| 71. |
- Samuelson, Karin, et al.
(författare)
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Memory in relation to depth of sedation in adult mechanically ventilated intensive care patients.
- 2006
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Ingår i: Intensive Care Medicine. - : Springer Science and Business Media LLC. - 0342-4642 .- 1432-1238. ; 32, s. 660-7
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate the relationship between memory and intensive care sedation. Design and setting: Prospective cohort study over 18 months in two general intensive care units (ICUs) in district university hospitals. Patients: 313 intubated mechanically ventilated adults admitted for more than 24 h, 250 of whom completed the study. Measurements: Patients (n = 250) were interviewed in the ward 5 days after discharge from the ICU using the ICU Memory Tool. Patient characteristics, doses of sedative and analgesic agents, and sedation scores as measured by the Motor Activity Assessment Scale (MAAS) were collected from hospital records after the interview. Results: Patients with no recall (18%) were significantly older, had higher baseline severity of illness, and experienced fewer periods of wakefulness (median proportion of MAAS score 3; 0.37 vs. 0.70) than those who had memories of the ICU (82%). Multivariate analyses showed that increasing proportion of MAAS 0-2 and older age were significantly associated with having no recall. Patients with delusional memories (34%) had significantly longer ICU stay (median 6.6 vs. 2.2 days), higher baseline severity of illness, higher proportions of MAAS scores 4-6, and more administration of midazolam than those with recall of the ICU without delusional memories. Conclusions: Heavy sedation increases the risk of having no recall, and longer ICU stay increases the risk of delusional memories. The depth of sedation during total ICU stay as recorded with the MAAS may predict the probability of having memories of the ICU.
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| 72. |
- Samuelson, Karin, et al.
(författare)
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Stressful experiences in relation to depth of sedation in mechanically ventilated patients.
- 2007
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Ingår i: Nursing in critical care. - : Wiley. - 1478-5153 .- 1362-1017. ; 12:2, s. 93-104
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Tidskriftsartikel (refereegranskat)abstract
- n mechanically ventilated patients, sedatives and analgesics are commonly used to ensure comfort, but there is no documented knowledge about the impact of depth of sedation on patients' perception of discomfort. The aim of this study was, therefore, to investigate the relationship between stressful experiences and intensive care sedation, including the depth of sedation. During 18 months, 313 intubated mechanically ventilated adults admitted to two general intensive care units (ICU) for more than 24 h were included. Patients (n= 250) were interviewed on the general ward 5 days after ICU discharge using the ICU Stressful Experiences Questionnaire. Patient data including sedation scores as measured by the Motor Activity Assessment Scale (MAAS) were collected from hospital records after the interview. Of the 206 patients with memories of the intensive care, 82% remembered at least one experience as quite a bit or extremely bothersome. Multivariate analyses showed that higher proportion of MAAS score 3 (indicating more periods of wakefulness), longer ICU stay and being admitted emergent were factors associated with remembering stressful experiences of the ICU as more bothersome. The findings indicate that the depth of sedation has an impact on patients' perception of stressful experiences and that light sedation compared with heavy seems to increase the risk of perceiving experiences in the ICU as more bothersome. In reducing discomfort, depth of sedation and patient comfort should be assessed regularly, non-pharmacological interventions taken into account and the use of sedatives and analgesics adapted to the individual requirements of the patient
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| 73. |
- Samuelson, Karin, et al.
(författare)
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Stressful memories and psychological distress in adult mechanically ventilated intensive care patients - a 2-month follow-up study
- 2007
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 51:6, s. 671-678
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To investigate patients' psychological distress in relation to memory and stressful experiences in the intensive care unit (ICU), and to identify early predictors for the development of high levels of acute post-traumatic stress disorder (PTSD)-related symptoms. Methods: A prospective cohort study was performed over 18 months in two general ICUs, including 313 intubated mechanically ventilated adults admitted for more than 24 h, 226 of whom completed the study. Patients were interviewed 5 days and 2 months post-ICU concerning their memories and psychological distress. The instruments used were the ICU Memory Tool, ICU Stressful Experience Questionnaire, Hospital Anxiety and Depression Scale and Impact of Event Scale-Revised (IES-R). Results: High symptom levels of anxiety, depression and acute PTSD 2 months post-ICU were present in 4.9%, 7.5% and 8.4% of the 226 patients, respectively. Psychological distress 2 months post-ICU was associated with experiences of the ICU rated as extremely stressful and with high levels of anxiety and depression 5 days post-ICU, but not with amnesia or delusional memories without factual recall of the ICU. Female sex, signs of agitation (increasing proportion of Motor Activity Assessment Scale scores of 4-6) and feelings of extreme fear during the ICU stay were significantly and independently associated with IES-R scores of 30 or more. Conclusions: Extremely stressful experiences of the ICU are associated with subsequent psychological distress. Female sex, agitation and extreme fear during the ICU stay seem to increase the risk of developing high levels of acute PTSD-related symptoms.
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| 74. |
- Samuelsson, Gillis, et al.
(författare)
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Incidence and risk factors for depression and anxiety disorders: Results from a 34-year longitudinal Swedish cohort study.
- 2005
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Ingår i: Aging & Mental Health. - : Informa UK Limited. - 1364-6915 .- 1360-7863. ; 9:6, s. 571-575
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Tidskriftsartikel (refereegranskat)abstract
- This study is based on a total cohort (N = 192) of people born in 1902 and 1903 and living in southern Sweden. Subjects were assessed at baseline when 67 years of age and on eight further occasions over 34 years or until death. The participation rate in the nine examinations ranged from 78-100%. Interviews, psychological tests, and medical examinations were used as well as information on medical diagnoses from primary health care records and hospital records. The cumulative probability for the development of clinical depression during the follow-up was 8% and for anxiety 6%. The incidence rate for depression and for anxiety was highest during the period 67-81 years. Persons with poor financial status were more likely to be diagnosed with depression but no significant risk factor for anxiety was found. Only 14% developed depression and anxiety during the follow-up period, females more often than men. The strongest risk factors for the development of depression were perceived economic problems.
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| 75. |
- Sandgren, Anna, et al.
(författare)
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Striving for emotional survival in palliative cancer nursing
- 2006
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Ingår i: Qualitative Health Research. - : Sage Publications. - 1049-7323 .- 1552-7557. ; 16:1, s. 79-96
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Tidskriftsartikel (refereegranskat)abstract
- In this grounded theory study, the authors analyze interviews and participant observation data related to palliative cancer nursing in hospitals. Striving for Emotional Survival emerged as the pattern of behavior through which nurses deal with their main concern, the risk of being emotionally overloaded by their work. It involved three main strategies: Emotional Shielding through Professional Shielding or Cold Shielding; Emotional Processing through Chatting, Confirmation Seeking, Self-Reflecting, or Ruminating; and Emotional Postponing through Storing or Stashing. Emotional Competence is a property of Striving for Emotional Survival that explains more or less adequate ways of dealing with emotional overload. The theory Striving for Emotional Survival can be useful in the nurses' daily work and provides a comprehensive framework for understanding how nurses deal with emotional difficulties. The authors suggest that health care organizations encourage self-care, prioritize time to talk, and offer counseling to nursing staff with emotionally difficult working conditions.
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| 76. |
- Sjöström-Strand, Annica, et al.
(författare)
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Stress in women's daily life before and after a myocardial infarction: a qualitative analysis.
- 2007
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Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 1471-6712 .- 0283-9318. ; 21, s. 10-7
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Tidskriftsartikel (refereegranskat)abstract
- Background: Little is known about women's perceptions of their daily life before and after a myocardial infarction (MI), especially with regard to stress, which is a risk factor for coronary heart disease (CHD). Aim: To describe and explore women's perceptions of stress before and after an MI. Method: Two interviews with women who suffered an MI, the first at the hospital (n = 20) and the second 4-10 months after the MI (n = 14), were analysed using a phenomenographic approach. Findings: The stress emanated either from within themselves (personal traits) or as an effect of their immediate surroundings. The period before the MI was stressful due to the different roles they had to maintain in their private and professional lives. They lost control over their daily life. After hospital discharge they both wanted and needed support, as they were terrified when they returned home. They did not know how much they could do and neither did their relatives, while little or no support was provided by the healthcare professionals. Conclusions: To prevent CHD in daily life and avoid reinforcing stress, it is important to place greater emphasis on stress as an important risk factor. An understanding of this phenomenon can assist primary healthcare, coronary care unit (CCU) and rehabilitation nurses in supporting these women as well as their partners to adapt their daily lives both before and after an MI. It is essential to formulate and implement individualised treatment plans and to provide support groups for women.
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| 77. |
- Sjöström-Strand, Annica, et al.
(författare)
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Women's descriptions of symptoms and delay reasons in seeking medical care at the time of a first myocardial infarction: A qualitative study.
- 2008
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Ingår i: International Journal of Nursing Studies. - : Elsevier BV. - 1873-491X .- 0020-7489. ; 45:7, s. 1003-1010
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Tidskriftsartikel (refereegranskat)abstract
- Background Coronary heart disease (CHD) is a major cause of mortality in women. Women have also been identified as late presenters in seeking medical care. Aim The aim of this study was to explore and describe women's symptoms and the reasons for delay in seeking medical care at the time of the first myocardial infarction (MI). Methods The study had an explorative and descriptive design based on content analysis approach. Nineteen women were interviewed at the hospital 2 or 3 days after hospitalisation. Results The result showed that the women had difficulties interpreting, understanding and linking the symptoms to CHD. They tried to handle the discomfort and even the chest pain, rather then ask for professional help. The women had problems with making the final decision. Conclusion Women need to be made aware of the clinical symptoms of CHD, in order to understand the consequences of delay in seeking medical care following an MI.
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| 78. |
- Strömberg, Anna, 1967-, et al.
(författare)
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Computer-based education for patients with chronic heart failure : A randomised, controlled, multicentre trial of the effects on knowledge, compliance and quality of life
- 2006
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Ingår i: Patient Education and Counseling. - Shannon, Ireland : Elsevier. - 0738-3991 .- 1873-5134. ; 7, s. 128-35
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To evaluate the effects of a single-session, interactive computer-based educational program on knowledge, compliance and quality of life in heart failure patients with special emphasis on gender differences.METHODS: One hundred and fifty-four patients, mean age 70 years, from five heart failure clinics were randomised to either receiving only standard education (n = 72) or standard education and additional computer-based education (n = 82).RESULTS: Knowledge was increased in both groups after 1 month with a trend towards higher knowledge (P = 0.07) in the computer-based group. The increase in knowledge was significantly higher in the computer-based group after 6 months (P = 0.03). No differences were found between the groups with regard to compliance with treatment and self-care or quality of life. The women had significantly lower quality of life and did not improve after 6 months as the men did (P = 0.0001).CONCLUSION: Computer-based education gave increased knowledge about heart failure. PRACTICE IMPLICATIONS: Computers can be a useful tool in heart failure education, but to improve compliance a single-session educational intervention is not sufficient. Gender differences in learning and quality of life should be further evaluated.
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| 79. |
- Sundell, Knut, et al.
(författare)
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The transportability of multisystemic therapy to Sweden: Short-term results from a randomized trial of conduct-disordered youths
- 2008
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Ingår i: Journal of Family Psychology. - : American Psychological Association (APA). - 0893-3200 .- 1939-1293. ; 22:4, s. 550-560
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Tidskriftsartikel (refereegranskat)abstract
- This randomized clinical trial assessed the effectiveness of multisystemic therapy (MST) for 156 youths who met the diagnostic criteria for conduct disorder. Sweden's 3 largest cities and I small town served as the recruiting area for the study. A mixed factorial design was used, with random allocation between MST and treatment as usual groups. Assessments were conducted at intake and 7 months after referral. With an intention-to-treat approach, results from multiagent and multimethod assessment batteries showed a general decrease in psychiatric problems and antisocial behaviors among participants across treatments. There were.no significant differences in treatment effects between the 2 groups. The lack of treatment effect did not appear to be caused by site differences or variations in program maturity. MST treatment fidelity was lower than that of other studies, although not clearly related to treatment outcomes in this study. The results are discussed in terms of differences between Sweden and the United States. One difference is the way in which young offenders are processed (a child welfare approach vs. a juvenile justice system approach). Sociodemographic differences (e.g., rates of poverty, crime, and substance abuse) between the 2 countries may also have moderating effects on the rates of rehabilitation among young offenders.
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| 80. |
- Svensson, Lennart, et al.
(författare)
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The use of language in understanding subject matter
- 2009
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Ingår i: Instructional science. - : Springer Science and Business Media LLC. - 0020-4277 .- 1573-1952. ; 37:3, s. 205-225
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Tidskriftsartikel (refereegranskat)abstract
- Empirical results show that frequently the meaning of expressions used by students in expressing their understanding of subject matter does not correspond to the meaning of those expressions in the subject matter theory that the students are expected to learn. There is also often a lack of identity of meaning between the same students' use of the same expression from one use of the expression to another, in very similar contexts. The context gives a specific meaning to any expression. This variation in context and meaning is very central to the phenomena of teaching and learning. In educational research there is a need to differentiate between specific meanings expressed in conceptualizing subject matter, on the one hand, and concepts and meanings seen as parts of cognitive systems and social languages, on the other. The contextual character of the use of language is crucial to the understanding of teaching and learning and needs to be more carefully considered. The article is a discussion of the problem of varying meanings of language expressions in relation to major traditions of research, focusing on meanings and concepts within the field of learning and teaching.
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