| 1. |
- Womack, Jennifer L., 1960-
(författare)
-
The Occupation of Caregiving : Moving Beyond Individualistic Perspectives
- 2018
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this research was to illuminate and describe caregiving as an occupation, informed by perspectives from older adult care partners and occupational therapists. An additional aim was to integrate and inform study findings with theoretical constructs that inform occupational therapy practice through occupational science and public health perspectives. Although caregiving was the main construct under consideration, the specific focus was on care situations involving older adults.Study 1 considered the narratives of 3 older adult women serving as informal (unpaid) caregivers to friends and family members. All of the women were over the age of 65 and of varied racial/ethnic backgrounds. Data were elicited through story prompts embedded in repeated semi-structured interviews and analyzed using a storyboarding approach and poetic transcription.Study 2 was an ethnographic case study considering how care dyads take part in community mobility, a common instrumental activity of daily living, with a particular focus on how the caregiver supports the participation of the care recipient. 3 care dyads (6 participants) over the age of 65 were consented into the study. The researcher employed participant observation, field note journaling and semi-structured interviews followed by thematic qualitative analysis to illuminate strategies used by these care dyads to remain active in community mobility in the context of their care situation.Study 3 used a constructivist grounded theory approach to explore the perspectives of occupational therapists regarding their interactions with older adult caregivers. Repetitive focus groups with 11 occupational therapy practitioners, researcher memos and individual reflections from 2 additional participants provided multifaceted data that the researchers analyzed through several levels of coding to construct a grounded theory of occupational therapist-caregiver interactions.Study 4 consisted of secondary data analyses of a national survey of adult caregivers conducted in the United States in 2014-2015. Data specific to 482 caregivers age 65+ and older and their care recipients were extracted from the overall sample and considered in relationship to responses to questions regarding support received from healthcare providers. Descriptive and inferential statistical analyses were employed to develop a profile of older adult care situations and predict inquiries of support from healthcare providers based on care situation characteristics.Findings from the first two studies highlighted the relational nature of caregiving and an expanded view of the caregiver role. Study 1 also revealed that interactions with health care providers in positions of authority are often challenging and compel caregivers to act in ways they perceive as risky. Study 2 reinforced that caregivers act in ways that are influenced as much or more by the history of their relationships as by caregiving demands, and led to the explication of relational versus individual perspectives. These findings influenced the approaches used in studies 3 and 4, which focused on interactions between healthcare providers and older caregivers, specifically occupational therapists in study 3 and other healthcare professionals in study 4. Findings from study 3 resulted in a theoretical stance that occupational therapists are influenced by biomedical contexts to situate caregivers as paraprofessionals to help meet care recipient goals. This perpetuates an individualistic lens on caregiving, emphasizing the biomedical priorities of the patient over the priorities or support needs of the care situation. Support offered by healthcare providers in the form of inquiries about the needs of older caregivers was found in study 4 to be less than optimal, and appears not to be predicted by any characteristics of the care situation other than the living situation of the care recipient. In sum, individualistic perspectives fail to realize the occupational complexity of caregiving, and provide an opportunity to explore more collective paradigms when supporting older adult care situations.
|
|
| 2. |
- AlHayali, Amani
(författare)
-
In vitro-solubility and supersaturation behavior of supersaturating drug delivery systems
- 2018
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The development of new pharmaceutical products has been challenged by the growing number of poorly water-soluble drugs, which often lead to suboptimal bioavailability. Various approaches, such as the use of amor-phous solid dispersions and cocrystals, have been used to improve the solu-bility, and subsequent bioavailability, of these drug molecules. Supersaturat-ing drug delivery systems (SDDSs) have potential for achieving adequate oral drug bioavailability by increasing the drug solubility and creating a su-persaturated state in the gastrointestinal tract. However, there is a need for better understanding of the supersaturation behavior in SDDSs and of the factors affecting supersaturation. The main objective of this thesis was to improve understanding of the supersaturation solubility behavior in SDDSs with a particular focus on rapidly dissolving solid forms (amorphous forms/cocrystals).In the course of the work, a new formulation for ezetimibe using an amorphous solid dispersion was prepared, cocrystals of tadalafil were pre-pared, and oral films of silodosin were formulated for the first time. These new formulations were thoroughly characterized using a number of solid-state and pharmaceutical characterization techniques.The dissolution and supersaturation behavior of the prepared SDDSs were studied. The effects of various factors on the supersaturation and precipita-tion characteristics were investigated. These factors included the preparation method, the temperature of the dissolution medium, the type of dissolution biorelevant medium (gastric/intestinal) used, the permeability of the relevant gastrointestinal membranes, the addition of polymers, and the addition of surfactants. The amorphous solid dispersions, cocrystals and oral films that were prepared represent new drug formulations that provide significantly higher dissolution rates and supersaturated solubility than crystalline drug forms. Solid dispersions prepared by the melting method had better super-saturation properties than those prepared by spray drying. The precipitation kinetics of the solid dispersion were faster at 37 ̊C than at 25 ̊C in bio-relevant media. Implementation of an absorption tool during in vitro evalua-tion of supersaturation levels could improve the prediction accuracy of su-persaturation and precipitation. A better understanding of the effects of ex-cipients on the supersaturation and precipitation behavior of these types of formulation was obtained in this thesis. The improvement in supersaturation solubility obtained by adding polymers and surfactants was not proportional to the amounts of excipient used.This thesis has made notable contributions to the field of pharmaceutical science by advancing our understanding of the supersaturation solubility behavior of the newly prepared SDDSs.
|
|
| 3. |
- Calner, Tommy
(författare)
-
Persistent musculoskeletal pain : A web-based activity programme for behaviour change, does it work? Expectations and experiences of the physiotherapy treatment process
- 2018
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis concerned persons with persistent musculoskeletal pain in primary health care and had three aims. The first aim was to evaluate the effects of a web-based programme for behaviour change. The second aim was to create and evaluate a multimodal intervention. The third aim was to explore and describe expectations andexperiences of the physiotherapy treatment process.In Study I, we evaluated the effects of a web-based activity programme for behaviour change added to multidisciplinary rehabilitation (MDR) in primary health care. Ninety-nine participants were randomized to 1) MDR with an additional web-based programme, and 2) MDR. Outcome measures were work ability, pain intensity, pain-relate disability and health-related quality of life. There were no significant effects of the web-based programme for any outcome measure at 4 or 12 months. In conclusion, this study provides no support for adding a self-guided web-based programme to MDR in primary health care.In Study II, we evaluated first the web-based programme from Study I compared to the waiting list. Effect measures were workability, pain intensity, disability and self-efficacy. Thereafter, we evaluated the effects and process of a novel multimodal intervention consisting of the web-based programme with additional individual counselling, and individually tailored physiotherapy treatment. Ten participants were included in the study. Effects were evaluated using a Single Subject Experimental Design (SSED) and the process was evaluated by interviews with the participants and log data of usage of the modalities. There were no conclusive effects of the self-managed web-based programme as compared to the waiting list. The SSED analyses of the multimodal intervention showed promising short-term results regarding disability and pain intensity, but no conclusive results for work ability or self-efficacy. The multi-modal intervention process seemed successfully implemented, and the importance of physiotherapy and, to some extent counselling, was emphasized by the participants. In conclusion, the newly designed multimodal intervention in primary health care seemed feasible and showed some promising short-term effects, while the implementation of a self-managed web-based programme as a single intervention seemed without effect.In Study III, qualitative interviews were conducted with ten participants to explore their expectations of physiotherapy. Data were analysed with qualitative content analysis and the findings described a multi-faceted picture of the participants’ expectations, encompassing several aspects regarding the treatment process and outcome. Regarding the treatment process, participants expected a good dialogue, to be confirmed as individuals, and to get an explanation for their pain. The participants expected tailored training with frequent follow-ups and their expectations of outcome ranged from hope of the best possible results to being realistic or resigned.In Study IV, qualitative interviews were conducted with 11 participants to explore their experiences in physiotherapy treatment. Data were analysed with qualitative content analysis. The findings show how the participants described how they used knowledge, awareness, movements and exercises learned from the physiotherapy treatment to develop strategies to manage pain and the process of acceptance. There were experiences involving the importance of establishing an alliance with the physiotherapist, based on trust and with a continuous dialogue. When exercises, activities and other treatment modalities were individualized, participants were actively involved in the process. This was rewarding but was also considered an effort and a challenge. The physiotherapist’s initiatives and actions were considered important for incentive and support.In conclusion, we found no effects of the web-based activity programme on behaviour change for persons with persistent musculoskeletal pain. The newly designed multi-modal intervention in primary health care seemed feasible and showed some promising short-term effects. Expectations of physiotherapy treatment were multi-faceted, encompassing both process and outcome. After finishing physiotherapy, the participants described how they used knowledge, awareness, movements and exercises learned from the physiotherapy treatment to develop strategies to manage pain and the process of acceptance. The importance of alliance and incentives for activities throughout the physiotherapy treatment process were also described.
|
|
| 4. |
- Melander, Catharina
(författare)
-
Piecing together a fragmented world : Structures to promote the understanding of people with advanced dementia
- 2018
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Understanding people with dementia whose verbal ability has been impaired is a complex and challenging task, even for professional nursing staff. The aim of this PhD thesis was to explore structures that may promote the understanding of people with advanced dementia living in nursing homes. It focusses specifically on (I) the clinical reasoning employed by assistant nurses when utilizing the NPI-NH (Neuropsychiatric Inventory Nursing Home version) as a tool to assess frequency and severity of BPSD (behavioural and psychological symptoms in dementia, i.e. problematic behaviours) in people with advanced dementia, (II) whether a sensor measuring electrodermal activity (EDA) can improve the identification of agitation in individuals with dementia, (III) how an EDA sensor impacts assistant nurses’ structured assessments of problematic behaviours amongst people with dementia and their choices of care interventions, and (IV) how Martha Nussbaum’s approach to human capabilities can apply to dignity in the lives of people with advanced dementia living in nursing homes. Study I used a method of discourse analysis that focussed on clinical reasoning utilized by assistant nurses when assessing problematic behaviours. In study II, a nonexperimental and correlational observation of the relationship between a sensor measuring EDA and assistant nurses’ structured observations of agitation in people with advanced dementia was applied. Study III used both quantitative and qualitative approaches; data were collected during structured assessments of problematic behaviours conducted by assistant nurses, as well as by focus group interviews with assistant nurses. Study IV took an ethnographic approach with participatory observations that were analyzed with a recursive analysis using a theoretical framework for the conditions necessary for a dignified human life. The structure of the NPI-NH provided a supportive framework that encouraged assistant nurses to discuss and broaden their understanding of the person with dementia (I). The EDA sensor provided continuous information regardless of staff presence and the potential to identify EDA prior to observing these behaviours (II, III), which supported the understanding of the person and when to introduce timely interventions to prevent the onset of problematic behaviours (III). The structure of Nussbaum’s approach to human capabilities illuminated that people with advanced dementia were at risk of living a life in which their opportunities for human capabilities were limited, and hence, the possibility to live a dignified life (IV). An overview of the findings in this thesis indicates that the studied structures were used to piece together fragments of information to create a comprehensive understanding of the needs of the person with dementia. For the structures to support the understanding of the person with dementia, it was crucial that nursing staff were present, attentive and engaged in each person’s situation in order for them to figure out how to piece together and integrate the structures into the overall understanding of the person and, based on that, formulate caring actions in daily life that are meaningful from the perspective of the person with advanced dementia.
|
|
| 5. |
- Strömbäck, Ulrica
(författare)
-
The second myocardial infarction : A known but different experience
- 2018
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to explore the second myocardial infarction (MI) and describe experiences of the second myocardial infarction from the perspectives of patients and personnel in cardiac rehabilitation (CR).This thesis includes four studies. Studies using quantitative method (I, II) and qualitative method (III, IV) were performed. Studies I and II were retrospective cohort studies based on data from the Northern Sweden’s MONICA myocardial infarction registry. A paired design was used. Study I included 1017 participants, and the corresponding figure for Study II was 820 participants. The participants had at least two MI events recorded in the MONICA MI registry from 1990 – 2009 (I) and 1986 – 2009 (II). The two MI events studied were the first and second events. Study III included eight patients who suffered two MIs. The data were collected through interviews about the experience of suffering a second MI. In Study IV, personnel working with CR were interviewed about the experience of working with patients suffering from a second MI and data from study III were used for describing the patients expressed needs during CR. Data were analysed by descriptive and analytic statistics (I, II) and by qualitative content analysis (III, IV).Both men and women had higher risk factor burdens when suffering the second MI compared when they suffered the first MI. Women had a higher risk factor burden at both first and second MI compared with men. Women also suffered the second MI with a shorter time interval than men did (I). The most common symptom reported in men and women at both MI events were typical symptoms. In men, 10.6 % reported different types of symptoms at first and second MI, and the corresponding figure for women was 16.2 % (II). The number of patients with a prehospital delay < 2 hours increased at the second MI. Furthermore, the results showed that patients with a prehospital delay ≥ 2 hours at the first MI were more likely to have a prehospital delay ≥ 2 hours at the second MI (II). Suffering a second MI is a known but different event compared to the first MI, it makes afflicted people realise the seriousness and the importance of making lifestyle changes (III). People express they are more affected after having the second MI, both physically and psychologically (III). In the analysis of congruence between the needs patients expressed linked to CR and personnel’s description of how they worked, a theme emerged: “Be seen as a unique person” 2(IV). The patients expressed a need of customised care, and the personnel described that it was important for them to individualise the care given to these patients.Suffering a second MI is experienced as a different and more serious event that the first one. The patients had gained valuable knowledge due to their previous experience and the second MI was a wake-up call for life style changes. A majority of the patients had typical symptoms at both MI events and an increased number of patients had a prehospital delay < 2 hours at the second MI. We suggest that the personnel in CR pay attention to first-time MI patients’ illness representation to enhance the patient’s awareness of the seriousness of the illness and the fact that they suffer from a chronic illness. The care given after an MI, including cardiac rehabilitation should be person-centred to involve the patient as an active participator in the care and were the patient’s resources and needs are in focus.
|
|
