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- Karlsson, Veronika, 1972-
(författare)
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Att vårdas vaken med respirator : patienters och närståendes upplevelser från en intensivvårdsavdelning
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In recent years, light or no sedation has become a common approach in patients who require mechanical ventilation (MV) when cared for in an intensive care unit (ICU). This new approach has resulted in medical advantages as well as a shorter time on MV and in the ICU. Aim: The overall objective of the thesis was to describe, illuminate and interpret patients' and relatives' experiences of caring and communication in connection with MV while the patient is conscious. Methods: The data collection methods were inductive and included interviews and observations, both audiotaped and video-recorded. The study group consisted of patients and relatives; fourteen patients in paper I, twelve in paper II and nineteen in paper III as well as ten relatives in paper IV. In paper I, the video-recorded interviews were analysed using content analysis and hermeneutics. The text in paper II was analysed using the phenomenological-hermeneutic method inspired by Ricoeur. The observations in paper III were analysed by means of a hermeneutic approach based on Gadamer's philosophy. In paper IV, relatives were interviewed on two occasions. The text from these interviews was also analysed using a hermeneutic method inspired by Gadamer. Results: The patients experienced an overall sense of being breathless. While conscious, they were aware of the mechanical ventilator as a life saver. Besides being breathless, being voiceless was considered the worst aspect. Communication was difficult and awkward as it demanded all their will power. Patients' communication patterns varied but there were commonalities; they also developed an individual style of communication. Being subjected to someone else's will and direction meant being painfully aware of one's dependency. Despite this, the patients struggled for independence in various ways as part of the recovery process. Being conscious while receiving MV demands caring communication, which in turn requires proximity, presence and constant attention by a nurse who is "standing by" and prepared to take care of the patient whatever happens. The patients' non-verbal communication through their gaze and facial expression was interpreted as sadness and sorrow, understood as expressions of unuttered suffering. The overall struggle and primary existential aim of relatives in the ICU is to be in contact with the patient, a need which overshadows everything else. Conclusion: Being conscious during MV means being painfully aware of one's dependency while voiceless and helpless. It is possible to endure this situation when the caregivers are "standing by", attentive to the patients' expressions, prepared to act to make sure that the patients are feeling better and do not leave them unattended. Caring for a conscious patient on MV presupposes nurses' ability to understand and be able to "standing by". If this approach is not possible, consciousness might be too painful and sedation should be considered.
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| 5. |
- Fredriksson-Larsson, Ulla
(författare)
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Fatigue och återhämtning efter hjärtinfarkt
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Fast and efficient acute medical treatment of myocardial infarction (MI) has developed during recent years and has resulted in a reduced number of days spent in hospital and increased survival. To optimize persons’ recovery, secondary preventive strategies are important. Fatigue has been reported to be the most bothersome symptom in 50% of persons treated for MI and was described as incomprehensible due to its unpredictable occurrence and unknown cause. Today, in cardiac rehabilitation programs there are typically few or no recommendations at all concerning strategies for dealing with fatigue after MI. The main focus was to explore how self-reported fatigue after MI could be measured in a psychometrically valid manner and to describe the symptom of fatigue in relation to other concurrent symptoms, how the heart attack was handled and its consequences in everyday life two months after MI. With a view to creating opportunities to identify and measure fatigue post-MI, the first specific aim was to validate the usefulness of the questionnaire Multidimensional Fatigue Inventory-20 (MFI-20). A psychometric method called Rasch analysis was used. The results showed that the MFI-20 can be used to obtain a global score reflecting an underlying unidimensional trait of fatigue; and transformation of the summarized raw scale scores into interval scale scores was possible. Also, four of the five original dimensions separately fitted the Rasch model and could be used to identify general fatigue, physical fatigue, mental fatigue and reduced activity. One of the specific aims was to examine persons’ experiences of fatigue consequences and strategies used to manage fatigue two months after the heart attack. Interviews were conducted (n= 18) and analyzed using constructivist grounded theory methodology. Grounded in the data, the main consequence of fatigue, as illustrated in the core category was I’ve lost the person I used to be. It indicates a sense of reduced ability to manage daily life due to experiences of fatigue. The core category was developed from the four categories: involuntary thoughts, certainties replaced with question marks, driving with the handbrake on and just being is enough. Another specific aim was to explore fatigue levels two months after myocardial infarction (MI) and examine associations with other concurrent symptoms, sleep quality and the coping strategies used to handle the MI. The results showed that a global fatigue score two months post-MI was associated with concurrent symptoms, such as breathlessness and stress, and coping strategies, such as change of values, intrusion, and isolation. In comparisons of present fatigue dimension levels (general fatigue, physical fatigue, reduced activity and mental fatigue) two months post-MI and baseline measurements (first week in hospital), the results showed that levels of fatigue dimensions had decreased. In comparisons with levels of fatigue four months post-MI in a reference group, we found lower levels of fatigue two months post-MI. In the final study, the aim was to validate a single-item measure of stress symptoms and to explore its association with fatigue in a sample of persons treated for MI. The results confirmed the convergent validity of the single-item measure of stress symptoms. In analyses of relations between stress and fatigue, it was found that the single-item stress measure was strongly associated with both the global fatigue score and all four fatigue dimension scores (general, physical and mental fatigue as well as reduced activity). In conclusion, fatigue two months post-MI had significant consequences because it restricted informants’ potential to function in daily life as they had done previously. The present thesis showed that post-MI fatigue could be identified both globally and multidimensionality. The results could serve as the basis for a future recovery intervention aimed at preventing and relieving post-MI fatigue and based on managing daily life in relation to personal experiences. By facilitating identification of fatigued persons using quantitative measurements and personal narratives about the consequences of fatigue, such an intervention would enable health-care professionals to tailor fatigue relief support during the recovery period. Elaboration of this intervention is a question for further research.
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- Rejnö, Åsa, 1970, et al.
(författare)
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Communication as a key in creating dignified encounters in unexpected sudden death by stroke
- 2018
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Ingår i: Palliative Medicine : A Multiprofessional Journal. Vol. 32, Suppl. 1. Abstract P253. - : SAGE Publications. - 0269-2163 .- 1477-030X.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Communication is present in all encounters in care and of importance to create a caring relation. A good relation between patients, next of kin and health care staff is crucial, not least in times of rapid changes in health and when questions about life and death are at stake such as in palliative care. The aim of this study was to illuminate communication and its meaning in unexpected sudden death with stroke as example, as experienced by next of kin and stroke team members. The design of the study is a secondary analysis of qualitative data as proposed by Heaton, from a project on unexpected sudden death by stroke. Material from four interview studies from the project with all in all twelve next of kin of patients who had died due to the acute stroke during hospital stay and twenty-seven stroke team members from stroke units were utilized. Data were analysed with qualitative content analysis according to Krippendorf and Baxter. The analysis reveals communication as the foundation for care and caring. The overarching theme foundation for dignified encounters in care is built up by six themes illuminating the meaning of communication in unexpected sudden death by stroke; creating relationship, information enabling understanding, giving ground for unanimity, personalizing the patient, preconditioning for decisions and giving and experiencing support. Communication and its meaning in unexpected sudden death as experienced by next of kin and stroke team members enables dignified encounters in care. Through the next of kin knowledge about the severely ill patient, possibility to preserve and uphold absolute dignity and dignity of identity is given, expressed through respect for the patient’s will and desire and derived through talks between carers and next of kin. Communication is one key to create dignified encounters in palliative care when unexpected sudden death occurs. It gives ground for unanimity about care and possibility to maintain and uphold dignity in care when acknowledging the next of kin familiarity with the patient. This gives ground for a person centeredness in palliative care despite the patients sever illness.
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- Axelsson, Malin, 1964
(författare)
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Personality and adherence to medication treatment
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Striving for improved adherence to medication treatment is of vital concern, as low adherence is a major obstacle in treating many prevalent chronic diseases. Several factors have been identified that seem to influence adherence behaviour, but limited research exists on the significance of personality for adherence to medication treatment. According to the Five-Factor Model (FFM), personality can be described in terms of five broad personality traits: Neuroticism, Extraversion, and Openness to experience, Agreeableness, and Conscientiousness. Reports on health-related quality of life (HRQL), asthma control and selfefficacy may also be influenced by personality. Therefore, the overall aim of the present research project was to explore the significance of personality traits in relation to adherence to medication treatment and asthma control, health-related quality of life and self-efficacy.
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- Berlin, Johan, 1975-, et al.
(författare)
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Samverkan mellan blåljusorganisationer
- 2011. - 1
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Bok (övrigt vetenskapligt/konstnärligt)abstract
- Samverkan mellan olika yrkesprofessioner på en olycksplats är komplicerat. Mycket på grund av att förväntningarna inte alltid överensstämmer med förutsättningarna. I boken problematiseras agerandet på olycksplatsen. Friktionen mellan yrkesprofessioner lyfts fram och olika beteendemönster diskuteras.I boken tar författarna samverkan från retorik till ett praktiskt redskap, något som är möjligt att konkretisera och utföra praktiskt i det dagliga arbetet. Boken utgör samtidigt en introduktion till övningstekniken 3-nivåsamverkan (3-NS).I den här boken bjuds på flera närgångna beskrivningar. Medarbetare från fältet berättar om sina erfarenheter av samverkan, hur den tillämpas, om vilka möjligheter som finns och vilka svårigheter som behöver hanteras.Boken riktar sig till alla som arbetar i eller i anslutning till blåljusorganisationer. Den kan med fördel användas som lärobok för universitets- och högskolestuderande som läser till yrken inom polis, räddningstjänst eller ambulanssjukvård. Boken passar också för vidareutbildning av redan yrkesverksamma. Den kan även med fördel läsas av forskare, tjänstemän och politiker med intresse för hur framtidens blåljusorganisationer ska ledas, organiseras och styras.
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| 9. |
- Brülde, Bengt, 1959
(författare)
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Can successful mood enhancement make us less happy?
- 2007
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Ingår i: Philosophica. - Gent, Belgien : Vakgroep wijsbegeerte en moraalwetenschap. - 0379-8402. ; 79, s. 39-56
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- The main question is whether chemically induced mood enhancement is (if successful) likely to make us happier, or whether it may rather have detrimental effects on our long-term happiness. This question is divided into three: (i) What effects are mood-enhancing drugs likely to have on the long-term happiness of the person who takes these drugs? (ii) How would these drugs affect the happiness of the immediate environment of the people who take them, e.g. children or spouses? (iii) What effects would a wide-spread use of mood-enhancing drugs have on society as a whole, and how would this affect the long-term happiness of its citizens? My answers to these questions are very tentative, partly because we know too little about what non-hedonic effects these drugs can be expected to have. It is possible that these drugs would have detrimental effects on some determinants of happiness, however, e.g. marriage and friendship, social and physical activity, rational problem-solving and mental effectiveness, political participation and interpersonal trust. But on the other hand, there are also a number of determinants of happiness that might be positively affected by a wide-spread and frequent use of mood-enhancing drugs.
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