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  • 1.
    Alderman Andersson, Yvonne
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Avstå eller avbryta livsuppehållande behandling - Intensivvårdssjuksköterskans delaktighet i beslutsprocessen2009Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
  • 2.
    Alftberg, Helene
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Vårdpreventivt arbetssätt för att förhindra undernäring hos äldre – Intervjuer med vårdpersonal inom tre vårdnivåer2009Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    The purpose was to describe nursing staffs’ perceptions of risks for malnutrition and preventive efforts thereof, for patients 70 years and older, at different care levels within one municipality. Descriptive design was used and twelve participants included; two district nurses, one physiotherapist and one occupational therapist from a health care centre, two registered nurses, one unit director and one physiotherapist from a nursing home in the municipality and four registered nurses from an internal medicine hospital ward. Interviews and qualitative content analysis was used resulting in four categories Conditions of risks for malnutrition, Ensuring nutritional intake, Structured way to work and Collaboration and responsibilities. The participants’ described diseases, disabilities and lost of apprehension concerning weight constituting malnutrition risks. Meals and meal environment influence nutritional intake. Risk assessments, interventions and evaluations mirrored structured way of working. Collaboration with colleagues, other professionals and care levels were highlighted together with responsibilities. Physicians’ participation in malnutrition preventions needs clarification. Improvements like documentation of the nutritional status among the elderly and reports between the different levels of care are needed to ensure safe nutritional care.

     

  • 3.
    Areteg, Marcus
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Utvärdering av postoperativ noninvasiv ventilationmed Bi-level Positive Airway Pressure av obesapatienter som genomgår elektiv gastric bypasskirurgi2009Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Obese patients have a higher risk for respiratory complications after general anesthesia related toreduced vital capacity (VC), functional residual capacity (FRC) and total lung capacity (TLC).Earlier studies have shown that postoperative treatment with Bi-level Positive Airway Pressureimproved forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1.0) andsaturation (SpO2) after elective gastric bypass surgery. Present study evaluates whether or not thesame postoperative treatment also shows differences in arterial blood gases, if compared with usualpostoperative treatment with nasal administered oxygen. A second aim was to describe how patientsexperienced the BIPAP treatment. Arterial blood gases from 18 patients were analyzed withanalytical statistics. The study showed that postoperative treatment whit BIPAP during 3 hoursresults in higher SpO2 and lower paCO2 than traditional postoperative treatment after electivegastric bypass surgery. Both treatments results in lower paO2 and unchanged pH. Several patientsexperienced discomfort during the BIPAP treatment.

  • 4.
    Asplin, Margret
    et al.
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Brink, Jenny
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Sjuksköterskors och läkares förhållningssätt till basala hygienrutiner inom slutenvård och primärvård2009Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    The aim of this study was to describe and compare nurses, district nurses and physicians approach to the hygiene guidelines. The data collection was conducted with a questionnaire within four hospital units and nine primary care units in a Swedish county during spring and early summer of 2009. A total of 186 healthcare workers returned the questionnaire, 86 from hospital units and 100 from primary care units. The main result of the study shows that the healthcare workers from both hospital and primary care didn´t estimate all, by the authors chosen, routines equally. A significant difference found between the units was that hospital personnel estimated the importance of not to wear private clothes during work higher than personnel from primary care. Also, they more rarely departed from the routines regarding to disinfect their hands after physical contact, not to wear jewelry or a watch on their hands or arms and not to wear private clothes during work hours. Nurses/district nurses from hospital and primary care units estimated the importance of following the guidelines to be higher than the physicians did from both units. They also estimated higher on the majority of the moments regarding compliance. This study shows the need of continued studies within this subject because of the lack of studies regarding healthcare workers approach to the guidelines and what effect it can have on improving compliance.

  • 5.
    Azar , Jonny
    et al.
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Snickars, Sophie
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Hur ungdomar med cancer hanterar sin sjukdom och vad de har för livskvalitet: en litteraturstudie2009Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    The aim of this literature study was to investigate how adolescents with cancer cope with there disease and how it effect their quality of life (QoL). This study was a descriptive literature study were the authors searched for scientific articles in the databases Medline, Cinahl, SweMed+ and PsykInfo. The result is based on fifteen articles. The result showed that social support such as parents and a special friend is important for the adolescents' well-being. The adolescents also described that it felt god to have someone to talk to that was in the same situation. A positive attitude and humour helped the adolescents to cope with their disease. One way to escape from the disease was trying to feel normal, a way of doing that was to wear accessories, modern clothes and pushing their limits. The adolescents spent a lot of time in the hospitals thus made them isolated, which resulted in alienation. Changed body image, fear and alienation are all factors that influence on the adolescents QoL. It was showed that adolescents with cancer had lower QoL than healthy adolescents, but as time pass by their QoL increased. In general the girls hade better QoL than the boys.

  • 6.
    Backlund, Helena
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Distriktssköterskans dokumentation av kroniska bensår i omvårdnadsjournalen2009Student thesis
  • 7.
    Baumeister, Per
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Patienters upplevelse av att ha en PICC-line kateter: En intervjustudie2009Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    The purpose of this study was to describe how persons with PICC-line catheter feel and how the patient's daily life is affected. The study had a descriptive design and ten persons from central Sweden participated in the study. Data were collected through semi-structured interviews and analyzed according to qualitative content analysis. The findings that emerged from the study were reported according to categories; Management of PICC-line catheter, Positive experiences of PICC- line catheter, Experienced problems, Normal living and Restritions of the daily life. Categories emerged from fifteen sub-categories. What emerged in the study was that participants felt that they accepted their situation after a short time and that they mostly could live normally without being affected by the PICC line catheter. The participants felt the requirements for a PICC-line catheter as restrictive in their daily lives, were the opportunity of using the sauna and go swimming, because the PICC-line catheter could get wet. The participants experienced anxiety in relation to district nurses bandaging of PICC-line catheter when the district nurses did not apply the same bandaging routine. If district nurses were to seek common guidelines and behaved in a similar manner to the patient associated with rescheduling, patients would be able to feel a greater security with his PICC-line catheter.

  • 8.
    Bellander, Lisa
    et al.
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Gunnarsson, Cajsa
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Vårdpersonals uppfattning av stöd gentemot syskon till svårt sjuka barn2009Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    The purpose of the study was to describe how health professionals estimate the usefulness of support and in what frequency they use the support towards siblings of seriously ill children. The aim was also to examine differences between nurses and assistant nurses regarding the estimated usefulness and frequency of use of support for siblings of severely ill children.

    The study was descriptive and comparative. A convenience sample was used. The data collection was done using a questionnaire that was distributed to 94 people in three care units and open care units in a mid-swedish region. Fifty-five respondents answered the survey and 53 of those met the inclusion criteria and were included in the study. The study group consisted of nurses and assistant nurses, all women. The questionnaire was a, into Swedish translated version of the instrument Sibling Social Support Questionnaire. The participants assessed the "usefulness" and "frequency" of support within 30 claims. These areas touched emotional-, instrumental-, informational-, and appraisal support. The main results showed that the area "Appraisal support" was considered most useful and also used most frequently. The results also showed a statistically significant difference between professional categories (p = 0.03). The nurses used the support area "Appraisal support" more frequently (mean rank 29.88) than the assistant nurses (mean rank 20.63).

  • 9.
    Berglund, Camilla
    et al.
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Löfvenberg, Latifa
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Upplevd livskvalitet hos patienter med cancer i den palliativa vården utifrån fysiskt, psykiskt och socialt perspektiv: en litteraturstudie2009Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    The purpose of this study was to describe the quality of life from a physical, mental and social perspective that cancer patients in the palliative phase experience. The search of the articles which were utilized in the study was made in different databases such as Medline (via pubmed), Science Direct and Academic Search Elite. The searches were made with simple key words or in combination with each other. Limits for the searches were put to the Swedish or English language, articles published between 2000 -2008, adult patients as well as a free acquisition through the database in full-text. In total, 17 articles were scrutinized, analyzed and then compiled under different perspectives: Physical, mental, and social. The result showed that the experience of the quality of life occurs through lack of pain. Pain is the most common physical symptom experienced by cancer patients at the palliative phase. Anguish and depression are the physical symptoms that are strongly related to deterioration in the quality of life that the patients experience through the whole palliative phase. One could even notice that good communication and dialogue between nurses and doctors in charge were highly appreciated by the patients. The palliative phase with regard to cancer patients was characterized by the fact that the social network with their families and relatives was profoundly intensified, which was an important part in order to be able to bid them farewell.

     

     

    Keywords:  Palliative Care, Patient Satisfaction, Quality of life, Terminally Ill, Terminal Care.

  • 10.
    Bergström, Annelie
    et al.
    University of Gävle, Department of Caring Sciences and Sociology. University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Algotsson, Martina
    University of Gävle, Department of Caring Sciences and Sociology. University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Influens på självuppskattad sjuksköterskekompetens inom psykiatrisk vård2009Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
  • 11.
    Billmark Elfstrand, Kristina
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Patientutbildning för personer med typ 2 diabetes. En kartläggning inom primärvården i Sverige2009Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Patient education is an important part of the treatment in type 2 diabetes. Today there is no collected survey of patient education. The aim of the study was to survey how patient education for persons with type 2 diabetes was carried out within the primary care in Sweden and study if there was some relation between how patient education was carried out and persons' HbA1c, BMI and physical activates. Totally 684 health care centres participated. Data was received from a questionnaire and the national diabetes register that covered 91637 patients with type 2 diabetes. Data was analyzed through qualitative content analysis and with multiple linear regression analysis. The result showed that most common form of education was "Patient education with a predestined content", that was practiced individually in 362 of the health care centres, 108 of these also practiced complementary group education.  "Patient education based on the patients needs" was carried out individually at 55 health care centres, 12 were also carried out complementary group education. "Unspecified patient education" was practiced in 267 health care centres. A statistical significant relation was found indicating that patients  receiving individual education based on the patient's needs HbA1c was lower (55 health care centres). The most common procedure was a checklist in which the care provider decided what the patient needed to know.  Most of the care providers in patient education disregarded the patient's needs and interest.

  • 12.
    Bolinder, Sandra
    et al.
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Falk, Anna
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Patienters uppfattning av livskvalitet efter en överviktsoperation.: - En litteraturstudie2009Student thesis
    Abstract [sv]

    Syftet med denna litteraturstudie var att beskriva hur patienter uppfattar sin livskvalitet efter en överviktsoperation. Litteratursökningen genomfördes i databasen Medline via Pubmed och kompletterades med manuella sökningar. Femton artiklar som mötte inklusionskriterierna granskades och analyserades. Resultatet visade att feta eller överviktiga patienter som genomgått en överviktsoperation uppfattade att de fått en livskvalitet förändrad till det bättre. Läkemedelsanvändandet som var relaterat till övervikten minskade drastiskt efter operationen och så även antalet sekundärsjukdomar. Det mentala välbefinnandet ansåg patienterna i stort blev bättre med tiden, även självförtroendet ökade samt utvecklades en mer positiv syn på sig själv. Den tilltagna möjligheten till fysisk aktivitet betydde mycket för patienterna, precis som den förbättrade relationen till sina medmänniskor samt ett förbättrat socialt liv. Även om förändringen genom viktnedgången var genomgående positiv, innebar inte detta att livet efter överviktsoperationen var enkel. Flera patienter menade att bli bemött på ett bättre sätt än tidigare sårade dem djupt. Resultatet visade vidare att viktnedgången efter en operation var starkt förknippat med förbättrad livskvalitet, men även att livskvalitet består och påverkas av flera faktorer samt är en subjektiv upplevelse.

  • 13.
    Bos, Elisabeth
    et al.
    Centre for Family and Community Medicine, Department of Neurobiology, Care Sciences and Society, Huddinge, Sweden.
    Löfmark, Anna
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Törnkvist, Lena
    Centre for Family and Community Medicine, Department of Neurobiology, Care Sciences and Society, Huddinge, Sweden.
    District nurses' experience of supervising nursing students in primary health care: A pre- and post-implementation questionnaire study2009In: Nurse Education in Practice, ISSN 1471-5953, E-ISSN 1873-5223, Vol. 9, no 6, 361-366 p.Article in journal (Refereed)
    Abstract [en]

    Nursing students go through clinical supervision in primary health care settings but district nurses' (DNs) circumstances when supervising them are only briefly described in the literature. The aim of this study was to investigate DNs experience of supervising nursing students before and after the implementation of a new supervision model. Ninety-eight (74%) DNs answered a questionnaire before and 84 (65%) after implementation of the new supervision model. The study showed that DNs in most cases felt that conditions for supervision in the workplace were adequate. But about 70% lacked training for the supervisory role and 20% had no specialist district nurse training. They also experienced difficulty in keeping up-to-date with changes in nurse education programmes, in receiving support from the university and from their clinic managers, and in setting aside time for supervision. Improvements after the implementation of a new model chiefly concerned organisation; more DNs stated that one person had primary responsibility for students' clinical practice, that information packages for supervisors and students were available at the health care centres, and that conditions were in place for increasing the number of students they supervised. DNs also stated that supervisors and students benefited from supervision by more than one supervisor. To conclude, implementation of a new supervision model resulted in some improvements.

  • 14.
    Brunn, Frida
    et al.
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Carlsson, Åsa
    University of Gävle, Department of Caring Sciences and Sociology. University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Anmälningar till landstingets patientnämnd gällande etik och bemötande          : En registerstudie2009Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 15.
    Carleson, Barbro
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Cancerrelaterad smärta: riktlinjer för smärtbedömning, patientundervisning och komplementär smärtbehandling1999Report (Other (popular science, discussion, etc.))
  • 16.
    Carleson, Barbro
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Kvalitetsindikatorer för bedömning av patienter med cancerrelaterad smärta2007In: Kvalitetsindikatorer inom omvårdnad, Stockholm: Gothia , 2007, 88-102 p.Chapter in book (Other (popular science, discussion, etc.))
  • 17.
    Carleson, Barbro
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Kvalitetsindikatorer för bedömning av patienter med cancerrelaterad smärta2001In: Kvalitetsindikatorer inom omvårdnad, Stockholm: Gothia , 2001, 127-139 p.Chapter in book (Other (popular science, discussion, etc.))
  • 18.
    Carleson, Barbro
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Nursing management of cancer-related pain: guidelines for pain assessment, patient education and complementary pain therapy2000Report (Other (popular science, discussion, etc.))
  • 19.
    Carleson, Barbro
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Omvårdnad2001In: Smärtbehandling i livets slutskede, Stockholm: Socialstyrelsen , 2001, 31-33 p.Chapter in book (Other (popular science, discussion, etc.))
  • 20.
    Carleson, Barbro
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Smärtupplevelse, sjukfrånvaro och livstillfredsställelse hos personer med långvarig smärta - En utvärdering 12 månader efter genomgången rehabiliteringskurs.2009Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
  • 21.
    Chowdhury, Patrik
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Aspekter som avgör anestesisjuksköterskans val av peroperativ ventilation vid bukkirurgi, volym eller tryckkontrollerad ventilation?2009Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund. Enligt den nya kompetensbeskrivningen för anestesisjuksköterskor framgår bland annat att anestesisjuksköterskan ska ha kompetens att övervaka och följa upp ventilation och cirkulation hos sina patienter. Det har länge varit vanligt att använda volymkontrollerad ventilation (VCV) till patienter som genomgår bukkirurgi. Nu finns det ett annat alternativ, tryckkontrollerad ventilation (PCV). Det är ett omdiskuterat ämne huruvida det mer traditionella VCV eller det senare PCV ska tillämpas på patienter som genomgår bukkirurgi. Syfte. Syftet med denna studie var att beskriva de aspekter som avgör anestesisjuksköterskans val av ventilationsmode vid bukkirurgi. Metod. Studien har en deskriptiv design med en kvalitativ ansats. Tio anestesisjuksköterskor fick svara på en frågeguide. Frågeguiden var konstruerad med öppna frågor. Svaren analyserades utifrån ett innehållsanalytiskt perspektiv. Resultat. Svaren på frågeguiden redovisas utifrån följande subkategorier: patientens bakgrund, operationsberoende aspekter, operationens förlopp, patient instabilitet, utbildning samt patientsäkerhet. Diskussion. Det visade sig att det fanns aspekter som påverkade anestesisjuksköterskan inför valet av ventilationsmode så som: patientens ålder, tidigare sjukdomar, operationsteknik samt kunskap om anestesiapparaten.

  • 22.
    Dahl, Joanne
    et al.
    University of Gävle, Department of Education and Psychology, Ämnesavdelningen för psykologi.
    Nilsson, Annika
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Evaluation of a randomized preventive behavioural medicine work site intervention for public health workers at risk for developing chronic pain.2001In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 5, no 4, 421-432 p.Article in journal (Refereed)
  • 23.
    Dahl, Joanne
    et al.
    University of Gävle, Department of Education and Psychology, Ämnesavdelningen för psykologi.
    Wilson, Kelly G
    University of Missisippi.
    Nilsson, Annika
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Acceptance and Commitment Therapy and the Treatment of Persons at Risk for Long-Term disability resulting from stress and pain symptoms: A Preliminary Randomizad trial2004In: Behavior Therapy, ISSN 0005-7894, E-ISSN 1878-1888, Vol. 35, no 4, 785-801 p.Article in journal (Refereed)
    Abstract [en]

    Approximately 14% of the working-age Swedish population are either on long-term sick leave or early retirement due to disability. Substantial increase of sick listing,reports of work disabilities and early retirement due to stress and musculoskeletal

    chronic pain suggest a need for methods of preventing loss of function resulting from these conditions. The present preliminary investigation examined the effects of a brief Acceptance and Commitment Therapy (ACT) intervention for the treatment of public health sector workers who showed chronic stress/pain and were at risk for high sick leave utilization. ACT was compared in an additive treatment design with medical treatment as usual (MTAU). A group of 19 participants were randomly distributed

    into 2 groups. Both conditions received MTAU. The ACT condition receivedfour 1-hour weekly sessions of ACT in addition to MTAU. At post and 6-month followup, ACT participants showed fewer sick days and used fewer medical treatment resources

    than those in the MTAU condition. No significant differences were found inlevels of pain, stress, or quality of life. Improvements in sick leave and medical utilization could not be accounted for by remission of stress and pain in the ACT group

    as no between-group differences were found for stress or pain symptoms.

  • 24.
    Dahlgren, Helene
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Informationens betydelse för livsstilsförändringar hos personer som genomgått hjärtinfarktIndependent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
  • 25.
    Dahlström, Anders
    et al.
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Johansson, Ulrika
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Hemodialyspatienters följsamhet gällande kost- och vätskerestriktioner. En empirisk studie.2009Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 26.
    Danielsson, Birgitta
    et al.
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Hellström, Linda
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Omvårdnadspersonalens uppfattning av hur smärta kan uttrycka sig hos personer med demens och vilka hjälpmedel de har i sin bedömning: en intervjustudie2009Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Abstract

    The aim of the study was to describe the level of understanding of nursing staff regarding the expression of pain by patients suffering from dementia. A further aim was to examine what help and support is available to nursing staff in aiding assessment of pain levels in these patients.

    The study is descriptive in character and has a qualitative perspective.

    Six interview subjects, who were strategically chosen for convenience, were selected to help in this study. The criteria used for selection was that all should have a minimum of three years experience caring for patients suffering from dementia. As an aid to the interview process, semi structured questions and an interview guide were used. The material gathered was then literally transcribed, analysed and divided into eight categories and sub categories.

    Interviewees report that patient express pain in a variety of different ways. Some patients use body language where they become withdrawn and their facial expressions and posture alters. Mood changes are also described, with patients becoming restless and anxious and sometimes aggressive. Verbal expressions of pain, such as wailing and screaming, are also described as well as the observation that patients suffering from dementia sometimes develop difficulties in sleeping and can wander off.

    Further observations from the study show that combined importance of really knowing and being familiar with the patient and his/her background, a good relationship between nursing staff and the patients relatives, and finally, the need of pain assessment tools.

     

  • 27.
    Dicksson Svensson, Anna
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Distriktssköterskor i primärvården och deras upplevelser av sin yrkesroll och vad som ingår i uppdraget: En intervjustudie med tio distriktssköterskor2009Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    The purpose of the study was to describe the district handles cross experience of their professional and what is included in the mission. The study had a descriptive design and ten district nurses from three health centers in central Sweden participated in the study. Data were collected through structured interviews and analyzed according to qualitative content analysis. The result that emerged during the interviews reported on the basis of three categories, creating a theme: To develop in the professional role and team work, despite the lack of a clear governing documents of the mission. The categories that emerged were: professional, team-work and district nurse assignments. District nurses felt their professional role as a broad, free, and a diverse profession with many opportunities to develop in. Working as a district nurse today was based on a team work with various professionals in health care and district nurse is the spider in the net around patients. District nurses know what is included in their duties but they have difficulty expressing what exactly their mission is. District nurses felt that they did not know if the order is written down somewhere and if it discussed or if it worked with what should be included in the mission at work. District nurses felt some anxiety in their professional capacity for the future related to several reorganizations within the County Council was at once

  • 28.
    Engelmark, Emilia
    et al.
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Johansson, Elin
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Upplevelser av livskvalitet i samband med en pacemakeroperation: En litteraturstudie2009Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    The purpose of this literature study was to describe how patients experience their quality of life while undergoing a pacemaker implantation. Searches were carried out in the databases Academic Search Elite, Ebsco Host, Pub Med, Pub Med Central, Science Direct and manually. Keywords used were quality of life, treatment outcomes, emotions, pacing and life. This resulted in nineteen peer rewieved articles that were selected for the study results. The results showed that patients undergoing a pacemaker implantation experienced an improvement in their physical health with increased functional status, more energy and strength. From a psychological perspective, some patients experienced an improvement in quality of life while others felt worried and depressed. A common factor among the patients was anxiety and insecurity concerning daily routine activities. The amount of time passed after the pacemaker implantation was also a common factor that had impact on how patients experienced their physical and psychological health. To get a deeper knowledge and understanding when meeting patients undergoing a pacemaker implantation it is important that more research, especially qualitative, is carried out.

  • 29.
    Englund, Nina
    et al.
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Persson, Gunilla
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Upplevelse av stöd från den psykiatriska vården till barn som har föräldrar med psykisk sjukdom: sett ur barns och vårdpersonals perspektiv2009Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Barn påverkas av föräldrars psykiska sjukdom i form av oro, rädsla och skuld samt har en förhöjd risk att själva drabbas av psykisk sjukdom. En utmaning för den psykiatriska vården är det ökande antalet av vuxna med psykiatrisk sjukdom som även är föräldrar till minderåriga barn. Sjuksköterskor inom psykiatrin har en viktig roll när det gäller att uppmärksamma dessa barn samt se till att de får adekvat hjälp och stöd. Syftet med studien var att beskriva hur barn till föräldrar med psykisk sjukdom upplever det stöd de får ifrån den psykiatriska vården samt beskriva vårdpersonals upplevelser av stöd till dessa barn. Metoden som användes var kvalitativa forskningsintervjuer som genomfördes med sex barn som har föräldrar med psykisk sjukdom och fjorton vårdpersonal som arbetar inom den psykiatriska vården. Intervjuerna analyserades med kvalitativ innehållsanalys och resultatet utmynnade i fyra kategorier. 1. Barn till föräldrar med psykisk sjukdom upplever sig bli hjälpta av stödet från den psykiatriska vården även om det bör förbättras. 2. Vårdpersonal upplever att den psykiatriska vården erbjuder olika verksamheter som ger ett gott stöd till barn även om det bör förbättras. 3. Vårdpersonal upplever att barn behöver uppmärksammas, informeras och stödjas i kontakten med sina föräldrar. 4. Vårdpersonal upplever svårigheter i form av osäkerhet kring sin egen kunskap samt föräldrars ovilja att blanda in barn i den psykiatriska vården. En slutsats av studien är att barn till föräldrar med psykisk sjukdom får ett relativt gott stöd även om det behöver förbättras. För att göra detta krävs utbildning av vårdpersonal och att verksamheten har framtagna rutiner och användbara metoder för att kunna stödja barn.

  • 30.
    Engström, Maria
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap. Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap..
    A Caregiver Perspective on Incorporating IT support into Dementia Care2006Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Aim: The overall aim of the present thesis was to describe and evaluate IT support in dementia care from the perspectives of staff and relatives. More specifically, it was to examine staff members’ satisfaction with work, life satisfaction and sense of coherence before and after increased IT support, to describe staff members’ opinions and perceptions of IT support during the process of implementation, to describe relatives’ opinions of IT support and to compare relatives’ perceptions of their irritations with care and life satisfaction before and after increased IT support. In addition, three questionnaires were further developed and tested among staff working in elderly care, and then used in the staff evaluation. Methods: A quasi-experimental design with baseline assessments and follow-ups and experimental and control groups was used in two studies to investigate the outcomes of IT support. A descriptive design was used to study staff views on IT support, and a correlative design was used in the methodological study. Participants were 33 staff members and 22 relatives in the evaluation, 14 staff members in the descriptive study and 299 staff members in the methodological study. Data collection methods were questionnaires and group interviews. The IT support consisted of passive passage alarms, fall detectors, sensor-activated night-time illumination of the lavatory, movement detectors, email communication, an Internet website and additional computers. Findings and conclusions: Staff job satisfaction and perceived quality of care increased in the experimental group. The relatives were generally positive about the IT support, and the experimental group showed a decrease in practical/logistical irritations. Staff described ‘moving from fear of losing control to perceived increase in control and security’ and ‘constant struggling with insufficient/deficient systems’. Conclusions are that IT support can be a resource in dementia care as perceived by caregivers if IT support is incorporated into the care system.

  • 31.
    Engström, Maria
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    IT-stöd i vården av personer med demens2007Other (Other (popular science, discussion, etc.))
  • 32.
    Engström, Maria
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Robotar i vård och omsorg: hur kan vi skapa en användar- och behovsdriven teknikutveckling som kompletterar den befintliga omsorgen/vården?2006In: Teknik & Vetenskap, ISSN 1402-5701, Vol. 22, no 4, 52-52 p.Article in journal (Other (popular science, discussion, etc.))
  • 33.
    Engström, Maria
    et al.
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap. Department of Public Health and Caring Sciences, Uppsala University, Sweden.
    Lindqvist, Ragny
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Ljunggren, Birgitta
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Carlsson, Marianne
    Department of Public Health and Caring Sciences, Uppsala University, Sweden.
    Relatives’ opinions of IT support, perceptions of irritations and life satisfaction in dementia care2006In: Journal of Telemedicine and Telecare, ISSN 1357-633X, E-ISSN 1758-1109, Vol. 12, no 5, 246-250 p.Article in journal (Refereed)
    Abstract [en]

    We studied relatives' opinions of IT support at a residential home for persons with dementia. We also investigated the relatives' perceptions of irritations and life satisfaction before and after increased IT support. This was accomplished using an experimental group (n = 14) and a control group (n = 8) of subjects in dementia care. The design was quasi-experimental with baseline assessments and three follow-ups. Data were collected using two questionnaires measuring opinions of the IT support: irritations in care (the Nursing Home Hassles Scale) and life satisfaction (the Life Satisfaction Questionnaire). Results showed that relatives' opinions of IT support were generally positive. In the experimental group, relatives' perceptions of practical/logistical irritations decreased between baseline and 12-month follow-up. In the control group, there was an increase in the total Nursing Home Hassles score between baseline and three-month follow-up. This difference did not persist at seven- and 12-month follow-ups. No significant differences were found for life satisfaction. We conclude that relatives had positive opinions of IT support, and their perceptions of practical/logistical irritations decreased after implementation of the IT support package.

  • 34.
    Engström, Maria
    et al.
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Lindqvist, Ragny
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Ljunggren, Birgitta
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Carlsson, Marianne
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Staff members' perceptions of a ICT support package in dementia care during the process of implementation2009In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 17, no 7, 781-789 p.Article in journal (Refereed)
    Abstract [en]

    Aim The aim of the present study was to describe staff members' perceptions of an information and communication technology (ICT) support package during the process of implementation. Background ICT in dementia care will likely increase in the future. The diffusion of new innovations can be better understood through diffusion research. Methods Fourteen staff members in dementia care were interviewed, in groups, once before the new ICT, twice during its implementation and once after. Data were analysed using qualitative content analyses. The ICT included monitors/alarms: passage alarms, fall detectors, sensor-activated night-time illumination of the lavatory, and communication technology: Internet communication and additional computers. Results The results showed two themes 'Moving from fear of losing control to perceived increase in control and security' and 'Struggling with insufficient/deficient systems'. Conclusions Staff perceptions of ICT were diverse and changed during the implementation. Benefits were more pronounced than disadvantages, and improvements were described both in care and in staff job situation. Implications for nursing management Functioning and use of ICT may relate to design as well as by application and the surrounding structure, and the whole system: the organizational structure, the employers and the new product needs to be taken into consideration when implementing new technology.

  • 35.
    Engström, Maria
    et al.
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Ljunggren, Birgitta
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Lindqvist, Ragny
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Carlsson, Marianne
    Staff perceptions of job satisfaction and life situation before and 6 and 12 months after increased information technology support in dementia care2005In: Journal of Telemedicine and Telecare, ISSN 1357-633X, Vol. 11, no 6, 304-309 p.Article in journal (Refereed)
    Abstract [en]

    We measured staff members' satisfaction with their work before and after increased information technology (IT) support in dementia care. Comparisons were also performed of perceived life satisfaction and sense of coherence. Data were collected before, and 6 and 12 months after implementation of the first part of an IT support project. Instruments used were the Satisfaction with Work Questionnaires, the Life Satisfaction Questionnaire (LSQ) and the Sense of Coherence (SOC) scale. The study was performed in a residential home for persons with dementia. The participants were 33 staff members. The IT technology included general and individualized passage alarms, sensor-activated night-time illumination, fall detectors and Internet communication. Results showed that staff members' job satisfaction and perceived quality of care improved in comparison with the control group. Personal development, workload, expectations and demands, internal motivation and documentation, as well as the total scores for 'psychosocial aspects of job satisfaction' and 'quality of care aspects', increased in the experimental group. There were significant interaction effects for the factors family relation, close friend relation (LSQ), the total SOC scale and the meaningfulness subscale. The study showed that IT support in dementia care increased staff members' satisfaction with their work in several ways.

  • 36.
    Engström, Maria
    et al.
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Ljunggren, Birgitta
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Lindqvist, Ragny
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Carlsson, Marianne
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Staff satisfaction with work, perceived quality of care and stress in elderly care: psychometric assessments and associations2006In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 14, no 4, 318-328 p.Article in journal (Refereed)
    Abstract [en]

    AIMS: To evaluate validity and reliability of three questionnaires measuring 'work satisfaction', 'patient care' and 'staff health' for staff in elderly care and to study the relationship between staff members' satisfaction with work and perceived stress.

    BACKGROUND: Increased workload, difficulties in recruiting and retaining nurses are reported in elderly care. Valid and reliable instruments measuring staffs' perceptions of work are needed.

    METHODS: A convenience sample of 299 staff answered the questionnaires.

    RESULTS: Factor analysis of 'work satisfaction' gave eight factors, 'patient care' four factors and 'staff health' two factors, explaining 52.2%, 56.4% and 56.8% of the variance. Internal consistency was mostly satisfactory. Multiple regression analysis revealed a model that explained 41% of the variance in perceived stress symptoms.

    CONCLUSIONS: There was support for the instruments' validity and reliability. Older age, higher scores/satisfaction with workload, cooperation, expectations and demands, personal development and lower scores on internal motivation contributed to less stress.

  • 37.
    Engström, Maria
    et al.
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Scandurra, Isabella
    Centre for eHealth, Uppsala University, Uppsala, Sweden.
    Ljunggren, Birgitta
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Lindqvist, Ragny
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Swedentet.
    Koch, Sabine
    Centre for eHealth, Uppsala University, Uppsala, Sweden.
    Carlsson, Marianne
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Evaluation of OLD@HOME virtual health record: staff opinions of the system and satisfaction with work2009In: Telemedicine journal and e-health, ISSN 1530-5627, E-ISSN 1556-3669, Vol. 15, no 1, 53-61 p.Article in journal (Refereed)
    Abstract [en]

    The aim of the present research was to study outcomes of use of the OLD@HOME Virtual Health Record with regard to staff opinions about information, communication technology, and satisfaction with work. A quasi-experimental design was used. Staff opinions about the information and communication technology were assessed using a study-specific questionnaire at the test site (n =22) and at other settings in the municipality (n =172). Staff (n =22) job satisfaction, perceived quality of care, and psychosomatic health were assessed using the Satisfaction with Work Questionnaires before and after a 5-month period of testing the technology in an intervention and a comparison group. Staff opinions about the information and communication technology were significantly more positive at the test site compared to other settings in the municipality. For the total scale of quality of care and the factor documentation, there were significant differences in change scores between intervention and comparison groups, with improvements for the comparison group. For job satisfaction and psychosomatic health, there were no differences in change scores between the groups. Participatory design enhances staff opinions about information and communication technology. However, a 5-month test period showed no benefits regarding staff satisfaction with work when compared to a comparison group. On the contrary, the comparison group improved in documentation, and for the intervention group, there was a trend toward deterioration, which may be due to their knowing how to document, but not having time when using both paper-based and electronic systems.

  • 38.
    Eriksson, Annelie
    et al.
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Sundström, Monica
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Smärta i rygg, leder och muskler samt sömnproblem hos ambulanspersonal2009Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    The purpose of the study was to describe the ambulance personnel’s self-assessment/experiences of pain in the back, joints and muscles as well as sleep, rest and recovery. A further aim was to investigate whether there are any differences in the problems related to gender and profession. Data were collected with questionnaires, and personnel at four ambulance stations in central Sweden participated in the study. A total of 110 questionnaires were distributed, and the overall response rate was 81 %. The results for soul-rated pain showed that 53 persons (59, 6 %) reported low back pain in the last 12 months. Thirty-nine persons (43, 6 %) reported neck pain the past 12 months. Twenty-nine persons (32, 6 %) reported shoulder/shoulder pain. The results show no statistically significant difference between gender and occupational categories. The results showed that 72 persons (81 %) experience that they slept pretty good to very good. Approximately half of the 89 participants, 53 % reported they could recover after each session and during her free period reported 49 persons (55 %) experience that they could recover almost every period. The results show no statistically significant difference between gender or occupational categories regarding.

    Conclusion: To improve the work environment for ambulance personnel, measures should be focused on load and strain ergonomic factors.

  • 39.
    Eriksson Salander, Kristina
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Effekter av individuella vårdplaner för nutrition på ett särskilt boende2009Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

     

    The aim for this study was to see if care plans in nutrition could improve nutritional status and thus even improve the quality of life of the caretakers.  The study’s design was a comparative quantitative investigation. The study was performed in a block of municipal service flats where 36 caretakers were living; their average ages were 87 years old. Nutritional assessment was made by using MNA-SF as a screening tool for malnutrition. The result from the MNA-SF screening was combined with nursing assessment to do the care plan considering nutrition. The time for overnight fasting was also measured to be considered making the plan. EQ-5D was used to measure the caretakers’ quality of life, care plans for their nutrition were made and they were realized. The caretakers used their care plans for four weeks. Then new assessments were made inclusive the EQ-5D.The result was that there were no significant correlation between changes in nutritional status and the caretakers’ quality of life in this study  and those four weeks is too short time to see any difference in a study like this.

     

  • 40.
    Eriksson, Victoria
    et al.
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Jovic, Dijana
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Omvårdnadspersonalens upplevelse av att vårda patienter med självskadande beteende.2009Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    The aim of this study was to describe the experiences of psychiatric healthcare workers in regards to their meeting and treatment of patients with self-destructive behavior. This study had a descriptive design and 21 registered nurses and practical nurses participated, from both somatic and psychiatric emergency wards. Data was collected via semi-structured interviews and analyzed from a qualitative content analysis. The results are presented from the categories that were formed by fallowing codes. The category “emotional difficulties” come from the codes: frustration, irritation, sympathy, manipulation, powerlessness over uncommunicative patients, powerlessness, anxiety, and describes the healthcare workers’ experiences of these selfdestructive patients. Self-destructive patients elicit very strong emotions amongst others, both positive and negative. The predominant feeling shown in this study concerning this category of patient was negative. The category “nursing difficulties” was drawn from the codes: helplessness in regards to the care, lack of time, lack of resources, the patient not wanting help, chronic behavior, and describes the experiences of caring for self-destructive patients. Caring for self-destructive patients is described by healthcare personnel as demanding and inadequate. The category “lack of skills” has emerged from the codes: the need for guidelines and strict rules, understanding the patient, inadequate knowledge, negative attitudes, divisions in the workgroup, and describes the care of self-destructive patients. Healthcare personnel said that they lacked the necessary training needed to give optimal care. Many problems and misunderstandings of self-destructive patients’ behavior arise on account of this lack of education/information and this affects the quality of care that they receive.

  • 41.
    Ernesäter, Annica
    et al.
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Holmström, Inger
    Folkhälso- och vårdvetenskap Uppsala Universitet.
    Engström, Maria
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Computerized decision support systems in telenursing: how it is perceived by telenurses2009In: Med-e-Tel 2009: proceedings, 2009, 409-410 p.Conference paper (Refereed)
    Abstract [en]

    Telephone advice nursing (telenursing) is an expanding service in many Western countries and in recent year’s centralization of telenursing services has occurred in some countries. Telenursing is a complex and knowledge intensive health service were registered nurses (RN’s) individually triage callers need for further care, give self care advice or refer the caller to appropriate care giver. These telenurses have numerous patient encounters every day, regarding all ages of callers and questions presented to the telenurses addresses a broad variation of medical conditions.  

    Telenursing has shown to be appreciated by the population as well as cost efficient.

     In an attempt to ensure quality and safety within telenursing the use of computerized decision support systems (CDSS) increased since CDSS enables uniformity and consistency of advices given to callers.   

    Traditionally, telenurses have relied on clinical knowledge, collegial support and books when triaging callers and few studies describe how telenurses perceive CDSS in their daily work.

    Eight telenurses from three different telephone advice call centres, all using CDSS took part in semi-structured interviews in 2006. Data were analysed using qualitative content analysis.

    The aim of the study was to describe telenurses experiences of working with CDSS. Telenurses described that the CDSS had both positive and negative influences of their work. They described that the CDSS simplified their work, complemented their knowledge and gave them a sense of security. They also described how the CDSS contributed to quality improvement of telenursing. The negative aspects of the CDSS were described as being inhibited by the system. Telenurses described how they perceived the system as partly incomplete and controlling and that they sometimes disagreed with the measures presented by the system.

    These advantages and disadvantages perceived within the system can be connected to the concepts of usability: user-worthiness and user-friendliness. Software should be easy to learn, contain few errors and be easy to orient in, to enhance usability. Hence usability could be further improved in the present system.

    There might be a risk that the CDSS will mechanize and undermine the communication between callers and telenurses. It is important, in order to increase the telenurses’ professional competence and the feeling of tele-presence that callers not only are given a correct estimation of their conditions but also a sense of security and confirmation. Otherwise callers may seek emergency care solely because of insecurity and anxiety.

  • 42.
    Ernesäter, Annica
    et al.
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap. Department of Public Health and Caring Sciences, Uppsala University, Sweden.
    Holmström, Inger
    Department of Public Health and Caring Sciences, Uppsala University, Sweden.
    Engström, Maria
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap. Department of Public Health and Caring Sciences, Uppsala University, Sweden.
    Telenurses' experiences of working with computerized decision support: Supporting, inhibiting and quality improving2009In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 65, no 5, 1074-1083 p.Article in journal (Refereed)
    Abstract [en]

    Aim. This paper is a report of a study conducted to describe telenurses' experiences of working with computerized decision support systems and how such systems could influence their work. Background. Telenursing is an expanding service in many Western countries, and in recent years centralization of telenursing services has occurred in Sweden. In connection with this, the use of computerized decision support has increased. Method. Eight Registered Nurses from three telephone advice call centres in Sweden who were using computerized decision support took part in semi-structured interviews in 2006. The data were analysed using qualitative content analysis. Findings. The findings are presented as one theme and three categories. Telenurses experienced their work with a decision support system as supporting, inhibiting and quality improving. Based on two of the categories -'supporting' and 'inhibiting'- a theme was revealed: being strengthened, but simultaneously controlled and inhibited. This theme represents the individual level. The telenurses found that the decision support system simplified their work, complemented their knowledge, gave them security and enhanced their credibility. They also described experiencing the system as incomplete, sometimes in conflict with their own opinions and controlling. The third category referred to the organizational level: the decision support system ensured the quality of telenursing. Conclusions. Although the telenurses experienced computerized decision support as both supporting and inhibiting, they preferred working with it. They also described how a computerized decision support system cannot replace telenurses'knowledge and competence, and that it should be considered as complementary.

  • 43.
    Falk, Susanne
    et al.
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Lindahl, Kenth
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Livskvalitet hos personer som genomgått en total höftledsplastik - en litteraturstudie2009Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    The purpose of the study was based on scientific literature to describe the quality of life of persons who have undergone a total hip replacement. The method was a descriptive literature review. The results showed that pain was the most obvious change after surgery. Mild pain before surgery was strongly associated with mild pain after surgery. But despite less pain were experienced early, it took 1 year to achieve the full benefits of improved physical function. It was found that there were no age-related differences in pain, physical function and quality of life. Patients regardless of ages showed improvements in pain, function and stiffness. Several studies revealed that the discomfort in the back, lower limb or back pain was a problem for patients after surgery and was associated with worse functional status after surgery. Back pain was also important in planning rehabilitation. The medical factors that were associated with worse functional status were obese, two or more chronic diseases and two or more common geriatric problems. The results also indicated a clear correlation between preoperative criteria and good performance of health-related quality of life after total hip replacement. Total hip replacement was cost-effective interventions that improve quality of life of patients. Quality of life was sustained 5 years after surgery the majority of patients.

    Keyword: Quality of life, hip replacement, physical function and pain.

  • 44.
    Fen Tang, Ping
    et al.
    Kunming Medical College, Kunming, Province of Yunnan, China.
    Johansson, Camilla
    Örebro University, Örebro, Sweden.
    Barbro, Wadensten
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Stig, Wenneberg
    Örebro University, Örebro, Sweden.
    Gerd, Ahlström
    School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Chinese nurses' ethical concerns in a neurological ward2007In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 14, no 6, 810-824 p.Article in journal (Refereed)
    Abstract [en]

    Our aim was to describe Chinese nurses' experiences of workplace distress and ethical dilemmas on a neurological ward. Qualitative interviews were performed with 20 nurses. On using latent content analysis, themes emerged in four content areas: ethical dilemmas, workplace distress, quality of nursing and managing distress. The ethical dilemmas were: (1) conflicting views on optimal treatment and nursing; (2) treatment choice meeting with financial constraints; and (3) misalignment of nursing responsibilities, competence and available resources. The patients' relatives lacked respect for the nurses' skills. Other dilemmas could be traced to the transition from a planned to a market economy, resulting in an excessive workload and treatment withdrawal for financial reasons. Lack of resources was perceived as an obstacle to proper patient care in addition to hospital organization, decreasing the quality of nursing, and increasing moral and workplace distress. The nurses managed mainly by striving for competence, which gave them hope for the future.

  • 45.
    Fläckman, Birgitta
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Work in eldercare - staying or leaving: caregivers' experiences of work and support during organizational changes2008Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The overall aim of the present thesis was to reveal nursing home (NH) caregivers’ work ex-periences when receiving support through education and clinical supervision over a two-year period, while the workplace was undergoing organizational changes. The studies (I-IV) com-bine qualitative and quantitative methods in a longitudinal two-year follow-up project in three Swedish NHs (NH I - III), in which support was given to the staff at NH I-II. NH III was in-cluded as a comparison. The thesis is based on interviews (I-IV) and self-assessment ques-tionnaires (I), which were conducted at three occasions: at start, after 12 and 24 months at the respective NHs. As a result of political decisions, NH I was informed of organizational changes and pending financial cutbacks shortly after opening. The other NHs were informed at around 12 months. The numbers of caregivers willing to participate at start were 32, 21 and 22 at the respective NHs. No new participants were included to replace dropouts. Descriptive statistics (I) and qualitative content analyses (I-IV) were used. Study I focused on the organ-izational climate and the prevalence of burnout symptoms in the three NHs. The result from NH I revealed an improvement over time as opposed to NH II, which showed negative pro-gression at 12 months, despite support. This corresponded to the time at which they received information about financial cutbacks. The improvement based on the interviews at NH I was not as distinct as that based on the self-assessment scores. The support given seemed to have helped the caregivers at NH I, but was not able to alter the situation at NH II. The develop-ment based on self-assessments at NH III was more constant throughout the study. Results from interviews at NH II and III were more in accordance with the scores. In Study II, the caregivers’ work experiences at NH II, while receiving support through education and clinical supervision, showed that they valued the caring milieu and their own knowledge. The value of knowledge was related to their different backgrounds and to the knowledge gained through the support, and it seemed to be one factor underlying participants’ continued willingness to stay. In Study III, caregivers’ experiences and reflections on working at NH III, while under threat of organizational changes and termination notice, showed a transition from ‘having a professional identity and self-confidence’ to ‘being a professional in a threatening situation caused by someone else’. Finally they were ‘struggling to adapt to a changed working envi-ronment as a person and a professional’. The caregivers experienced a loss of pride and satis-faction. Included in Study II and III were interviews from those caregivers who had been interviewed on all three occasions. Study IV focused on what had caused caregivers at the three NHs to decide to leave their employment during the study period. Caregivers’ decisions to leave work could be encompassed in one main category: ‘Unmet expectations’. Their ex-periences were lack of encouragement, trust and professional development. Also reported were feelings of insecurity, different opinions on the care delivered, being disregarded and betrayed, followed by thoughts of leaving work and pursing other opportunities. It can be concluded that the changes at all three NHs seemed to have over-shadowed attempts to im-prove working conditions. Successful changes require a vision that justifies them. High-level decision-makers and managers ought to be conscious of the factors that facilitate or impede similar transitions. They should also focus on supporting caregivers during change processes, as the literature shows a risk for decreasing quality of care.

  • 46.
    Fläckman, Birgitta
    et al.
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap. Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.
    Fagerberg, Ingegerd
    Department of Caring and Public Health Sciences, Mälardalen University, Västerås; Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.
    Häggström, Elisabeth
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap. Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.
    Kihlgren, Annica
    Department of Health Sciences, Örebro University, Örebro, Sweden; Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.
    Kihlgren, Mona
    Centre of Nursing Science, Örebro University Hospital, Örebro, Sweden; Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.
    Despite shattered expectations a willingness to care for elders remains with education and clinical supervision2007In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 21, no 3, 379-389 p.Article in journal (Refereed)
    Abstract [en]

    Despite shattered expectations a willingness to care for elders remains with  education and clinical supervision The aim was to describe nursing home (NH) caregivers’ work experiences while receiving education and clinical supervision for 2 years. Working in elder care seems to be losing its attraction especially with organizational changes, cutbacks and changes in work place conditions. Clinical supervision has been reported to increase job satisfaction and creativity. Semi-structured interviews from caregivers working at an NH in Sweden were conducted, at the start and again at 12 and 24 months. At about 12 months the caregivers were informed of planned cutbacks. Content analysis was the method used to analyse the interviews from seven caregivers who participated throughout the entire period. Findings show that the value of a caring milieu was one category generated by the subcategories: experiences related to work activities and changes, and experiences related to relationships. The value of knowledge was the other category that was influenced by the experiences related to the different backgrounds and the experiences related to increased knowledge gained from the support through education and clinical supervision. The categories contained positive as well as negative influences on care. The initial focus on practical duties associated with the opening of the NH shifted towards caregiver activities with the elders they spoke warmly about. After 2 years the caregivers’ willingness to care continued despite their disappointment in the worsened working conditions. The main theme that resulted was: Despite shattered expectations a willingness to care for elders remained. Continued education and clinical supervision seems to be one factor behind the retained willingness. These findings demonstrate that support and caregiver involvement in educational programmes are important during times of change and when disappointments arise in the workplace.

  • 47.
    Fläckman, Birgitta
    et al.
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap. Karolinska Institute, Stockholm, Sweden.
    Hansebo, Görel
    Karolinska Institute, Stockholm, Sweden; Ersta Sköndal University College, Stockholm, Sweden.
    Kihlgren, Annica
    Karolinska Institute, Stockholm, Sweden; Örebro University, Örebro, Sweden.
    Struggling to adapt: Caring for older persons while under threat of organizational change and termination notice : Feature2009In: Nursing Inquiry, ISSN 1320-7881, E-ISSN 1440-1800, Vol. 16, no 1, 82-91 p.Article in journal (Refereed)
    Abstract [en]

    Organizational changes are common in elder care today. Such changes affect caregivers, who are essential to providing good quality care. The aim of the present study was to illuminate caregivers' experiences of working in elder care while under threat of organizational change and termination notice. Qualitative content analysis was used to examine interview data from 11 caregivers. Interviews were conducted at three occasions during a two-year period. The findings show a transition in their experiences from 'having a professional identity and self-confidence', to 'being a professional in a threatening situation caused by someone else' and to 'struggling to adapt to a changed working environment as a person and a professional'. The caregivers experienced a loss of pride and satisfaction. Previous literature indicates that this may have consequences for the quality of care and that employees may be at risk of negative health effects. However, the caregivers continued to struggle, doing their best to complete their duties. The study has implications for high-level decision-makers, managers and caregivers in similar work-life situations in that it deals with factors that facilitate or impede similar transitions.

  • 48.
    Fläckman, Birgitta
    et al.
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Sørlie, Venke
    Kihlgren, Mona
    Unmet expectations: why nursing home staff leave care work2008In: International Journal of Older People Nursing, ISSN 1748-3735, Vol. 3, no 1, 55-62 p.Article in journal (Refereed)
    Abstract [en]

    Background. The shortages of healthcare professionals have been a common topic in care of older people.

    Aim and objectives. The aim of the present study was to illuminate what caused the nursing home caregivers to decide to leave their employment.

    Design. A two-year intervention study was performed in three nursing homes in Sweden.

    Method. This qualitative interview study was conducted with 18 caregivers who decided to leave their employment during the first year. Content analysis was the method used to analyse the interviews.

    Result. The caregivers’ decisions to leave their work in care of older people could be encompassed in one main category: ‘Unmet Expectations’. Their experiences were of lack of encouragement and trust and professional development. Feelings of insecurity, different opinions on the care delivered, being disregarded and betrayed followed as did thoughts of leaving work and pursuing other opportunities.

    Conclusions. The main findings indicated that organizational work pressure with information about pending financial cutbacks caused the caregivers to leave the nursing homes.

    Relevance to clinical practice. The study’s results show the value of meeting the needs of caregivers, as caregivers consider that they meet the needs of the older people. Optimal use of caregivers’ skills, experiences, competence and respect for their aspirations is also likely to result in cost-efficient care.

  • 49.
    Forsmark, Cecilia
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Vårdgivares uppfattning om fallrisker och fallprevention inom tre vårdnivåer2008Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    The progress of the health among the elderly has a major meaning for the needs of care, nursing and social services. The health of the elderly has improved but fall and fall accidents are a major problem. Acute diseases, activities and environment risks are often related to fall accidents. The aim of the study was to describe health care staffs’ opinions about fall risk and fall prevention. The study had a qualitative approach with a descriptive design. Twelve persons from a primary healthcare centre, a hospital and a community elder care unit in the middle of Sweden were interviewed. The material was analyzed through qualitative content analysis and data from the interviews resulted in two categories; The category “Factors contributing to falls” was formulated from the subcategories; The older persons health status and their care needs, Physical environment, Lack of competence among staff, Lack of time, stress and insufficient staffing, Staffs’ responsibilities and not followed routines and Insufficient cooperation between professional groups. The category “Factors preventing falls” was formulated from the subcategories; Physical environment and physical aid, Competence and fall risk assessment instruments, Different professionals’ responsibilities and Cooperation between different professionals. The results showed that the health care staff viewed several factors, which according to them contributed to falls as well as prevented falls. Cooperation between different professionals, increased competence and use of systematic fall risk assessment instruments were mentioned resulting in advantages for the patient.

  • 50.
    Fröjd, Camilla
    et al.
    Department of Public Health and Caring Sciences, Psychosocial Oncology, Uppsala University, Uppsala, Sweden.
    Lampic, Claudia
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Larsson, Gunnel
    Department of Medical Sciences, Section of Endocrine Oncology, Uppsala University, Uppsala, Sweden.
    Birgegård, Gunnar
    Department of Medical Sciences, Section of Haematology, Uppsala University, Uppsala, Sweden.
    von Essen, Louise
    Department of Public Health and Caring Sciences, Psychosocial Oncology, Uppsala University, Uppsala, Sweden.
    Patient attitudes, behaviours, and other factors considered by doctors when estimating cancer patients' anxiety and desire for information2007In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 21, no 4, 523-529 p.Article in journal (Refereed)
    Abstract [en]

    The aim was to describe the patient attitudes, behaviours, and other factors, considered by doctors when estimating cancer patients' worry about how the disease may develop and the desire for information about the disease and its treatment. Data was gathered through semi-structured interviews with 19 doctors regarding 29 patients within endocrine oncology and haematology care, and the data were analysed by content analysis. The doctors considered the patients' verbal expressions, verbal behaviours, questions, body language, and facial expressions together with their own professional knowledge and experience, when estimating the patients' worry and desire for information. The doctors also considered contextual factors, patients' demographical factors, and medical situation when estimating the patients' worry, and also when estimating the patients' desire for information. The findings illustrate that estimating patients' worry and desire for information is a multifaceted and complex task, and that doctors consider not only the patients' verbal and nonverbal cues, but also factors, such as their own professional knowledge and experience, contextual factors, and patients' demographical variables. The findings should be communicated to doctors who meet cancer patients in medical consultations in order to illuminate the complexity of the medical consultation. The awareness of potentially important patient cues and other factors may aid doctors in their efforts to gain insight about their patients' emotions and informational needs.

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