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- Alm Pfrunder, Annika
(författare)
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Jämlik vård ur ett prehospitalt akutsjukvårdsperspektiv
- 2018
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Bakgrund: Målsättningen för jämlik vård är enligt Världshälsoorganisationen (WHO) och Hälso- och sjukvårdslagen (HSL) 1982:763 att hälso- och sjukvården ska ge god hälsa och en vård på lika villkor för hela befolkningen, oavsett bostadsort, ålder, kön, funktionsnedsättning, utbildning, social ställning, etnisk eller religiös tillhörighet eller sexuell läggning. Tidigare forskning visar dock att det finns skillnader inom olika delar av hälso- och sjukvården som har både könsrelaterade och socioekonomiska orsaker. Även olikheter i patienters symtombild i relation till kön samt faktorer såsom kön, ålder, utbildningsnivå och attityder hos personalen som omhändertar patienten kan påverka om vården bedrivs jämlikt eller inte. Det är dock oklart om ovan beskrivna orsaker till ojämlik vård även har inverkan på vården som bedrivs prehospitalt, inom ambulanssjukvården. Syfte: Det övergripande syftet med denna avhandling var att utforska ambulanspersonalens omhändertagande av patienter ur ett jämlikhetsperspektiv. Metod: Två studier har genomförts, en med kvantitativ studiedesign (I) och en med kvalitativ studiedesign (II). Studie I, baseras på ambulanspersonalens dokumentation gällande bedömning och smärtlindring av patienter (n=722) som drabbats av höftfraktur. Studie II är en intervjustudie genomförd med ambulanspersonal (n=11). Resultat: I delstudie I framkom att ambulanspersonal med yrkeserfarenhet mindre än 10 år administrerat mer smärtstillande läkemedel jämfört med personal med yrkeserfarenhet mer än 10 år. Det som även visade sig i studien var att patienterna i stor grad (>80 %) uppgav smärta men det var en relativt låg andel som smärtlindrades enligt dokumentationen. I delstudie II framkom att bristande svensk-engelska kunskaper hos den vårdsökande var ett hinder för att utföra en optimal bedömning, identifiering av vårdbehov och initiering av behandling samt symtomlindring vilket kan riskera en ojämlik vård. Ambulanspersonalen anpassade sig emellertid till situationen och beskrev hur de använde en palett av strategier när de försökte övervinna språkbarriärerna. Konklusion: Studierna visar att det finns en risk för att vården ur ett prehospitalt akutsjukvårdsperspektiv kan vara ojämlik. Kön och yrkeserfarenhet hos ambulanspersonalen påverkade frekvensen av smärtlindring vid vård av patienter med höftfraktur. Bristande svensk-engelska kunskaper hos de vårdsökande riskerar även att orsaka en ojämlik vård men ytterligare studier behövs i ämnesområdet för att kunna bekräfta/förkasta denna slutsats.
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- Andersson, Ewa
(författare)
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Group based antenatal care : expectations, attitudes and experiences from parents’ and midwives’ perspective
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Group based antenatal care (GBAC) is a model of antenatal care that has been implemented in Sweden since year 2000. Sparse research has been conducted in Sweden but in the USA, where the model is more common, the research has found that women ́s satisfaction with GBAC is higher than with standard individual care (SC). The purpose of this thesis was to study women’s expectations of antenatal care and parents’ experiences of GBAC in Sweden. Midwives attitudes and thoughts about GBAC and their work in SC were also investigated. Method: In Study I, 28 parents who received GBAC were interviewed about their experiences and qualitative content analysis was used to understand and describe their responses. Studies II and III are based on the controlled clinical trial (CCT), which was conducted in 12 clinics in different geographical areas in Sweden between 2008-2010. The design of the study consisted of midwives who were randomized to GBAC or SC and women in both groups evaluated the given care. Study II compared 700 women ́s expectations of antenatal care before the intervention in the CCT with 3061 women in an earlier national cohort (KUB) and also compared expectations in women who later received GBAC or SC. Study III was based on two questionnaires given to women before the intervention in the CCT and six months after birth. The study explored differences in mothers’ satisfaction with the two models of antenatal care. Descriptive and comparative statistics were performed in studies II and III. In Study IV structured interviews were used to explore 56 midwives attitudes to GBAC. Descriptive statistics and quantitative content analysis were used. Results from Study I showed that parents valued that their medical needs were fulfilled, and they felt prepared for childbirth but not for parenthood. Parents appreciated their midwives for their medical knowledge but were critical of their awareness of gender issues. In GBAC parents had opportunities to socialised with other couples and when sharing their situations with each other, they felt more normalized. They also recommended this model for all parents. The expectation of content of care in Study II showed changes since the National cohort 10 years ago. Currently women have lower expectations in health related issues and in attending parental classes but higher expectation about information. They also have a higher expectation that during antenatal care midwives will treat them with respect and support their partner’s involvement. Two significant differences were found between GBAC and SC in the CCT: women who later received GBAC had higher expectations about information on breastfeeding and the importance of attending parental classes. Regardless of model of care, women in CCT had lower expectations of continuity of caregiver and there were also fewer women who preferred more visits then recommended compared to women in the national cohort. In comparison between GBAC and standard care in Study III, there were no significant differences in general satisfaction between the two models. In GBAC, women reported significantly less deficiencies with all information, except information about pregnancy. Women in GBAC reported more engagement from the midwives, that they were taken more seriously and that they had more time to plan the birth. Women in GBAC was also more satisfied with antenatal care in supporting contact with other parents and that the care helped them in initiating breastfeeding. Women reported deficiencies in almost 50% of antenatal care content regardless of model. Midwives in Study IV weighed pros and cons of initiating GBAC and considered the model inappropriate for immigrants and well-educated parents. They also expressed organisational barriers to implement the model. The majority of the midwives reported high work satisfaction and 55% requested to run GBAC. In conclusion, the findings of this thesis found few differences in women’s expectations about the content of care between GBAC and SC, but expectations have changed over the last ten years. Parents who experienced GBAC appreciated the group model. Similar overall satisfaction in both models of antenatal care suggests that GBAC can be introduced without altering women ́s satisfaction with antenatal care but midwives viewed constraints to implement GBAC.
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- Andersson, Åsa
(författare)
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Adverse events in nursing care : a study of reports by patients, families and healthcare providers
- 2017
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Patient safety has, over the last decades, been increasingly established as an important global issue. Patient safety is jeopardized by for example adverse events and most of the current evidence on adverse events originates from hospitals, but many adverse events also happen in nursing homes. It is clear that adverse events occur in nursing care and can cause suffering and even death, which could have been avoided if adequate actions had been taken. While the literature on improving patient safety is extensive, there is a dearth of studies from the perspectives of patients and their relatives. Aim: To gain new insights about adverse events in nursing care from the perspective of patients and their relatives as well as health care providers, and describe contributing factors to serious adverse events. The specific aim in paper I was to examine adverse events in nursing care as they are experienced by patients and relatives. In paper II the aim was to identify the most common serious adverse events that occur in nursing homes, and their most frequent contributing factors, in order to contribute to the improvement of safe nursing care. Methods: The design was descriptive, based on a total sample of data collected from national registries in Sweden. The method was content analysis with both a qualitative and a quantitative approach. Results: The findings in study I showed that experiences of adverse events in nursing care, reported by patients and relatives, included suffering from both physical and mental injuries caused by the nursing care. Lack of participation caused negative consequences for patients or relatives, as well as physical adverse events. The findings from study II showed that medication errors, falls, delayed or inappropriate interventions and missed nursing care caused the vast majority of the serious adverse events in nursing homes. The most common contributing factors to serious adverse events were 1) lack of competence 2) incomplete, or lack of documentation 3) teamwork failure 4) and inadequate communication. A comparison of the results of studies I and II showed that there were discrepancies between the adverse events reported by patients and their relatives and the serious adverse events reported by health care providers. Conclusion: Carers, as well as leaders in health care, can learn from patients’ and relatives’ experiences of adverse events in nursing care in order to improve the quality of nursing care. The contributing factors to serious adverse events frequently interacted, yet they varied between different groups of serious adverse events. A holistic approach to improve safe care in nursing homes requires competence of the staff, safe environments as well as resident’s and relative’s participation.
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- Andersson, Åsa G
(författare)
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Characterization of first ever stroke patients : functional status with special reference to risk of falls and fracture
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction. The costs for falling accidents in Sweden are very high. There is now evidence that assessments and intervention programmes are effective in reducing the risk of falling. It is important to identify which patients have a risk of falling and therefore would benefit most from fall prevention measures. Patients with stroke have a high risk of falling. The falls may result in fear of falling again and fractures. Hip fractures constitute one of the most serious ones. Compared with the general population, stroke survivors have an increased risk of hip fracture. The risk is up to four times higher than for age-matched control subjects. The most likely explanations are an increased risk of falling and reduced bone density. Aims. Our aims in the present study were to determine if certain test instruments can identify fallers and predict hip fractures, determine the relationship between fear of falling and functional characteristics, describe the circumstances that prevailed when the patients sustained their hip fractures, compare bone mineral density in patients with stroke and hip fracture and to investigate side differences in bone mineral density in patients with stroke alone. Methods. Patients with first ever stroke treated in the stroke unit at Örebro University Hospital during one year were included in the present study. One hundred and sixty-two of the 218 patients who were included participated in the follow-up after six or twelve months. Nine of the patients fractured their hip within two years after stroke. Bone mineral density was measured in eight of them, as well as in 76 control subjects. Results. The results of Berg Balance Scale (BBS), Stops Walking When Talking (SWWT) and Timed Up & Go (TUG) differed between fallers and non-fallers. Previous falls as well as using sedatives and impaired vision was associated with falling. Impaired physical function was significantly associated with scoring low fall-related self-efficacy, both for fallers and non-fallers. All patients who subsequently sustained hip fracture had their fractures indoors when they were performing everyday activities. Hip fracture was associated with previous fractures, impaired vision and impaired cognition. Bone mineral density in patients with hip fracture tended to be lower whether they had a stroke or not. Side differences may occur even in patients who can walk independently at stroke onset and all patients who fractured their hip did not have osteoporosis. Conclusions. BBS, SWWT, TUG and Falls Efficacy Scale - Swedish version could add useful information in a multidisciplinary fall risk analysis. The same factors were associated with an increased risk of falling and having a hip fracture in patients with stroke as for people in general. For a frail, elderly person who already has very small margins, the onset of stroke may mean the difference between falling or not falling, having a hip fracture or not.
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- Anåker, Anna
(författare)
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Physical environment of stroke units : importance to health care
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: The physical environment is essential for health and well-being. Early rehabilitation is crucial for the person who has had a stroke to be able to regain knowledge and abilities lost as a result of the illness. There are few studies on how the design of the physical environment of a stroke unit can support patient ́ activities and care. Furthermore, the knowledge is limited as to how the physical environment impacts multi-professional teamwork in stroke units. Aim: The overall aim of this thesis was to generate knowledge about the physical environment of stroke units and the complex relationship between the design of the environment, the care and the user's experience of the physical environment. Method: The thesis was based on four studies. These studies had a descriptive and exploratory design. The case study as method was used throughout. In studies I, II and IV, structured observations were used to quantify the amount and nature of patients ́ activity, their location in a setting and the other people present. In studies I, II and IV, non-structured observations were also used. These aimed to explore support and obstacles in the physical environment for patients and the multidisciplinary team. For study III, a qualitative method was used which, with the help of interviews, aimed to study the patients’ experiences in terms of the physical environment. Results: Study I showed that in the new stroke unit, the patients spent more time alone in their rooms, were less active, and had fewer interactions than the patients in the original unit. Changes in the physical environment may have affected patient activity and interaction. Study II showed that the stroke units differed in terms of patient activity level and the proportion of the day that they were alone in their rooms. Patients had higher levels of activity in a stroke unit that had a combination of single and multiple bedrooms compared to a stroke unit with only single rooms. Stroke units that were easy to navigate and offered variations in the physical environment had an impact on patients ́ activities and care. In study III, two main themes were identified: (i) incongruence exists between community and privacy and (ii) connectedness with the outside world provides distraction and a sense of normality. In the single rooms, the patients experienced loneliness and an absence of social community. The patients were positively distracted when they looked at nature or watched activities happening outside their windows. Study IV showed that the multidisciplinary team did not work together in their meetings with patients. Furthermore, the results demonstrated various supports and obstacles in terms of the physical environment that affected the team’s activities: for example, barriers in the form of a physically divided environment for the team. Conclusions: This thesis serves to contribute to an increased understanding and improved knowledge in terms of the physical environment of stroke units. In the case of evidence-based design of stroke units, it is central that this understanding and knowledge be used and that the physical environment is looked at in terms of how it can be a support for both the person who has had a stroke and the multidisciplinary team. The physical environment should be designed to reduce both inactivity and the experience of loneliness, and to contribute to the multidisciplinary team having suitable locations where members can work together.
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