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- Sluys, Kerstin, 1956-
(författare)
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Adult and pediatric trauma : outcomes and health-related quality of life
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Trauma is the number one killer of children and young adults and the most common cause for hospital admissions for these age-groups in Sweden. Trauma is also one of the most common causes for hospital care and early death for older people. In the last decades trauma care has advanced and improved short-term survival of injured but knowledge of the long-term outcome is limited.The overall aim of this thesis is to investigate long-term outcome and health-related quality of life after injuries in different age groups and to identify factors associated with outcome.Methods: The thesis is based on four studies. In the first study patients with major trauma were contacted 5 years after injury and HRQL was measures using the SF-36 questionnaire and compared to an age and sex-matched reference group. In the second study data was collected on children with injuries to describe demographic and injury characteristics and outcome. The sample in the second study was the source for the third and fourth study. The third study measured HRQL using the PedsQL 4.0 in a cohort of children 6 years after injury and determined the relationship within subgroups in the cohort. The fourth study measured child HRQL in a sample of children after injury and their parent´s and determined the relationship within scoring results and the impact of parents reported mental health status.Results: The adult major trauma patients (n=205) reported significantly lower HRQL scores in all eight domains compared to the reference group. A large number of patients suffered from physical (68%) and psychological disabilities (41%) and nearly half reported the need for better follow-up after discharge from hospital. The severity of the injury did not anticipate a lower health-related quality of life. In the pediatric group (n=432) the median injury severity score was 4 (IQR 1-9), 50% sustained head injuries and the most severe head injuries were seen in the youngest age group. Mortality rate was low (1%), 19% stayed in a PICU and the median length of hospital stay was two days. In the follow-up study (n=204) the youngest children had the lowest PedsQL scores. Children who suffered from extremity injuries had lower scores in the school functioning compared to children with head injuries. The levels of agreement between child self-report and parent proxy report of PedsQL 4.0 scales were excellent (ICC≥0.80) for all scales with the exception of children´s self-reported emotional functioning. Multiple regression analyses showed that poor parental mental health status contributed to worse child self-report and parent proxy report of children´s HRQL.Conclusion: Adult major trauma patients have significant disabilities 5 years after injury. Improved follow-up by trauma specialist teams are needed. Children´s HRQL 6 years after trauma seems to in parity or better than healthy peers. Parent´s mental health status can possibly impact on children´s HRQL long after an injury. Further studies are recommended to evaluate the PedsQL 4.0versions for self-report in pediatric trauma population.
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| 2. |
- Holmgren, Jessica, associate professor, senior lecturer
(författare)
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Conditions for relatives' involvement in nursing homes
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to describe and analyse how the involvement of relatives is conditioned in nursing homes from different critical perspectives. Gender perspectives, discourse analysis and intersectional theory are applied, based on social constructionist ontology. The thesis comprises three qualitative papers and data are based on ethnographically-focused fieldwork in three municipal nursing homes in the form of formal/informal interviews, participating observations and the analysis of documents.Based on gender perspectives, the routines and reasonings among nursing staff were studied and thematically analysed in relation to how these conditioned the involvement of relatives in the daily caring activities (I). In the second study (II), the nursing staff were interviewed in groups to describe, discursively analyse and identify the biopolitical meaning in the "involvement discourse" that was collectively constructed in the speech of the nursing staff concerning the involvement of relatives. In the last study (III), interviews with relatives were thematically analysed in the context of intersectional theory about their involvement in the nursing homes.The findings show that the conditions for relatives’ involvement were dynamic and constantly in re-negotiation, but also conservative and inflexible. This placed relatives in both privileged and unprivileged social positions in the nursing homes, which were relevant for their involvement. The relatives were considered to be "visitors", which conditioned the characteristics and levels of involvement in the care of the residents and was linked to gendered notions of the division of labor, both within the groups of relatives and between nursing staff and relatives (I). The involvement of relatives was conditioned by the biopolitics of an "involvement discourse" that prevailed in the nursing homes. This built upon family-oriented rhetorics and metaphors that upheld and legitimised notions about relatives. The relatives were considered to be members of the "old" family in relation to the "new" family represented by the nursing staff (II). The relatives described how they were positioned in a betweenship, squeezed between different competing social musts from the older family members, the nursing homes as institutions and the nursing staff (III).Inverting the prevailing picture of the involvement of relatives would make it possible to consider the nursing staff as pedagogical, professional and caring "visitors" in the nursing homes for the benefit of the residents and their relatives. This could be achieved through a constructive change management which emphasises the learning of nursing staff, their responsibility and the emotions of relatives, along with a focus on alternative notions of involvement, where relatives are included in the development of quality of care in Swedish nursing homes.
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| 3. |
- Kneck, Åsa, 1973-
(författare)
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Living with diabetes : a lifelong learning process
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Living with diabetes, as a lifelong illness, is interlaced with learning and to face continual changes. However, the role of time in this learning process is not yet well understood. The overall aim of the thesis was to gain a deepened understanding of learning to live with diabetes for those recently diagnosed and over a three year period. The thesis, involving four studies where qualitative inductive content analysis (I, III) and phenomenological hermeneutical interpretation (II, IV) were used, has a lifeworld approach and a qualitative and longitudinal design. Thirteen persons, recently diagnosed with diabetes (type I or II), were interviewed on three different occasions over a three year period. All interviews focused on the experience of living with diabetes and situations where diabetes had to be taken into account. The aim of study I was to reach an understanding of how learning to live with diabetes is experienced in the first 2 months after diagnosis. The findings revealed to be taken over by a new reality, with a body that played a role in life with the health care service as a necessary partner. The aim of study II was to illuminate the meaning of learning to live with diabetes three years after being diagnosed. The findings revealed learning as making decisions through use of different sources of information and as solving the life-puzzle – a delicate balance to create a desired life. The aim of study III was to identify patterns in learning when living with diabetes, from recently being diagnosed, and over a 3-year period. In the findings five patterns were identified illuminating different learning processes emerging over time. A longer time living with diabetes did not per se mean increased satisfaction in living well with illness or increased confidence in understanding one’s own needs. The aim of the IV study was to illuminate the meanings of trigger situations in learning to live with diabetes. The findings revealed trigger situations, such as being encumbered by vulnerability and temporality in unsustainable situations with an unpredictable body and a life involving new concerns for the future. The thesis conducted that learning was an informal and ongoing everyday process in life. Time living with diabetes meant both an increased mastery of a changed life situation, but also increased difficulties in achieving well-being and with a dependency on health care. Hence, health care interventions must adhere to the individual’s needs and not be based on duration of illness. Understanding the body and the role of health care, as well as what facilitates and hampers learning, changed with time. It is therefore important that health care personnel illuminate the individual understanding and experiences of those living with diabetes as this was found to be important for the learning process as well as for their sense of well-being.
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