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  • 301.
    Liedgren Dobronravoff, Pernilla
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för socialt arbete.
    Att bli, att vara och att ha varit: om ingångar i och utgångar ur Jehovas vittnen i Sverige2007Doctoral thesis, monograph (Other academic)
  • 302.
    Lind, Agnetha
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Distriktssköterskans upplevelser av att nattetid möta närstående till cancersjuka patienter som vårdas i hemmet.2008Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Abstract

    The aim of the study was to describe district nurses experiences meeting intimate of cancer patients in home care. The study had a qualitative approach with a descriptive design. The sample consisted of ten district nurses employed in primary health care, working in emergency duty in a district in the Middle of Sweden. The results are presented from the two categories; to communicate and being competent, which was formulated to one theme. The theme “Being safe in one´s professional role, being aware of possibilities and difficulties when encountering intimates in home care”. The district nurses experienced that they had an important role since they had to notice and understand the needs of the intimates as well as to refute and confirm them. To act like ‘a guest’ in the patient's home was important and regarded a respectful behavior towards the family, according to the district nurses. To give intimates ‘time’ was stated urgent and described possible during the nightshifts. According to the district nurses well informed intimates felt more secure in their situation. The district nurses experienced that it is important to observe and understand the intimate’s body language and empathized that both verbal and non verbal communication must be paid attention. They stated that encountering intimates included answering their questions as well as they could. The district nurses felt that it was not always easy to refute the questions asked and they could feel deficiencies in their own capability and competence. Sometimes, encountering intimates, the districts nurses experienced difficulties being professional since they felt lack of ‘tools’.

     

     

     

     

    Keywords: Intimates, cancer, district nurses, nightshift, homecare, encounter

  • 303.
    Lindberg, Magnus
    et al.
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap. Centre for Research and Development, Uppsala University/County Council of Gävleborg, Gävle, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Lindberg, Per
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Wikström, Björn
    Department of Medical Sciences, Uppsala University, Uppsala University Hospital, Uppsala, Sweden.
    Medication discrepancy: a concordance problem between dialysis patients and caregivers.2007In: Scandinavian Journal of Urology and Nephrology, ISSN 0036-5599, E-ISSN 1651-2065, Vol. 41, no 6, p. 546-52Article in journal (Refereed)
    Abstract [en]

    Objectives. Extensive drug utilization, and non-concordance between the patient and the caregiver about prescriptions andactual medicine intake, are associated with the risk of non-adherence to medication as well as medication-related illness. Toachieve reliable estimates of drug use, it is important to consider the patient’s self-reported drug utilization as well as toconsult his/her medical record. The present multicentre study was conducted with the aim of examining the self-reporteddrug consumption of dialysis patients and its congruence with medical records.

    Material and methods. Consumption ofpharmaceutical agents was recorded by 204 patients undergoing haemo- or peritoneal dialysis at 10 Swedish clinics. Drugrecord discrepancies were identified by comparing the self-reported use of prescribed medicines with the subsequentlyobtained medication lists.

    Results. The median drug intake was 11 prescribed medicines and by including on-demand drugsthis increased to 12. Discrepancies between the self-reported use of prescribed drugs and the medical record were prevalentin 80.4% of cases, with a median of three discrepancies per patient.

    Conclusions. Dialysis patients have an extensive need formedication but there is an undesirable deviation between consumption and prescription. A single medication list, accessiblefor the patient and for all prescribers, is a possible solution to achieve concordance but other measures, such as analysis ofthe reasons for discrepancy and tailored measures, would also benefit concordant medicine-taking.

  • 304.
    Lindberg, Magnus
    et al.
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap. entre for Research and Development, Uppsala University/County Council of Gävleborg, Gävle, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Prütz, Karl-Göran
    Department ofNephrology and Transplantation, Malmö University Hospital, Malmö, Sweden.
    Lindberg, Per
    Department of Psychology, Uppsala University, Uppsala, Sweden.
    Wikström, Björn
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Interdialytic weight gain and ultrafiltration rate in hemodialysis: lessons about fluid adherence from a national registry of clinical practice2009In: Hemodialysis International, ISSN 1492-7535, E-ISSN 1542-4758, Vol. 13, no 2, p. 181-188Article in journal (Refereed)
    Abstract [en]

    Excessive interdialytic weight gain (IWG) and ultrafiltration rates (UFR) above 10 mL/h/kg body weight imply higher morbidity and mortality. This study aimed to estimate the prevalence of high fluid consumers, describe UFR patterns, and describe patient characteristics associated with IWG and UFR. The Swedish Dialysis DataBase and The Swedish Renal Registry of Active Treatment of Uremia were used as data sources. Data were analyzed from patients aged ≥18 on regular treatment with hemodialysis (HD) and registered during 2002 to 2006. Interdialytic weight gain and dialytic UFR were examined in annual cohorts and the records were based on 9693 HD sessions in 4498 patients. Differences in proportions were analyzed with the chi-square test and differences in means were tested using the ANOVA or the t test. About 30% of the patients had IWG that exceed 3.5% of dry body weight and 5% had IWG ≥5.7%. The volume removed during HD was >10 mL/h/kg for 15% to 23% of the patients, and this rate increased during the first dialytic year. Patient characteristics associated with fluid overload were younger age, lower body mass index, longer dialytic vintage, and high blood pressure. By studying IWG and dialytic UFR as quality indicators, it is shown that there is a potential for continuing improvement in the care of patients in HD settings, i.e., to enhanced adherence to fluid restriction or alternatively to extend the frequency of dialysis for all patients, e.g., by providing daily treatment.

  • 305.
    Lindberg, Maria
    et al.
    Centre for Research and Development, Uppsala University/County Council of Gävleborg, Gävle, Sweden; Section for Caring Sciences, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Carlsson, Marianne
    Section for Caring Sciences, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Högman, Marieann
    Centre for Research and Development, Uppsala University/County Council of Gävleborg, Gävle, Sweden.
    Skytt, Bernice
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap. Section for Caring Sciences, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Suffering from meticillin-resistant Staphylococcus aureus: experience and understanding of colonisation2009In: Journal of Hospital Infection, ISSN 0195-6701, E-ISSN 1532-2939, Vol. 73, no 3, p. 271-277Article in journal (Refereed)
    Abstract [en]

    The objective was to explore individuals' experiences and understandings of meticillin-resistant Staphylococcus aureus (MRSA) colonisation. Thirteen interviews were performed and processed using content analysis, resulting in the theme ‘Invaded, insecure and alone’. The participants experienced fears and limitations in everyday life and expressed a need to protect others from contagion. Moreover, they experienced encounters with, and information from, healthcare workers differently: some were content, whereas others were discontent. The described fears, limitations and inadequate professional–patient relationship generated unacceptable distress for MRSA-colonised persons. Thus, the healthcare sector should assume responsibility for managing MRSA, and healthcare workers must improve their professionalism and information skills, so as to better meet MRSA-colonised persons' needs

  • 306.
    Lindberg, Sara
    et al.
    University of Gävle, Department of Caring Sciences and Sociology.
    Olsson, Åsa
    University of Gävle, Department of Caring Sciences and Sociology.
    Utbrändhet: -obearbetad sorg i förklädd form2009Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 307.
    Lindberg, Sophia
    et al.
    University of Gävle, Department of Caring Sciences and Sociology.
    Persson, Maria
    University of Gävle, Department of Caring Sciences and Sociology.
    Hur personer med smärta av WAD upplever vardagen.2007Independent thesis Basic level (degree of Bachelor), 10 points / 15 hpStudent thesis
    Abstract [en]

    The aim of this study was to describe how persons with Whiplash associated disorder experience how the pain affects them in their daily life. The design of the study was descriptive with qualitative, individual interviews, questionnaire with background facts of the examination group, and diary notes from persons with pain of WAD. Method for selection was convenience. Through contact with the association of whiplash group in a county in middle of Sweden, the majority of the examination group for the study was found. Five persons where given information about the study, one of them choose not to take part of the study, and one of the persons did not complete the study. One further person was asked to participate in the study and did take part and completed. Four persons choose to take part and completed the study, all women and between the ages 31-60. The result is presented in categories: To live with pain of WAD, Loss of quality of life, Changes in life after injury, Consequences of activity, Relations and isolation, Pain and sleep. The legible emerge that could be seen in the study was that planning the days was necessary to handle the intensity of pain. The pain controlled the days and the social relations to friends and relatives experience deteriorated because the degree of experienced pain controlled the day. All persons in the examine group emphasized that their injury can not be seen, and because that the acceptance for their injury and pain is low from the society.

  • 308.
    Lindblom, Maria
    et al.
    University of Gävle, Department of Caring Sciences and Sociology.
    Westergren, Ida
    University of Gävle, Department of Caring Sciences and Sociology.
    "Leva med cancer" Bröstcancerdrabbade kvinnors upplevelser av att hantera sin situation - en litteraturstudie2008Independent thesis Basic level (degree of Bachelor), 10 points / 15 hpStudent thesis
    Abstract [en]

    Breast cancer is the most common form of cancer which struck women around the world. When a human is exposed to threat or stress, e.g. breast cancer, different coping strategies are used in order to cope with the situation by the afflicted person. The aim of this literature study was to describe how women, who suffered from breast cancer, experienced coping with their situation. Scientific articles were found in the databases Medline (Pub Med) and Cinahl. A total of 14 articles were chosen regarding to the inclusion criteria and were assessed, analyzed and compiled. The result of the study showed that the women coped with their situation with different and varied strategies. These strategies were categorised in all ready known main categories: problem based, emotional, meaning based and religious coping. The sub categories that emerged under problem based were: seek and find support, educate oneself, have a positive attitude and remaining strategies, under emotional; avoidance and distraction, live a normal life, emotionally composed activities, the use of humour, have a passive attitude, under meaning based; acceptance, the will to survive, lean on hope, newfound meaning and personal development, under religious; faith and spirituality, the relationship to God, prayer for strength and support and remaining categories. Altogether the result displayed a variety of coping strategies that were different depending on the person and the unique situation and it is of great importance that medical staff possesses this knowledge in order to understand patients different ways to cope with their illness.

  • 309.
    Lindeborg, Marie
    et al.
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Suders, Rebecka
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Nyexaminerade sjuksköterskors upplevelser av transitionsprocessen: En litteraturstudie2009Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    The purpose of this literature study was to describe the experiences of the transition period.Data were collected through databases CINAHL and Medline / Pubmed 19 articles wereincluded in the study. The result was divided into five different items. Given the result thenewly graduated nurses found out that the process of transition was an uncertain timefollowed by faltering confidence. They were totally unprepared for the clinical work and theresponsibility which followed. The pressure and expectations from themselves and colleagueswere big and heavy to carry. Colleagues saw the most recent graduates as unprofessional and"eternal students". Good and constructive support and guidance shows that transition processis easier to handle while an inadequate support could affect the performance of graduates and,at worst, lead them leaving the profession. The great responsibility that the graduates facedwere experienced very stressful especially medical management and patient safety, increasedtheir anxiety and that they found it difficult to transfer their theoretical knowledge intopractice. The results also show the positive experiences of the newly graduates. Manyexperienced the transition process as challenging and evolving, and something that they couldlearn from.

  • 310.
    Lindqvist, Petra
    et al.
    University of Gävle, Department of Caring Sciences and Sociology.
    Falkerhorn, Suzanne
    University of Gävle, Department of Caring Sciences and Sociology.
    Effekter och upplevelser av aromaterapi, taktilmassage och akupunktur inom palliativ omvårdnad2008Independent thesis Basic level (degree of Bachelor), 10 points / 15 hpStudent thesis
    Abstract [en]

    The aim of the present literature review was to describe and evaluate the effects and experiences within the complementary approaches such as aromatherapy, tactile massage and acupuncture amongst palliative care patients. Search through Medline (through Pub Med) database and additional manual search was conducted. In total 16 articles fulfilled the inclusion criteria and were reviewed. The result was presented under respectively category: aromatherapy, tactile massage and acupuncture. Physical and psychological effects as well as experiences from the treatments were also documented under the different complementary approaches. Aromatherapy and tactile massage were found to be more effective for reduction in anxiety and depressive mood whilst acupuncture had a greater impact on physical symptoms such as fatigue/insomnia, nausea/vomiting and chemotherapy induced emesis and also xerostomia. Not only did the patients experience relaxation and peacefulness but also feelings of comfort from the aromatherapy and tactile massage therapies. The result also showed that acupuncture felt invigorating and generated more energy for the patients to cope with more activities in their daily lives. In conclusion the complementary therapies aromatherapy, tactile massage and acupuncture are effective and alleviating and therefore very beneficial for patients in palliative care. The complementary therapies is a perfect and valuable tool for symptom management and strengthens the caregiver/patient relationship.

  • 311.
    Lindqvist, Ragny
    et al.
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Kristofferzon, Marja-Leena
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Computer skills among Swedish nursing students2000In: Nursing informatics one step beyond: The evolution of technology and nursing / [ed] Saba V, Carr R, Sermeus W & Rocha P, Auckland: Adis International Limited , 2000, p. 822-822Conference paper (Refereed)
  • 312.
    Lindström, Evilina
    et al.
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Kjellsson, Katrin
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Ungdomars upplevelser av att leva med diabetes: En empirisk studie2009Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    The purpose of the study was to describe young people's experience of living and cope with a diabetes disease with focus on friends, family, diet and exercise. The study was qualitative with descriptive design. The participants were collected through convenience sampling and they answered a questionnaire. The data were analyzed with qualitative content analysis. Resulted in four categories, from everyday motion to hard training, diet effects on life with diabetes, relationships with friends and family, and live and cope with diabetes disease. Participants felt that all four areas were relevant to their experience of diabetes disease. The training varied greatly among participants. Despite previous training workout now perceived as compulsory. When they applied the diet, it was important to decide when, what and how much to eat. Among friends relationship was often unchanged. The complicated relationships within the family was when the participants felt that they were controlled. Participants had negative feelings about their illness in the beginning but became more positive feelings when they learned to cope with the disease. Conclusions of the study was that participants feel that they need knowledge, information and planning to manage their illness in a good way and that it was important to have friends and family who are there and cares. Keywords: experience, young people, diabetes and disease management

  • 313.
    Lindström, Gunilla
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Personalens betydelse för att främja amningen av förtidigt födda barn: en litteraturstudie2009Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    The purpose of this literature review was to describe what the staff could do to facilitate breast-feeding for the premature baby at the neonatal department. The method used was a literature study with descriptive design. The result contained 30 scientific articles. The main results of the study showed that the mother’s connection to her child was of great importance for her ability to maintain breast milk production, until the child was mature enough to breast-feed. The staff facilitated the mother’s connection to her child, by providing information about the important role of the mother. The enforced separation between mother and child affected maternity binding. Parental participation in the care of the child was important for their binding to the child, maintenance of breast milk quantities and finally for the mother's ability to breast-feed her child. When staff worked according to mutual objectives and policies as well as encouraged and informed about the benefits of breast-feeding, the mother could be motivated to breast-feed her child. It was important that an appropriate complementary feeding method was used, not to affect the initial steps of breast-feeding negatively. It was important that breast-feeding was not just to provide food for the child, but also to strengthen the relationship with the child.

  • 314.
    Lindström, Victoria
    et al.
    University of Gävle, Department of Caring Sciences and Sociology.
    Lingman, Elenora
    University of Gävle, Department of Caring Sciences and Sociology.
    Dokumentation inom äldreomsorgen: En jämförande studie2008Independent thesis Basic level (degree of Bachelor), 10 points / 15 hpStudent thesis
    Abstract [sv]

    Vårt syfte med arbetet har varit att göra en undersökning om hur den dagliga dokumentationen genomförs inom äldreomsorgen i två olika kommuner. Avgränsningen vi valt är ett boende/avdelning per kommun. Vi trodde när vi påbörjade vår undersökning att det ena boendet skulle visa sig vara överlägset det andra vad gällde dokumentation. Tittat närmare har vi gjort på olika riktlinjer och arbetssätt de använder sig av i de olika kommunerna, hur rutinerna fungerar kring utförande av dokumentationen samt att senare ta del av densamme. I undersökningen ingick även att ta reda på om personal och chefer har samma syn på dokumentation, om de anser det vara svårt eller lätt att skilja på SoL- (Socialtjänstlager) och HSL (Hälso- och sjukvårdslagen) dokumentationen samt vilka för- och nackdelar de kan se med att använda sig av dokumentation som arbetssätt. Huruvida för- eller nackdelarna får konsekvenser för de boende och den omsorg de går.

    De intervjuer samt den enkätundersökning vi gjort har visat oss att de två boenden vi undersökt var mer nära varandra i rutiner och arbetssätt runt dokumentation än vi trodde när vi påbörjade undersökningen. Personalen såväl som de två enhetscheferna hade väldigt likartade upplevelser och tankar runt för- och nackdelar med dokumentation. De lagar som verksamhetens dokumentation grundar sig på är bland annat SoL, HSL och Sekretesslagen. När det handlar om dokumentation är det viktigt att kommunikationen är tillfredställande personalen emellan. För att åstadkomma detta är det elementärt att begreppen information, meddelande och förståelse fungerar tillsammans och bildar en enhet.

  • 315.
    Lundin, Iza
    et al.
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Jansson, Marika
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Livskvalitet, coping, socialt stöd och sjukdomens påverkan på familjen hos föräldrar till hjärtsjuka barn: en litteraturstudie2009Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Syftet med detta arbete var att beskriva situationen för föräldrar till barn med medfött hjärtfel. Denna studie riktade in sig på föräldrarnas livskvalitet, de copingstrategier de använde sig av i vardagen för att hantera situationen, det sociala stöd de ansåg att de får, samt hur sjukdomen påverkar familjen.

  • 316.
    Lundin, susanne
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Specifik omvårdnad under ambulanstransport vid hjärtinfarkt-Jämförande studie mellan kvinnor och män2009Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 317.
    Lundquist, Martin
    et al.
    University of Gävle, Department of Caring Sciences and Sociology.
    Wohlin, Sofia
    University of Gävle, Department of Caring Sciences and Sociology.
    Nutritionens betydelse för sårläkning: en litteraturstudie2008Independent thesis Basic level (degree of Bachelor), 10 points / 15 hpStudent thesis
    Abstract [en]

    The purpose with this literature study was that through literature describe the nutrition’s significance for healing wounds. The study was made as a descriptive literature study where the method was conducted by searching scientific articles in the databases Medline, Cinahl and Academic Search Elite. Seventeen articles were chosen. The result showed that patients with leg ulcers or pressure sores in many cases don’t attain the recommendations for nutrition that are available. It showed that it is normal that these patients are on the border of being undernourished. It was discovered that the nutrient intake rarely covers the energy needs. Above all the zinc levels were throughout very low and that shows that there is also lack of some other substances. The substances that have been shown especially good for healing wounds are protein, vitamin C, zinc and arginine. However, for patients with burn injuries the salt ornithine α-ketoglutarate has been shown to reduce protein catabolism and also improve protein synthesis, which are essential to healing wounds. The conclusion from this study was that nutrition may be an important but also a determining factor to healing wounds.

  • 318.
    Lyck, Eva-Lena
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Att vara syskon till barn med cancer: en litteraturstudie2009Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Syftet med denna studie var att belysa hur litteraturen beskriver hur syskon till barn med cancer mår, vilka behov de har och vad som görs för dessa syskon. Fjorton artiklar inkluderades i studien och dessa hittades i databaserna Cinahl och Medline (via Pub Med). Sökorden cancer, siblings, emotions, childhood neoplasms, feelings, neoplasms, coping och support har använts i kombination för att hitta artiklarna. Av studiens resultat framkom att många syskon fick förändrad livskvalitet. De kände sig oroliga för det sjuka barnet, en del fick beteende problem som försvann, medan andra kvarstod under en längre tid hos andra. En del kände av konkurensen om föräldrarna. Syskonen visade sig ha behov av att få prata av sig, få socialt stöd och information om vad som händer med det sjuka barnet. Ett sätt tycks vara att de får komma bort och träffa andra syskon med samma problem så att de känner att de inte är ensamma. Stödgrupper och lägerverksamhet är en del av aktiviteterna som syskonen kunde ta del av.

  • 319.
    Löf, Kristina
    et al.
    University of Gävle, Department of Caring Sciences and Sociology.
    Johnsson, Camilla
    University of Gävle, Department of Caring Sciences and Sociology.
    Bemötande av barn vars föräldrar är döende eller har avlidit. En litteraturstudie2007Independent thesis Basic level (degree of Bachelor), 10 points / 15 hpStudent thesis
    Abstract [en]

    Each year over 3000 children in Sweden lose a parent. The loss of a parent may cause some grave changes in a child’s life, leading to both mental and physical consequences. The purpose of this literature study is to examine the different ways in which health care personnel can better receive and relate to children whose parents are dying or have passed away.

    Data was collected through such sources as Pubmed, Academic Search Elite and Cinahl, which resulted in the inclusion of sixteen subsequent articles, ten of which were quantitative and six of which were qualitative. Thirteen of the said articles illustrate how children act in response to a dying or deceased parent and what measures were needed for them to move on with their lives. The child, bereaved parent and health care personnel were all examined within the studies. However, the authors of the remaining three Swedish articles had quite a different purpose from those already mentioned. There aim was to examine recommendations as to whether a child should visit a seriously ill relative at an Intensive Care Unit, as well as the subsequent opinions of both parent and health cars personnel to this visitation. Results showed that it was very beneficial for children and parents alike to receive information and support from health care personnel both during and after the parents period of suffering and eventual death. It was found that, if health care personnel or other adult for that matter regularly engaged with the child, alleviating any fears, then the risk for further psychological problems was reduced.

  • 320.
    Löf, Louise
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
     Journalföring vid läkemedelsgivning: en journalstudie gällande dokumentation av given vid behovsmedicinering2009Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Syftet med denna studie var att belysa om lagstiftningen efterföljs vid behovsmedicinering på SÄBO (Särskiltboende) samt beskriva vilka likheter och skillnader som finns i dokumentationen gällande när vid behovs medicinering ges. Designen var jämförande, deskriptiv, kvantitativ, retrospektiv journalstudie. Urvalet var 100 patientjournaler från tre SÄBO i mellan Sverige. Journalerna har granskats utifrån följande variabler: demens- eller somatisk-avdelning, läkemedelsnamn, styrka, dos, orsak till att medicinen givits, effekten av medicinen, yrkestillhörighet på dokumenteraren samt jämförande med gammalt/nytt journalsystem. Resultatet visade signifikanta skillnader i dokumentationen utifrån om det var ett demensboende eller ett somatikboende. Ingen skillnad i dokumentationen fanns att finna mellan gammalt och nytt datasystem. Läkemedelsnamnet var det som förekom mest i dokumentationen vid behovsmedicinering. Minst förekommande var anteckningar angående utvärderad effekt. Dokumentationen kring given vid behovsmedicinering var bristfällig och resultatet i denna studie visade bland annat att det inte var journalföringssystemet som var orsaken.

  • 321.
    Löfgren, Patrik
    et al.
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för socialt arbete.
    Göterfors, Helene
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för socialt arbete.
    När hjälpmedlet blir en identitet: kvällstidningarnas bild av rullstolsburna - en diskursanalys2009Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    För personer med funktionsnedsättning har vardagen förändrats väldigt genom tiderna. Från att förr ha blivit kallad alla möjliga misskrediterande glåpord och haft begränsade rättigheter har personer med funktionsnedsättningar i senare tids handikappolitik helt andra rättigheter där de skall ha möjlighet att leva som andra och få ett bättre bemötande.

     

    Vi har i denna studie undersökt två kvällstidningar, Expressen och Aftonbladet, med syfte att studera hur man använder termen rullstolsburen i sina artiklar och hur detta användande blir till ett stigma för personer med funktionsnedsättning. Vi valde ut dessa två tidningar eftersom de konsumeras över hela landet och är de största av de kvällstidningar som produceras och därmed har flest läsare som påverkas av artiklarna. För att begränsa oss och även för att påvisa antalet artiklar av detta slag som publicerades under en viss tidsperiod, är materialet som användes från april 2009 och tre år tillbaka i tiden. Denna sökning resulterade i att vi använde 81 st artiklar till studien.

     

    Med hjälp av den kritiska diskursanalysen har vi analyserat språkbruket i dessa artiklar och utforskat sammanhanget i vilka man använder termen rullstolsburen. Diskursanalysen har använts för att undersöka hur media har makten att genom sina artiklar och inslag påverka samhällsmedborgarnas uppfattning om vad som räknas till normalt och inte och därmed även makten att skapa och upprätthålla stigman för utsatta grupper i samhället.

     

    I resultatet framkom att man i artiklarna i vissa fall ersatte personernas identitet med termen rullstolsburen samt att tidningarna huvudsakligen använder sig av termen rullstolsburen vid rapporteringen av brott och orättvis behandling.

  • 322.
    Löfmark, Anna
    et al.
    University of Gävle, Department of Caring Sciences and Sociology. Section of Caring Sciences, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Gustafsson, Christina
    Department of Education, Uppsala University, Uppsala, Sweden.
    Wikblad, Karin
    Department of Medicine and Care, Division of Nursing Science, Faculty of Health Science, Linköping University, Linköping, Sweden.
    Student nurses’ ability to perform pain assessment.2003In: Nurse Education in Practice, ISSN 1471-5953, E-ISSN 1873-5223, Vol. 3, p. 133-143Article in journal (Refereed)
    Abstract [en]

    The objective of this study was to investigate student nurses' ability to handle a pain assessment situation. A systematic way of working based on knowledge within the area is emphasised in nursing education today. The performance of 32 student nurses at a university college in Sweden took place in an arranged assessment situation that closely simulated clinical practice. The conversation between the student and the patient (a voluntary patient) was videotaped and analysed with content analysis according to predetermined components of pain assessment. The results showed that one-third of the students had performed adequately based on the requirements for pain assessment in the curriculum for nursing education. Two-thirds of the group did not handle the situation systematically and also showed a lack of knowledge of pain assessment, and among these was a group of students whose performance was inadequate. The results indicate that during their education it is very important for student nurses to obtain experience and guidance in how to work systematically and to have their knowledge and skills in pain assessment evaluated.

  • 323.
    Löfmark, Anna
    et al.
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Hansebo, Görel
    Department of Health Care Sciences, Ersta Sköndal University College, Stockholm.
    Nilsson, Marina
    Department of Health Care Sciences, Ersta Sköndal University College, Stockholm.
    Törnkvist, Lena
    Centre for Family and Community Medicine, Karolinska Institutet, Stockholm, Sweden.
    Nursing students' views on learning opportunities in primary health care2008In: Nursing Standard, ISSN 0029-6570, E-ISSN 2047-9018, Vol. 23, no 13, p. 35-43Article in journal (Refereed)
    Abstract [en]

    AIM: To evaluate a new supervision model for nursing students' placements in primary care in Sweden and to document students' opinions on their learning experiences in this setting. METHOD: Nursing students' (n=238) opinions were collected using a questionnaire administered before and after implementation of a new supervision model for student placements in primary care. RESULTS: Respondents were generally satisfied with their placements and rated factors that supported the new model: distinct structure for following students during the placement period; continuous caring experiences with some patients; having more than one district nurse as a mentor during the period; and seminars in primary care settings. However, just one third of respondents felt that they gained insight into how nursing research could be used in patient care. CONCLUSION: The evaluation of the new supervision model and learning opportunities in primary care were positively rated by respondents. Application of nursing research and planned time for reflection were ranked low, findings that are noteworthy and should be investigated further.

  • 324.
    Löfmark, Anna
    et al.
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap. Department of Health, Stord/Haugesund University College, Stord, Norway.
    Morberg, Åsa
    University of Gävle, Department of Education and Psychology, Ämnesavdelningen för didaktik.
    Öhlund, Lennart S.
    University of Gävle, Department of Education and Psychology, Ämnesavdelningen för folkhälsovetenskap. Department of Health Sciences, Aalesund University College, Aalesund, Norway.
    Ilicki, Julian
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för socialt arbete.
    Supervising Mentors' Lived Experience on Supervision in Teaching, Nursing and Social Care Education. A Participation-Oriented Phenomenological Study2009In: Higher Education, ISSN 0018-1560, E-ISSN 1573-174X, Vol. 57, no 1, p. 107-123Article in journal (Refereed)
    Abstract [en]

    Research concerning the supervisor role in separate educational programmes has been undertaken, but cross-professional studies are few. The aim of this study was to explore the lived experience of supervising mentors in Sweden during the practice-based, off-campus sections of the education in teaching, nursing, and social care. The study used a participatory phenomenological approach in which four researchers and nineteen supervising mentors worked together in the research process which was accomplished in four different phases. The data collecting method used was interview. The results constituted a main essence entitled "Struggle of power and control of professional quality enhancement" built upon four themes: "Constitutes a motivating force", "Feelings of responsibility", "Feelings of frustration" and "Wishes for alteration". Conclusions from the study are that communication, information and contact between the professionals in the fields and university teachers need to be strengthen to keep up supervising mentors' motivating force and to give them support.

  • 325.
    Löfmark, Anna
    et al.
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Smide, Bibbi
    Wikblad, Karin
    Competence of newly-graduated nurses: a comparison of the perceptions of qualified nurses and students2006In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 53, no 6, p. 721-728Article in journal (Refereed)
    Abstract [en]

    AIM: This paper reports a study that compares opinions of final year nursing students, rating their own competence, with the opinions of experienced nurses on the competence of newly-graduated nurses. BACKGROUND: The transition of nursing preparation into higher education is regarded as positive, although it has led to differences in opinion about the competence of newly-graduated nurses and their readiness to enter the nursing profession. There are studies showing that newly-graduated nurses perceive themselves as holistically focused, professional practitioners, while other nurses are concerned that newly-graduated nurses do not have necessary skills. METHODS: A convenience sample of 106 nursing students in the final week of their course and 136 nurses who had experience of supervising nursing students completed a questionnaire. The data were collected in 2002. RESULTS: Own competence, in the form of ability to perform nursing care, was rated by nursing students to be good or strongly developed in most of the investigated areas of nursing care. Experienced nurses also estimated newly-graduated nurses' competence to be good or strongly developed, although to a lesser extent. Nurses qualified within the previous 5 years rated newly-graduated nurses' competence to be higher in comparison with those with less recent education. CONCLUSIONS: Further studies are needed to broaden our understanding of why some areas of nursing care, such as ethical awareness, were rated very highly, while others, like informing and teaching of co-workers and planning and prioritizing interventions had the lowest rating.

  • 326.
    Löfmark, Anna
    et al.
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Thorell-Ekstrand, Ingrid
    An assessment form for clinical nursing education: a Delphi study2004In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 48, no 3, p. 291-298Article in journal (Refereed)
    Abstract [en]

    Aim. This paper reports a study to develop further the existing assessment form and to capture new aspects of assessment for the nursing profession of the future for inclusion in the form.

    Background. Since nursing education became part of the higher education system, the assessment of clinical periods of the programme has become more complicated and requirements are more demanding. Changes in the health care sector, such as demographic changes and shorter hospitalization, create demands upon the independent nursing role of the future. Many educational documents, such as an assessment form, must continuously be up-dated and adapted to changes in society.

    Method. A Delphi study concerning the content of this assessment form was carried out using two rounds. Through this process, an expert panel gave their opinions about the form and possible changes to it.

    Results. There was general acceptance of the content in the current assessment form. Suggested changes were the addition of two factors concerning collaboration with the family and society, and development of the student's independence. Two new area headings were suggested: one about ability to use the nursing process, and the other about development of a professional stance.

    Conclusions. The suggested changes in the assessment form match expected changes in the health care sector and the demands of an academic nursing education

  • 327.
    Löhman, Marie
    University of Gävle, Department of Caring Sciences and Sociology.
    Inflytande och delaktighet: Del 1 Införande av arbetsrotation på mottagningsenheten vid Bollnäs sjukhus1998Report (Other academic)
  • 328.
    Löhman, Marie
    University of Gävle, Department of Caring Sciences and Sociology.
    Inflytande och delaktighet: Del 2 Utvecklingsarbete vid Södertulls hälsocentral1999Report (Other academic)
  • 329.
    Löhman, Marie
    University of Gävle, Department of Caring Sciences and Sociology.
    USU-projektet: utbildning-samverkan-utveckling. D. 1, Samarbete mellan primärvård och hemtjänst i Ovanåkers kommun2000Report (Other academic)
    Abstract [en]

    The USU-project which stands for development, cooperation and education is a cooperating project including the local medical care centre and the old age care centre in the city of Ovanåker. Great demand for medical and personal care as well as demands to effect economies require new methods of working with elderly and sick people in the future. The thrust is to make it possible for all fellow workers in the field of action to participate in a common process in purpose to analyse the needs of care as well as the needs of development in the future. The project mainly focus on quality, efficiency and pleasure in one's work. An external evaluator was connected to the project in purpose to describe how the staff as well as those in need of professional care experience the field of action today and to which extent they will experience any development connected to the project in the future. This report, which is the first of two, describes what have been done in the project workduring 1999 and how the staff and the patients experience the old age care today. The data have been collected during the period of January to June 1999. Observations and interviews have been done with bosses, other fellow-workers and people in need of professional care. The results show that the staff as well as the patients has a very positive opinion about both the medical and the social care in the city of Ovanåker. The results also shows that there are fields of development which are important to pay attention to in a vision of the future. The fields are for example development of the leadership in the field of social care, development of the competence and responsibility in the teams of social care and further development of the cooperation between the social and the medical care. For instance through meetings for individual care planning, common group meetings and further training.

  • 330.
    Lüdge-Albertsson, Katarina
    et al.
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Anna-Carin, Andersson
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Livsstilsförändringar efter en hjärtinfarkt. En kvalitativ intervjustudie.2009Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    I Sverige har insjuknandet och överlevnanden i hjärtinfarkt förbättrats de senaste åren. Levnadsvanor och livsstil har betydelse. Människor som drabbas av hjärtinfarkt blir utskrivana från sjukhuset allt tidigare idag mot förut. Detta bidrar till att patienter och anhöriga/närstående får ta ett större ansvar efter utskrivningen. Informationsbehovet kring livsstilsförändringar är därför stort. Syftet var att beskriva människors erfarenhet av vad som underlättar respektive försvårar att göra de livsstilsförändringar de fått rekommendation om efter en diagnostiserad hjärtinfarkt. Metoden var en beskrivande studie med kvalitativ ansats. Öppna intervjuer genomfördes med sex informanter. Data analyserades med innehållsanalys. Av informanterna framkom information om hur de upplevt tiden efter insjuknandet gällande de rekommenderade livsstilsförändringarna. Huvudresultatet visade att det som dominerade bland svaren och vad som underlättat att genomföra livsstilsförändringar var den egna motivationen till en förändrad livsstil. Vad som ansågs försvårande var den sociala begränsningen informanterna upplevde. Slutsatsen är att det är viktigt med information till sjukvårdspersonal om vilka faktorer som underlättar livsstilsförändring och att den informationen når ut till patienterna.

    Nyckelord: Livsstilsförändring, hjärtinfarkt. upplevelser

  • 331.
    Magnusson, Ann-Charlotte
    et al.
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Bengter, Lena
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Omvårdnad av patienter med postoperativ smärta på en ortopedisk vårdavdelning: en litteraturstudie.2009Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
  • 332.
    Maja de Bernardo, Maja
    University of Gävle, Department of Caring Sciences and Sociology.
    Sjuksköterskors upplevelser av noninvasiv ventilatorbehandling av patienter med akut andningssvikt på lungavdelning2009Independent thesis Advanced level (degree of Master (One Year)), 15 credits / 22,5 HE creditsStudent thesis
    Abstract [en]

     

     

     

     

    Abstract

    The aim of the study was to describe factors of nurse’s experiences when they give NIV treatment to patients with acute respiratory failure in a lung department. Semi structured interview questions about how nurses experience to give NIV treatment on a ordinary lung department was done on 10 nurses, who work in a lung department were NIV treatment is given. Data were analyzed with content analysis. In the result there was shown two themes. The two themes were knowledge and cooperation during NIV treatment and time and support accomplish NIV treatment easier to give. The first themes were knowledge and cooperation during NIV treatment. The theme was created by four categories: “specific knowledge about NIV treatment”, “cooperation with doctors” ”documentation about the treatment”, and ”teamwork between nurses”.  The theme time and support accomplish NIV treatment easier to give, was also created by four categories:” support for next of kin” satisfaction when the treatment is helping, “the patients need of support” and “time for the patient”. NIV treatment is a treatment that is god but in need of development, according to the nurses on the lung department, but there is a lot around the treatment that could be better. For example: getting more time with the patient and further educate doctors and nurses, so that NIV treatment can be given under assured requirements and to more patients.

     

    Key words: nurses, experiences, NIV treatment, COPD patients, technological equipment

  • 333.
    Malinovschi, A.
    et al.
    Department of Medical Cell Biology, Intgrative Physiology, Uppsala University, Uppsala, Sweden.
    Janson, C.
    Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University, Uppsala, Sweden; Asthma and Allergy Research Centre, Uppsala University, Uppsala, Sweden.
    Holmkvist, T.
    Department of Medical Cell Biology, Intgrative Physiology, Uppsala University, Uppsala, Sweden.
    Norbäck, D.
    Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Box 571, SE-751 23 Uppsala, Sweden; Asthma and Allergy Research Centre, Uppsala University, Uppsala, Sweden.
    Merilainen, P.
    Department of Engineering Physics and Mathematics, Helsinki University of Technology, Helsinki, Finland.
    Högman, Marieann
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för medicinsk vetenskap. Department of Medical Cell Biology, Intgrative Physiology, Uppsala University, Uppsala, Sweden; Asthma and Allergy Research Centre, Uppsala University, Uppsala, Sweden.
    Effect of smoking on exhaled nitric oxide and flow-independent nitric oxide exchange parameters2006In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 28, no 2, p. 339-345Article in journal (Refereed)
    Abstract [en]

    It is a well-known fact that smoking is associated with a reduction in exhaled nitric oxide (NO) levels. There is, however, limited knowledge relating to the smoking-induced changes in production or exchange of NO in different compartments of the airways. This study comprised 221 adult subjects from the European Community Respiratory Health Survey 11, who were investigated in terms of their exhaled NO, lung function, immunoglobulin E sensitisation and smoking habits. The following parameters were determined using extended NO analysis: airway tissue nitric oxide concentration (Caw,NO), airway transfer factor (or diffusing capacity) for nitric oxide (Daw,NO), alveolar nitric oxide concentration (CA,No) and fractional exhaled nitric oxide concentration at a flow rate of 50 mL(.)s(-1) (FeNO,0.05). Maximum total airway nitric oxide flux (J'aw,NO) was calculated from Daw,NO(Caw,NO-CA,NO). Current smokers (n=35) exhibited lower (geometric mean) FeNO,0.05 (14.0 versus 22.8 ppb), Caw,NO (79.0 versus 126 ppb) and J'aw,NO (688 versus 1,153 pL(.)s(-1)) than never-smokers (n=111). Ex-smokers (n=75) were characterised by lower FeNO,0.05 (17.7 versus 22.8 ppb) and Jaw,NO (858 versus 1,153 pL-s(-1)) than never-smokers. These relationships were maintained after adjusting for potential confounders (sex, age, height, immunoglobulin E sensitisation and forced expiratory volume in one second), and, in this analysis, a negative association was found between current smoking and CA,NO. Snus (oral moist snuff) consumption (n=21) in ex-smokers was associated with an increase in Daw,NO and a reduction in Caw,No, after adjusting for potential confounders. Passive smoking was associated with a higher CA,NO. Using extended nitric oxide analysis, it was possible to attribute the reduction in exhaled nitric oxide levels seen in ex- and current smokers to 6 lower total airway nitric oxide flux in ex-smokers and reduced airway and alveolar nitric oxide concentrations in current smokers. The association between snus (oral tobacco) use and reduced nitric oxide concentrations in the airways and increased nitric oxide transfer from the airways warrants further studies.

  • 334.
    Malinovschi, Andrei
    et al.
    Department of Medical Cell Biology: Integrative Physiology, Uppsala University, Uppsala, Sweden.
    Janson, Christer
    Asthma and Allergy Research Centre, Uppsala University, Uppsala, Sweden; Department of Medical Sciences: Respiratory Medicine and Allergology, Uppsala University, Uppsala, Sweden.
    Holmkvist, Thomas
    Department of Medical Cell Biology: Integrative Physiology, Uppsala University, Uppsala, Sweden.
    Norbäck, Dan
    Asthma and Allergy Research Centre, Uppsala University, Uppsala, Sweden; Department of Medical Sciences: Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden.
    Meriläinen, Pekka
    Department of Engineering Physics and Mathematics, Helsinki University of Technology, Helsinki, Finland.
    Högman, Marieann
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för medicinsk vetenskap. Asthma and Allergy Research Centre, Uppsala University, Uppsala, Sweden; Department of Medical Cell Biology: Integrative Physiology, Uppsala University, Uppsala, Sweden.
    IgE sensitisation in relation to flow-independent nitric oxide exchange parameters2006In: Respiratory Research, ISSN 1465-9921, E-ISSN 1465-993X, Vol. 7, article id 92Article in journal (Refereed)
    Abstract [en]

    Background: A positive association between IgE sensitisation and exhaled NO levels has been found in several studies, but there are no reports on the compartment of the lung that is responsible for the increase in exhaled NO levels seen in IgE-sensitised subjects. Methods: The present study comprised 288 adult subjects from the European Community Respiratory Health Survey II who were investigated in terms of lung function, IgE sensitisation ( sum of specific IgE), smoking history and presence of rhinitis and asthma. Mean airway tissue concentration of NO (Caw(NO)), airway transfer factor for NO (Daw(NO)), mean alveolar concentration of NO (Calv(NO)) and fractional exhaled concentration of NO at a flow rate of 50 mL s(-1) ( FENO0.05) were determined using the extended NO analysis. Results: IgE-sensitised subjects had higher levels ( geometric mean) of FENO 0.05 (24.9 vs. 17.3 ppb) ( p < 0.001), Daw(NO) ( 10.5 vs. 8 mL s(-1)) ( p = 0.02) and Caw(NO) (124 vs. 107 ppb) ( p < 0.001) and positive correlations were found between the sum of specific IgE and FENO 0.05, Caw(NO) and Daw(NO) levels ( p < 0.001 for all correlations). Sensitisation to cat allergen was the major determinant of exhaled NO when adjusting for type of sensitisation. Rhinitis and asthma were not associated with the increase in exhaled NO variables after adjusting for the degree of IgE sensitisation. Conclusion: The presence of IgE sensitisation and the degree of allergic sensitisation were related to the increase in airway NO transfer factor and the increase in NO concentration in the airway wall. Sensitisation to cat allergen was related to the highest increases in exhaled NO parameters. Our data suggest that exhaled NO is more a specific marker of allergic inflammation than a marker of asthma or rhinitis.

  • 335.
    Mamhidir, Anna-Greta
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Ethical challenges related to elder care: perspectives of staff and high level decision-makers2008In: Nursing Ethics and Health Care Policy: Bridging Local, National, and International Perspectives : International Conference Nursing Ethics (ICNE), Yale University New Haven, Conneticut, USA, 17-19 juli 2008, 2008, p. 1-5Conference paper (Refereed)
  • 336.
    Mamhidir, Anna-Greta
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Meeting ethical and nutritional challenges in elder care: the life world and system world of staff and high level decision-makers2006Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The overall aim of the thesis was to describe the issue of malnutrition and use it as a focal point of interest in elder care. A further aim was to illuminate how this issue could be addressed focusing on older adults’ integrity and high level decision-makers’ reasoning about ethically difficult situations (I-IV). Older adults, caregivers and high level decision-makers (HDMs) i.e. elected politicians and civil servants participated in the studies.

    Study I focused on the frequency of underweight, weight loss and related risk factors among older adults living in 24 sheltered housing units located in one county. Measurements were obtained from 719 and were repeated after one year with the 503 still participating (I). Weight changes in older adults and changes in mealtime routines and environment were followed after a three month integrity promoting intervention. The participants were living at two nursing homes, 18 from the intervention ward (I-ward) and 15 from the control ward (C-ward) (II). The HDMs’ views and reasoning regarding malnutrition in elder care were illuminated (III). Also highlighted were the HDMs’ experiences of the meaning of being in ethically difficult situations related to elder care (IV). Participating in studies III-IV were eighteen HDMs from the municipality or county council level. The inclusion area encompassed two counties (I-IV). Methods used in the studies were: descriptive statistics and logistic regression (I), descriptive and comparative statistics as well as manifest content analysis (II), latent content analysis (III) and phenomenological hermeneutic analysis (IV).

    A considerable percentage of the older adults in the sheltered housing units were underweight or exhibited weight loss. After a year, significant changes were found such as declined cognitive and functional capacity, eating dependencies, and chewing and swallowing problems. Risk factors associated with underweight and weight loss were cognitive and functional decline, eating dependencies and constipation (I). After the intervention that included staff training, the meal environment and routines were changed and weight increases were seen in 13 of 18 older adults from the I-ward compared with two of 15 from the C-ward. The individual weight changes correlated significantly to changes in the intellectual functions. Increased contact with the older adults and a more pleasant atmosphere was reported (II). The HDMs cited the older adults’ poor health status, caregivers’ lack of knowledge and inflexible routines as possible causes for the malnutrition. They suggested the need for increased physician intervention, more education and individualised care. The HDMs placed the responsibility for the issues more with caregivers and physicians then with the local managements and themselves (III). Both ethical dilemmas and the meaning of being in ethically difficult situations related to elder care were revealed by the HDMs (IV). The dilemmas mostly concerned difficulties of dealing with extensive care needs with a limited budget. Other aspects included the lack of good care for the most vulnerable, weaknesses in medical support, dissimilar focuses between caring systems and justness in the distribution of care. Being in ethically difficult situations was associated with being exposed, having to be strategic, feelings of aloneness, loneliness and uncertainty, lack of confirmation, risk of being threatened or becoming a scapegoat and avoidance of difficult decisions (IV).

    Different levels in a health care system seem to be intertwined with ethical and nutritional challenges that confront and are associated with the different assumed roles. The results are reflected in the so called life world that concerns relationships, the system world that concerns routines and the governing of goals, and the tension between these two worlds. Structures that enable dialogues where ethical issues can be brought up from the different levels and between the different professionals inside the health care system seem to be important for the reduction of feelings of distrust and an improvement in elder care.

  • 337.
    Mamhidir, Anna-Greta
    et al.
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Karlsson, Ingvar
    Norberg, Astrid
    Kihlgren, Mona
    Weight increase in patients with dementia, and alteration in meal routines and meal environment after integrity promoting care2008In: Research and practice in Alzheimer's disease. Vol 13, 2008, 2008, p. 121-124Chapter in book (Other academic)
  • 338.
    Mamhidir, Anna-Greta
    et al.
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Kihlgren, Annica
    Wimo, Anders
    Community nurses’ referrals of older adults to emergency departments: a follow-up study in a Swedish context [Poster]2009In: International Psychogeriatric Association (IPA) Conference, Rio de Janeiro, Brasilien, 4-7 maj 2009, 2009Conference paper (Refereed)
  • 339.
    Mamhidir, Anna-Greta
    et al.
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Kihlgren, Mona
    Sorlie, Venke
    Ethical challenges related to elder care: high level decision-makers' experiences2007In: BMC Medical Ethics, ISSN 1472-6939, E-ISSN 1472-6939, Vol. 8, no 3Article in journal (Refereed)
    Abstract [en]

    Background

    Few empirical studies have been found that explore ethical challenges among persons in high public positions that are responsible for elder care. The aim of this paper was to illuminate the meaning of being in ethically difficult situations related to elder care as experienced by high level decision-makers.

    Methods

    A phenomenological-hermeneutic method was used to analyse the eighteen interviews conducted with political and civil servant high level decision-makers at the municipality and county council level from two counties in Sweden. The participants worked at a planning and control as well as executive level and had both budget and quality of elder care responsibilities.

    Results

    Both ethical dilemmas and the meaning of being in ethically difficult situations related to elder care were revealed. No differences were seen between the politicians and the civil servants. The ethical dilemmas mostly concerned dealings with extensive care needs and working with a limited budget. The dilemmas were associated with a lack of good care and a lack of agreement concerning care such as vulnerable patients in inappropriate care settings, weaknesses in medical support, dissimilar focuses between the caring systems, justness in the distribution of care and deficient information. Being in ethically difficult situations was challenging. Associated with them were experiences of being exposed, having to be strategic and living with feelings such as aloneness and loneliness, uncertainty, lack of confirmation, the risk of being threatened or becoming a scapegoat and difficult decision avoidance.

    Conclusion

    The high level decision-makers feel that something worthwhile is at stake in elder care. A risk exists that older adult and decision-maker needs are not being met. The results provide further insight into the ethical challenges and reasoning found among high level decision-makers, which are important since their decisions affect older patients, relatives and caregivers, and can be useful when conducting discussions within health care organisations. Future research is suggested on how people are affected when loyalties to a position come into conflict with personal convictions. Since ethical dilemmas that confront all levels of health care organisation will persist, the concept of organisational ethics also needs further research.

  • 340.
    Mamhidir, Anna-Greta
    et al.
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Kihlgren-Larsson, Annica
    Kihlgren, Mona
    Wimo, Anders
    Funktionsförmåga och vårdbehov inom särskilt boende: RAI-bedömningar vid 24 boenden i X-län vid studiens start och efter 12 månader2003Report (Other (popular science, discussion, etc.))
  • 341.
    Mamhidir, Anna-Greta
    et al.
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Lundman, Berit
    Having control over type 2 diabetes means daring to be free2004In: Journal of Diabetes Nursing., ISSN 1368-1109, Vol. 8, no 1, p. 12-16Article in journal (Refereed)
    Abstract [en]

    In this article we describe the process of assuming control from the patient's perspective. A qualitative study into the meaning of control and freedom of people with type 2 diabetes was conducted. Insight into the responsibility and loss of freedom that diabetes entails created emotional strain, but learning to know the body's reactions and how to test blood glucose gave a feeling of security. Participants emphasised personal choice in everyday life at the same time as feelings of fear and guilt about lapses in self care. A positive view of life made it easier for people with diabetes to find a suitable lifestyle and establish a feeling of freedom. An encouraging approach to caring for people with diabetes helped to build self-confidence and freedom.

  • 342.
    Mamhidir, Anna-Greta
    et al.
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Löfmark, Anna
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Studenters och handledares uppfattning om den förändrade utbildningsnivån inom den verksamhetsförlagda delen av utbildningen i specialist-sjuksköterskeprogrammet med inriktning mot distriktssköterska: Nationell konferens, Stockholms Universitet, den 6-7 november 2008. Poster 2008Conference paper (Refereed)
  • 343.
    Mamhidir, Anna-Greta
    et al.
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Strandell, Sonja
    Kihlgren-Larsson, Annica
    Kihlgren, Mona
    Wimo, Anders
    Funktionsförmåga, behandlingar och stödinsatser inom basal hemsjukvård: RAI-bedömningar vid 33 hälsocentraler i X-län vid studiens start och efter 12 månader2003Report (Other (popular science, discussion, etc.))
  • 344.
    Matsson, Annelie
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för vårdvetenskap.
    Intensivvårdsjuksköterskors tillämpning av de evidensbaserade riktlinjerna för att förhindra uppkomsten av ventilator-associerad pneumoni2009Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Ventilator-associated pneumonia is the most common infection in the intensive care unit. It is a complication that causes major morbidity, increased mortality and growing healthcare costs. There are many evidence-based clinical practice guidelines in order to prevent that VAP arises, where the nurse has a significant role. Several studies have established that there is deficiencies in the nurse's knowledge to apply to the evidence-based guidelines in order to prevent the origin of VAP. The aim with the study was to describe intensive care unit nurses' application of the evidence-based guidelines in order to prevent the origin of VAP at intensive care patients and to compare the application of the evidence-based guidelines between subgroups. A structured questionnaire was distributed out to all intensive care nurses (N=40) on an intensive care unit in the middle of Sweden, of which 30 responded to the questionnaire. The result showed that the intensive care nurses apply to the evidence-based guidelines in a high extent on the basis of self-reports. There were no significant differences between they with short (0-5 year) and long (> 5 year) experience as an intensive care nurse, as regards in what extent they use the evidence-based guidelines in order to prevent the origin of VAP. The respondents knowledge and application of the evidence-based guidelines can be considered to be good in this study, on the basis of self-reports. Most of the respondents had got education/information about VAP, what can have caused the result that appeared. Many previous studies have shown that education increases the application of the evidence-based guidelines.

  • 345.
    Mentzer, Johanna
    University of Gävle, Department of Caring Sciences and Sociology.
    Patienters och anhörigas upplevelser och åsikter vid omvårdnaden av Anorexia Nervosa samt olika behandlingsformer2008Independent thesis Basic level (degree of Bachelor), 10 points / 15 hpStudent thesis
    Abstract [en]

    The object with the study of this literature was to describe differente programs of care and patients and relatives experience and opinion about the caring for patients with Anorexia Nervosa. The method the author used was a descriptive literature study based on imperial studies. The studies were based on 15 scientific articles within the chosen field. The results shows that these patients hade special needs to be seen and heard as individuals, involved in their own treatment, and have good contact with the caring staff. The study also shows which methods were mostly appreciated involving nurses, patients and relatives. Results show the patients appreciating the individual therapy and an empathetic caring staff. Parents though thought that family therapy was the best treatment. Here they felt they could show their feelings and at the same time get help and advice in handling different situations. The result also shows problem areas such as framing oneself from the world or patients starting a competition of weight loss among the group members. The study also shows the difference in the nurses views of the different situation. Most nurses found it difficult to treat Anorexia Nervosa or to understand the illness, didn’t feel they had enough knowledge of the psychological health. It also shows that more studies and knowledge is needed in regards to forms and ways of treatment and the different causes of the illness.

  • 346.
    Michailakis, Dimitris
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för socialt arbete.
    Anställningsbarhet och funktionshinder2006In: Loop. Tidskriften om ledarskap, organisation och personal, ISSN 1653-073X, Vol. 2, no 5, p. 50-53Article in journal (Refereed)
  • 347.
    Michailakis, Dimitris
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för socialt arbete.
    Communication Overload in Interaction Systems2004In: Scandinavian Journal of Disability Research, ISSN 1501-7419, E-ISSN 1745-3011, Vol. 6, no 1, p. 37-54Article in journal (Refereed)
    Abstract [en]

    The article aims at exploring the relevance of Luhmann's sociological systems theory to understand disability as communication about impairments. The questions to be considered in the following are: What happens to interaction systems when confronted with individuals with psychical or physical impairments (deviating bodies, perception difficulties, difficulties to process information)? What are the essential characteristics of interaction where disabled people participate? Trying to answer these questions, a broader question is raised: In which ways does communication in interaction systems become strained or overloaded? I argue that from the viewpoint of systems theory, disability as a social phenomenon, as part of social systems ‐ historically evolved and intelligible only in a systems/environment relationship ‐ must be linked to communication. Individuals’ impairments strain interaction with respect to time, objectively and socially because interaction systems are a combination of perception and communication.

  • 348.
    Michailakis, Dimitris
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för socialt arbete.
    Observing Disability as Communication2004In: Exploring the living conditions of disabled people / [ed] Jan Tøssebro & Anna Kittelsaa, Lund: Studentlitteratur, 2004Chapter in book (Other (popular science, discussion, etc.))
  • 349.
    Michailakis, Dimitris
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för socialt arbete.
    Rollteori eller systemteori2005In: Nordiske organisasjonsstudier, ISSN 1501-8237, Vol. 1, no 3, p. 187-199Article in journal (Refereed)
  • 350.
    Michailakis, Dimitris
    University of Gävle, Department of Caring Sciences and Sociology, Ämnesavdelningen för socialt arbete.
    Some Considerations on Inclusive Education in Sweden2004In: Inclusive Education: A Framework for Reform : proceedings of the International Conference on Inclusive Education, 16-19 December 2003, 2004Chapter in book (Refereed)
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