarens säkerhet.

    Design. Kvalitativ design.

    Metod. Individuella semistrukturerade intervjuer och fokusgruppintervjuer genomfördes under 2015 med totalt nio deltagare som arbetat med ebola-patienter i Sierra Leone. Intervjuerna transkriberades och analyserades med kvalitativ innehållsanalys.

    Resultat. Analysen resulterade i sex teman: tillit till försiktighets- och skyddsåtgärder, hantering av smittorisker och andra risker, påminnelse om döden, successiv seger över rädslor, strategier för omvårdnad trots barriärer och känsla av meningsfullhet. Deltagarna beskrev tillit genom träning, organiserad insats, strikta riktlinjer och utrustning. De hade respekt för smittorisken, gjorde riskbedömningar, tog ansvar, hanterade riskfyllda situationer samt blev påmind om lidande och död. Det var nödvändigt att hantera sin egen rädsla och ge omvårdnad utifrån de förutsättningar som låg till grund. Det riskfyllda arbetet gav mening. Säker vård går som en röd tråd genom arbetet med ebola-patienter där vårdrelationen utmanas.

    Konklusion. Säker vård kan bedrivas trots kontakt med ett mycket smittsamt ebolavirus. Det är tänkbart att andra smittsamma sjukdomar med hög dödlighet kan drabba oss i västvärlden, därför är upplevelser hos vårdpersonal också relevant för oss i Skandinavien. 

  • 72.
    Andertun, Sara
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hajdarevic, Senada
    Umeå University, Faculty of Medicine, Department of Nursing.
    Ebola virus disease: caring for patients in Sierra Leone - a qualitative study2017In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 73, no 3, p. 643-652Article in journal (Refereed)
    Abstract [en]

    AIM: The aim of this study was to describe Norwegian healthcare staffs' experiences of participating in care of patients with Ebola virus disease in Sierra Leone.

    BACKGROUND: Ebola is one of the most feared viruses known. Ebola virus disease is highly contagious with high mortality. The few qualitative studies made on experiences among healthcare professionals have highlighted problems as lack of protective resources, insufficient personnel and risk of societal stigmatization.

    DESIGN: Descriptive study with qualitative approach.

    METHOD: Individual narrative and focus group interviews were obtained during 2015 with eight nurses and one physician who had worked in Ebola care in Sierra Leone. The interviews were analysed using qualitative content analysis.

    RESULT: The analysis resulted in the two themes: 'Experiencing security by learning to manage risks'; and 'Developing courage and growth by facing personal fears'. Subthemes were: 'Relying on safeguard actions', 'Managing risk of contagion', 'Developing strategies for care despite risks', 'Constantly reminded of death', 'Successively defeating fears' and last, 'Increasing motivation through meaningfulness'. The participants described the reliance on training, organized effort, strict guidelines and equipment. They were respectful of the risk of transmission, made risk assessments, took responsibility, handled risky situations and were reminded of suffering and death.

    CONCLUSION: Despite challenges, the hazardous work with Ebola virus disease patients was experienced as meaningful which was an important motivator. Safe care was central in working with Ebola patients, but the care relation was challenged.

  • 73.
    Angström-Brännström, Charlotte
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Norberg, Astrid
    Umeå University, Faculty of Medicine, Department of Nursing.
    Children undergoing cancer treatment describe their experiences of comfort in interviews and drawings.2014In: Journal of Pediatric Oncology Nursing, ISSN 1043-4542, E-ISSN 1532-8457, Vol. 31, no 3, p. 135-46Article in journal (Refereed)
    Abstract [en]

    Children with cancer often undergo a long course of treatment, described as painful, and associated with feelings of discomfort and need of comfort. The aim of this descriptive interview study was to investigate how children, aged 3 to 9 years, undergoing cancer treatment describe their experience of comfort. The children were interviewed and asked to make drawings. Data were content analyzed and four themes were constructed-enduring discomfort, expressing discomfort, finding comfort, and comforting others. The findings show that the children endured discomfort during treatment, and were sometimes able to express it. They found comfort especially from their family and from hospital staff. The children also described that they comforted family members. The findings are in accordance with previous research about children's and adults' accounts of comfort. An incidental finding is that parents were surprised when they listened to the children's accounts of their experience of discomfort and comfort and achieved a better understanding of their children.

  • 74.
    Anth, Marie
    Umeå University, Faculty of Medicine, Department of Nursing.
    En jämförelse mellan olika tekniker vid trakeal intubering av obesa patienter: - En litteraturstudie2013Independent thesis Advanced level (degree of Master (One Year)), 40 credits / 60 HE creditsStudent thesis
    Abstract [sv]

    ABSTRAKT

    Syfte och mål: Att jämföra olika tekniker vid trakeal intubering av obesa patienter. Bakgrund: Fetma blir vanligare och behovet av kunskap inom vården ökar för att på ett säkert sätt ta hand om dessa patientgrupper. Anestesisjuksköterskan ska kunna hantera, prioritera och ta snabba beslut vid akuta tillstånd och förebygga komplikationer som kan uppstå. Kunskap och beredskap inför akuta situationer är av stor vikt för att hantera den svåra luftvägen och kunna ge en god och säker omvårdnad genom anestesin.                                                                   Design: En litteraturstudie med kvantitativ ansats genomfördes.                     Metod: Databasen EBSCO genomsöktes gällande studier som var publicerade mellan 2003-2013 där följande tekniker gällande trakeal intubering hos obesa patienter valdes; intubering med larynxmask (ILMA), videolaryngoskop/glidescope vid vakenintubation och generell anestesi, Rapid Sequence Induction (RSI), the Shikani optical stylet, LMA Ctrach, flexibelt fiberoptiskt bronkoskop och Airtraq med sedvanlig och omvänd manöver. Dessa tekniker bedömdes efter intuberingstid, lyckad intubering vid första försöket, ömhet/skada i halsen och Body Mass Index (BMI). Åtta studier inkluderades av vilka en kvalitetsgranskning genomfördes.         Resultat: RSI med vanligt laryngoskop hade högst frekvens gällande lyckad intubering på första försöket. Kortast intuberingstid ses vid användning av Airtraq laryngoskop med omvänd manöver. Längst tid tar vakenintubation med laryngoskop. När det gäller skada eller postoperativ ömhet i hals och svalg har det fiberoptiska bronkoskopet flest fall trots relativt kort intubationstid. Användning med Airtraq och omvänd manöver hade en låg frekvens gällande komplikationer i svalget samtidigt som intubationstiden var kort.                                                    Slutsats: Flera faktorer spelar in och det viktigaste är att en preoperativ bedömning gjorts och att den som intuberar har vana och erfarenhet av tekniken för en snabb och säker etablering av luftvägen.Relevans för klinisk verksamhet: Anestesisjuksköterskan kommer alltmer möta patienter med obesitas och kunskap om olika tekniker för att säkerställa luftvägarna hos överviktiga är av stor betydelse för en säker omvårdnad.                                                                       Nyckelord: Intubering, fetma, teknik, luftvägar, komplikationer

    Strukturen på examensarbetet är justerat efter instruktioner från ”The Journal of Clinical Nursing”, en tänkbar tidskrift för publikation.

  • 75.
    Anth, Marie
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå universitet.
    Sikström, Josefin
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå universitet.
    Instrument för bedömning av smärta inom intensivvård  - en litteraturstudie om två mätinstruments validitet och reliabilitet2012Independent thesis Advanced level (degree of Master (One Year)), 40 credits / 60 HE creditsStudent thesis
  • 76.
    Antonia, Rosencrantz
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Löfström, Erik
    Umeå University, Faculty of Medicine, Department of Nursing.
    Kommunikation i det intraoperativa teamet: Anestesisjuksköterskans upplevelser2017Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Kommunikation är en viktig del av anestesisjuksköterskans arbete för att kunnasamarbeta med medlemmarna i det intraoperativa teamet och säkerställa säkerheten förpatienten på operationssalen. 50% av alla komplikationer som sker efter en operation kanrelateras till kommunikationsproblem och skulle kunna undvikas. För att förståkommunikationen i det intraoperativa teamet och kunna göra förbättringar är det av intresse attundersöka och skapa en förståelse av anestesisjuksköterskans erfarenheter av kommunikation.Syfte: Syftet var att belysa anestesisjuksköterskans upplevelser av kommunikationen i detintraoperativa teamet på operationssalen.Metod: Tio semistrukturerade intervjuer av anestesisjuksköterskor från två olika sjukhus iSverige genomfördes. Deltagarna valdes ut med hjälp av ett bekvämlighetsurval. Intervjuernatranskriberades och analyserades utifrån en tematisk innehållsanalys.Resultat: Analysen resulterade i tre teman baserade på åtta underteman. Första temat Känslanav samarbete baserades på tre underteman: tydlighet i det som sägs, verbal respons ochuppdaterad information. Känsla av trygghet var det andra temat och här beskrev deltagarna ettförberedande samtal inför operationen samt att kunna tolka utan att prata. Dessa två temanbeskrev sådant som deltagarna identifierade som bra kommunikation medan det tredje tematKänslan av utanförskap däremot identifierade negativa erfarenheter och upplevelser avkommunikationen i det intraoperativa teamet. Här beskrev anestesisjuksköterskorna frånvaroav kommunikation, att inte bli bekräftad och att inte våga prata.Slutsats: Anestesisjuksköterskorna hade erfarenhet av positiv och negativ kommunikation i detintraoperativa teamet på operationssalen. Det fanns en dynamik och variation ikommunikationen som berodde på teammedlemmarnas förmåga att kommunicera och utövandeav makt i kommunikationen. Därför finns ett behov av ökad medvetenhet, utbildning ochövning i det kommunikativa samspelet. Eftersom teamet består av flera olika professioner ochdet bara är anestesisjuksköterskans synvinkel som undersökts krävs det vidare forskning för attkunna skapa en helhetsbild.

  • 77.
    Antonsson, Helena
    Umeå University, Faculty of Medicine, Department of Nursing.
    Interaktion i särskilt boende för personer med utvecklingsstörning och utmanande beteende2013Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: People with learning disabilities communicate in various ways depending on their abilities. Communication difficulties affect interactions between people with learning disabilities and their professional carers’ and this places a high demand on the carers to interpret and understand each individual’s wishes and needs. At the same time, there is a risk that the carers will be misunderstood. If carers fail to understand what the residents are trying to communicate, and vice versa, situations with challenging behaviour such as an unwillingness to interact or verbal and physical aggression may occur.

    Aim: The overall aim of this thesis was to explore the interactions between adults with learning disabilities and carers in special accommodations as well as to evaluate the effects of an intervention created for carers working with people with learning disabilities at special accommodations.

    Method: The setting for the study was at special accommodations in one county in northern Sweden. In study I, information regarding 556 adults with learning disabilities was collected. In both study II & III, 11 people with learning disabilities and 16 of their carers participated. In study IV, 7 carers and one person with learning disabilities participated. Data in study I consist of carers’ estimations of the residents disabilities and frequency of restraint use. Video-recorded observations and individual narrative interviews were used in study II and study III, and in study IV multiple methods of data collection were used in a mixed method design with both carers’ estimations using instruments and with semi-structured interviews. Methods for analyses in study II, III and IV were qualitative content analysis and in study I and IV statistical analyses were used.

    Results: Study I revealed that of the 556 residents studied, 99 (18%) had been subjected to physical restraint use over the previous week. Of these participants, almost all were subjected to more than one type of restraint. The most commonly used physical restraint was a belt in chair (74%). Use of physical restraint can be related to both physical disabilities and challenging behaviours in the interaction between people with learning disabilities and their carers’. In interviews for study II, the carers reflected on both successful and unsuccessful interactions after viewing video of situations where they have been participating. Examples of successful interactions included understanding cues, satisfying needs, and managing situations with challenging behaviours. The carers’ reflected on how successful interactions could influence their feeling of security, confidence, and satisfaction among the residents. The carers also reflected on the consequences of unsuccessful interactions, which included causing irritation, aggression and violence. In study III, interactions between 11 residents with learning disabilities and 16 of their caregivers were recorded on video. Verbal and non-verbal interaction skills used among the carers were identified. Four ‘caring situations’ were chosen as examples of skilled interactions. The results showed that skilled interactions between the carers and their clients were based on being confirming, sharing daily life experiences, giving time and space, and using congruent and distinct language. Study IV evaluated the effects of a web-based learning intervention, based on a theoretical model, and the results showed an increased ability among the carers to handle situations with challenging behaviour and a decreased frequency of challenging behaviour.

    Conclusion: Physical restraint is commonly used in special accommodations for people with learning disabilities. Use of physical restraint can be related to both physical disabilities and challenging behaviours in the interaction between people with learning disabilities and their carers. Carers find the use of physical restraint difficult and exhausting. A break in communication between people with learning disabilities and their carers could lead to impaired interaction that creates situations of challenging behaviour. When carers are able to interact successfully with people who have limited ability to communicate verbally, it seems to give satisfaction to both the residents and their carers in group homes. Carers often experience helplessness and uncertainty in situations with challenging behaviour and express a need for support. The carers considered the web-based training program to be useful. Further, a decrease of situations of challenging behaviour was observed after the web-based program was implemented. This indicates that the web-based training program may be useful in training for carers, both novices and more experienced carers in special accommodations for people with learning disabilities

  • 78.
    Antonsson, Helena
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hällgren Graneheim, Ulla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Isaksson, U
    Åström, Sture
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lundström, Mats
    Umeå University, Faculty of Medicine, Department of Nursing.
    Effects and experiences of a web-based training program for professional carers working with people with learning disabilities and challenging behaviourManuscript (preprint) (Other academic)
  • 79.
    Antonsson, Helena
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hällgren Graneheim, Ulla
    Umeå University, Faculty of Medicine, Department of Nursing. University West, Department of Health Sciences, Trollhättan, Sweden.
    Isaksson, Ulf
    Umeå University, Faculty of Medicine, Department of Nursing.
    Åström, Sture
    Umeå University, Faculty of Medicine, Department of Nursing. University West, Department of Health Sciences, Trollhättan, Sweden.
    Lundström, Mats O.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Evaluation of a Web-Based Training Program for Professional Carers Working With People With Learning Disabilities and Challenging Behavior: A Pilot Study with SSED-Design2016In: Issues in Mental Health Nursing, ISSN 0161-2840, E-ISSN 1096-4673, Vol. 37, no 10, p. 734-743Article in journal (Refereed)
    Abstract [en]

    The interaction between people with intellectual disabilities and professional carers is often influenced by communicative difficulties contributing challenging behaviours. The aims of this study were to evaluate to a web-based training program aimed at improving carers' abilities to interact with people with learning disabilities who exhibit challenging behaviours and to explore carers' experiences of participating in such a program. A single-subject experimental design and mixed methods were used to integrate qualitative and quantitative data. Triangulation of questionnaires, interviews with carers, and assessments of one woman's behaviour was performed. The participants were professional carers aged 20 to 55 years. The web-based training program increased carers' abilities to handle challenging behaviours and decreased challenging behaviours in daily care. The program improved the opportunities to offer training to carers who work in community-based accommodations with limited time to receive training.

  • 80.
    Antonsson, Helena
    et al.
    Umeå University, Faculty of Medicine, Omvårdnad.
    Hällgren Graneheim, Ulla
    Umeå University, Faculty of Medicine, Omvårdnad.
    Lundström, Mats
    Umeå University, Faculty of Medicine, Omvårdnad.
    Åström, Sture
    Umeå University, Faculty of Medicine, Omvårdnad.
    Caregivers' reflections on their interactions with adult people with learning disabilities.2008In: Journal of Psychiatric and Mental Health Nursing, ISSN 1365-2850, Vol. 15, no 6, p. 484-91Article in journal (Refereed)
  • 81.
    Antonsson, Helena
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Åström, Sture
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lundström, Mats
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hällgren Graneheim, Ulla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Skilled interaction among professional carers in special accommodations for adult people with learning disabilities2013In: Journal of Psychiatric and Mental Health Nursing, ISSN 1351-0126, E-ISSN 1365-2850, Vol. 20, no 7, p. 576-583Article in journal (Refereed)
    Abstract [en]

    ACCESSIBLE SUMMARY: • Communicative difficulties affect interactions between people with learning disabilities and their carers. • Interactions between carers and residents in special accommodations for people with learning disabilities were recorded on video and skilled interactions were illuminated. • Results of the study show that skilled interaction between the carers and the people with learning disabilities is based upon being confirming, sharing daily life experience, giving time and space, and using congruent and distinct language.

    ABSTRACT: Communicative difficulties affect interactions between people with learning disabilities and their carers. Despite such difficulties, however, some carers seem to interact successfully with people who have limited ability to communicate verbally and exhibit challenging behaviour. This study aims to illuminate skilled interaction among carers working in special accommodations for people with learning disabilities. Interactions between 16 caregivers and 11 residents with learning disabilities were recorded on video. Verbal and non-verbal interaction skills among the carers were identified. Four caring situations with people with learning disabilities were chosen to illuminate skilled interaction. The transcribed text was subjected to qualitative content analysis and core stories were created. The results show that skilled interaction between the carers and the people with learning disabilities is based upon being confirming, sharing daily life experience, giving time and space, and using congruent and distinct language. In this paper we present examples that offer concrete suggestions of how to promote successful interaction and create meaning in the shared day-to-day life in special accommodations for people with learning disabilities.

  • 82.
    Appelblad, Hanna
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Bersani, Sandra
    Umeå University, Faculty of Medicine, Department of Nursing.
    Distriktssköterskors upplevelse av patientkontakt utanför arbetstid i tätortsnära landsbygd.2015Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Abstrakt

    Bakgrund: Få studier är utförda där distriktssköterskors upplevelser inom primärvården av att möta patienter utanför arbetstid studerats. Framför allt finns det få studier som beskriver distriktssköterskors erfarenhet att arbeta och leva i mindre samhällen. Många patienter har kontinuerlig kontakt med hälsocentraler och träffar ofta samma sjuksköterskor. För distriktssköterskor som arbetar i tätortsnära landsbygd är det lättare att etablera kontakt med patienter utanför arbetstid.

    Syfte: Syftet med denna studie var att beskriva distriktssköterskors upplevelse av att bo nära och möta patienter utanför arbetstid i tätortsnära landsbygd inom Västerbottens län.

    Metod: Genom semistrukturerade intervjuer samlades data in från distriktssköterskor inom primärvården. Data analyserades med en kvalitativ innehållsanalys.

    Resultat: I studien deltog 7 kvinnliga distriktssköterskor. Resultatet av studien resulterade i 4 kategorier som bland annat beskriver distriktssköterskornas upplevda kontakt med patienter utanför arbetstid som påfrestande.

    Slutsats: Resultatet visar på att de flesta distriktssköterskor upplever patientkontakt utanför arbetstid som påfrestande. Studien kan bidra till en förbättrad patientsäker omvårdnad då resultatet åskådliggör distriktssköterskors upplevelse av att bo och arbeta på en tätortsnära landsbygd. Eventuella brister och komplikationer inom vården kan då diskuteras och åtgärdas. Fler studier inom området behövs för djupare kunskap och vidare handläggning av eventuella problematiska situationer som distriktssköterskan inom primärvården ställs inför relaterat till möten med patienter utanför arbetstid.

  • 83.
    Appelgren, Cornelia
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Karlsson, Daniel
    Umeå University, Faculty of Medicine, Department of Nursing.
    Mitt liv, ditt liv: Patienters upplevelse av att leva med ett donerat organ2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Patients with life threatening organ failure are offered organ transplantation when other curating treatment no longer is an option. Approximately 700 organ transplantations are done yearly in Sweden. An organ transplantation affects the recipient's physical and psychological health. The objective of the organ transplant is to increase the recipient's quality of life and to prolong their life.

    Aim: The aim of the study was to illuminate patients experiences of living with a donated organ.

    Method: A literature review with nine qualitative studies have been quality reviewed, analysed and summarized.

    Result: Patients who have undergone an organ transplant experiences the transplantation as a process that increases their quality of life but at the same time brings a lot of mixed feelings and consequences on their everyday life. The results were divided into three categories: a second chance, a cataclysmic experience and to handle life after the transplant. They perceived that the organ transplant had an effect on their self-image, gave them a new perspective of life and death and gave them a sense of responsibility of their new organ. The importance of support from the surroundings was also described. Finally, the organ transplant implied a need to make adjustments in the everyday life and the need to use different strategies to cope with these consequences and adjustments.

    Conclusion: Patients who have undergone an organ transplant views the transplantation as a cataclysmic experience that changes their life for ever. Health care staff should consider the fact that an organ transplant affects the recipient physically as well as psychologically and therefore consider the need of physical as well as psychological after care.

  • 84.
    Appelvik Tängdén, Linnea
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hedberg, David
    Anestesisjuksköterskors upplevelser av arbetsrelaterad stress: - en kvalitativ intervjustudie2018Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Abstract

    Background: Among occupational groups exposed to severe stress in Sweden, and in the world, are nurses and doctors in one of the highest groups. Stress can lead to secondary diseases which means considerable suffering for those who are affected. However, there was sparse research done in Sweden aboute nurses anesthetist experience of work-related stress.

    Purpose: To investigate how nurses anesthetist experience work-related stress, the consequences it has for their well-being and how they handle work-related stress.

    Design: A qualitative interview study with inductive approach.

    Method: During autumn 2017 semi-structured interviews were held with eight anesthetic nurses in a hospital in northern Sweden. A qualitative content analysis was conducted. The content analysis resulted in three categories and eleven subcategories.

    Result: Individual and structural stress at work describes the feeling of not having control and experience of demands and expectations - both at individual and structural levels. Special situations such as when children were involved or life-threatening situations with patients, felt extra stressful. In Emotional and bodily influences of stress in the individual as well as the impact in working situations the negative consequences of stress were mentioned, such as fear, sadness, frustration, headache, fatigue and blockages. The stress could also bring positive consequences as efficiency and focus in working situations. In the third category Managing stress through own strategies, resources and support of others describes how stress was managed by gaining control in working situatuions and that both support from colleagues and work experience could reduce stress.

    Conclusions: The results shows that in spite of the occurrence of stress, the stress itself was not always perceived as negative, provided the existence of a manageable and controlled workload. However, organizational factors such as demands for production and high workload led to negative stress. Future research is proposed with both more participants and several hospitals. 

  • 85.
    Arciniegas, Sara
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Frech, Malin
    Umeå University, Faculty of Medicine, Department of Nursing.
    Ensam är inte stark: En litteraturstudie om äldres upplevelser av ensamhet2016Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Titel: Ensam är inte stark – en litteraturstudie om äldres upplevelser av ensamhet

    Bakgrund: Forskning visar på att ensamhet påverkar hälsan både psykiskt och somatiskt. Vi människor behöver gemenskap med andra. Äldre personer är en utsatt grupp med ökad risk att drabbas av ensamhet. Ensamhet är en av anledningarna till äldres suicidförsök och kan öka risken för demens, depression och högt blodtryck.

    Syfte: Att undersöka hur äldre personer upplever ensamhet.

    Metod: Sökningar i 3 olika databaser gjordes. Efter urval utifrån inklusions- och exklusionskriterier samt kvalitetsgranskning valdes 9 kvalitativa studier ut som svarade på syftet. Studiernas resultat analyserades och sammanställdes.

    Resultat: Äldre personer upplever ensamhet som något negativt. Ensamheten upplevdes som ett hinder och var svår att ta sig ur. De äldre kände att ensamheten var en hopplös och maktlös situation. Ensamheten ledde till att de äldre kände att livet tappat sin mening. Ensamheten var även en stigmatiserad känsla som inte gärna pratades om.

    Konklusion: Ensamhet är något som påverkar äldre personers hälsa på flera olika plan. Äldre upplever att ensamhet är något icke önskvärt. Sjuksköterskan skulle kunna ha en nyckelroll i att upptäcka och uppmärksamma äldre personer som lever i ensamhet samt förhindra ohälsa på grund av ensamhet. Fler interventionsstudier krävs för att minska ensamhet hos gruppen äldre.

    Nyckelord: ensamhet, äldre, upplevelser

  • 86. Arestedt, Kristofer
    et al.
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Umeå University, Faculty of Medicine, Department of Nursing.
    Johansson, Peter
    Blomqvist, Kerstin
    Social support and its association with health-related quality of life among older patients with chronic heart failure2013In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 12, no 1, p. 69-77Article in journal (Refereed)
    Abstract [en]

    Background: Social support is generally known to influence health-related quality of life (HRQoL), but this association is not well explored among older patients with chronic heart failure. Aims: (1) To describe social support in older patients with chronic heart failure in relation to gender. (2) To investigate if age, gender, cohabitation, perceived financial situation, and disease severity are associated with social support. (3) To investigate if social support is associated with HRQoL after controlling for age, gender, and disease severity. Methods: Data were collected in a sample of 349 patients (>= 65 years) with chronic heart failure. Patients' HRQoL was measured with the Minnesota Living with Heart Failure Questionnaire and the Short Form-12 Health Survey Questionnaire. The Interview Schedule for Social Interaction measured social support. Data were analysed with descriptive statistics, repeated-measure ANOVA, and multiple linear regression analyses with robust standard errors. Results: Social support was generally rated high, although being a man, living alone, perceiving a problematic financial situation, and high disease severity (NYHA) were associated with lower levels of social support. Age was not associated with social support. Social support was generally associated with HRQoL, in particular the emotional dimensions. Conclusion: Taking social support into account when caring for older patients with heart failure can be of importance for improving or maintaining HRQoL.

  • 87.
    Armelius, Bengt-Åke
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Sundbom, Elisabet
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Fransson, Per
    Umeå University, Faculty of Medicine, Department of Nursing.
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Personality organization defined by DMT and the structural interview1990In: Scandinavian Journal of Psychology, ISSN 0036-5564, E-ISSN 1467-9450, Vol. 31, no 2, p. 81-8Article in journal (Refereed)
    Abstract [en]

    The psychoanalytic concept of Personality Organization (PO) may be operationalized by means of a Structural Interview as well as by means of psychological tests. The present study utilized the Structural Interview and a projective test called the Defence Mechanism Test (DMT) to operationalize the PO concept on a sample of 50 psychiatric inpatients. The reliability of the PO judgements were found to be acceptable for both the Structural Interview and the DMT. The validity, which was estimated as the correlation between the two methods, was also found to be substantial. The conclusion is that the concept of PO may be reliably operationalized for psychiatric patients and seems to have concurrent validity. Both the DMT and the Structural Interview may be used for differential diagnosis of PO.

  • 88.
    Arnesson, Annelie
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hedlund, Nina
    Umeå University, Faculty of Medicine, Department of Nursing.
    Upplevelsen av arbetsmiljö i öppna kontor inom IT-sektorn: - En kvalitativ intervjustudie2015Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Aim:

    The aim of the study was to describe the experience of working environment in open plan office within IT- sector.

    Background:

    Previously was the most common office model cell office, open plan office is now the most common. A good working environment in theise two office types needs different attributes. A theory to explain relationship between health and unhealth is Karasek and Theorells demand- control- supportmodel.

    Method:

    A qualitative interview study was performed to gain a deeper understanding of the experience of working in open plan office within IT- sector. Ten informants from two different organizations were chosen. The result has been analyzed with qualitative content analysis.

    Results:

    The analyses resulted in three themes and six sub-themes. The result showed that there were both positive and negative aspects of working environment in open plan office. Positive aspect was mentioned as good communication and good social interaction while high sound level and disturbing working situation was mentioned as negative aspects.

    Conclusion:

    The result shows that there is many aspects to take in consideration white work in open plan office. To have a good working environment there is need to have a deeper understanding from the organization how the open plan office affect the individual.

  • 89.
    Arnkvist, Pernilla
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Dan, Hammarström
    Umeå University, Faculty of Medicine, Department of Nursing.
    PATIENTERS UPPLEVELSER AV HÄLSOFRÄMJANDE SAMTAL INOM RAMEN FÖR VÄSTERBOTTENS HÄLSOUNDERSÖKNINGAR2017Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: There are guidelines both globally and nationally to enhance public health. There is currently an ongoing project for enhancing the public health in Västerbotten county called VIP, Västerbotten Intervention Program, where motivational interviewing (MI) has a role to support health enhancing lifestyle-changes. Primary health care nurses are responsible for these health examinations and related health counselling. Caregivers, though are reported to experience difficulties in counselling and use of methods like motivational interviewing because of lack of preconditions for implementation. Health counselling has a potential to enhance patient empowerment and help people to achieve positive lifestyle changes.The purpose of this study was to describe the patient's experiences of health promoting counselling within the Västerbotten Intervention Program.Design: The design of the study was descriptive.Method: Qualitative method. Data was collected during september 2017 using semi-structured interviews analyzed with qualitative content analysis. The target group of this study was people in age 40, 50 and 60 years who had participated in health examinations within VIP the last year. In total, nine persons participated of whom 3 were men.Results: The participants experience from the health examination were described in the two themes: The interaction of the health promoting dialogue were based on closeness as well as distance, and the health promoting counselling created awareness about personal responsibility and need of support.Conclusion: Health promotive counselling seem to have a positive impact on the patient’s health, however it imposes a challenge for both health professionals and the organization, due to the possible need of further education in health dialogue methods that encourage the patient’s empowerment and motivation to change.

  • 90.
    Aronsson, Elin
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Persson, Sandra
    Umeå University, Faculty of Medicine, Department of Nursing.
    Äldre kvinnors upplevelser och erfarenheter av att utsättas för våld i nära relation: En litteraturstudie2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Violence against women is a global health problem and the older battered women needs to be more noticed. There are major deficits in the way health care treats this group. More knowledge and understanding are required.Aim: To describe older women’s experiences of being victims of domestic violence.Method: A literature study with eight qualitative articles that were analyzed with qualitative content analysis.Result: Results showed that the experience of insecurity was felt through fear, anxiety, worry, guilt, shame and sexual exposedness. The experience of vulnerability was described through fragility and a loss of self-worth and self-power. The experience of living up to expectations lead to a loss of the own self, but also an inner strength. The experience of living in silence was expressed as an inner pain, a lifelong suffering, alienation and invisibility.Conclusion: Older battered women are suffering and it needs to be acknowledged as a social problem. Future research about how health professionals are using and following resources is needed, but also about why people use violence. The government needs to act and the health care needs concrete acts to provide adequate help

  • 91. Arouca, Aline B
    et al.
    Santaliestra-Pasías, Alba M
    Moreno, Luis A
    Marcos, Ascensión
    Widhalm, Kurt
    Molnár, Dénes
    Manios, Yannis
    Gottrand, Frederic
    Kafatos, Anthony
    Kersting, Mathilde
    Sjöström, Michael
    Sáinz, Ángel Gutiérrez
    Ferrari, Marika
    Huybrechts, Inge
    González-Gross, Marcela
    Forsner, Maria
    Umeå University, Faculty of Medicine, Department of Nursing. Högskolan Dalarna.
    De Henauw, Stefaan
    Michels, Nathalie
    Diet as a moderator in the association of sedentary behaviors with inflammatory biomarkers among adolescents in the HELENA study.2018In: European Journal of Nutrition, ISSN 1436-6207, E-ISSN 1436-6215Article in journal (Refereed)
    Abstract [en]

    AIM: To assess if a healthy diet might attenuate the positive sedentary-inflammation relation, whereas an unhealthy diet may increase the effect of sedentary behaviors on inflammatory biomarkers.

    METHODS: In 618 adolescents (13-17 years) of the European HELENA study, data were available on body composition, a set of inflammation markers, and food intake assessed by a self-administered computerized 24 h dietary recall for 2 days. A 9-point Mediterranean diet score and an antioxidant-rich diet z-score were used as dietary indices and tested as moderators. A set of low-grade inflammatory characteristics was used as outcome: several cytokines in an inflammatory ratio (IL-6, IL-10, TNF-α, TGFβ-1), C-reactive protein, three cell-adhesion molecules (sVCAM-1, sICAM-1, sE-selectin), three cardiovascular risk markers (GGT, ALT, homocysteine) and three immune cell types (white blood cells, lymphocytes, CD3). Sedentary behaviors were self-reported and analyzed as total screen time. Multiple linear regression analyses tested moderation by diet in the sedentary behaviors-inflammation association adjusted for age, sex, country, adiposity (sum of six skinfolds), parental education, and socio-economic status.

    RESULTS: Both diet scores, Mediterranean and antioxidant-rich diet, were significant protective moderators in the effect of sedentary behaviors on alanine-transaminase enzyme (P = 0.014; P = 0.027), and on the pro/anti-inflammatory cytokine ratio (P = 0.001; P = 0.004), but not on other inflammatory parameters.

    CONCLUSION: A higher adherence to the Mediterranean diet or an antioxidant-rich diet may attenuate the onset of oxidative stress signs associated by sedentary behaviors, whereas a poor diet seems to increase inflammation.

  • 92.
    Arvidsson Kälverot, Sarah
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lindgren, Sanna
    Umeå University, Faculty of Medicine, Department of Nursing.
    Reducering av stråldos vid angiografier och endovaskulära interventioner: En litteraturstudie om metoder för ökad strålsäkerhet2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Reducering av stråldos vid angiografier och endovaskulära interventioner-En litteraturstudie om metoder för ökad strålsäkerhet

    Bakgrund: Angiografier och endovaskulära interventioner är patientgynnande undersökningar och behandlingar som till skillnad från kirurgi innebär mindre risk för komplikationer samt en kortare läkningstid. Längre genomlysningstid och ökat antal exponeringar medför dock en högre risk för oönskade strålskador hos patienten.

    Syfte: Litteraturstudiens syfte var att beskriva metoder för att reducera stråldosen till patienter som genomgår angiografier samt endovaskulära interventioner.

    Metod: Syftet besvarades i en litteraturstudie. 10 kvantitativa studier analyserades och sammanställdes. Sökning av studier genomfördes i databasen Pubmed.

    Resultat: Materialet bearbetades samt delades in i två domäner: metoder gällande personalen samt metoder gällande utrustningen. Resultaten som innefattade stråldosreducerande metoder presenterades som kategorier.

    Konklusion: Att ha uppdaterad och utbildad personal resulterar i miljö med högre patientsäkerhet. I takt med att teknologin utvecklas bör verksamheten se över sina behov och prioritera fortsatt utbildning av personal samt investera i anpassad utrustning. Fortlöpande forskning är viktig för att utvärdera effekter av den nya teknologin och röntgensjuksköterskor kan bidra med kompetens inom området.

    Nyckelord: Angiografi, Endovaskulär intervention, Strålskydd, Patientsäkerhet.

  • 93.
    Asp, Christin
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Öhman, Mona
    Umeå University, Faculty of Medicine, Department of Nursing.
    Barnmorskestudenters upplevelse av förberedelse, stöd och handledning: gällande verksamhetsförlagd utbildning2017Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    AbstractObjective: To study the student midwife’s experiences of preparation for clinical practice, and of support and supervision during the clinical practice at the delivery ward.Method: A descriptive cross-sectional study with quantitative and qualitative approach was performed. Data was collected through 171 questionnaires. The results were analyzed by descriptive and comparative statistics where the significance level was set to p < 0.05. Qualitative data was analyzed by manifest content analysis. As a theoretical framework, the “International Code of Ethics for Midwives” was used.Participants: Active students in their third semester at midwifery education (n = 80), and midwives with a degree in June 2016 or January 2017 (n = 91), across all universities in Sweden.Findings: The respondents in the study indicated that midwifery education is too short and intensive. Continuity regarding preceptor was found to be important for the students, but difficult to accommodate in the delivery ward. Active students were compared to newly-examined midwives more often supervised by temporary staff (p < 0.05). Generally, the respondents wished for more clinical practice, both of acute and non-acute conditions that may occur in the delivery ward. In addition, they desired more time for reflection, in groups or individually with preceptors, to process emotions and consolidate their skills.Conclusion: To provide a safe learning environment for the student where he/she is allowed to step up and develop the opportunity to excel in midwifery, experienced preceptors are required to convey knowledge and values, as well as provide support to the student during the demanding education. The student needs regular time allocated for reflection, in groups or individually with supervisors, to process emotions and consolidate their knowledge. The lack of experienced midwives is thought to be one reason that students are more widely assigned to temporary preceptors now in comparison to the last year.Clinical Implications: This study may give an indication of the coping of midwife students during the education at the delivery ward. Many students wish for extended education, which is also discussed by the national federation of midwives, the institutions of higher education and the education board

  • 94.
    Aspevall, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Molin, Anna
    Umeå University, Faculty of Medicine, Department of Nursing.
    En kvalitativ studie som undersöker arbetande personers uppfattningar och erfarenheter om sjuknärvaro på arbetet2013Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Introduktion: Sjuknärvaro innebär att gå till jobbet trots sjukdom. Sjuknärvaro är ett förekommande problem, även internationellt. Det finns många faktorer som bidrar till sjuknärvaro,som individuella egenskaper och arbetsplatsfaktorer. Sjuknärvaro bidrar till högre sjukfrånvaro och ohälsa hos arbetstagare. Sverige och Norge har starka sociala skyddssystem vid sjukdom. I Sverige finns karensdag vid sjukfrånvaro.

    Syfte: Att undersöka arbetande personers uppfattningar och erfarenheter om sjuknärvaro på arbetet.

    Metod: Totalt 12 kvalitativa intervjuer har genomförts i Sverige och Norge. Hälften av deltagarna är kvinnor och hälften är män med olika yrken. Informanterna har valts ut genom bekvämlighetsurval. Kvalitativ innehållsanalys har använts vid analys av textmaterialet.

    Resultat: Hälsa och sjukdom är subjektiva begrepp och människor har olika tröskel för bedömning av sjukdom. Individens egna känslor och personlighet är drivkrafter till sjuknärvaro. Många ägnar sig åt självrannsakan före en sjukskrivning.Sjuknärvaro kan medföra risker för kollegor och för arbetsplatsen. Sjukfrånvaro anses få konsekvenser för andra människor och även för individen själv, vilket bidrar till sjuknärvaro.Yrke och arbetsuppgifter har betydelse för sjuknärvaro. Fysisk och psykosocial arbetsmiljö och arbetsplatskultur är också faktorer som spelar in. Samhällsfaktorer som bidrar till sjuknärvaro är samhällsklimatet, ekonomiska faktorer och brister i sjukförsäkringssystemet.

    Diskussion:Sjuknärvaro är ett problem i samhället som inte bara påverkar individen utan hela arbetsgruppen,arbetsplatsen som organisation och samhället i stort. Det finns många anledningar till att människor går sjuka till jobbet. Forskning behövs för att komma till rätta med detta problem.Forskning behövs också för att internationellt sett stärka arbetstagares rättigheter och villkor,arbetsgivarens skyldigheter och samhällets ansvar.

  • 95.
    Aspioti Delija, Alexandra
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hur upplever sjuksköterskor som arbetar på en häloscentral mötet med ambulanspersonal?2018Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Nurses in healthcare clinics often meet patients that has searched care from the wrong care level and therefor need to be transported with ambulance to the nearest hospital.

    Motive: For the patient to achieve good care and for a high safety of the patient, it is important that all parts of the care-chain function and that the handover process is of good quality.

    Aim: The aim of this study was to elaborate how nurses from health care clinics experience the encounter with ambulance staff in connection to the handover of the patient.

    Method: The study used a qualitative research design with an inductive approach. Data was collected through semi-structured interviews. Eight nurses working in healthcare clinics in Norrbotten was interviewed during March and April 2018. The criteria for participating in the study was a minimum of one-year work experience in a healthcare clinic and that they had participated in encounters with ambulance staff. The interviews were transcribed verbatim and analyzed with a qualitative content analysis.

    Result: The result was presented in three main categories: Difficulties in understanding each others competence; To have control over the situation, and To encounter conversation. The nurses experienced that the ambulance staff is very competent but that they often felt being a lower rank insecure in their presence. They experienced that they often were challenged and that their judgement tocontact the ambulance was wrong. There were some positive experiences when the encounter went smooth, and the nurses had enough time to prepare the patient for departure before the ambulance staff arrived.

    Discussion: To feel insecure at work can lead to a worsened work environment and may affect patient safety. To strive for a safe patient care should be the goal for both professions. Earlier experiences matters in how the encounters with ambulance staff could go. Good teamwork and respect for one another’s competence matters. A structured reporting procedure is a key-component for not loosing important information. Every encounter is unique and require communication ability and flexibility.

    Conclusion: The understanding of each other’s competence needs to improve. More studies, highlighting the experiences from different perspectives may increase the understanding. Inviting to encounters between the two departments may contribute to a better understanding and a better teamwork.

  • 96.
    Asplund, Kenneth
    Umeå University, Faculty of Medicine, Department of Nursing.
    The experience of meaning in the care of patients in the terminal stage of dementia of the Alzheimer type: interpretation of non-verbal communication and ethical demands1991Doctoral thesis, comprehensive summary (Other academic)
  • 97.
    Astergren, Lina
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Winter, Emelie
    Umeå University, Faculty of Medicine, Department of Nursing.
    Intensivvårdssjuksköterskors erfarenheter av att vårda patienter under Extracorporeal Membran Oxygenering (ECMO) behandling2016Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Syfte: Att undersöka intensivvårdssjuksköterskors erfarenheter av att vårda patienter under Extracorporeal Membran Oxygenering (ECMO) behandling.

    Bakgrund: Intensivvårdssjuksköterskor har som arbetsuppgift att ta hand om kritiskt sjuka patienter. Patienter som har behov av ECMO behandling har ökat och används när ingen annan behandling har visat sig fungera. ECMO är en komplex behandling och ställer höga krav på intensivvårdssjuksköterskor. Det krävs specifika kunskaper och förmågor att handha avancerad apparatur, planera, prioritera och samarbeta runt patienten.

    Design: En kvalitativ intervjustudie.

    Metod: Kvalitativa intervjuer med semistrukturerade frågor genomfördes med nio intensivvårdssjuksköterskor på en intensivvårdsavdelning i Sverige 2016. Intervjuerna analyserades genom kvalitativ innehållsanalys.

    Resultat: Det analyserade materialet resulterade i två kategorier: omständigheter i arbetet för en otrygg och riskfylld vård, förutsättningar i arbetet för en trygg och säker vård. De två  kategorierna resulterade i sju subkategorier.

    Konklusion: Intensivvårdssjuksköterskors erfarenhet av att vårda patienter med ECMO är att det är en utmanande, krävande och komplex patientgrupp att vårda. Intensivvårdssjuksköterskorna önskar kontinuerlig utbildning och större patientflöde för att minska otryggheten och få en fördjupad kunskap av patientkategorin.

     

  • 98.
    Atri, Arash
    Umeå University, Faculty of Medicine, Department of Nursing.
    Kommunikationsstrategier mellan vårdare och patienter utifrån ett mångkulturellt perspektiv2014Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Den ökade immigrationen till Sverige under senaste decennier har inneburit en ökning av antalet patienter med invandrarbakgrund som söker vård. Detta betyder att röntgensjuksköterskor oftare kommer att träffa patienter med utländsk härkomst. Kommunikation är en röntgensjuksköterskas viktigaste verktyg och utgör grunden till alla mänskliga möten. Det kan bli problematiskt när patienten inte behärskar svenska språket och ska kommunicera med vårdare. Detta ställer krav på röntgensjuksköterskor att hitta lämpliga strategier för att kunna kommunicera med patienten på bästa möjliga sätt. Syfte: Syftet med litteraturstudien var att belysa vårdarens strategier vid kommunikation med personer av utländsk härkomst som inte behärskar det svenska språket. Metod: Metoden var litteraturstudium med kvalitativ ansats, sökningen på artiklarna har gjorts i databaserna CINAHL och PubMed och litteraturstudien baseras på åtta vetenskapliga artiklar som har analyserats med innehållsanalys. Resultat: Analysen resulterade i två kategorier och fem subkategorier. Kategorierna var tolk och icke-verbal kommunikation. Slutsats: Röntgensjuksköterskor har ett ansvar att erbjuda jämlik vård på lika villkor till alla. Därför ska de använda olika strategier för att kunna kommunicera med patienter som inte talar samma språk. Resultatet visade att professionell tolk var den bästa och säkraste metoden för kommunikation med sådana patienter. Därför finns det ett behov av utbildning för röntgensjuksköterskor angående tolkbokning. Dessutom finns det ett behov av tydliga rutiner för att förbättra tolktjänstsystemet när professionella tolkar användas i möten med patienter som inte behärskar språket.

  • 99. Audulv, Åsa
    et al.
    Norbergh, Karl-Gustaf
    Asplund, Kenneth
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    An ongoing process of inner negotiation: a grounded theory study of self-management among people living with chronic illness2009In: Journal of nursing and healthcare of chronic illness, Vol. 1, no 4, p. 283-293Article in journal (Refereed)
    Abstract [en]

    Aim. The aim of this study was to better understand the main concern of self-management processes among people with chronic illness.

    Background. One aspect of living with chronic illness is self-management that can reduce the illness impact on daily life and promote future health. Although factors that influence self-management have been identified in previous research, little attention has been brought to the process of making self-management decisions. In clinical settings, use of a theory could facilitate patient-empowering approaches.

    Method. The data collection for this Grounded Theory was mostly conducted in 2006. Data were collected by interviews with 26 adults with a variety of chronic illnesses, including rheumatoid arthritis, diabetes mellitus, inflammatory bowel syndrome, multiple sclerosis, ischaemic heart disease and chronic kidney failure.

    Results. Individuals are conflicted by competing preferences when taking decisions about self-management. Consequently, the decision-making process can be understood as an ongoing inner negotiation between different incompatible perspectives, e.g. social needs vs. medical needs. The process of negotiating self-management starts with the individual's considering beliefs about health and illness, which make the individual face illness threats and the need for self-management. Several aspects influence negotiating self-management namely, assessing effects of self-management; evaluating own capacity; perceiving normality or stigmatisation; and experiencing support and external resources. The process has been demonstrated in a model.

    Conclusions. The process of negotiating self-management is an ongoing inner debate rather than a one-time decision. This opens up new ways of understanding, and communicating with, patients. The described model also links behavioural theories and research findings in a comprehensive understanding.

    Relevance to clinical practice. This model could be applicable as a communication tool for health-care providers in identifying barriers to, and resources in, self-management behaviour among individuals with chronic illness.

  • 100.
    Aurö, Aurora
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Stenman, Lina
    Umeå University, Faculty of Medicine, Department of Nursing.
    Att anmäla till socialtjänsten vid misstanke om att ett barn far illa: En svår uppgift för sjuksköterskor2015Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Omvårdnad är en viktig del i sjuksköterskans arbete och enligt svensk lag har barn rätt till god omvårdnad och trygghet. Hälso- och sjukvårdspersonal har skyldig­het att omedelbart anmäla till socialtjänsten när de i sin verksamhet får kännedom om eller misstänker att ett barn far illa. Det finns många oklarheter när det gäller sjuksköterskors kunskap, vilja att anmäla och hantering av anmälningar. 

    Syfte: Syftet med studien var att beskriva sjuksköterskors upplevelser av barn som far illa och att anmäla detta till socialtjänsten. 

    Design: Studien genomfördes med en kvalitativ metod. 

    Metod: Studien genomfördes på två pediatriska avdelningar i norra Sverige. Materi­alet samlades in vid 10 intervjuer, och analyserades med induktiv innehållsanalys. Stu­dien utfördes under våren 2015. 

    Resultat: Tre teman och åtta subteman identifierades: (1) Att ta sig an en svår uppgift: Mod att anmäla, Svårt att identifiera barn som far illa, Rädsla för att ha anmält i onödan, Osäkerhet på grund av kunskapsbrist, (2) Att arbeta med kollegor och familjer: Vikten av stöd från kollegor, Vikten av att bevara en god relation till familjen, (3) Att ha bristande förtroende för socialtjänsten: Känslan av att anmälan inte tas på allvar, Samarbete med socialtjänsten. 

    Slutsats: Att anmäla till socialtjänsten om att ett barn far illa är en svår uppgift som präglas av osäkerhet, vilket kan leda till att anmälan uteblir. Det är många faktorer som påverkar sjuksköterskan, kunskapsbrist, dåligt förtroende för socialtjänsten, en önskan om att bevara en god relation med familjen och samarbetet med kollegor.

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