| 1. |
- Mattsson, Janet
(författare)
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Uncovering pain and caring for children in the pediatric intensive care unit : nurses’ clinical approach and parent’s perspective
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: The thesis has a standpoint in a synthesis of caring science and educationscience from a clinical perspective. Children in a Pediatric Intensive Care Unit (PICU) are in an exposed position, dependent on nurses to acknowledge their needs. The alleviation of children’s pain has been investigated from various perspectives, but undertreated pain remains a problem in the PICU. There is a preponderance of empirical evidence pointing toward the role of nurses in uncovering children’s pain and suffering. How nurses interpret the child’s expressions and judge the clinical situation influences their actions in the clinical care. In a PICU, the basis for nurses’ concerns and interpretation of what is meaningful in the nursing care situation are formed by professional concern, workplace culture, traditions, habits, and workplace structures. This influences how parents interpret the meaning of care as well. Patricia Benner’s theory on clinical judgment forms a reference framework for this thesis. The assumption is that children need to be approached from a holistic perspective in the caring situation in order to acknowledge their caring needs. A nurse’s clinical education and insights allow for the possibility to enhance the quality of care for children and parents in the PICU.Aim: To uncover clinical concerns, from caring and learning perspectives, in caring for children in the Pediatric Intensive Care Unit (PICU) from nurses and parents perspective.Methods: Qualitative methods were used in all studies to unfold and explore the phenomena in the nurses’ and parents’ everyday clinical life world. In Papers I and II, a phenomenographic method was adopted. In Papers III and IV, an interpretive phenomenological approach was adopted.Findings: Nurses that have a holistic view of the child and approach the child from a multidimensional perspective, with a focus on the individual child and his/her caring needs, develop a clinical “connoisseurship” and meet the parents’ expectations of the meaning of care. The nurses express that it is only when they focus on the child that subtle signs of pain are revealed. The meaning of nursing care, in the ideal case, is a holistic care where all aspects are integrated and the child as a person has first priority.Conclusion: The meaning of caring and children’s needs must become elucidated to improve the cultural influence of what can be seen as good nursing care within the PICU.
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| 2. |
- Thernström Blomqvist, Ylva, 1974-
(författare)
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Kangaroo Mother Care : Parents’ experiences and patterns of application in two Swedish neonatal intensive care units
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Kangaroo Mother Care (KMC) is an alternative model of care that prevents parent-infant separation when preterm infants need neonatal intensive care by skin-to-skin contact between infants and their parents. KMC is also a strategy that involves parents in their infants’ care and enables them to assume the responsibility for the care. Furthermore, KMC promotes parent-infant bonding and attachment.The overall aim of this thesis was to gain a deeper understanding and knowledge about parents’ capacity, willingness, and experiences of KMC and to which extent parents choose to use KMC throughout their infants' hospital stay. These studies were conducted in the NICUs at two Swedish university hospitals (NICU A and NICU B).Mothers of infants cared for at NICU A (n=17) answered a questionnaire about their experiences of KMC (Paper I). Twenty parents of infants cared for at NICU A recorded the duration of each KMC session during a period of 24 hours and the identity the KMC provider (Paper II). Seven fathers were interviewed about their experiences of KMC (Paper III) and 76 mothers and 74 fathers completed a questionnaire about what facilitated or rendered it difficult to perform KMC (Paper IV). The time of initiation of KMC and duration in minutes, and the identity of the KMC providers was recorded continuously during the infants’ (n=104) hospital stay: 83 mothers and 80 fathers also completed a questionnaire during their infants’ hospital stay (Paper V).This thesis provides new knowledge about parents’ practice of KMC, also continuously day and night, in a high tech NICU in an affluent society, with good resources for infant care in an incubator by trained staff. The accuracy of parents’ records of KMC were comparable to nurses’ records. The results indicate that parents want to be together with their infant in the NICU and be actively involved in the infants’ care. Although parents may experience KMC as exhausting and uncomfortable, they still prefer KMC to conventional neonatal intensive care as it supports their parental role. Early initiation of KMC after birth appears to result in a longer total duration of KMC during the infants’ hospital stay.
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| 3. |
- Ericson, Jenny, 1976-
(författare)
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Breastfeeding in mothers of preterm infants : Prevalence and effects of support
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to describe the prevalence of breastfeeding in preterm infants and to evaluate the effectiveness and mother’s experiences of proactive person-centred telephone support after discharge. Furthermore, to describe the duration of breastfeeding and risks of ceasing breastfeeding up to 12 months. The first study, a register study with data from the Swedish Neonatal Quality register (SNQ), included breastfeeding data at discharge from 29 445 preterm infants born from 2004-2013. The results demonstrated that the prevalence of exclusive breastfeeding among preterm infants in Sweden decreased during the study period, especially among extremely preterm infants (<28 weeks). We also performed a multicentre randomised controlled trial (RCT) of 493 breastfeeding mothers of preterm infants discharged from six neonatal units in Sweden. The intervention consisted of a proactive breastfeeding telephone support system in which a breastfeeding support team called the mothers once everyday up to 14 days after discharge. The control group received reactive support; the mothers were invited to call the breastfeeding support team if they wanted to talk or ask any questions (i.e., usual care).The RCT demonstrated that the intervention did not affect exclusive breastfeeding at eight weeks after discharge (primary outcome) or up to 12 months. The proactive support did not affect maternal breastfeeding satisfaction, attachment, quality of life or method of feeding (secondary outcomes). However, parental stress was significantly reduced in mothers in the intervention group. Mothers in the intervention group were significantly more satisfied and involved in the support and felt empowered compared with mothers in the control group, who experienced reactive support as dual. Further findings showed that a lower maternal educational level, partial breastfeeding at discharge and longer stay in the neonatal unit increased the risk of ceasing breastfeeding during the first 12 months of postnatal age. In conclusion, the trend for exclusive breastfeeding at discharge in preterm infants is declining, which necessitates concern. The evaluated intervention of telephone support did not affect breastfeeding, in the short-or long-term. However, maternal stress was reduced and mothers were significantly more satisfied with the proactive support and felt empowered by the support.
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| 4. |
- Gabrielsson, Hanna, 1977-
(författare)
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Adults with Spina bifida : voices from everyday life and exploration of living conditions
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to generate knowledge about living with Spina bifida, by mapping the condition and together with the adults with Spina bifida explore their living conditions and experiences in everyday life. Methods Study I was a quantitative study with a cross-sectional design. In Study II, individual experiences of daily life were explored by deep interviews using a reflective lifeworld approach. Study III had a participatory approach including five members of a photovoice group who met for eight sessions. Photographs taken by the members served as a starting point for the dialogue about what was of interest in their daily life. A narrative analysis was conducted by the researchers, incorporating the analysis the group did together. Study IV focused on alignment with the methodology in which photovoice is grounded. By returning to the ideological cornerstones of photovoice, the empirical experiences from Study III and examples from the literature were elaborated through processes within photovoice. The findings show that those adults with Spina bifida who were >46 years old had less complex medical conditions and better physical and cognitive functions, and had attained a higher level of education. The main theme in Study II was presented as “The contradictory path towards wellbeing in daily life.” In Study III, the members’ experiences in everyday life showed that many solutions offered by society were “An adaptation for us, but it works for no one.” The findings are further presented under three themes: “Accessibility – a never-ending project,” “Tensions of a normative view” and “Power to influence.” By focusing on action and narrative in Study IV, it is shown that dialogue, action, and interaction are important aspects of using photovoice. In conclusion, not all adult persons receive the support they need in everyday life, something future generations of adult persons with Spina bifida may have a higher need for. The stories and experiences of adults with Spina bifida in this thesis paint a history of not being asked, concerning their own situation. This shows that there is insufficient integration of the persons’ experiences in society’s efforts to plan for, and support, these individuals. The photovoice method was feasible for this group, providing opportunity for being part of dialogue, action, and interaction.
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| 5. |
- Nothhaft, Camilla, 1976-
(författare)
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Moments of lobbying : an ethnographic study of meetings between lobbyists and politicians
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this study is to define and further the understanding of the practice of lobbying as it manifests in the participants’ interactions with each other and to identify its specific conditions (rules, standards, traits).A research overview shows that lobbying as a political phenomenon is well researched, but that the action per se tends to been taken for granted as ‘talking’. Communication between lobbyists and politicians has predominantly been reconstructed as transmission, informationexchange. The study addresses this deficiency by applying an ethnographic method, shadowing, and by focussing on the micro-level of lobbying as a socio-political phenomenon. Lobbying is researched in moments of interaction between interest representatives and representatives of the political system, i.e. MEPs and their assistants.Seven lobbyists and politicians in Brussels have been shadowed for one week each; a further 34 interviews were conducted. The analytical strategy was to infer from the actors’ impression management (Goffman). The study is informed by a neo-institutional perspective. It assumes that cognitive, normative, and regulative structures provide meaning to social behavior, and that these resources are identifiable.Goffman’s concept of team and the distinction between frontstage and backstage emerged as central categories. My results suggest that the small world of the EU’s capital results in a sense of ‘us in Brussels’ shared by lobbyists, politicians and assistants alike. Lobbying-interaction in frontstage-mode is governed by strict conventions; ignorance or transgression are sanctioned as unprofessional. The key result, however, is that lobbyists actively work towards engagement on other terms. Lobbyists employ various strategies and build relations with politicians in order to create moments of backstage-interaction. In backstage-mode, lobbyists not only gain access to soft information, but can negotiate ways of working together with politicians in pursuit of different, but partly overlapping agendas.
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| 6. |
- Strandberg, Gunnar
(författare)
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Experimental Studies on Diagnostic and Therapeutic Aspects of Intraosseous Access
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Reliable access to the circulation is paramount in most medical and surgical emergencies. When venous access cannot be expediently established, intraosseous (IO) access is indicated. This method has a high success rate even in relatively inexperienced hands and there is considerable clinical experience of IO administration of drugs and fluids. There is however limited evidence on the use of IO samples for laboratory analysis. Also, uptake of drugs during shock has not been extensively studied. Further, there have been concerns that analysis of IO samples may damage laboratory equipment. We have studied, in a porcine model, the use of IO samples for point of care analysis of blood gases, acid base parameters and blood chemistries in stable circulation, in experimental septic shock, and in hypovolemia after major hemorrhage, comparing IO samples with arterial and venous samples, and comparing IO samples from different sites. We have also studied coagulation assays on IO samples in stable circulation and after major hemorrhage. Furthermore, we have compared IO and intravenous administration of antibiotics in experimental sepsis.Average differences between IO and arterial/venous samples varied between the studied analytes. During stable circulation, average IO levels of blood gases, acid-base parameters, hemoglobin/hematocrit and several blood chemistries approximated venous levels relatively well. Differences in acid-base and blood gas parameters, and lactate, were more pronounced in hypovolemia, as well as in sepsis. The dispersion of the differences was often relatively large, indicating limited precision. Average differences between two intraosseous sites were small.Intraosseous samples were clinically hypercoagulable with a strong tendency to clot in vitro, and thromboelastography demonstrated shortened reaction times compared with venous samples. Major bleeding and hemodilution moderately affected the studied coagulation parameters.In endotoxemic animals with circulatory instability, concentrations of cefotaxime and gentamicin in samples from the pulmonary artery were comparable at 5 minutes after intraosseous and intravenous administration, and during a 3 hour observation period.In summary, agreement between analytes in intraosseous and conventional blood samples was variable and often unpredictable, especially during circulatory compromise. Intraosseous samples clinically appeared hypercoagulable, and thromboelastography confirmed this. High and comparable concentrations of cefotaxime and gentamicin were found after intraosseous and intravenous administration of equivalent doses, suggesting that uptake is acceptable during septic instability.
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| 7. |
- Söderberg, Ewa
(författare)
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Experimental septic shock – Effects of endotoxemia with special reference to pathophysiological responses in the pig
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Sepsis and septic shock are conditions, with severe outcome or in many cases death. Sepsis is a systemic inflammatory response trigger by bacteraemia but systemic inflammatory response can also be triggered by major trauma, major surgery, pancreatitis, severe burns etc.The systemic inflammatory reaction initiating the evolvement of septic organ dysfunction can be modelled using endotoxin, a Gram-negative bacterial lipopolysaccharide. This thesis used a porcine experimental sepsis model to examine timing of the inflammatory response due to endotoxin infusion (Paper I) and the influence of steroid treatment on the inflammatory response in endotoxemic pigs (Paper II). Timing of steroid treatment and the role of neutrophil granulocyte activation was evaluated with pig specific NGAL assessing neutrophil activation (Paper III). A clinical observational study was performed with the aim to differentiate between sepsis and other inflammatory conditions (e.g. trauma due to major surgery) evaluated by calprotectin as a marker of neutrophil activation (Paper IV).There was a dose-dependency in endotoxin tolerance which was measured with TNF-a. Pre-exposure to endotoxin did not reduce the pulmonary response to endotoxemic challenge. In fact, both PaO2 / FiO2 and static pulmonary compliance were reduced in this group when pre-treated with endotoxin at low dose.Endotoxemic animals treated with hydrocortisone were more stable in circulatory variables than those without such treatment. This was not explained by an ability of steroids to modulate the production of NO (Nitric oxide), which has been suggested to be a mechanism of steroids in this aspect.Pre-treatment with hydrocortisone attenuated the neutrophil granulocyte response and consequently diminished the release of NGAL in plasma. Circulatory derangement was associated with high plasma NGAL levels. Urine NGAL levels did not differ among the four groups.Plasma calprotectin levels on ICU admission is a sensitive marker of systemic inflammation and are markedly increased in patients with sepsis and patients with systemic inflammatory response. Plasma Calprotectin performed better than any of the other inflammatory variables in predicting mortality at 30 days, except from the composite mortality prediction score, SAPS 3.
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| 8. |
- von Seth, Magnus, 1978-
(författare)
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Oxygen delivery and mitochondrial dysfunction as assessed by microdialysis during interventions in experimental sepsis
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Early administration of broad-spectrum antibiotics is the first goal in sepsis treatment. Besides from bacteriostatic/bactericidal effects, some antibiotics may also modify the host´s response to infection. The novel antibiotic tigecycline may exert such properties; however, this property has not been evaluated in large-animal trials. We compared tigecycline with doxycycline and placebo in relation to anti-inflammatory, circulatory and organ dysfunction effects in a sterile pig model of sepsis. Doxycycline, but not tigecycline, reduced the inflammatory response as manifested by tumor necrosis factor alpha levels in plasma. Tigecycline, however, had a stabilizing effect on the circulation not exerted by doxycycline or placebo.To achieve rapid restoration of the circulating blood volume - another major goal in sepsis treatment - fluid bolus administration of is some-times practiced. In addition to crystalloids, albumin-containing solutions are suggested. Yet, some animal-experimental data suggests that rapid bolus administration of albumin reduces albumin’s plasma-expanding effect. We compared a rapid intravenous bolus of radiolabeled albumin with a slow infusion in a sterile pig model of sepsis. Rapid bolus of administration did not reduce plasma levels of albumin following administration and did not increase the amount of albumin that left the circulation.Inadequate oxygen delivery (DO2) by the circulation to the tissues may cause increased plasma lactate, which is the most striking effect of sepsis on the metabolism. However, experimental data and clinical trials refute this link, instead, suggesting other mechanisms, including impaired oxygen extraction, mitochondrial dysfunction and accelerated aerobic glycolysis. We investigated the impact of DO2, oxygen consumption (VO2), hemodynamic parameters and inflammatory response on plasma lactate and organ dysfunction in two experimental sepsis models. In the most severe cases of shock, with DO2, there was an increase in plasma lactate, but without a decrease in VO2, invalidating the assumption that the increase in lactate is due to anaerobic metabolism.To identify critical steps in the sepsis-induced increase in lactate, we inhibited the major energy-producing step in the electron transport chain (ETC). The combination of sepsis and ETC inhibition led to a cellular energy crisis. This finding suggests that early sepsis induces a partial mitochondrial dysfunction.
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| 9. |
- Eklund, Petter, 1989-
(författare)
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Design of Rare Earth Free Permanent Magnet Generators
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Low speed permanent magnet (PM) synchronous generators (SGs) are commonly used in renewable energy. Rare earth (RE) PMs such as neodymium-iron-boron are a popular choice due to their high performance. In 2011 supply and cost issues were added to the previously existing environmental concerns regarding REPM raw materials as the world's major producer China imposed export restrictions. This thesis aims to investigate and propose design solutions for PMSGs that do not use REPMs. Two approaches are used: to design generators using the cheaper and more abundant ferrite PM materials, and to investigate how properties of new PM materials influence SG design.A ferrite PM rotor is designed to replace a REPM rotor in an experimental 12 kW wind power generator. The new design employs a flux concentrating spoke type rotor to achieve performance similar to the old REPM rotor while using ferrite PMs. The ferrite PM rotor design is built. The air gap length, magnetic flux density in the air gap, PM remanence, and voltage at both load and no load are measured. The generator has lower no load voltage than expected, which is mainly explained by lower than specified remanence of the ferrite PMs in the prototype. With the measured remanence inserted into the calculations some discrepancy remains. It is found that the discrepancy can be explained by the magnetic leakage flux in the end regions of the spoke type rotor, which is not modeled in the two dimensional simulations used for the design calculations.To investigate the influence of PM material properties three different PM rotor topologies are optimized for torque production using PM materials described by their remanence, recoil permeability, and demagnetization resistance. Demagnetization is considered using currents determined by a novel, winding design independent short circuit model. It is found that the spoke type rotor gives the highest torque of the three rotor topologies for low remanence materials as long as the PMs have sufficient demagnetization resistance. For high remanence materials the surface mounted PM rotor can give higher torque if the demagnetization resistance is high, but otherwise a capped PM rotor gives higher torque.
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| 10. |
- Eklund, Petter, 1989-
(författare)
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Rare Earth Metal–Free Permanent Magnet Generators
- 2016
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Permanent magnet (PM) synchronous generators (SGs) are used in renewable energy production. The preferred PM material is neodymium-iron-boron (NdFeB), which has very high performance and, until recently, low cost. In recent years there has emerged a cost and supply insecurity in NdFeB PMs due to export restrictions imposed by China, where the majority of the raw materials are produced. In this thesis various methods of avoiding the use of PM materials based on NdFeB, or other rare earth metals, are investigated.One approach is the use of the cheap and abundant ferrite PM. A ferrite PM rotor intended to be interchangeable with an NdFeB PM rotor is designed and built. Some initial investigation of the performance of the new rotor, and how this relates to manufacturing tolerances, is also made.Another approach is to make parameter studies in anticipation of new PM materials. A study of how three different rotor topologies perform with different PM materials, described by their remanence and recoil permeability, is made. The rotor topologies are: a spoke type PM rotor, a surface mounted PM rotor and a capped PM rotor.It is concluded that a viable replacement rotor can be designed using ferrite PMs. The new rotor will be heavier and mechanically more complex, and give slightly lower output voltage. Losses in the machine will increase slightly. A study is made on the impact of manufacturing tolerances on the performance of the resulting rotor.The different rotor topologies work best with different PM material properties. The surface mounted PM and capped PM rotors require higher remanence for good performance; the spoke type PM rotor works well with larger amounts of low remanence material. The recoil permeability should be low for the surface mounted and high for the capped PM rotor.
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