| 1. |
- Engström, Åsa
(författare)
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A wish to be near : experiences of close relatives within intensive care from the perspective of close relatives, formerly critically ill people and critical care nurses
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this doctoral thesis was to describe the experiences of close relatives within intensive care, from the perspective of close relatives, formerly critically ill people and critical care nurses. Data were collected by means of qualitative research interviews with close relatives of people who had been critically ill and cared for in an intensive care unit (ICU) and with the people themselves. Data were also collected by means of focus-group discussions with critical care nurses. Collected data were analysed using qualitative thematic content analysis and phenomenological hermeneutic interpretation. This thesis reveals that it was a frightening experience for close relatives to see the person critically ill in an unknown environment. It was important to be able to be near the ill person. Showing respect for and confirming the dignity of the ill person were essential. The uncertainty concerning the outcome for the ill person was hard to manage. Close relatives wanted to feel hope, even though the prognosis was poor. The presence of close relatives was taken for granted by critical care nurses. Information from close relatives made it possible for critical care nurses to provide personal care for the critically ill person. Critical care nurses supported close relatives by giving them information and being near. Close relatives were described as an important but demanding part of the critical care nurses' work. People who had been critically ill had felt their close relatives' presence. Through the help of close relatives they felt they were understood and safe. Close relatives made it possible for them to do various things, which were appreciated, but they also engendered feelings of guilt. They realized their own, and the close relatives' significance, which gave them the power to continue the struggle. The possibility for people who had been critically ill, and their close relatives, to return together to the ICU for a follow-up visit after discharge and talk about what happened during and after their stay in the ICU was appreciated. Receiving explanations and being able to discuss one's experience were valuable. Meeting the ICU staff again enabled them to express their gratitude for their work, to give opinions about the care and to suggest improvements. This thesis shows that the critically ill person is the focus of close relatives' existence. The uncertainty of the time causes close relatives' suffering and they felt vulnerable. To be able to be close to the critically ill person, to be allowed to participate in and receive explanations about what was happening and why, to be met by dignity and to be able to keep hope alive are all prerequisites for enduring a radically changed everyday life which close relatives experience when someone they love is, or has been, critically ill. The crucial challenge is how these needs can be met by the staff of the ICU.
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| 2. |
- Jacobson, Inger
(författare)
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Injuries among female football players
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Football is a popular female team sport played by approximately 40 million women in over 100 countries all over the world. In Sweden football is the largest female team sport with more than 56,000 players over 15 years of age. Aim: The aims of this thesis were to investigate injuries and injury incidences among female non-elite players in second division as well as elite football players in the premiere league in Sweden over an entire football season with special emphases on regional and level differences; to investigate range of motion (ROM) at the beginning of the football season in relationship to upcoming joint (sprain) and muscle-tendon (strain) injuries; to investigate if the injury incidence varied during the different phases of the menstrual cycle and if there was a difference in injury incidence according to oral contraceptive (OC) pill usage. Material and methods: Thirty teams (n=522 players) from two different league levels in Sweden, the second division (9 teams from the most Northern league and 9 teams from the most Southern league, comprising 18 teams) and the premiere league (12 teams), were studied during an entire football season. Baseline information was obtained and ROM was measured. During the season menstruation and OC usage, football exposure and injuries were registered. Result: A total of 466 injuries were studied. The overall injury incidence was 9.6 injuries/1000 hours of football in the second division and 4.6 injuries/1000 hours of football in the premiere league. Traumatic injuries were in majority (59-69%), and the most common type of traumatic injury was sprain, mainly to the ankle. The distribution of injuries varied between regions; the number of total injuries as well as the total injury incidence was higher in the northern than southern region in the second division. Both traumatic and overuse injuries occurred mainly during the early preseason and at the beginning of the competitive spring season. Increased/decreased ROM in the lower extremity did not appear to be a predisposing risk factor for joint (sprain) or muscle-tendon (strain) injuries of the lower extremity. More than half the players began their football season with physical complaints, which in most cases disturbed their football activity. A total of 2 586 menstrual cycles were studied. An increased injuries incidence was noted during the menstrual phase compared to the pre- ovulatory phase as well as during the post-ovulatory phase compared to the pre-ovulatory phase for non-OC users. An increased incidence of traumatic injuries was also noted during the menstrual phase compared to the pre- ovulatory phase for non-OC users. There were no differences between the OC/non-OC groups concerning injury incidence during practice, game or total football. Conclusion: Evidence is presented in this thesis that regional factors as well as play- level are associated with injury incidence. Preseason ROM measurements cannot identify players at risk for upcoming sprain or strain injuries. An increased injury incidence during the menstrual phase was found, however, no significant difference in injury incidence between OC-users and non- users were found.
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| 3. |
- Lindberg, Birgitta
(författare)
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When the baby is premature : experiences of parenthood and getting support via videoconferencing
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this doctoral thesis was to describe parents' experiences of having an infant born prematurely and experiences on the use of real-time videoconferencing in providing support to parents of preterm born infants at home. A descriptive qualitative method was chosen to achieve the overall goal of this thesis. Qualitative research interviews were used for data collection and qualitative content analysis was used for data analysis. All studies included in this thesis were conducted in collaboration with a neonatal intensive care unit (NICU) in the northern part of Sweden.This thesis describes parents' reaction to the preterm birth as unexpected; they were not ready or prepared for it. The initial time after the birth felt surreal and it was hard to feel like a mother or a father. Parenting was experienced with anxiety as well as with a lot of stressors. Parents were unacquainted with and had a great need for knowledge about preterm birth. The lack of knowledge was straining, as parents wanted to understand what was happening. Parents were worried about the infant getting ill, injured, and being affected for life, or not even surviving. Being close to their infant was vital. Fathers also wanted to be with their partner as they were protective over both mother and infant. The preterm birth made it possible for fathers to spend time with their infant and they thought that they had a stronger bond with their baby compared with those who had full-term children.Taking their infant home was experienced with mixed feelings, but this made it possible for the whole family to be together. The experience with most staff was regarded as positive as parents felt they were well treated. The opposite was also described - not being involved in the infant's care and in making decisions to the extent that they wanted. To be able to cope and feel confidence about caring for their infants, parents needed support, both at the NICU and after going home. Parents must be given the opportunity to share their experiences of having an infant born prematurely with others, especially the partner, nursing staff, and parents with children born prematurely.Having access to staff at all hours by videoconferencing was supportive and gave parents confidence in their new situation. However, the need to control the use of videoconferencing was expressed. The videoconference meetings were comparable with the meetings parents and certified pediatric nurses (CPNs) had at the NICU. Videoconferencing enabled CPNs to meet the whole family and to assess the overall situation at home; security could be provided to the family. The use of the equipment made them reflect on continuing and developing the use of videoconferencing, but it takes time to implement changes. Videoconferencing can be a way to offer support to families after bringing their preterm infant home. This implies a change in traditional nursing care in order to avail of perceived benefits using technology. The results in this thesis have implications for nursing staff meeting families with a child born prematurely as well as for parents with prematurely born infants. Understanding the specific needs of parents is of outmost importance for nursing staff to enable them to provide support and facilitate parenting. Meeting parents with openness and listening to their experiences can help them both as individuals and as a whole family.
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| 4. |
- Lindberg, Inger
(författare)
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Postpartum care in transition : parents' and midwives' expectations and experience of postpartum care including the use of videoconferencing
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aims are to explore pregnant women's expectations of postpartum care, midwives experience of organizational and professional change and parents' and midwives' experiences of postpartum care using VC. During the 1980s early discharge was introduced to facilitate a more family-oriented postpartum care. At present new parents are discharged from the maternity ward about 48 hours after childbirth. Studies of new parents' needs in the postpartum period show that continuity of care, practical, informational and emotional support are important issues. The midwife's role in postpartum care is evaluated as having a significant importance for new parents through being available, competent and supportive both emotionally and practically. Structural change with the introduction of early discharge and the centralisation of specialties to a few hospitals has affected the parents' situation as well as the midwife's ability to practise care for the new mother, child and family. Sweden's most northern county council has been progressive in its development of ICT and associated ideas concerning its application to healthcare. An intervention was carried out using videoconferencing (VC) equipment between a maternity ward and parents' homes. Data were collected by questionnaires completed by pregnant women (I), parents (III) and midwives (IV), focus-groups' discussions with midwives (II) and interviews with parents and midwives. The data were analysed using descriptive statistics (I, II, IV), thematic content analysis (II, III) and qualitative content analysis (IV). Accessibility to healthcare staff predominated in pregnant women's evaluating of important issues in the postpartum period and when parents used videoconferencing. Distance to healthcare services was not found to be a determining factor when pregnant women wanted to be discharged. One advantage of using VC was that it was felt it saved time and money for the parents. Support during breastfeeding, information about the child's behaviour and condition, were important aspects that needed to be covered in the postpartum period. Midwives felt their work had become more a fragmentised due to the short hospital stay. Parents and midwives found meeting via VC to be almost like a real-life encounter. They had no problem handling the VC equipment and did not have any problem preserving their integrity. Before introducing e-health in postpartum care, midwives stressed the importance of investigating consequences regarding organisation and work assignments. From this thesis it can be understood that VC can function as a bridge to facilitate a caring encounter between the parents and the midwives in the postpartum period. Further research into postpartum care is needed from the perspective of the parents and the midwives as well as into the consequences of implementing e-health
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| 5. |
- Lindelöf, Nina
(författare)
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Effects and experiences of high-intensity functional exercise programmes among older people with physical or cognitive impairment
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Exercise programmes with functional exercises improve lower-limb strength, balance, and gait ability in older people. Exercising at high intensity produce better results than low-intensity training. Perceptions and experiences of exercise impact on motivation to and attendance in exercise programmes. An intake of protein immediately before or after exercising has shown an increase of the exercise effects on muscle mass and strength. However, there are few studies investigating the effects, perceptions or experiences of high-intensity physical exercise in older people with pronounced physical or cognitive impairment. The aims of the thesis were to evaluate the effects on physical performance of high-intensity functional exercise programmes among older people with physical or cognitive impairments, to evaluate the perceptions and describe the experiences of participating, and to investigate whether an intake of protein-enriched energy supplement immediately after the exercises increases the effect of the training. In a single subject experimental design, three frail older women with residual problems after hip fracture performed a functional exercise programme using a weighted belt. Visual and statistical analyses of graphs showed improvements in dynamic balance and in comfortable and maximum gait speed for all three participants. The results were difficult to interpret for isometric knee extension strength and indicated no or very small improvements. One hundred and ninety-one older people with a Mini Mental State Examination (MMSE) score of 10 or more, dependent in activities of daily living, and living in residential care facilities, participated in a randomized controlled trial using the intention-to-treat principle. They were randomized to exercise intervention or control activity, both of which included 29 sessions over three months, and to protein-enriched energy supplement or placebo taken immediately after each session. At a three-month follow up the exercise group had improved significantly regarding comfortable gait speed. At six months comfortable gait-speed, Berg Balance Scale, and one repetition maximum in leg press, all improved compared with the control group. The intake of protein- enriched energy supplement did not increase the effects of the exercise. Participants with a MMSE score of 21 or more from the exercise group (n=20), and from the control group (n=28), answered a questionnaire. The perceptions of having participated in the activities were reported in a similarly positive way in both groups. However, significantly more respondents in the exercise group prioritized the exercise above other activities, had had positive outcome expectations, and felt encouraged during the sessions. They reported that, as a result of the exercise, they felt less tired and perceived improvements in lower-limb strength, balance, and safety and security when mobile, to a significantly greater degree than the participants in the control group. The experience of participating in the high-intensity functional exercise programme was described in interviews conducted with nine of the exercise participants. The interviews were analysed using qualitative content analysis. The findings show that the informants believed in positive effects and had a strong will to be active in order to avoid decreased capacity. They were struggling with failing bodies that constituted barriers to exercise. The support from the supervisors and belief in personal success facilitated performance of the exercise. The informants told of improvements in body and soul and that exercising in groups created a sense of togetherness. In conclusion, among older people with physical or cognitive impairments, high-intensity exercise programmes resulted in improved physical performance, both when measured by physical tests and when reported as subjective perceptions. A protein-enriched energy supplement, however, did not increase the exercise effects. Although bodily limitations could constitute barriers to exercise, the respondents communicated positive perceptions and experiences of participating in the high-intensity exercise programmes and reported a low rate of discomfort.
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| 6. |
- Näslund, Annika
(författare)
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Dynamic ankle-foot orthoses in children with spastic diplegia : interview and experimental studies
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Dynamic ankle-foot orthosis (DAFO) is a thin supra malleolar orthosis used as a compliment to the total treatment program in children with cerebral palsy (CP) in order to facilitate function in sitting, standing and walking. The DAFO keeps the foot in a functional position and is said to provide the child with proprioceptive feedback for balance- and postural control. The aim of the present thesis was to explore how parents of children with spastic diplegia experience the use of DAFOs and to determine the effects of DAFOs in standing during a reaching movement, in relation to postural orientation, anticipatory- and compensatory postural adjustments, and the quality of the reaching movement. The parents of 15 children, aged 4-18 years, who had spastic diplegia and wore DAFOs were interviewed with a broad research question "How do you perceive that DAFO influence your child" and analysed with content analysis. Children with spastic diplegia, aged 5-12 years, (n=6 in studies II and IV and n=4 in study III) classified at level II-IV according to Gross Motor Function Classification System (GMFCS) and typically developing children (controls) (n=8 in study III and n=6 in study IV) in the same age-group performed a voluntary reaching movement towards a target while standing on force plates. This allowed for registration of forces, movement and muscle activity (EMG). Children with spastic diplegia used DAFOs and/or shoes during the experiment while controls used shoes only. The parents experienced that DAFOs with their stabilizing effect on the foot and ankle enabled postural control and alignment, which contributed to functional activities under more favourable physical conditions. Moreover, psychosocial aspects such as a feeling of security, safety and freedom were regarded by the parents as being as important as the physical effects. Our findings showed that children with more severe spastic diplegia applied their body weight in standing more evenly between the legs and improved extension of the knee using DAFOs compared to wearing shoes alone. To initiate the reaching movement, despite different support conditions, children with spastic diplegia wearing DAFOs, as well as the controls make use of anticipatory postural adjustments. Furthermore, during the acceleration and deceleration phase of the reaching movement, children with spastic diplegia make use of compensatory postural adjustments characterized by co-contraction of tibialis anterior (TA) and lateral gastrocnemius (LG) muscles bilaterally. The postural adjustments in the controls were characterized by increased TA activity on the reach side during the acceleration phase and increased LG activity on the non-reach side during the deceleration phase. Movement quality in reaching in children with spastic diplegia showed that coordination between upward and forward reach velocity differed regarding temporal phasing and amplitudes of velocity peaks compared to the controls. According to parents´ perceptions DAFOs can be regarded as a part of treatment that improves stability, balance and functional skills. Children with severe spastic diplegia wearing DAFOs can, in spite of different support conditions, practice standing with a more evenly distributed body weight on the feet. The practice of reaching movements while standing with DAFOs can promote motor learning of postural adjustments and thereby improve the ability to use the hands in daily activities.
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| 7. |
- Prellwitz, Maria
(författare)
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Playground accessibility and usability for children with disabilities : experiences of children, parents and professionals
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Studies have identified barriers in the physical environment causing restricted participation in play activities for children with disabilities. Therefore, was the overall aim of this thesis to identify and explore aspects of playground accessibility and usability for children with disabilities based on the experiences of children, parents and professionals. The design of the thesis includes four studies examining different aspects of playground accessibility and usability. Data were collected in Study I through interviews with creators of playgrounds (i.e., persons in a municipality responsible for playgrounds), and with users of playgrounds (i.e., children with restricted mobility, and adults that accompany the children to playgrounds). Data in Study II were collected using a questionnaire completed by persons responsible for playgrounds in 41 municipalities of northern Sweden. In Study III, data were collected through interviews of children with different abilities and in Study IV parents of children with disabilities were interviewed regarding playground design. Data from the interviews were analysed qualitatively while data from the questionnaire were analysed using descriptive statistics. Results of the studies showed that persons responsible for playgrounds have not always considered accessibility for children with disabilities. In fact, many of them had never thought about the issue and also expressed a lack of knowledge needed for building accessible playgrounds (I, II). Further, based on children’s experience, playgrounds are important environments for all children, but these are not accessible and usable for all (III). According to the parents, playgrounds do not support play or social interaction for children with disabilities and the design of most playgrounds made their children dependent on adult support. This in turn limited contact with peers and causing the children a sense of being different (IV). To conclude, the results showed that playgrounds are not an accessible or usable environment for many children with disabilities in Sweden. This has affected children with disabilities in negative ways that in turn can cause play deprivation, dependency and stigmatization. The results also indicated that there seems to be lack of awareness regarding children’s rights in society and legislation that governs playgrounds.
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