| 1. |
- Andersson, Edith M
(författare)
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Acute confusion in orthopaedic care. With the emphasis on the patients' view and the episode of confusion.
- 2002
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aims of this thesis were to investigate factors of significance for the development of acute confusional state (ACS), the confusional episodes, the lived experiences of having been confused in elderly patients admitted for emergency or elective surgery in orthopaedic care. A further aim was to investigate the nurses’ view of the ACS and the encounter with patients who developed ACS. A case study with one patient preceded the main study including 457 patients, of whom 51 patients developed ACS. Results are based on assessments of the patients’ orientation with Organic Brain Syndrome (OBS) scale, observations during the period of confusion, and interviews with patients who had developed ACS after the confusion had ceased and with nurses (n=48) who took care of the patients in connection with the ACS. Patients admitted for hip fracture had a higher incidence of ACS (20.2%) than patients admitted for elective surgery for coxarthrosis or gonarthrosis (3.6%). Factors associated with development of ACS were four or more physical diseases, emergency admission, impaired vision, more preoperative treatment because of cardiovascular or pulmonary problems, longer anaesthesia time, higher score on the OBS scale on admission and age. The higher the score on the OBS scale on admission, and the more rapid the development of ACS after admission, the longer the period of ACS. Disturbances in motor activity, speech and mood, and symptoms that developed rapidly and fluctuated during the day and from day to day were signs of the confusion. “Struggling to understand and to gain control when in a state of confusion and viewing oneself as being confused” was the main theme illuminated in the texts from the observations during the ACS. In the struggle to achieve understanding and take control over themselves and what was currently taking place, the patients used various strategies: trying to achieve clarity, making a sensible story out of the present and imputing meaning to the present by using their life story. The meaning of the patients’ lived experiences of being and having been confused was interpreted as “being trapped in incomprehensible experiences and a turmoil of past and present and here and there”. It meant that impressions of all kinds invaded the mind of the person and were experienced as reality. They seemed to be victims of these impressions rather than having control over what came into their mind. The findings indicated that one possible approach to the patients is to confirm and support them in narrating their experiences both during the confusion and also after the ACS has ceased. The nurses’ experiences of the encounter with acutely confused patients obtained from the interviews revealed that they had difficulties in reaching the patients and their reality, and understanding their experiences. The nurses found it difficult to reach the patients’ reality because the patients were felt to be in a divided and/or different world. The interaction with the confused patients indicated insufficient and/or broken reciprocity. The nurses used various strategies to meet the patients, being a companion and following the patients’ reality and/or being a surrogate and taking over the patients’ responsibility. The results were more successful when the strategies were derived from the nurses’ interpretation of the patients’ situation and the nurses paid attention to the patients and confirmed them, i.e. being a companion. The results of this thesis are basic for understanding and meeting people in acute confusional state. General vulnerability in elderly people means an increased risk of developing ACS, earlier debut and longer duration of confusion. The patients both understand and do not understand their situation and they struggle to recapture control during the confusion. After the confusion the patients remembered and could narrate their experiences. From the nurses’ perspective it was clear that they had lost contact with the patient during the confusion, and a helpful approach may be to alternate between the validation and the reality orientation approach.
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| 2. |
- Blomqvist, Kerstin
(författare)
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Everyday living with persistent pain in old age. Pain and its alleviation as perceived by functionally dependent older persons and by staff.
- 2002
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis explores everyday living with persistent pain from the perspectives of functionally dependent older persons in pain and of staff. A combination of qualitative and quantitative methods was chosen. Data were collected using interviews and tools for assessing pain. The first data collection included 66 persons (65+) living in sheltered accommodation and their corresponding contact nurses. Seventy-five per cent of those who managed to perform a self-assessment of pain were in pain frequently. The staff assessed frequent pain in 57% of persons with impaired cognition. Agreement between assessment by the staff and the older persons was no higher than moderate, in general pain characteristics were underestimated and those with impaired speech were at risk of not having their pain identified. Pain recognition was interpreted as an interactive communicative process that could be facilitated or hindered by characteristics of both the older persons and the staff. Among cognitively impaired older persons, pain was mainly identified by verbal, para-linguistic, facial, and bodily expressions and immobility was viewed as the most common cause of pain. Another data collection included staff (n=52) and persons (n=94, 75+) with persistent pain living in special accommodation or receiving home help in their ordinary homes. One group of older persons felt competent and were proud of their ability to manage life. Others felt confident and serene despite a high level of dependence due to pain. Resignation and feeling sad or misunderstood and inadequately treated characterised other groups. How the pain restricted their daily life was often considered more problematic than the pain itself. The pain was mainly handled by medication, distraction and a balance between rest and mobility. In the 50% of the cases, the older persons had taken prescribed medication although they perceived the effect as not helpful or only somewhat helpful. Non-pharmacological pain-specific methods were seldom employed. A tendency for staff to perceive activities to alleviate pain as more helpful than older persons was marked for ‘medication’, and ‘talking about pain.’ The staff perceived older persons with pain as a heterogeneous group. When the pain was perceived as ‘real’, ‘endured’ and ‘inarticulate’, caring was satisfying, while caring for persons with ‘exaggerated’, ‘care-inflicted’, ‘concealed’ and ‘self-caused’ pain was demanding or frustrating. How the staff perceived the older persons’ pain seemed to influence how the pain was handled. Findings demonstrate that recognising and alleviating older person’s pain is complicated and requires that the older persons’ perspectives are found out and considered.
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| 3. |
- Elgán, Carina
(författare)
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Influence of lifestyle behaviours on bone mineral density among young healthy women: A two-year study. A Tentative Salutary Model.
- 2003
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this prospective observational study with a salutogenic approach was to investigate bone mineral density (BMD) and BMD changes in the heel bone, in a group of healthy women, in relation to physiological factors and lifestyle behaviours over a two-year period as well as investigating the women’s view of their lifestyle behaviours. Data were collected in 1999 (T1) and 2001 (T2). Healthy young women (n=152) filled in a structured questionnaire, BMD measurements were performed by a heel bone scanner (DEXA), and deoxypyridinoline (U-DPD) was measured. Data were analysed by means of simple and multiple linear regression and logistical regression. Data were collected by means of qualitative interviews with eleven of the informants, and grounded theory was used as the method of analysis. Of the participants, 62% had decreased/unchanged bone density, and 38% had increased their bone density over the 2 years. Use of oral contraceptives (OC) and alcohol consumption were associated with an increased risk of negative BMD changes. Self-reported poor health was associated with decreased BMD. Smokers had lower BMD although OC seemed to moderate the negative impact of smoking probably related to bone turnover. Irrespective of smoking and OC, self-reported sleep satisfaction explained 3% of the variability in BMD change. Time spent outdoors was associated with BMD change irrespective of smoking and OC use. Women with OC induced regular menstruation had higher BMD than women with naturally regular menstruation. OC use in combination with smoking was linked to high alcohol consumption and higher frequency of self-reported body weight reduction. There was a positive association between a high level of physical activity, body weight and BMD. When the sample was divided according to underweight (BMI <19), normal weight (BMI 19-24) and overweight (BMI >24), cross-sectional body weight was of no significance for the prediction of BMD (T2). Among underweight women, DPD (T1) explained 46.3% of the variability in BMD (T2), and a high level of physical activity had a negative impact on BMD. Among overweight women, the difference in time spent outdoors during winter between T1 and T2 was the single most important factor for BMD levels, and self-reported sleep satisfaction was associated with increased BMD. The women’s (N=11) views on lifestyle behaviours were characterised by a number of interrelated dimensions; motivation, goals, actions and strategies. Women with a relaxed outlook on life had increased BMD while women with a rigid outlook on life had decreased their BMD irrespective of smoking and physical activity. Respondents who had a rigid outlook on life viewed actions such as lifestyle habits as a means to an end, where the goal of, for example, physical activity was a way of staying slim. For respondents with a relaxed outlook on life, the enacted lifestyle behaviours, such as physical activity, were a goal in themselves. It was hypothesised that women with a relaxed outlook on life were more satisfied with their sleep, and the whole quantitative sample (n=152) was divided into two groups according to self-reported sleep satisfaction. The result from the comparative analysis showed that women who were more satisfied with their sleep were significantly more likely to have healthier lifestyle behaviours, better physical and psychological subjective health, and were more likely to have increased BMD. In conclusion, time spent outdoors may moderate the negative influence of smoking on BMD, while motivation and sleep may be salutary factors associated with improved BMD. A tentative bio-psychosocial salutary model of the association between motivation, outlook on life, sleep, lifestyle behaviours and BMD is presented.
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| 4. |
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| 5. |
- Jakobsson, Liselotte
(författare)
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Everyday problems in men with prostate cancer. Aspects of micturition, indwelling urinary catheter treathment and sexual life
- 2000
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim was to investigate the presence of everyday problems in men with prostate cancer, their relation to health-related quality of life, HRQOL, and sense of coherence, SOC, and to compare with men with benign prostatic hyperplasia, BPH, and a sample from the general population. The aim also was to investigate what nursing care needs there were in men with prostate cancer and how these were met during an in-patient period. Semi-structured interviews exploring everyday problems in men with prostate cancer (n=11) created the basis for further investigation. This was followed by an interview investigation (n=25) focusing the specific problems. The specific problems were also focus for the development of a study-specific questionnaire administered by mail-out mail-in procedure to men with prostate cancer (n=155), BPH (n=131), and the general population (n=129) and focused on micturition problems and sexual life problems, as well as provision and satisfaction with information. For assessment of indwelling urinary catheter treatment those with such experience were selected (prostate cancer n=71, BPH n=37). HRQOL (EORTC QLQ C-30) and SOC were additionally assessed. Living with prostate cancer meant alterations in life continuum, patients’ dealing with the altered life continuum and leaning on the next-of-kin for help and support, and that life was rearranged in relation to physical and existential fatigue, life in itself, life quality, and significant others. Living with micturition problems, indwelling urinary catheter treatment and sexual life meant a changed life continuum and changed life quality. Patients interpreted as passive (n=8) receivers were explicitly and implicitly stating unmet nursing care needs, or explicitly stating satisfaction and implicitly contradicting their statements. Active receivers (n=3) were explicitly stating unmet needs but seemed to get nursing care that met their needs, while passive receivers did not. HRQOL was reported at the same level though significantly lower (p=<0.002) in men with prostate cancer or BPH than in the general population. Those having a cancer diagnosis did not report more problems than those with BPH. Most troublesome urinary problems were leakage (m 2.74), feelings of discomfort (m 2.01) and disrupted urinary function and frequency (m 1.87). Sexual problems were related to pleasure and attraction (m 2.84), erectile function and sexual satisfaction (m 2.74), and sexual performance (m 2.83). Indwelling urinary catheter treatment was connected with discomfort in wearing a catheter (m 1.65), practical and psychosocial difficulties in handling and wearing (m 1.60), and discomfort at instalment (m 1.48). The information given on disease and treatment was stated to be satisfactory, however, reported to be too little. The results give some insights into what it means to live with prostate cancer or BPH. Special problems with micturition, catheter treatment and sexual life were identified, as well as the need for emotional support and professional availability indicating areas for nursing care measures.
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| 6. |
- Jakobsson, Ulf
(författare)
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Chronic pain and quality of life among older people.
- 2003
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim was to investigate chronic pain, quality of life and factors associated with pain as well as with quality of life among older people, aged 75 years and above. Further, the aim was to investigate the use of methods for pain management and their effects for those with pain and in need of help for daily living. Data were collected from a larger population study and in the first study 4093 people aged 75–105 years were studied regarding the prevalence of chronic pain, factors associated with pain and quality of life (QoL). Those who reported pain (n=1654) were compared with those who did not (n=2439). The aim of the second study was to study (n=1622) the oldest old (aged 85+) in pain in comparison with those not in pain regarding QoL and related factors. In the third study (n=532; aged 75–102 years) QoL and factors associated with QoL were investigated among those in pain and in need of help for daily living. In the fourth and last study those in pain and in need of help for daily living (n=294; aged 76–100 years) were investigated regarding the use of methods for pain management and comparisons were made between different living conditions. The results showed that chronic pain is common and often a major problem among older people. With higher age the prevalence of pain tended to be more prevalent, as did other complaints, such as functional limitations, fatigue, depressed mood, that were related to both age and pain. Those in chronic pain were most likely to suffer more from other complaints than those without pain, because the prevalence as well as the severity of these related complaints was even higher. Also QoL was significantly lower in the higher age groups and even lower among those in pain. Besides the fact that functional limitations (e.g. walking problems/mobility problems) were more common, also the need for help with IADL and PADL was higher in higher ages and among those in pain. High degree of pain, related complaints and low QoL were above all identified among the oldest old (85+) and among those in need of help to manage daily living. The use of various methods for pain management was found in this thesis to be sparse and tend to be unsystematic among those in need of help to manage daily living. A cluster analysis revealed above all two main clusters. The first cluster represented those using few (md: 2) and the most common methods used (prescribed medicine, rest, distraction). This first cluster included those who were significantly older than the second cluster that represented those that used more methods (md: 6) but reported significantly more pain severity and interference in daily life. Among the oldest old (in pain) functional limitations, fatigue and depressed mood were areas to be intervened against to improve their QoL. Also living alone and living in sheltered housing that was associated with low QoL, as well as the economic situation must be considered. For those in pain and in need of help in daily living, functional limitations, fatigue, sleeping problems, depressed mood and living in special accommodations were associated with low QoL.
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| 7. |
- Jansson, Annkristin
(författare)
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Sjuksköterskan i primärvård med särskilt fokus på barnhälsovård
- 2000
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- ‘The Nurse in Primary Health Care with Special Focus on Child Health Care’ The function of nurses in Swedish primary care involves health care and medical care for people of all ages, and in their health-promotion work there is a focus on child health care. Child health care in Sweden is mostly provided by nurses. The work encompasses all children from birth to school age; it is voluntary and free of charge. A newborn baby, especially if it is the first one, means a great change in the parents’ life. The child has needs which must be satisfied round the clock, and everyday life for the parents is affected in practical, social and emotional terms. The first period with a newborn baby is a sensitive time for the family. The nurse’s efforts at this time are important and must be adjusted to the family’s needs. There has hitherto been little study of which aspects parents consider important during the first months of the child’s life. The overall aim of the thesis was to study the function of nurses in primary care, specifically child health care, and to focus on aspects of importance for good child health care and the first encounter between the nurse and the family. A combination of quantitative and qualitative methods has been used, and different perspectives have been explored to arrive at as complete a description as possible and to increase the reliability of the results. In studies II and III the same random sample was used. The studies were carried out locally in a primary care district in southern Sweden between 1984 and 1989 (study I), regionally in southern Sweden in 1999 (study IV), and nationally in Sweden in 1995 and 2000 (studies II, III, and V). In study I, data from computerized records were studied over a six-year period. The data came from an individual-based computer system for the population of a geographically defined area and their contacts with health care. The data registered were: personal identity number, date of visit, type of visit, place of visit, person in charge, diagnosis, blood pressure, and actions taken. One patient record was used by all categories of staff. The study used data registered during the period by doctors, nurses, and assistant nurses. The study was a total investigation, covering all contacts with the population (approx. 21,700 inhabi-tants) in the primary care district by doctors, nurses, and assistant nurses. The results did not show that organization in care teams led to any reduction in the number of visits. The increase in the number of visits to both doctors and nurses was greatest in the area with a system of care teams. During the period of the study the nurse had retained her independent role; half of the visits was not prescribed by a doctor. The doctor mainly met middle-aged people while the nurse mainly met children and elderly people. Children mostly visited the doctor in cases of illness, while the nurse was responsible for health care among children. Home visits by nurses to elderly people greatly increased in number while visits to children decreased slightly. The second study, concerning mothers (n=676), investigated their visit patterns and ratings of formal and informal social support for simple health problems in the child. The analysis also focused on differences between mothers related to occupation, country of birth, the child’s health, and the number of children. The questionnaire covered the following topics: utilization of child health care, the age of the mother, number of children, the child’s health, the mother’s country of birth, occupation, and compliance with advice. Questions about informal and formal social support were constructed by the authors as a scenario and were hypothetically formulated. The questions concerned everyday health problems in the child: somatic problems (diarrhoea), behavioural problems (persistent crying), and preventive advice (child safety). All mothers rated the nurse’s advice and support highly for everyday health problems in the child, and the majority of the mothers followed her advice. As regards social support in solving health problems, however, there were differences in the mothers’ ratings in relation to socio-economic classification (SEC), country of birth, and number of children. Mothers of low SEC and first-time mothers valued the nurse’s advice more than mothers of high/medium socio-economic background and first time mothers, who relied more on their own competence and what they learned from literature and mass media. Foreign-born mothers turned to emergency medical care more than Swedish-born mothers, who turned to the nurse in child health care. The third study analysed and compared mothers’ (n=676) and nurses’ (n=243) perceptions of aspects of importance for good child health care. The study consisted of two nationwide postal questionnaires, one for mothers and one for nurses. Both mothers and nurses were selected at random. The questionnaire was constructed with similar questions for mothers and nurses to enable comparisons. The topics illuminated in the questionnaire were good child health care, a good nurse, forms of visits for the first encounter, accessibility, and continuity. The mothers stated 14 different factors and the nurses 13 factors which they considered important for good child health care in their responses to the open-ended questions. Mothers and nurses had largely the same views that accessibility, information/advice, support, and friendly treatment were aspects of importance for good child health care. Mothers mentioned information/advice and support to a slightly larger extent than nurses, who had a greater tendency to stress competence and continuity. Accessibility and friendly treatment were highly rated by both mothers and nurses. Time and friendly treatment was registered by both mothers and nurses, but these were not expressed in the official goals of the work. Differences between the mothers’ perceptions of good child health care emerged in relation to SEC, country of birth, and number of children. The fourth study, which was qualitative, was performed with the aid of focus group interviews with nurses (n=21). The nurses discussed in groups important factors for the first encounter with new parents. In the latent content analysis the factors “creating trust”, “creating a supportive climate”, and “creating a picture of the family’s life situation” were established. Sub-categories of “creating trust” were good contact/reciprocal relationship, listening, guest/equal roles, time/peace and quiet. The category “creating a supportive climate” comprised the sub-categories confirmation/support and individual advice. The third category, “creating a picture of the family’s life situation”, had the sub-categories the family in its environment/holistic impression and socio-cultural aspects. The general interpretation of the nurses’ statements was that they found that by listening and being sensitive to the family’s situation, a good mutual relationship was established. Obtaining a holistic impression of the family’s situation was also emphasized as important, so that in future contacts with the family they could give individual advice, support, and confirmation. Home visits were regarded as the best aid to be able to establish trust and to create a picture of the family’s situation, which in turn was essential for establishing a supportive climate. The nurses’ perception of home visits was unanimous. The nurses said that they tried to avoid the patriarchal structure of the health service and the medicalization of everyday health problems. The aim was to study the function of the nurse in primary care, specifically child health care, and investigate important aspects of good child health care and of the first encounter between the nurse and the family. Data from computerized records were used to follow the development of consultations with nurses and doctors and diagnoses over a six-year period in a defined primary care area. Nationwide postal questionnaires were used to investigate mothers’ and nurses’ perceptions of good child health care and the first encounter with the nurse in child health care and the mothers’ assessment of the nurse’s support and advice when the child had simple health problems. The chi-squared test was used to analyse differences between groups. Manifest content analysis was used to categorize open-ended questions. Focus group interviews were conducted to obtain a better understanding of nurses’ perceptions of important aspects of the first encounter with the family. The interviews were analysed using latent content analysis. A modified version of the instrument ‘Quality from the Patients’ Perspective’ (QPP) and the sense of coherence scale (SOC) were incorporated in a nationwide questionnaire to study mothers’ perceived satisfaction with the nurse in child health care. Student’s t-test was used to test the hypotheses and Pearson’s correlation coefficient was used to strengthen the association between the mothers’ ratings of the quality of care and their sense of coherence. Mothers were more satisfied with the first encounter if they received a home visit than if they visited the clinic. Mothers from a low socio-economic classification (SEC) were less satisfied with the first encounter than mothers from a high/middle SEC. There was an association between mothers’ satisfaction and their sense of coherence. Mothers and nurses had largely the same perception of important aspects of good child health care: time, personal treatment, advice and support, and accessibility. Differences in perception were seen above all between mothers depending on the number of children they had and the SEC group they belonged to. All mothers gave high ratings to the nurse’s advice and support, and the majority complied with the advice. There were differences between mothers’ r
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| 8. |
- Lindholm, Maud
(författare)
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The management and leadership of nurse managers in top positions within health care
- 2000
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis was to illuminate the management and leadership of nurse managers within Swedish health care organizations and to recognize influencing factors of importance for the nurse managers in exercising and developing their management. The interviewees were all active in their positions at the time of the interviews. The nurse managers served at top management levels in either executive or staff positions. The results are based on open-ended interviews with nurse managers (n=30), chief physicians (n=11), hospital directors (n=3) and politicians, chairmen of the local health board (n=3) in three Swedish cities. A number of nurse managers (n=205) from all over the country answered a self-reported questionnaire focusing on professional/social networks, job/social support, demand/control at work and self-rated health. Data were analysed through qualitative and quantitative methods. Power was the overall factor and was related to power within the organization, acceptance in power position, and freedom to act. Four different leadership styles were identified among the nurse managers, which were directed towards the formations of hierarchical authority, hierarchical adjustment, career approach and devotional approach. Nurse managers with a composite leadership style experienced more management problems than nurse managers with a clear leadership style. There was a change in management direction and role from operational level towards adjustment and development levels in nurse managers over a period of three years. Nurse managers who completed a post basic education increased their management focus in relation to research and nursing development. Nurse managers who worked full-time in leading positions for a period of three years increased their communication channels outside health care and distributed power down the organization. Nurse managers with high demand at work in combination with low job support, low emotional support and with no affiliation to professional network showed increased odds for low self-rated health. Nurses in management position constituted a group under pressure influenced by traditional hierarchical power structure, with a high demand at work in relation to changing processes within health care organizations.
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| 10. |
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