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Sökning: AMNE:(SOCIAL SCIENCES Other Social Sciences Social Sciences Interdisciplinary) > Karolinska Institutet

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1.
  • Joelsson-Alm, Eva, et al. (författare)
  • Perioperative bladder distension : a prospective study
  • 2009
  • Ingår i: Scandinavian Journal of Urology and Nephrology. - 0036-5599 .- 1651-2065. - 0036-5599 ; 43:1, s. 58-62
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective. Postoperative urinary retention and bladder distension are frequent complications of surgery. The aim of this study was to determine the incidence of perioperative bladder distension in a surgical setting and to identify predisposing factors among patients undergoing common general and orthopaedic procedures. Material and methods. This was a prospective observational study of 147 adult patients admitted to orthopaedic and surgical departments. Bladder volumes were measured with an ultrasound scanner on three occasions: after emptying the bladder before being transported to the operating theatre, and then immediately before and after surgery. Results. Thirty-three patients (22%) developed bladder distension (500 ml), eight preoperatively and 25 postoperatively. A total of 21 patients (14%) had a bladder volume 300 ml immediately before surgery. Orthopaedic patients were more likely to develop preoperative bladder distension than surgical patients and had significantly higher postvoid residual volumes. In the binary logistic regression analysis age, gender and time of anaesthesia could not predict bladder distension. Patients undergoing orthopaedic surgical procedures, however, were prone to bladder distension (odds ratio 6.87, 95% confidence interval 1.76 to 26.79, p=0.006). Conclusions. This study shows that orthopaedic surgical patients are more prone to bladder distension perioperatively. The conventional method of encouraging patients to void at the ward before being transported to the operating theatre does not necessarily mean an empty bladder at the start of the operation.
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2.
  • Öhlén, Joakim, 1958, et al. (författare)
  • Exploration of communicative patterns of consultations in palliative cancer care.
  • 2008
  • Ingår i: European journal of oncology nursing : the official journal of European Oncology Nursing Society. - : Elsevier BV. - 1462-3889 .- 1532-2122. ; 12:1, s. 44-52
  • Tidskriftsartikel (refereegranskat)abstract
    • Building on the research conducted on institutional communication, and the analysis of actual communication taking place in clinical settings, this study describes and highlights features of palliative care consultations and focuses on the distribution of discursive space (i.e., share of words, lengths of turns), occurring topics and conversational frames. Six consultations between physicians, patients and significant others were videotaped and all participants took part in audio-taped interviews. The recordings were transcribed and analysed in regard to expectations of, the discursive space of, and topics addressed in the consultations. The distribution of the discursive space was unequal; the physicians had the greatest share of words and length of turns in all six consultations, and they mostly initiated discussion of medical issues connected to examinations and treatment, while only patients initiated the topic of the patient's future. During the consultations, institutional framing tended to dominate over client framing. There was found to be room for further study of the structure and content of palliative care consultations with emphasis on how the voice of the patient can manifest itself within the framework of the medical agenda of the consultation and its significance for palliative cancer team work.
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3.
  • Uvnäs-Moberg, Kerstin, et al. (författare)
  • Sensory Stimulation and Oxytocin : Their Roles in Social Interaction and Health Promotion
  • 2022
  • Ingår i: Frontiers in Psychology. - : Frontiers Media S.A.. - 1664-1078. ; 13
  • Tidskriftsartikel (refereegranskat)abstract
    • The aim of this call was to collect papers describing how oxytocin may be released by different kinds of sensory stimulation to induce wellbeing and restorative processes and to inhibit pain, stress and inflammation. A large number of interesting articles of very high quality were received and 19 papers were accepted for publication. All the included articles have contributed to expand the knowledge about oxytocin in a very substantial way both regarding its effect spectrum and regarding its association with sensory, somatosensory stimulation, in particular. In fact, the obtained data contribute to prove the hypothesis that the oxytocinergic system is a widespread integrative system, which is linked to social interaction, wellbeing, reduction of stress and pain as well as to reproductive, growth promoting and restorative effects. The activity of this archaic oxytocin system is under control of hormones and sensory nerves, which convey information regarding the state of the internal and the external environment. The oxytocin linked effects may be induced in the short-term as well as in the long-term perspective. All of the articles which were accepted and included in this issue, in their own unique way, contribute to describe oxytocin beyond its classical role in birth and milk ejection in accordance with the concept described above. We describe and discuss the data after having categorized the results presented in the articles according to certain subjects. 
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4.
  • Stenfors-Hayes, Terese, et al. (författare)
  • A phenomenographic approach to research in medical education
  • 2013
  • Ingår i: Medical Education. - : Blackwell Publishing. - 0308-0110 .- 1365-2923. ; 47:3, s. 261-270
  • Tidskriftsartikel (refereegranskat)abstract
    • Context  Phenomenography is a qualitative approach to research which has revolutionised the way that researchers and teachers think about the processes and outcomes of learning in higher education. Phenomenography has also been used successfully in medical and health care research for the last 20 years. Phenomenography provides a lens through which to view certain types of research question. It also provides direction for how to empirically carry out the research.Methods  This paper introduces phenomenography as a viable qualitative approach for use in medical education research.Results  A phenomenographic study maps the qualitatively different ways in which people experience a phenomenon. This type of study can have an important impact on, for example, patient communication, clinical practice and health care education.Conclusion  We suggest that a phenomenographic approach can be used to explore many medical education research issues, and can facilitate more solid links between research and educational development and change.
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5.
  • Håkanson, Cecilia, et al. (författare)
  • Being in the Patient Position : Experiences of Health Care Among People With Irritable Bowel Syndrome
  • 2010
  • Ingår i: Qualitative Health Research. - Thousand Oaks, USA : Sage Publications. - 1049-7323 .- 1552-7557. ; 20:8, s. 1116-1127
  • Tidskriftsartikel (refereegranskat)abstract
    • The purpose of this study was to gain in-depth understanding of what it is like for a person with irritable bowel syndrome to be in the patient position in encounters with health care providers. We conducted qualitative interviews with nine individuals. Our analysis, guided by interpretive description, revealed experiences of unsupportive and supportive encounters. Unsupportive encounters were shaped by humiliation, insignificance, and abandonment. Not feeling believed and acknowledged as persons made the participants lose trust in their own experience, which enhanced their unfamiliar mood of being in the world. Supportive encounters were less prominent. These were characterized by openness and acknowledgment of the patient’s lifeworld. Feeling significant and being listened to promoted feelings of being in a partnered, cocreating relationship. It is reasonable to assume that care originating in the patient’s lifeworld would support the patients to use their strength to manage illness and regain familiarity in everyday life.
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6.
  • Andersson, Åsa, 1963-, et al. (författare)
  • Fear of falling in stroke patients : relationship with previous falls and functional characteristics
  • 2008
  • Ingår i: International Journal of Rehabilitation Research. - 0342-5282 .- 1473-5660. ; 31:3, s. 261-264
  • Tidskriftsartikel (refereegranskat)abstract
    • The objectives of this study were to determine the relationship between fear of falling and functional characteristics of patients after stroke as well as to determine what characterizes fallers who score high fall-related self-efficacy, and nonfallers who score low fall-related self-efficacy. Patients (n=140) treated in a stroke unit during a 12-month period were included. On follow-up, fallers were identified and patients answered the questions in the Falls Efficacy Scale, Swedish version (FES-S). Assessments of motor capacity, functional mobility and balance were also made. In univariate analysis, low fall-related self-efficacy was significantly associated with increased age, female sex, earlier falls, visual and cognitive impairment, low mood and impaired physical function. In multivariate analysis, only earlier falls and physical function remained significant. Twenty percent of the patients scored low fall-related self-efficacy without having experienced a fall, and 11% who experienced a fall scored high fall-related self-efficacy. Impaired physical function was significantly associated with scoring low fall-related self-efficacy, for both fallers and nonfallers. Fear of falling is significantly associated with poor physical function and earlier falls. Falls Efficacy Scale, Swedish version could add useful information to a fall risk analysis. Patients scoring low fall-related self-efficacy should be offered fall prevention measures whether they have fallen or not.
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7.
  • Forsberg, Anette, et al. (författare)
  • Falling ill with Guillain-Barré syndrome : patients' experiences during the initial phase.
  • 2008
  • Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 22:2, s. 220-226
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: Research describing the personal experiences of Guillain-Barré syndrome (GBS) is limited, but is important for identifying the patients' need of support. The aim of this study was to describe experiences of falling ill with GBS, with the focus on the onset of disease, the diagnosis and the illness progress during hospital care. METHODS: The study included 35 persons, 20-78 years old. They were interviewed 2 years after the onset of GBS. The interviews were analysed using qualitative content analysis. RESULTS: The onset was described as either an incomprehensible, prolonged, increasing deterioration with puzzling sensations or as a frightening, rapid onset with a sudden loss of body control. The majority of the persons relied heavily on the reassurance of a positive prognosis, and expressed immense confidence in being able to recover. During the early phase at the hospital, a rapid and steady course of improvement inspired hope in many persons. In contrast, even in this early phase of hospital care some individuals expressed doubts of a slow recovery. Feelings of fear and insecurity were evident when losing body functions, thus causing helplessness. Sensations of pain, numbness and lost body image increased their vulnerability. Half of the ventilator-treated persons expressed vivid memories of scary hallucinations. CONCLUSION: The onset is characterized by an incomprehensible bodily deterioration or a frightening, rapid paralysis. In the initial phase, there is hope for recovery, which for many individuals is reinforced by a steady recovery. In contrast, early psychosocial support may be necessary for some persons with an alarmingly slow recovery.
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8.
  • Josefsson, Karin (författare)
  • Municipal elderly care : implications of registered nurses' work situation, education, and competence
  • 2006
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Registered nurses (RNs) are key figures in municipal elderly care. It is a challenge to create necessary conditions that enable them to provide quality nursing care. These studies aimed to increase insight into RNs work conditions in municipal elderly care, and to compare RNs working solely in dementia care (DC) with RNs working in general elder care (GC). The specific aims were to describe RNs’ perceptions of: (I) their work situation, regarding demands, influences, and social support, as well as RNs characteristics; (II) violence and threats directed at them, other staff, and care recipients, as well as access to prevention measures and routines for handling violence and threats; (III) their education and competence development; (IV) their needs for knowledge, possibilities for competence development, supervision, organisation of RNs’ development, financial support, competence utilisation, and managers’ competence. A descriptive and comparative design was used. The setting consisted of 60 special housing with subunits in a large city in the middle of Sweden. A total of 213 RNs participated, with a response rate of 62%. Of those, 95 (45%) worked in DC and 118 (55%) in GC. A structured questionnaire, designed for these studies was used. Study I showed on average high time pressure in both groups. Greater knowledge and higher emotional and conflicting demands were found in DC. The majority reported greater opportunities to plan and perform daily work tasks than to influence the work situation in a wider context. On average, there was a high level of support at work from management and fellow workers. Study II indicated that RNs had witnessed and experienced a high degree of indirect threats, direct threats of violent acts, and violent acts, with care recipients also subject to threats and violence. The RNs in DC had greater access to education in managing threats and violence, and routines for managing violence and a door with a lock to their working unit. Study III revealed that RNs possessed a broad range of formal competence. On average, the RNs had 18 years of work experience as an RN. The majority lacked a Degree of Bachelor in Nursing. Few had adequate specialist competence. RNs in DC were willing to invest more in competence development whereas RNs in GC were more motivated to invest in competence development by seeking another position and by attaining a greater authority to make important decisions at work. Study IV showed that, on average, the RNs did not lack or hardly lacked knowledge in the examined domains. RNs in GC lacked knowledge of dementia, falls, and fall injures to a greater extent than RNs in DC. RNs in DC perceived greater possibilities for competence development at work. Most RNs, especially in GC, requested a better organisation for competence development. The majority of RNs had no supervision. Although the utilisation of the competence of RNs was high, RNs used their highest competence about half of the working hours. The employers’ financial contribution to RNs’ continuing education was poor. Conclusions drawn from the studies are: (I) RNs’ time pressure needs to be decreased and their influence on decisions increased. (II) Violence occurs equally frequently without any difference between DC and GC. More often, RNs in DC are offered education on how to manage violence and threats, and have routines for management of violence. Therefore, municipal authorities should increase staff education for management of violence and creating safety routines. Violence needs to be taken seriously with a ‘zero tolerance’ attitude. (III) It is important to develop the RNs’ competence and increase the utilisation of their competence. It is also essential to increase the number of RNs who have specialist competence. (IV) Better organisation and greater possibilities for RNs’ competence development is needed. Employers need to make a greater financial contribution to RNs’ competence development. RNs also need supervision. When combined, high demands and low control in the work situation form the most critical combination for the health of RNs. This may lead to sick-absenteeism and staff turnover. Thus, RNs’ time demands should be decreased, violence be minimised, and influence in decision-making increased in both groups. Further research is required on RNs’ competence development, family conditions, leisure, health, their ‘ideal work’, and the concept of general elder care.
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9.
  • Langius-Eklöf, Ann, et al. (författare)
  • Health-related quality of life in relation to sense of coherence in a Swedish group of HIV-infected patients over a two-year follow-up
  • 2009
  • Ingår i: AIDS Patients Care and STDs. - New York : Mary Ann Liebert. - 1087-2914 .- 1557-7449. ; 23:1, s. 59-64
  • Tidskriftsartikel (refereegranskat)abstract
    • The purpose of the present study was to describe HIV-infected patients' self-reported health-related quality of life (HRQOL) in relation to sense of coherence over a 24-month period. A total of 104 HIV-infected patients (71% males) answered questionnaires at three times at 12-month intervals. At the same time, clinical characteristics were collected from the patients' medical records. HRQOL was measured by the HIV-symptom scale, the Health Index, and the Well-Being Scale. Coping ability was measured with the 29-item sense of coherence (SOC) scale. The patients were divided into three groups depending on SOC scores (low, moderate, high). The results indicate that the group with low SOC scores rate their HRQOL worse than the other groups at all three measurements (p values from <0.05 to <0.001). Over the 2-year period, the patients' CD4 cell count=mm3 increased significantly (p values <0.001), indicating good response to antiretroviral treatment. However, their HRQOL did not improve during these 2 years. Patients with higher SOC rate their HRQOL better than those with a lower SOC, during these years. Future studies should investigate the predictive value of the SOC scale of HRQOL in HIV-infected patients.
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10.
  • Skovdahl, Kirsti, 1964-, et al. (författare)
  • Demanding behaviours and workload in elderly care in Sweden : occurrence at two time points within a decade
  • 2008
  • Ingår i: Scandinavian Journal of Caring Sciences. - Oxford : Blackwell. - 0283-9318 .- 1471-6712. ; 22:3, s. 323-330
  • Tidskriftsartikel (refereegranskat)abstract
    • The aim of this study was to investigate the occurrence of demanding behaviours in persons ‡65 years receiving home care or living in sheltered accommodation at two points in time, 1993 and 2002. Another aim was to investigate whether the perceived workload in staff had changed during this period. All persons ‡65 years living at home and utilizing home care services or those who lived in some form of sheltered housing were included and assessed by staff using a three-part questionnaire, in two cross-sectional studies. The study group comprised 1187 and 1017 participants which equals 77% and 99% respectively. Symptoms and degree of behavioural and psychiatric symptoms common in dementia that were assessed with a subscale in The Gottfries-Bra°ne-Steen Scale, demonstrated an all over increase from 1993 to 2002. Items from The Multi Dimensional Dementia Assessment Scale (MDDAS) measured a decrease in ‘daily’ occurrences of dementia symptoms but an increase in ‘sometimes per week’. A mixed pattern was seen concerning behaviours where increases as well as decreases were found. The behaviours ‘constantly seeking attention’ and ‘shrieking continuously’ increased significantly. The number of individuals showing restless, aggressive or shrieking behaviours increased significantly over the decade. Two items from the MDDAS were used to measure the workload. The physical workload increased significantly over the decade whereas the rising tendencies of the psychological workload were not statistically significant. The mean age over the decade had increased from 83 to 86 years, which together with the findings make the recipients of home care and sheltered housing a very vulnerable group. The demanding problems place considerable pressure on staff.
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