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- Dahlberg, Karuna, 1979-
(författare)
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e-Assessed follow-up of postoperative recovery : developement, evaluation and patient experiences
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The majority of all surgeries are performed as day surgery. After discharge, patients are expected to take responsibility for their postoperative recovery themselves. Recovery Assessment by Phone Points (RAPP) is an e-assessment developed for assessing and providing follow-up on postoperative recovery, which includes the Swedish web-version of the Quality of Recovery questionnaire (SwQoR). It also enables the patient to get in contact with the day surgery unit. The overall aim of this thesis was to further develop and evaluate a systematic follow-up of postoperative recovery using a mobile app in adult persons undergoing day surgery, as well as to describe their experiences of postoperative recovery when using the mobile app. Study I: This study included three steps. Equivalence testing between the paper and app versions of the SwQoR showed agreement (n=69). The feasibility and acceptability evaluation showed that participants (n=63) were positive towards using a mobile phone application during postoperative recovery. Content validity of the SwQoR reduced the original 31 items to 24. Studies II and III: A multicentre, two-group, parallel, single-blind randomized controlled trial including 997 participants was conducted to investigate the effect of e-assessment on postoperative recovery (II) and cost-effectiveness (III) in a RAPP group compared with a control group. The RAPP group reported significantly better quality of postoperative recovery on postoperative days 7 and 14 compared with the control group. Moreover, RAPP may be cost-effective as it provides low-cost care. Study IV: Explored experience of postoperative recovery in participants using a mobile phone app during their postoperative recovery. Qualitative inductive semi-structured interviews (n=18) were performed. Findings showed that feeling safe is important during postoperative recovery. This feeling can be created by patients themselves, but sufficient support and information from health care and next of kin is needed. Overall, this thesis showed positive results for RAPP, suggesting that RAPP is a solution that may benefit patients after day surgery.
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| 2. |
- Gabrielsson, Hanna, 1977-
(författare)
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Adults with Spina bifida : voices from everyday life and exploration of living conditions
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to generate knowledge about living with Spina bifida, by mapping the condition and together with the adults with Spina bifida explore their living conditions and experiences in everyday life. Methods Study I was a quantitative study with a cross-sectional design. In Study II, individual experiences of daily life were explored by deep interviews using a reflective lifeworld approach. Study III had a participatory approach including five members of a photovoice group who met for eight sessions. Photographs taken by the members served as a starting point for the dialogue about what was of interest in their daily life. A narrative analysis was conducted by the researchers, incorporating the analysis the group did together. Study IV focused on alignment with the methodology in which photovoice is grounded. By returning to the ideological cornerstones of photovoice, the empirical experiences from Study III and examples from the literature were elaborated through processes within photovoice. The findings show that those adults with Spina bifida who were >46 years old had less complex medical conditions and better physical and cognitive functions, and had attained a higher level of education. The main theme in Study II was presented as “The contradictory path towards wellbeing in daily life.” In Study III, the members’ experiences in everyday life showed that many solutions offered by society were “An adaptation for us, but it works for no one.” The findings are further presented under three themes: “Accessibility – a never-ending project,” “Tensions of a normative view” and “Power to influence.” By focusing on action and narrative in Study IV, it is shown that dialogue, action, and interaction are important aspects of using photovoice. In conclusion, not all adult persons receive the support they need in everyday life, something future generations of adult persons with Spina bifida may have a higher need for. The stories and experiences of adults with Spina bifida in this thesis paint a history of not being asked, concerning their own situation. This shows that there is insufficient integration of the persons’ experiences in society’s efforts to plan for, and support, these individuals. The photovoice method was feasible for this group, providing opportunity for being part of dialogue, action, and interaction.
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| 3. |
- Karlberg-Traav, Malin, 1962-
(författare)
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Evidence-based nursing : reflections from different perspectives
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to describe the use of evidence-based nursing (EBN) with respect to the four cornerstones of EBN: research, nursing theory, the patient’s perspective and clinical competence. Study I explored registered nurses (RNs) self-reported research utilization (RU) in relation to their work climate. A quantitative approach was used; further analyze led to a cluster solution of the measured variables, and low reported RU were compared with higher reported RU. The result showed that an academic degree underpinned the instrumental research utilization (IRU), also women reported higher use of conceptual research utilization (CRU). An association between low RU and dynamism/liveliness was seen, and younger RNs and RNs with shorter working experience reported higher scores for playfulness/humor and conflicts. Study II described how nurses conceived working in a ward where a nursing philosophy had been implemented. A phenomenographic method was used. The philosophy supported the clinical work and underpinned reflection and shared values. A prerequisite was a dedicated leader. The RNs described the care being of high quality. First line nurse managers (FLNMs) role and their experience of opportunities and obstacles to support EBN, was explored in study III. Data was collected using focus groups and analysed using phenomenography. The result showed that the FLNMs need to make an entity of vision and reality to be supportive according of EBN. The last study was an integrative literature review and the perspective of the patient in articles reporting on interventions designed to improve nursing was in focus. The result in study IV showed that the perspective of the patient represents five aspects, and that reporting clinical implications is important. In conclusion; the different perspectives all relates to EBN. Registered nurses need to be encouraged to develop their academic training, to be able to work according to EBN. A nursing philosophy provides time for reflection and a feeling of performing care of high quality. FLNMs need to take their role to support the RNs in order to work evidence-based. Conscious and communicated aspects supported the perspective of the patient.
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| 4. |
- Pettersson, Miriam, 1977-
(författare)
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Routine procedures in the care of the full-term newborn
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis presents four studies on routine procedures used in the care of the full-term newborn. The overall aim of the thesis was to study the effects of these routines and endeavour to find ways to improve them.Study I, an observational study, included 28 healthy newborns, assessing pain during neonatal hip examination. Pain was assessed using Premature Infant Pain Profile-Revised (PIPP-R), near infrared spectroscopy (NIRS) and galvanic skin response (GSR). The results showed that the pain scores and NIRS and GSR readings were significantly higher for hip examination than for the heart auscultation indicating that neonatal hip examinations are painful.Study II was as a double blind, randomized controlled trial (99 patients included) evaluating whether oral sweet solution has a pain relieving effect during neonatal hip examination. Total crying time, crying time during the hip examination, ALPS-Neo and VAS (when assessed by the physician) were all significantly decreased in the group of infants receiving glucose, the conclusion drawn from this is that oral sweet solution seems to have a painrelieving effect during neonatal hip examination.Study III and IV were based on a multicenter randomized controlled study, where 147 patients from 6 hospitals were included. Study III evaluated whether home phototherapy could be a feasible and safe alternative to in hospital phototherapy for term newborns. The results showed that home phototherapy could be a safe alternative to inpatient phototherapy for otherwise healthy newborn infants with hyperbilirubinemia if daily check-ups and 24/7 telephone support can be provided.Study IV, examined parent’s experiences of home phototherapy (n=15) using a qualitative design. The study showed that the overall experience was positive and that parents expressed a sense of feeling safe with managing the treatment at home. They also felt that the ability to provide phototherapy at home helped them to adapt to everyday life and enhanced their positive experience of parenthood.
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| 5. |
- Svanberg, Mikael, 1958-
(författare)
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Psykologiska faktorer vid rehabilitering av patienter med långvarig smärta
- 2022
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Chronic pain is common and a burden for both the individual and society. In chronic pain, the pain has lost its function as a warning system and instead has become a disease in itself. Neurobiologically, several areas of the brain are involved, but to gain a broader understanding of the long-term pain, the biopsychosocial model is the best starting point. In line with thisand many scientific studies since the late 90's, psychological factors have proven to be an important factor in the development and maintenance of chronic pain. Interdisciplinary multimodal rehabilitation programs (IMMRP) are the treatment currently given to patients with long-term pain in the specialized pain rehabilitation. When the IMMRP has been reviewed, patients have shown improvement over time, but it is not possible to say whether it is the IMMRP or which parts of the IMMRP that explain the improvement (1).In this licentiate thesis, I have studied the importance of psychological factors in the rehabilitation of patients with chronic pain. This has been done in three studies reported in three published articles. All the studies have been close to the clinic and have been performed on patients in the specialized pain rehabilitation care in Sweden.The first article studied the effect of the multimodal investigation (MMI). More specifically, it was investigated whether alliance building and feelings of validation in patients with chronic pain affected their acceptance of pain, pain management, catastrophic thoughts, and depression. This was performed in a "single case" study on six patients in MMI. The results showed that despite good alliance and sense of validation, acceptance increased only in one patient and no improvement was seen in pain management, catastrophizing, and depression.In study two, subgroups of patients with chronic pain were studied. The subgroup analysis showed that patients referred for IMMRP could be divided into groups with different profiles regarding emotional problems and pain avoidance. These profiles were important for how the patients relatedto their pain and the results of IMMRP. The results of the study can increase the understanding of which patients should be selected for IMMRP and how the treatment can be adapted to the patients' needs.In study three, opioid treatment in patients with long-term pain who were referred to IMMRP was studied. The result showed that opioid prescribing was common and 55% of the participants received at least one prescription for opioids during the two years after the first assessment. It also turns out that there was a connection between individual patient characteristics (especially pain and depressive symptoms) and opioid prescription. Understanding how individual patient characteristics relate to prescribing patterns and long-term opioid use is an important prerequisite for managing opioid prescribing and the basics for preventing overuse. Overall, this licentiate thesis shows that MMU has no therapeutic effect on patients with long-term pain. It also shows that patients with chronic pain are a heterogeneous group that can be divided into subgroups based on psychological characteristics. The subgroups, in turn, had different ways of managing their pain and absorbing the treatment offered. In addition, it emerged that opioid prescribing was common among patients with long-term pain and that there was a link between opioids and patient characteristics.
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