| 1. |
- Tosterud, Randi, 1955-
(författare)
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Simulation used as a learning approach in nursing education : Students’ experiences and validation of evaluation questionnaires
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim was to investigate bachelor nursing students’ experiences with simulation as a learning approach conducted under various conditions. Additionally, the aim was to translate and validate questionnaires for the evaluation of simulation in a Norwegian context.Methods: Quantitative and qualitative methods were used. Nursing students responded to three questionnaires after attending either low- or high-fidelity simulation. Data were analyzed with statistics (I). Two evaluation questionnaires were subjected to a principal components analysis (II, III). Data were obtained from nursing students through focus group interviews, and analyzed with a qualitative content analysis (IV). Main findings: Independent of the fidelity level in the simulation and educational level, the students reported satisfaction and that the emphasized features in learning were present. Those who had used a paper/pencil case study were the most satisfied (I). Debriefing was reported to be crucial for learning, but in particular by attending the large groups, also as a stressful and intrusive situation (IV).The Norwegian version of the questionnaire, the Student Satisfaction and Self-Confidence Scale, revealed no stable factor solution (II). The translated version of the Debriefing Experience Scale was shown to hold a good potential for evaluating debriefing, but benefited from reducing the subscales (III). To ensure safety and security were reported to be a prerequisite for learning, with the students requesting a more frequent use of simulation and a higher degree of familiarity with active learning in their program in general (IV).Conclusions: Simulation at all fidelity levels should be used in nursing education. To exploit the potential, the learning approaches should be integrated into the program in general through a systematic and structured building of a learning community. A further validation and testing of the questionnaires in different programs and contexts is needed.
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| 2. |
- Larsen Moen, Øyfrid, 1969-
(författare)
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Everyday life in families with a child with ADHD and public health nurses’ conceptions of their role
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- ADHD is one of the most common behavioral disorders diagnosed in children. These children have difficulties regarding the regulation of emotions, maintaining attention and impulse control, all of which influence family and social life. The aim of this study was to describe and explore the everyday life of families with a child with ADHD and public health nurses’ role in relation to these families. The parents were contending with- and adapting to the parental role and social network. The family attempted to safeguard a functioning family in managing their everyday life, tuning themselves in on the child’s shifting moods, using strict boundaries and developing special skills. The family fought for acceptance and inclusion when interacting with their social network and professionals. Parents with ADHD and families with non-medicated children reported more problems in family functioning. Characteristics in parents and the child with ADHD, as well as support from the social network and community health services, all influenced family functioning. The PHNs described their role as both a peripheral and collaborating partner, asking for guidelines and multidisciplinary collaboration. The public health nurse is in a unique position to support and supervise these families.
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| 3. |
- Ballangrud, Randi, 1959-
(författare)
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Building patient safety in intensive care nursing : Patient safety culture, team performance and simulation-based training
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The overall aim of the thesis was to investigate patient safety culture, team performance and the use of simulation-based team training for building patient safety in intensive care nursing.Methods: Quantitative and qualitative methods were used. In Study I, 220 RNs from ten ICUs responded to a patient safety culture questionnaire analysed with statistics. Studies II-IV were based on an evaluation of a simulation-based team training programme. Studies II-III included 53 RNs from seven ICUs and ten RNs from a post-graduate programme (II). The data were collected with questionnaires (II) and measurement scales (III), and analysed with statistics. In Study IV, 18 RNs were interviewed and the data were analysed with a qualitative content analysis.Main findings: The RNs had positive perceptions of the overall patient safety culture in the ICUs. Hence, a potential for improvements was identified at both the unit and hospital level. Differences between types of ICUs and between hospitals were found. The dimensions at the unit level were predictors for the outcome dimensions (I). The RNs evaluated the simulation-based team training programme in a positive way. Differences with regard to scenario roles, prior simulation experience and area of intensive care practice were found (II). The expert raters assessed the teams’ performance as advanced novice or competent. There were differences between the expert raters’ assessments and the RNs’ self-assessments (III). One main category emerged to illuminate the RNs’ perceptions of simulation-based team training for building patient safety: Regular training increases the awareness of clinical practice and acknowledges the importance of structured work in teams (IV).Conclusions: Patient safety culture measurements have the potential to identify areas in need of improvement, and simulation-based team training is appropriate to create a common understanding of structured work in teams with regard to patient safety.
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| 4. |
- Samuelsson, Bodil
(författare)
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Gender differences in patients with hip fracture : aspects on care and recovery
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Hip fractures in the elderly are common and impose a substantial burden on the healthcare system. This fracture population consists of many subgroups that often require differentiated and extensive acute and postfracture care. The aim of this thesis was to basically characterise a hip fracture population at time of admission, present postoperative results and discuss aspects that may influence recovery. Gender differences are specifically addressed. Study I, II and IV derive from a consecutive series of 2213 patients with hip fracture admitted to four major hospitals in Stockholm, while Study III was a small pilot study. In Study I we investigated the effect of time-to-surgery on: ability to return to own home, incidence of pressure ulcers, length of stay (LOS), and mortality. Patients who had surgery within 24, 36 or 48 hours were compared with those who had surgery later. The ability to return to own home was affected in patients who had to wait longer than 36 and 48 hours. The incidence of pressure ulcers and LOS increased at all time limits. In Study II we investigated gender differences in two subgroups, characterized by normal cognitive function versus cognitive dysfunction, and whether such differences influenced patient ability to: return to own home, regain walking ability and perform activities of daily living (ADL). Cognitive function was assessed by the Short Portable Mental Status Questionnaire (SPMSQ). Dysfunction was equally common by gender. Patients with normal function (SPMSQ 8-10) were younger and healthier, resided more often in their own homes and were able to manage ADL independently, with no gender differences. In patients with dysfunction (SPMSQ 0-7), men had more comorbidity on admission, greater loss of walking ability and higher mortality after the fracture episode. We found that cognitive status was the overarching most important factor for predicting outcome. In Study III we examined gastric emptying time of 400 ml carbohydrate rich drink in ten elderly women with acute hip fracture, and compared results with two reference groups of healthy women. The mean half gastric emptying time in the study group was 57 ± 5 (39-82) minutes, to be compared with 58 ±4 (41-106) and 58 ±5 (33-72) in the two reference groups. No adverse event was observed during anesthesia. Consequently, it should be possible to give patients a carbohydrate-rich drink before surgery instead of ordering strict fasting (NPO), which in turn could improve the patients’ chances to recover and regain prefracture status. In Study IV we focused on gender differences in complications; specifically on factors associated with common general complications. Complications were common with an incidence of 59% in men and 56% in women (ns). Most common were urinary tract infection, pressure ulcer, cardiac complications and pneumonia. Male gender emerged as an independent risk factor for suffering from pneumonia, and female gender for urinary tract infection. Besides gender, time-to-surgery, cognitive function, cardiovascular and pulmonary disease on admission were independent risk factors for suffering complication. In conclusion, there are gender differences among patients admitted to a hospital for acute hip fracture, both with regard to status on admission and outcome. Cognitive dysfunction, equally common among women and men, has a major impact on incidence of complication and functional recovery. Men with cognitive dysfunction are at greater risk. With increased awareness of risk factors and gender bias, along with reduced waiting time for surgery, it should be possible to decrease complication incidence and improve outcome. We found no evidence for prolonged gastric emptying time of a carbohydrate-rich beverage, which implies it may be possible to provide patients with a carbohydrate-rich drink before surgery instead of adhering to strict fasting
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| 5. |
- Weimand, Bente Margrethe, 1961-
(författare)
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Experiences and Nursing Support of Relatives of Persons with Severe Mental Illness
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The overall aim of this thesis was to illuminate experiences of relatives of persons with severe mental illness, and their need for support from formal care. Furthermore, to illuminate nursing support of relatives of persons with severe mental illness.Methods: A mixed methods design was used. In study I, data was collected with a questionnaire responded by 226 relatives and analysed with statistics. In study II, data was gathered with interviews with a strategic sample of 18 relatives, analysed with phenomenography. Study III gathered data from 216 relatives using open-ended questions in the questionnaire (I), analysed with qualitative content analysis. In study IV, data was collected by means of focus-group interviews with 4 groups of nurses, working in mental healthcare and analysed with phenomenography.Main findings: The relatives experienced that their lives were intertwined with the life of their severely mentally ill next of kin. The relatives experienced burden and a poor health, and there were associations between burden and health (I). The relatives had to balance between multiple concerns and make choices on behalf of others and themselves, constantly struggling between opposing feelings and between reflections (II). Relatives’ encounters with mental health personnel were mainly negative, although some had positive experiences. They strived for involvement in mental healthcare for the sake of their severely mentally ill next of kin, and wanted inclusion and support for their own sake, but mostly felt left alone with straining but inescapable responsibilities (III). The nurses conceived that their responsibility was first and foremost the patient and to develop an alliance with him or her. The nurses often felt they had to exclude relatives, but were sometimes able to support them (IV).Conclusions: Relatives’ lives are intertwined with the life of their severely mentally ill next of kin. Relatives’ overall demanding life situation means that the mental health services must involve relatives for the sake of the severely mentally ill person but also include them for their own sake. They need practical and emotional support. Guidelines must be designed to address relatives’ needs, and support must be adapted to the individual relative.
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| 6. |
- Wentzel Persenius, Mona, 1958-
(författare)
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Nutritional Nursing Care : Nurses’ interactions with the patient, the team and the organization
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of the thesis was to gain a deeper understanding of nutritional nursing care in municipal care and county council care, with specific focus on enteral nutrition (EN) in intensive care. Quantitative and qualitative methods were used. Telephone interviews regarding assessment of the nutritional status of patients were carried out with special medical nurses (CNs) (n = 14) in municipalities in one county and first line managers (CNs) (n = 27) in one county council. Registered nurses (RNs) in municipalities (n = 74) and county councils (n = 57) answered a questionnaire about nutritional assessment and documentation (I). RNs (n = 44) at three different intensive care units answered a questionnaire about responsibility, knowledge, documentation and nursing interventions regarding EN. Observations (n = 40) on nursing care interventions for patients with EN were carried out (II). RNs (n = 8), enrolled nurses (n = 4) (III) and patients (n = 14) (IV) were interviewed and nutritional nursing care was observed (III-IV) at an intensive care unit. The results showed that assessment of nutritional status was not performed on all patients, according to RNs/CNs. Malnourished patients were estimated to occur to a varied extent. Sixty-six percent of RNs/CNs answered that there were no guidelines for nutritional care and 13% that they did not know if there were any. RNs saw the VIPS model as a guide in nursing care, but also as an obstacle to information exchange (I). A majority of RNs answered that there were guidelines for EN. There were differences between the RNs’ opinions about their responsibility, knowledge and documentation. Deviations from recommended nursing care interventions occurred (II). The developed substantive theory of nurses (RNs and enrolled nurses) concerns and strategies of nutritional nursing care for patients with EN, includes the core category ”to have and to hold nutritional control – balancing between individual care and routine care” and the categories ”knowing the patient”, ”facilitating the patients’ involvement”, ”being a nurse in the team”, ”having professional confidence” and ”having a supportive organization”. In order for RNs and enrolled nurses to have a sense of control over the patients’ care in relation to nutrition, a balance between routine care and individual care was required (III). The developed substantive theory regarding the patients’ experiences of nutritional care includes the core category ”grasping nutrition during the recovery process”. The core category is reflected in, and dependent on, the categories ”facing nutritional changes”, ”making sense of the nutritional situation” and ”being involved with nutritional care”. The patients alternated emotionally between worry, fear and failure, and relief and hope. The patients experienced a turning point and felt an improvement in their condition when their appetite returned, when the stomach and gut were functioning and when the feeding tube was removed (IV). The conclusion is that quality and safety in relation to nutritional nursing care is dependent on the interactions between the nurse and patient, between the nurse and the team, and the nurse and the organization.
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| 7. |
- Abrahamsen Grøndahl, Vigdis, 1964-
(författare)
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Patients’ perceptions of actual care conditions and patient satisfaction with care quality in hospital
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- There are theoretical and methodological difficulties in measuring the concepts of quality of care and patient satisfaction, and the conditions associated with these concepts. A theoretical framework of patient satisfaction and a theoretical model of quality of care have been used as the theoretical basis in this thesis. Aim. The overall aim was to describe and explore relationships between person-related conditions, external objective care conditions, patients’ perceptions of quality of care, and patient satisfaction with care in hospital. Methods. Quantitative and qualitative methods were used. In the quantitative study (I-III), 528 patients (83.7%) from eight medical, three surgical and one mixed medical/surgical ward in five hospitals in Norway agreed to participate (10% of total discharges). Data collection was conducted using a questionnaire comprising four instruments: Quality from Patients’ Perspective (QPP); Sense of Coherence scale (SOC); Big Five personality traits – the Single-Item Measures of Personality (SIMP); and Emotional Stress Reaction Questionnaire (ESRQ). In addition, questions regarding socio-demographic data and health conditions were asked, and data from ward statistics were included. Multivariate statistical analysis was carried out (I-III). In the qualitative study 22 informants were interviewed (IV). The interviews were analysed by conventional content analysis. Main findings. Patients’ perceptions of quality of care and patient satisfaction ranged from lower to higher depending on whether all patients or groups of patients were studied. The combination of person-related and external objective care conditions explained 55% of patients’ perceptions of quality of care (I). 54.7% of the variance in patient satisfaction was explained, and the person-related conditions had the strongest impact, explaining 51.7% (II). Three clusters of patients were identified regarding their scores on patient satisfaction and patients’ perceptions of quality of care (III). One group consisted of patients who were most satisfied and had the best perceptions of quality of care, a second group of patients who were less satisfied and had better perceptions, and a third group of patients who were less satisfied and had the worst perceptions. The qualitative study revealed four categories of importance for patients’ satisfaction: desire to regain health, need to be met in a professional way as a unique person, perspective on life, and need to have balance between privacy and companionship (IV). Conclusions. Patients’ perceptions of quality of care and patient satisfaction are two different concepts. The person-related conditions seem to be the strongest predictors of patients’ perceptions of quality of care and patient satisfaction. Registered nurses need to be aware of this when planning and conducting nursing care. There is a need of guidelines for handling over‑occupancy, and of procedures for emergency admissions on the wards. The number of registered nurses on the wards needs to be considered. Healthcare personnel must do their utmost to provide the patients with person‑centred care.
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| 8. |
- Kvist, Linda
(författare)
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Care and treatment of women with inflammatory symptoms of the breast during lactation
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Care and treatment of women with inflammatory symptoms of the breast during lactationInflammation of the breast during lactation causes considerable discomfort to mothers and carries a risk of early abandonment of breastfeeding. Little is known about the effects of care interventions, including acupuncture, used for these mothers or about mothers’ experiences of the complaint. Aim: to study care and treatment given at a midwife-led breastfeeding clinic to mothers with inflammatory symptoms of the breast during lactation, to gain knowledge of mothers’ experiences of being afflicted by breast inflammation and to investigate factors which may be associated with the development of breast abscess. Methods: method triangulation was used to study different aspects of the phenomenon of inflammatory symptoms of the breast during lactation; two randomised controlled trials I (n = 88) and II (n = 210), a descriptive study III (n = 210), an interview study with a Grounded Theory approach IV (n = 14), and a population-based register study V (n = 1,454,068 singleton deliveries). Results: mothers’ symptoms were more effectively relieved when acupuncture was used but acupuncture treatment did not shorten contact with health services. Nine percent (I) and 15 % (II) respectively, of mothers were prescribed antibiotics. Twelve percent experienced renewed symptoms requiring health care contact within 6 weeks (III). Seven mothers (0.1% of breastfeeding mothers) developed breast abscess, which was comparable to the figure in the population-based study (V). The presence of Group B streptococci in the breast milk was related to longer contact with health care (II). Mothers’ “will to breastfeed” may make it possible for them to withstand physical and emotional difficulties caused by the illness. Mothers considered access to clinical expertise to be an important factor in their care (IV). Primiparous mothers, those over the age of 30 years and those who give birth after 41 weeks gestation appear to be at a significantly increased risk for the development of breast abscess (V).Conclusions: mothers’ symptoms were more effectively dissipated when acupuncture treatment was used. However, acupuncture treatment did not shorten mothers’ contact with health care services. Interventions, including acupuncture treatment for relief of symptoms may help mothers to withstand their discomfort and await the body’s own anti-inflammatory response and therefore make it possible to substantially reduce the use of antibiotic therapy for this group. The results indicate a need for a better understanding of the influence on breastfeeding of hormones administered to birthing and breastfeeding women. The availability of immediate clinical expertise is an important factor for these mothers, which health care planners should be aware of. Information on potential breastfeeding problems should be improved.Key words: acupuncture, antibiotics, breast abscess, breastfeeding, care interventions, inflammatory symptoms, lactation mastitis
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| 9. |
- Skoogh, Annika
(författare)
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Patient safety in intrapartum care : Adverse events and healthcare professionals’ perceptions of patient safety, patient safety culture and teamwork
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of the thesis was to describe adverse events for women with planned vaginal births and healthcare professionals’ perceptions of patient safety. Further, to test the reliability and validity of a teamwork questionnaire and to investigate patient safety culture and teamwork among healthcare professionals in intrapartum care.Methods: Paper I had a retrospective design, with 311 birth record reviews. Paper II had a descriptive and qualitative design using a phenomenographic approach, including interviews with 19 healthcare professionals in three labor wards. Paper III and IV had cross-sectional designs. Healthcare professionals’ (n=450) in various wards responded to the TeamSTEPPS® Teamwork Perceptions Questionnaire (T-TPQ) (III). Healthcare professionals’ (n=184) in three labor wards responded to the Swedish version of the Hospital Survey on Patient Safety Culture and the T-TPQ (IV). Confirmatory factor analysis and descriptive and inferential statistics were used.Main results: Adverse events in women occurred in 11% of planned vaginal births (I). Four descriptive categories with nine perceptions described patient safety for women giving birth (II). Confirmatory factor analysis of the T-TPQ indicated a good fit (III). Main and interaction effects of profession and labor ward on patient safety culture and teamwork were found (IV).Conclusions: The results highlight the occurrence of 3rd- or 4th-degree lacerations, distended urinary bladder, and anesthesia-related adverse events. For safe care, it is crucial for healthcare professionals to provide supportive care and to listen to the woman. Using team members’ competences in a tolerant atmosphere, with a reasonable workload, and learning from failure as well as from success are preconditions for patient safety. The Swedish version of the T-TPQ shows acceptable reliability and validity. Differences between labor wards seemed to have a greater impact than differences between professions on patient safety culture and teamwork.
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