| 1. |
- Andersson, Maria, 1969-
(författare)
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Oral care quality in intensive care units and short-term care units : Nursing staff and older people's perspectives
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to investigate oral care and its quality through the perspectives of nursing staff in intensive care units and short-term care units and from the perspectives of older people in short-term care units. Methods: The mix-method study (I) had a concurrent embedded design and was cross-sectional. Eighty-eight intensive care nurses (response rate (RR) 40%) responded to the Nursing Care related to Oral Health questionnaire, and the data were analysed with analytic statistics and qualitative content analysis. The quantitative studies (II-IV), which were also cross-sectional, included 432 nursing staff in intensive care and short-term care (RR 51–52%) and 391 older people (RR 77%) in short-term care units. Participants responded to the modified version of the Quality from Patients’ Perspective instrument and provided information about person-related conditions. Descriptive and analytical statistics were used. Main results: Intensive care nurses perceived having the antecedents, knowledge, and skills to provide optimal oral care quality, but the result indicated that they were having difficulties putting these into practice (I). Areas for improvement in oral care quality were identified in both care environments (II). Older people preferred personalised information about oral health and oral care (III). Nursing staff as well as older people’s perceptions of oral care quality and its humanity aspects, seemed to be related to person-related conditions and differed between the two care environments. In short-term care, nursing staff’s preferences for the humanity aspects of oral care quality were higher compared to older people’s preferences (IV). Conclusion: Oral care is complicated and proactive and requires registered nurses’ and other nursing staff’s attention as well as educational and organisational initiatives. Many older people were assessed to have oral health problems. With early identification and optimal oral care, unnecessary suffering might be prevented. The identified quality improvement areas might guide RNs, nurse managers, and other nursing staff to further oral care quality development.
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| 2. |
- Arakelian, Erebouni, 1973-
(författare)
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Operating Room Efficiency and Postoperative Recovery after Major Abdominal Surgery : The Surgical Team’s Efficiency and the Early Postoperative Recovery of Patients with Peritoneal Carcinomatosis
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In selected patients, surgical treatments such as cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have enabled curative treatment options for previously incurable diseases, such as peritoneal carcinomatosis (PC). The introduction of resource demanding surgery could affect the work process, efficiency, and productivity within a surgical department and factors influencing patient postoperative recovery processes may have an impact on the efficiency of patient care after major surgery.The aim of this thesis was to investigate operating room efficiency from the perspective of both staff and leaders’ in two different settings (Papers I and II) and the early postoperative recovery of patients with peritoneal carcinomatosis (Papers III and IV).Interviews were held with 21 people in a county hospital and 11 members of the PC team in a university hospital, and a phenomenographic approach was used to analysis the data (Papers I and II). The patients’ postoperative recovery and pulmonary adverse events (AE) were determined from data retrieved from the electronic health records of 76 patients (Papers III and IV).The concept of efficiency was understood in different ways by staff members and their leaders (Paper I). However, when working in a team, the team members had both organisation-oriented and individual-oriented understanding of efficiency at work that focused on the patients and the quality of care (Paper II).The patients with PC regained gastrointestinal functions and could be mobilised during early postoperative recovery phase, although many patients suffered from psychological disturbances, sleep deprivation, and nausea (Paper III). Postoperative clinical and radiological pulmonary AE were common, but did not affect the early recovery process (Paper IV).In conclusion, leaders who are aware of the variation in understanding the concept of efficiency are better able to create the same platform for staff members by defining the concept of efficiency within the organisation. In a team organisation, the team members have a wider understanding of the concept of efficiency with more focus on the patients. The factors affecting postoperative recovery and pulmonary AE should be considered when designing individualised patient care plans in order to attain a more efficient recovery.
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| 3. |
- Arvidsson, Igor, 1976-
(författare)
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Theoretical Investigations of Boron Related Materials Using DFT
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In the history of Chemistry, materials chemists have developed their ideas mainly by doing experiments in laboratories. The underlying motivation for this laboratory work has generally been pure curiosity or the ambition to find a solution to a specific problem. Minor changes in the composition or structure of a material can cause major changes in its properties. The development of powerful computers has now opened up the possibility to calculate properties of new materials using quantum mechanical methods.The Chemistry of different boron-related materials has been evaluated in this thesis by Density Functional Theory (DFT). Cubic boron nitride (c-BN) is a most interesting material for the microelectronics and tool industry. During thin film deposition of c-BN, several problems arise which most often result in unwanted BN isomorphs. Chemical processes at the (110) and (111) surface of c-BN have been investigated in order to shed light upon some of these complex processes. Typically adsorption energies and surface reconstruction were found to differ significantly between the two surfaces. Other materials investigated are layered transition-metal diborides (MeB2). Incorporation of transition-metal atoms into elemental boron in its most fundamental structure, ά-boron, has also been investigated. The calculations on MeB2 focused on the stability of the planar compared to the puckered structure of MeB2. Stability was investigated by calculating Density of States (DOS) and bond populations. Deviations in the cell parameters from their ideal values were also considered. A separate project concerned reactivity of the TiB2(001) surface. Molecular and dissociated adsorption energies and adsorption geometries were calculated for H2, H2O and O2. It was concluded that the titanium surface was more reactive than the boron surface and that the adsorption energies were comparable to or stronger than other well known surface-active compounds like TiO2.
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| 4. |
- Carlsson, Carl Mikael, 1982-
(författare)
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Det märkvärdiga mellantinget : Jordbrukares sociala status i omvandling 1780−1900
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- During a period corresponding to approximately 1789−1872 the Swedish system of estates was phased out. New ideas challenged the organic view of society, and through a number of political reforms the estate privileges were abolished one by one. The reforms went hand in hand with a change in the social stratification at that time. The distinct difference between peasants and gentlemen that had characterized the countryside were erased and replaced by new ways of categorising people. This development has been described in broad strokes in previous research, leaving the roles of individuals overshadowed.This thesis is about individuals who were on the border between being peasants and gentlemen, how they were viewed by the class society, and the role they played in the dissolution of the same. The focus is centred on a population of wealthy farmers around the rural areas of Västerås during the years 1780−1900, and how they were perceived and acted in terms of title, lineage, education, occupation, farm holdings, building customs, naming customs and political life.The investigation shows that the differences between peasants and gentlemen remained during the period, but that it changed in character from a difference in kind, to a difference in degree. Important reasons for this were the gentlemen’s increased interest in agriculture and the emergence of a group of very wealthy farmers. The increase of rich farmers was more prevalent in the first half of the nineteenth century. They embraced some of the gentry’s behaviour, for instance through the acquisition of mansions, but as they often held political positions that by law should be held by peasants, they also preserved their common appearance. In this way the limits for what could be considered common were moved forward, and the difference between peasants and gentlemen weakened. The gentry’s interest in agriculture increased gradually and was marked by the introduction of agricultural institutes in the mid-1800s. As the old elite increasingly devoted themselves to agriculture they used titles as ”possessionat” and ”godsägare” (landlord) to rise above the peasants. They made themselves the elite in the peasants' own field, thus opening up to being associated with rich farmers.
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| 5. |
- Franck-Larsson, Karin
(författare)
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Gastrointestinal Manifestations and Pathophysiological Mechanisms in Systemic Sclerosis
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Systemic sclerosis (SSc) is a rare systemic, autoimmune disease characterized by vascular changes and fibrosis of the skin and internal organs. Patients with SSc more frequently than healthy controls reported upper gastrointestinal (GI) symptoms, which was more abundant in the diffuse cutaneous form (dcSSc) of the disease than in the limited (lcSSc). One-third of a population-based cohort of 79 SSc patients reported faecal incontinence, compared to 11% in 158 healthy matched controls (p<0.001), and this symptom negatively influenced general well-being and social life. Impaired rectal sensibility, rectal bleeding, irritable bowel syndrome-like symptoms, abdominal pain, the need for manual assistance at defecation, and the use of oral laxatives were more common in patients than in controls. SSc patients reported lower scores in both physical and mental scales of the SF-36 questionnaire than controls, indicating worse health-related quality of life. Gastric emptying was slower in patients than in controls, and a higher prevalence of delayed gastric emptying in patients with dcSSc indicated more severe GI tract involvement than in lcSSc. Electrogastrographic recordings did not correlate to gastric emptying results, indicating factors other than defective myoelectric signals contributed to disturbed gastric function. SSc patients with faecal incontinence had lower anal squeeze pressures than patients without this symptom. Only patients with faecal incontinence had ultrasonographic abnormalities in the internal and external anal sphincters, and absence of the rectoanal inhibitory reflex. Thus, faecal incontinence in SSc patients may depend on both neurogenic and structural mechanisms. A discrete increase in fibre density observed in a majority of SSc patients might have implications from a disease mechanistic perspective. Sera from 47% of 70 SSc patients had the capacity to induce interferon (IFN)-α, production which correlated to the presence of anti-RNP and anti-SSA autoantibodies. Increased serum levels of IFN-inducible protein were associated with vascular manifestations, and increased serum levels of IFN-α with digital ulcers. Increased serum levels of monocyte chemoattractant protein-1 or IFN-α were associated with lung fibrosis. An activated type I IFN system previously observed in several other systemic autoimmune diseases is also present in SSc and may contribute to vascular pathology and the pro-fibrotic process.
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| 6. |
- Glimskär, Bo, 1954-
(författare)
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The Adoption of Ergonomic Innovations for Injury Prevention : Examples from the building construction and health care industries
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- A good work environment is important for the individual, for industry and for society. The work environment research has, predominantly, targeted identification of problems and the measurement of the size of these problems.Innovations to reduce the incidence of musculoskeletal disorder, MSD, have been introduced in different branches of industry, but with limited success.Few of the ergonomic innovations developed for the building and construction industry have reached a sufficient level of adoption. Ergonomic innovations in the health care sector are of an incremental character and seem to have similar problems of adoption as the ones in the building and construction industry.Three examples of ergonomic innovation are examined in the thesis:a glue spreader for floor layersa four-wheel walker with a lifting devicea sonographer’s scanning support deviceThe studies show that an ergonomic innovation is not adopted for prevention of occupational injury unless the innovation also has other relative advantages apart from the ergonomic ones. For the group who already has sustained an injury, it is enough that the ergonomic problems are solved, while the other, symptom-free group, requires other advantages in order to adopt the innovation; increased production economy seems to be the most prominent potential advantage.
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| 7. |
- Gunnarsson, Anna-Karin
(författare)
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Patients with Hip Fracture : Various aspects of patient safety
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of the thesis was to investigate whether patient safety can be improved for patients with hip fracture by nutritional intervention and by pharmacological treatment with cranberry concentrate. Another aim was to describe the patients’ experience of involvement in their care. The thesis includes results from four studies that include both quantitative and qualitative design. Studies I and II were intervention studies with a quasi-experimental design, with intervention and comparison groups. Study III was a randomised, double-blind, placebo-controlled trial with intervention and control groups. Study IV took a qualitative approach.Study I showed that when patients with hip fracture received nutritional supplementation according to nutritional guidelines, from admission until five days postoperatively, fewer patients developed pressure ulcers. Study II showed that it is possible to objectively evaluate a short-term nutritional intervention through the nutritional biochemical marker IGF-1, as it was affected by a five-day high-energy regimen. The randomised controlled trial, Study III, showed that a short-term treatment from admission until five days postoperatively with cranberry as capsules does not seem to be useful in preventing positive urine cultures in female patients with hip fracture and a urinary catheter. Finally, Study IV showed that patients with hip fracture reported experiencing very little involvement in their nursing care, to the extent that fundamental aspects of nursing care went unfulfilled. Patients did not feel valued by the nurses and unbearable pain that affected rehabilitation was reported. Positive interactions with nurses, however, did encourage patients to be more active.It is possible for every nurse to improve patient safety at bedside when caring for patients with hip fracture. Simply by increasing caloric/energy intake, it is possible to prevent pressure ulcers. It is also important to involve patients in nursing care, since the patients have experienced low or almost no involvement in care. Nurses need to see each patient as a whole person with different wishes and needs. However, certain prerequisites have to be in place to give nurses the opportunity to increase patient safety at bedside for patients with hip fracture.
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| 8. |
- Hasselblad, Annika, 1991-
(författare)
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Unraveling the Socio-Technical Tensions of Performance Measurement in Public Welfare Organizations
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In the name of efficiency, performance measurement has gained traction in public welfare organizations. The idea of performance measurement originates from views of all organizations rooted in scientific management notions that emerged during industrialization, as kinds of production units, according to an industrial logic. However, the primary objectives of public welfare organizations are to meet situational needs of individuals. Thus, applying performance measurement in public welfare organizations has resulted in tensions between social and scientific perspectives that have led to devaluation of welfare professionals’ reasoning and judgement in relation to performance measures. The purpose of the thesis is to unravel the sociotechnical tensions between performance measurement and public welfare practice by addressing the underlying logics in theory and praxis. In addition, the knowledge acquired from theory and praxis used to reflect on a practical case of performance measurement design, to advance the design of performance measurements in public welfare organizations and avoid dysfunctional effects. All six papers have contributed to elucidation of important aspects of the socio-technical tensions. First, they have provided theoretical insights regarding underlying logics and values (Paper I), and constructive and deconstructive approaches (Paper II) in public performance measurement research. Second, they have provided practical lessons showing how industrial values have obtained precedence in design, decision-making and management, as well as in the choice of data. In this sense, although they are based on a welfare logic, public welfare organizations are haunted by the ghost of industrialization, which has fueled anxiety among welfare workers, with dysfunctional consequences, as they have had to adjust to a measurement regime that does not sufficiently value their reasoning and judgement. Thus, welfare logic needs to be integrated into definitions of performance and its measurement. Third, they have informed reflections on the design of performance measurements from an empirical case study. Together with the theoretical insights and practical lessons, the reflections reveal in detail how a welfare logic can be easily subordinated in the construction of performance measurement as welfare workers are often only involved in the use stage. In summary, this thesis makes a multi-level contribution to unraveling the socio-technical tensions of performance measurement in public welfare organizations, which I hope will be useful for public welfare performance measurement researchers, measurement practitioners, welfare professionals, and managers.
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| 9. |
- Helgesen, Ann Karin, 1962-
(författare)
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Patient participation in everyday life in special care units for persons with dementia
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis was to acquire knowledge about patient participation in everyday life of persons with dementia living in SCUs in nursing homes. Data collection and analysis in studies I-III was carried out according to Grounded Theory. Data was collected by open non- participant observations during 51 hours, and conversations with 8 residents and 17 health care personnel (I), interviews carried out twice with 12 relatives (II) and 11 nursing personnel (III), and by a study specific questionnaire based on the findings from study I-II to 233 relatives (IV). Descriptive and non-parametric statistics were used (IV).Presence of nursing personnel in body, mind and morality was found to be the prerequisite for patient participation (I). This required personnel with high competence in dementia care, commitment to and interest in the resident, and continuity in their work (I, III). Wellbeing and dignity in the resident’s everyday life was found to be the most important goal, not necessarily a high level of patient participation (II-III). The level of participation had to be adjusted to the resident’s ability and wish to take part in decisions in the very moment. However, the level was often primarily adjusted to suit the personnel’s ideas about how to carry out daily care (I, III). Relatives had an important role in the participation process by interacting, and exchanging information, with the personnel. By forming a basis for individualised care in this way, relatives made a difference to the resident’s everyday life and contributed to their wellbeing and dignity (II-IV). The SCU’s context also affected patient participation (I-IV).Patient participation must be given attention by leaders and be prioritised in dementia care. Nursing personnel can enhance patient participation by promoting relatives’ partaking in the participation process, as this has potential for further contributing to quality of care.
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| 10. |
- Jakobsson Larsson, Birgitta, 1965-
(författare)
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Quality of life, Coping and need for Support during the ALS disease trajectory
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to investigate quality of life, coping and emotional distress (i.e. anxiety and depression) among newly diagnosed ALS patients. An additional aim was also to investigate relatives’ experiences of the care for the patient and the support they received for themselves during the disease progression.The most nominated areas of importance for the patient’s overall QoL were family, friends and own physical health. Most patients rated their QoL as good, which did not change at subsequent measurement, despite their physical function having changed for the worse during disease progression. Some patients had symptoms of clinical anxiety and depression during the first year after diagnosis. The total quality of life score did not correlate with physical function but with depression early on after diagnosis. Most patients used support and independence as strategies to cope with the disease during the first six months after diagnosis. There were few changes early on after the diagnosis, and the patients used several different strategies. The results show that the use of coping strategies remained stable over time. Both physical function and emotional distress correlated significant with different coping strategies, with some variation during the disease progression. Relatives experienced the care of their loved one as positive and based on the patient’s needs and desires. The treatment, knowledge, support and help from the staff were important for the relatives’ feeling of security. Different factors influence the use of support for themselves. The relatives did not think of their own needs, but their focus was rather on the patient.The results of the thesis highlight the importance of providing support both to patients and their relatives during the disease progression. With early and regular evaluation on quality of life, coping and emotional well-being among the patients, the health professionals may be able to support the patients based on their specific needs, which probably will increase their quality of life.
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