| 1. |
- Anheim, F., et al.
(författare)
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Learning organizations in the Swedish construction area
- 2001
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Ingår i: [Host publication title missing]. - Göteborg : Dept. of Building Economics and Management, Dept. of Service Management, Chalmers Univ. of Technology. ; , s. 259-266, s. 259-266
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Konferensbidrag (refereegranskat)
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| 2. |
- Arvidsson, Barbro, 1945-
(författare)
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Group supervision in nursing care : a longitudinal study of psychiatric nurses' experiences and conceptions
- 2000
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Inom hälso- och sjukvården betonas att vården ska ges utifrån ett patientorienterat sätt. Om sjuksköterskor skall kunna ge patienten god omvårdnad, måste de själva ha en god arbetssituation. Det blir allt vanligare att sjuksköterskor i arbetet utsätts för en mängd negativa psykiska påfrestningar, såsom hot och våld, som kan leda till stress. Stress kan också relateras till att sjuksköterskorna i sitt arbete ställs inför komplicerade etiska övervägande. Det är viktigt att få möjligheter att reflektera över vilka etiska principer och ställningstagande arbetet baseras på. En metod som möjliggör reflektion är grupphandledning i omvårdnad. Deltagarna i grupphandledning bör ha samma yrkesbakgrund och ledas av en utbildad handledare, som också har samma yrkesbakgrund, som de som deltager i handledning. I handledning reflekteras över genomförda omvårdnadssituationer utifrån frågor som Vad hände? Vilka etiska aspekter förekommer? Vad kan sjuksköterskan göra annorlunda om det händer igen? Det handlar om att genom reflektion undersöka hur sjuksköterskan agerar, gör bedömningar, tänker och känner i olika omvårdnadssituationer. I detta sammanhang kan hon/han få emotionell och teoretisk återkoppling, ges möjlighet att kritiskt granska och diskutera svåra ställningstaganden samt få alternativa handlingsmöjligheter. Det övergripande syftet med föreliggande studie var att granska och undersöka hur psykiatrisjuksköterskors professionella kompetens över tid förändrades genom grupphandledning i omvårdnad. Tre delstudier genomfördes. Undersökningsgruppen bestod av tolv psykiatrisjuksköterskor, fördelade på två grupper som erhöll handledning i omvårdnad under två år. Inför den första delstudien konstruerades två frågeformulär för att undersöka om deltagarna i grupphandledning upplevde trygghet, tillit och lärande under handledningssammankomsterna. Resultatet från delstudie 1 visar att psykiatrisjuksköterskorna i hög grad upplevde att handledningssammankomsterna karakteriserades av ett humanistiskt synsätt. Deltagarna upplevde stöd, hjälp och att man lyssnade på varandra samt att alla hade en inlevelseförmåga. Efter varje handledningssession skrevs dagbok över vad som hänt. Avsikten med dagboksanteckningarna var att få material som beskrev handledningssituationerna. En allmän kunskapsutvecklande handledningsmodell skapades av de i resultatet framtagna orden och formuleringarna. Handledningsmodellen kan användas vid uppbyggnad och genomförande av handledning och undervisning inom olika yrkesområden för att stimulera till ökad yrkesmässig utveckling. Delstudie 2 och 3 utgjordes av svar från intervjuer med deltagarna efter ett år och två år, under pågående handledning, samt fyra år efter avslutad grupphandledning i omvårdnad. Resultatet visar att psykiatrisjuksköterskorna kände ökad arbetstillfredsställelse. De förvärvade ökad kunskap och kompetens och fick förstärkt säkerhet i omvårdnadssituationer. Vidare uppfattade de att deras självförtroende ökat. Vid fyra årsuppföljningen framkom att psykiatrisjuksköterskornas yrkesidentitet hade förstärkts. De hade integrerat omvårdnadsperspektivet i det dagliga arbetet. Grupphandledning i omvårdnad bidrog till att deltagarna vidmakthöll styrka och hade kraft att fortsätta att arbeta. Psykiatrisjuksköterskorna önskade att grupphandledning i omvårdnad skulle utgöra en integrerad del i deras yrkesverksamhet. Efter avslutad handledning kvarstod känslan av gemenskap bland de som deltagit i handledning. I Sverige är omvårdnadsforskning på frammarsch och ger sjuksköterskor en god möjlighet till uppdatering och att bli mer avancerade och skickliga i sina uppgifter. Presenterade studie visar att grupphandledning i omvårdnad är ett sätt att få ökad medvetenhet om hur omvårdnadsforskningens resultat kan förklaras, tydliggöras och tillämpas. Grupphandledning i omvårdnad bör vara en naturlig del i sjuksköterskeutbildningen.
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| 3. |
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| 4. |
- Bergman, Stefan, 1959-, et al.
(författare)
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Chronic widespread pain: A three year followup of pain distribution and risk factors
- 2002
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Ingår i: Journal of Rheumatology. - Toronto : Journal of Rheumatology Publishing Co. Ltd.. - 0315-162X .- 1499-2752. ; 29:4, s. 818-825
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To describe the change of pain reports over time in 3 cohorts derived from the general population: (1) no chronic pain (NCP, n = 1156); (2) chronic regional pain (CRP n = 502) and (3) chronic widespread pain (CWP; n = 242). To identify risk factors that predict the development or persistence of chronic widespread pain. Methods. A 3-year followup from 1995 to 1998 with postal questionnaire to 2425 subjects of both sexes aged 20-74 years on the west coast of Sweden. Results. At followup, a larger proportion of subjects with initial CRP compared to initial NCP reported CWP (16.4 and 2.2%, respectively; p < 0.001). The majority of subjects (56.9%) who primarily reported CWP remained in that group at followup, but 26.8% had changed status to CRP and 16.3% to NCP. The number of painful regions (7-12 vs 0 regions) reported at baseline was the strongest predictor for the development of CWP with an odds ratio (OR) of 12,13 (95% CI 4.47-32.88). The development of CWP was also predicted by higher age (OR = 3.13, 95% CI 1.47-6.69, age-group 59-74 years vs age-group 20-34 years), and a family history of chronic pain (OR = 1.87, 95% CI 1.14-3.07). A habit of drinking alcohol weekly (OR = 0.42, 95% Cl 0.21-0.85) compared to the habit of never or seldom drinking alcohol was protective, as well as having personal social support (OR = 0.49, 95% CI 0.28-0.85). The persistence of CWP was predicted by the number of painful regions (13-18 vs 1-6 regions) at baseline (OR = 7.56, 95% CI 2.17-26.30), and being an immigrant (OR 3.22, 95% CI 1.33-7.77). Conclusion. Although the overall prevalence of CWP was stable over a 3-year period there was a considerable variation on an individual basis. This variability in expressing CWP was moderately predicted by a combination of risk factors. the most important being the number of painful regions at baseline. Future research will need to show how useful the identified factors are in clinical practice and whether intervention aimed at changing these factors will improve pain outcome.
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| 5. |
- Bergman, Stefan, 1959-, et al.
(författare)
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Health status as measured by SF-36 reflects changes and predicts outcome in chronic musculoskeletal pain: a 3-year follow up study in the general population
- 2004
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Ingår i: Pain. - Philadelphia : Ovid Technologies (Wolters Kluwer Health). - 1872-6623 .- 0304-3959. ; 108:1-2, s. 115-123
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Tidskriftsartikel (refereegranskat)abstract
- The SF-36 is a well-validated health status instrument measuring eight different health concepts. One aim of this study was to compare health status as measured by SF-36 in subjects from the general population with no chronic pain (NCP), chronic regional pain (CRP), and chronic widespread pain (CWP). A second aim was to assess if SF-36 could reflect changes in pain status over time. A third aim was to study if health status at baseline, measured by SF-36, could predict pain status 3 years later. The study was designed as a 3-year follow up with a postal questionnaire, including the SF-36 health survey, to 2357 subjects from the general population aged 20-74 years. The results were controlled for age, sex, co-morbidity, and socio-economic status. At baseline, all eight health concepts of SF-36 discriminated between subgroups with NCP, CRP and CWP. Changes in SF-36 over the 3-year follow up time coincided with improvement or deterioration of pain status. Baseline SF-36 scores predicted pain outcome 3 years later. These results support that both physical and mental aspects of health status as measured by SF-36 are affected by the burden of musculoskeletal pain, are sensitive to changes in pain status, and also predict the further development of pain. (C) 2003 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.
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| 6. |
- Boström, Barbro, et al.
(författare)
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A comparison of pain and health-related quality of life between two groups of cancer patients with differing average levels of pain
- 2003
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Ingår i: Journal of Clinical Nursing. - Chichester : Wiley-Blackwell Publishing Inc.. - 0962-1067 .- 1365-2702. ; 12:5, s. 726-735
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Tidskriftsartikel (refereegranskat)abstract
- A study was performed to describe and compare pain and Health-Related Quality of Life (HRQOL) in two groups of cancer patients in palliative care as well as to describe the correlation between pain and HRQOL. ○ Forty-seven patients with mild average pain [Visual Analogue Scale (VAS) < 3] and 28 patients with moderate to severe average pain (VAS > 3) were included. Medical Outcomes Study Short Form (SF-36) was used to evaluate HRQOL, pain intensity levels were measured with the VAS on Pain-O-Meter. ○ Compared to patients with mild pain, patients with moderate to severe pain had statistically significant, higher pain intensity for the items 'pain at time of interview', 'worst pain in the past 24 hours' and 'pain interrupting sleep.' They also had the lowest scores of the SF-36 dimensions: physical functioning, role-physical, and bodily pain. Patients with moderate to severe pain had statistically significant, fewer months of survival. There were statistically significant positive correlations between pain items and negative correlation between pain and SF-36 dimensions. ○ The conclusion is that pain has a negative impact on HRQOL, especially on physical health and that pain increases towards the final stages of life. Even if patients have to endure symptoms such as fatigue and anxiety during their short survival time, dealing with pain is an unnecessary burden, which can be prevented.
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| 7. |
- Boström, Barbro
(författare)
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Acute postoperative and cancer-related pain management, Patients´ experiences and perceptions in relation to health-related quality of life and the multidimensionality of pain
- 2003
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis describes patients in acute postoperative pain as well as patients with acute cancer-related pain in palliative care, and their experiences and perceptions of pain management in relation to HRQOL and the multidimensionality of pain. A combination of qualitative and quantitative methods was chosen. Data were collected using interviews and questionnaires; APS, SF:36 and a new developed questionnaire PC-PPQ measuring care related to pain management in palliative care. For assessing pain VAS and Pain-o-Meter were used. The study group consisted of 100 patients on their second postoperative day, and of 75 patients with cancer-related pain from two palliative care teams. The result showed that at the time of the interview 29 of the patients with postoperative pain reported a pain > 3 on VAS and 79 reported VAS > 3 as worst pain past 24 hours. The higher the intensity of pain the less satisfied the postoperative patients were with the nurses´ way of treating their pain. Thirty-three patients stated that they had received information regarding the importance of pain relief. Patients with postoperative pain as well as patients with cancer-related pain had been prescribed analgesics mostly a combination of Paracetamol, NSAID and opioid. Of the 75 patients with cancer-related pain and in palliative care 22 patients reported pain >3 on POM-VAS and 47 patients reported >3 on POM-VAS as worst pain past 24 hours. Twenty-eight patients reported an average pain > 3 on POM-VAS past 24 hours. Twenty-four patients used the words troublesome or tiring when describing their affective pain. Sensory pain was described as prickling or sore by 15 patients. The patients perceived their pain as “aching all over” and expressed a wish for pain relief as well as a fear for increased pain. HRQOL especially physical functioning decreased for patients with average pain > 3. Being cared for by a nurse-led or a physician-led palliative care team indicated no statistically significant differences for patients´ HRQOL or pain intensities. The patients had experienced a statistically significant better care after being referred to a palliative care team, despite that pain control had not been optimized. Patients expressed a need for communication, planning and trust in order to improve pain management. Continuity of care and the opportunity to talk increase the patients feeling of security, as well as improved their perceived pain control. Structured ongoing discussion concerning pain management from an early stage of the disease or already preoperatively can provide an important intervention to meet the results of this thesis. Pain assessment covering the multidimensionality of pain, and pain treatment plans including both pharmacological and non-pharmacological treatment are further important interventions.
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| 8. |
- Boström, Barbro, et al.
(författare)
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Cancer patients' experiences of care related to pain management before and after palliative care referral
- 2004
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Ingår i: European Journal of Cancer Care. - : Wiley-Blackwell. - 0961-5423 .- 1365-2354. ; 13:3, s. 238-245
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Tidskriftsartikel (refereegranskat)abstract
- Pain is the main problem for patients with cancer referred to palliative care (PC). Pain management in PC requires a multidimensional approach. A questionnaire was used to determine cancer patients' experiences of care related to pain management, before and after being referred to PC, and to also discover possible correlations between pain control and other aspects of care. Seventy-five consecutive patients from two PC teams were included in the study. The patients had experienced a statistically significant (P < 0.01) improvement in care after being referred to PC, despite the fact that pain control had not been optimized. Patients' description of 'pain control' after being referred to PC had a statistically significant correlation with their 'feeling of security' and 'continuity of care' throughout the same period. The conclusion is that care provided in PC is vital to successful pain management. Pain control depends not only on analgesics but also on many other aspects of care provided by the nurse. Continuity of care and the opportunity to talk increases the patients' feeling of security, which is also of utmost importance to successful pain management.
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| 9. |
- Boström, Barbro, et al.
(författare)
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Cancer-related pain in palliative care : patients' perceptions of pain management
- 2004
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Ingår i: Journal of Advanced Nursing. - : Blackwell Publishing. - 0309-2402 .- 1365-2648. ; 45:4, s. 410-419
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Tidskriftsartikel (refereegranskat)abstract
- Background: Pain is still a significant problem for many patients with cancer, despite numerous, clear and concise guidelines for the treatment of cancer-related pain. The impact of pain cognition on patients' experiences of cancer-related pain remains relatively unexplored. Aim: The aim of this study was to describe how patients with cancer-related pain in palliative care perceive the management of their pain. Method: Thirty patients were strategically selected for interviews with open-ended questions, designed to explore the pain and pain management related to their cancer. The interviews were analysed using a phenomenographic approach. Findings: Patients described 10 different perceptions of pain and pain management summarized in the three categories: communication, planning and trust. In terms of communication, patients expressed a need for an open and honest dialogue with health care professionals about all problems concerning pain. Patients expressed an urgent need for planning of their pain treatment including all caring activities around them. When they felt trust in the health care organization as a whole, and in nurses and physicians in particular, they described improved ability and willingness to participate in pain management. While the findings are limited to patients in palliative care, questions are raised about others with cancer-related pain without access to a palliative care team. Conclusion: The opportunity for patients to discuss pain and its treatment seems to have occurred late in the course of disease, mostly not until coming in contact with a palliative care team. They expressed a wish to be pain-free, or attain as much pain relief as possible, with as few side effects as possible.
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| 10. |
- Boström, Barbro, et al.
(författare)
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Pain and health-related quality of life among cancer patients in final stage of life : a comparison between two palliative care teams
- 2003
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Ingår i: Journal of Nursing Management. - Chichester, West Sussex : Blackwell Publishing. - 0966-0429 .- 1365-2834. ; 11:3, s. 189-196
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Tidskriftsartikel (refereegranskat)abstract
- A two-centred descriptive study was performed in order to describe and compare pain and health-related quality of life (HRQOL) among cancer patients, in their final stage of life. The patients were cared for by either a nurse-led palliative care team I (PCT I) or a physician-led palliative care team II (PCT II). Forty-six consecutive, stratified patients (PCT I, n = 21 and PCT II, n = 25) participated. The medical outcomes study short form 36 (SF-36) was used for evaluating HRQOL and the Pain-O-Meter for assessing pain. Patients' pain intensity, pain quality and HRQOL showed no significant difference between the two groups PCT I and PCT II. The patients from PCT I had significantly longer survival time (P = 0.017) than those from PCT II. The different composition of the teams being led by nurses or physicians is worth further research; both from the patient's and staff's viewpoint, there may also be cost-benefits worth examining.
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