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- Wieslander, Inger
(författare)
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Women’s recovery after a first myocardial infarction from an organisational, a relational and an individual perspective
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to explore and describe women’s recovery after a first myocardial infarction (MI) from an organisational, a relational and an individual perspective. In this thesis a longitudinal, explorative and descriptive design combining both quantitative (papers I-II) and qualitative (papers III-IV) methods has been used. Data was collected from healthcare professionals at 18 acute hospitals (paper I), which on two occasions answered a questionnaire dealing with cardiac rehabilitation efforts. From these 18 hospitals, 240 women who had suffereda first MI (paper II) were consecutively chosen to answer a questionnaire on three occasions on the subject of social support and social network. Descriptive and inferential statistics were used to analyse data over time. Paper III and IV had an exploratory and descriptive design based on an inductive, qualitative content analysis approach. Interviews were conducted with 20 cardiac rehabilitation nurses (CRN) (paper III) and with 26 women suffering a first MI (paper IV).The results showed that patients with MI, and their next of kin, were offered a well-functioning cardiac rehabilitation on both measurement occasions. None of the hospitals offered a CRP that was specifically designed for women (paper I). The women perceived that the extent of general support, support from relatives, and professional support changed positively over time (paper II). The CRNs experienced that women’s recovery was influenced by their ability to cope with the stresses of life, if they wanted to be involved in their own personal care and how they related to themselves, and their opportunities to receive support (paper III). Women experienced that ability to approach the new perspective of life depended on how they embraced the three dimensions; behaviour, i.e. women’s acting and engaging in various activities, social i.e. how women receive and give support in their social environment, and psychological i.e. their way of thinking, reflect and appreciate life (paper IV).In conclusion, the four studies show that women’s recovery after a first MI is depending on factors emerging from an organisational, a relational and an individual perspective. Using knowledge from these three perspectives the possibility of a holistic approach to women’s recovery process to health will increase and the risk of a reductionist thinking will decrease.
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| 2. |
- 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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| 3. |
- Junehag, Lena
(författare)
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Peer mentoring - A complementary support to persons after an acute myocardial infarction
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of the thesis was to investigate the experience of having an acute myocardial infarction in newly afflicted persons living in sparsely populated counties, and whether an intervention with peer mentors would provide support by affecting the perception of illness, health related quality of life and everyday life. The aim was also to describe the support of peer mentors from their perspective and what the mentoring meant to them. The thesis was based on four empirical studies (I-IV) and had a prospective, longitudinal, quasi-experimental, comparative design. A suitable sample was recruited, comprising 72 individuals who were newly afflicted with an acute myocardial infarction (AMI) for the first time; 34 of them were offered contact with a peer mentor, while 38 were not. Furthermore, 34 peer mentors participated in the project. The results were based on data collected from 28 individuals with mentors, 33 individuals without and 22 peer mentors. In studies I and III, qualitative approaches were used based on individual interviews with 20 newly afflicted individuals with (n=11) and without (n=9) mentors one year after AMI. The aims were to describe individuals’ perceptions of the psychosocial consequences of an acute myocardial infarction (AMI) and of their access to support one year after the event (I) and to describe individual perceptions of their lifestyle and support, 1 year after an AMI with or without mentorship (III). Study II was quantitative, consisting of data from questionnaires IPQ-R and SF-36 answered by 61 newly afflicted individuals with (n=28) and without (n=33) mentors. It aimed to investigate whether changes in illness perception and health-related quality of life occur over time after an intervention with peer mentors 1, 6 and 12 months after an AMI. Study IV had a mixed design and included peer mentors with the purpose to describing the personal meaning of being a peer mentor, for a person recovering from an acute myocardial infarction. Data consisted of individual interviews (n=15) and some data from IPQ-R and SF-36 that were provided on two occasions (n=22). All of the interviews (I, III, IV) were digitally recorded and analysed by qualitative content analysis, while the quantitative studies included descriptive data and were further compared using analysis of variance (ANOVA) (II) and the paired-sample t-test (IV). The results from all four studies are interpreted and presented together, and they show differences and similarities between the newly afflicted with or without peer mentors and the peer mentors. The results comprise six main areas; the meaning of becoming a person with an AMI (I, II, III) pointed toward an awareness of the situation expressed both in positive and negative terms, as being thankful or of being afraid of having a second AMI. View at health care (I) indicated that follow-up after discharge was sometimes a positive experience but more often resulted in dissatisfaction with this part of the health-care system. Consequences (II) showed significant effects between groups in the dimensions ‘consequences’ and ‘timeline acute/chronic’ (IPQ-R), with higher mean values for those without mentors and a significant effect of time in both dimensions. There were also physical consequences for many of the participants (I, II, III, IV) as well as psychological consequences (I, II, IV). Everyday life (I, III) was affected by AMI that sometimes limited activities. There were demands to change areas of life-style that were perceived as both positive and negative. Health (II, III, IV) showed that health increased for most individuals during the year, as confirmed by significant values for time for those newly afflicted. The peer mentors showed a decrease in mean values but expressed that they felt healthier after compared with before their commitment. Meaning of support (I, IV) indicated that families and relatives had an important, supportive role for newly afflicted participants. The mentorship showed that the relationship was, in some cases and for different reasons, unsuccessful. However, most of them were satisfied, and new friendships arose. More of the mentors felt pride and were thankful because their experience was shown to be valuable to others in addition to themselves. The results were synthesised using the Human Becoming nursing theory, which confirmed that recovery after an AMI is a process that occurs over time in which that those afflicted must accept and be comfortable being a person who is afflicted by an AMI. Some tendencies indicated an advantage for the newly afflicted participants who had received contact with a peer mentor. Conclusion: Because the mentor had experienced the same event, the relationship contributed to the security of the mentee. The peer mentors matured with the task because they felt that their experience was valuable and they felt unique.
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| 4. |
- Karlsson, Christina
(författare)
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Detection and assessment of pain in dementia care practice : Registered nurses’ and certified nursing assistants’ experiences
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The overall aim of the thesis was to explore and describe registered nurses’ (RNs) and certified nursing assistants’ (CNAs) experiences of detection and assessment of pain in older people with cognitive impairment and dementia. A further aim was to evaluate the Abbey Pain Scale-SWE (APS-SWE) in dementia care practice.Methods: An exploratory and descriptive design was used in Study I. An exploratory and interpreting design was used in Study II and Study III. A prospective, descriptive, observational and instrumental design was used in Study IV. Focus group interviews (I) and individual interviews (II, III) were applied to explore and describe RNs’ and CNAs’ experiences of pain assessment in people living with dementia. Qualitative content analysis (I) and philosophical hermeneutics (II) were used to analyse qualitative data. Observation, instrument, and questionnaire were applied to evaluate reliability and face validity of the APS-SWE for pain assessment. Descriptive statistics and reliability analyses were used to analyse quantitative data (IV).Results: RNs in special housing accommodation settings experiences that pain assessment in people with dementia is challenging primarily due to their changed RN consultant role, which to a great extent is directed into administrative and consultative tasks rather than bedside care. This has led to decreased time in daily nursing care, preventing recognising symptoms of pain. This have also led to that RNs are dependent on information from CNAs who are the front-line staff providing daily care (I). CNAs’ perception of signs of pain in people with dementia emerges from being present in the care situation and alertness on physical and behavioural changes that could be due to pain, and from providing the care in a preventive, protective and supportive way to prevent painful situations occurring (II). RNs and CNAs working in home healthcare team use a variety of strategies to detect and assess pain. A trustful work relationship based on staff continuity and a good relation to the person in need of care facilitates pain assessment situations (III). Systematic observation of older people living in special housing accommodation during rest and mobility using the APS-SWE demonstrates that the scale has adequate internal consistency, reliability, and face validity for pain assessment (IV).Conclusions: This thesis found that the RNs’ and CNAs’ detections and assessments of pain rely on solid cooperation, staff continuity, and good knowledge of the person cared for. It was also revealed that there is a lack of using appropriate and assisting pain tools. The APS-SWE show adequate reliability and face validity and can serve as a useful pain tool to assist in detection and assessment of pain in older people who are limited in verbalising pain recognisable. Further evaluation of how the person-centred perspective is applied in pain assessment situations is needed in order to evaluate positive outcomes in people with dementia. Further psychometric evaluation of the APS-SWE in clinical dementia care practice is needed to strengthen validity and reliability.
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