| 1. |
- Eriksson, Heléne, 1964-
(författare)
-
End of Life Stroke Care : perspectives of health-care professionals and family members
- 2019
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- IntroductionEven though medical improvements have reduced the mortality rates for patients afflicted by stroke, mortality during the first few days at hospital is significant. Today, there is an increasing recognition that the principles of palliative and supportive care are important components of meeting the needs of patients severely afflicted by stroke even in acute settings. However, there is limited knowledge about which factors have an impact on the end-of-life care (EoLC) for these patients or about how these last days of life are experienced from the family members’ perspective.AimThe overall aim of this thesis was to describe the EoLC of patients severely afflicted by stroke and to identify factors impacting upon EoLC for the patients and their family members in Sweden out of various contexts and methods.Design and MethodsThis thesis is based upon four papers employing qualitative, quantitative and mixed-method designs.Paper I is a qualitative study based on focus-group interviews with 41 health-care professionals (HCPs) in different professions related to stroke care at three stroke units. The aim was to study ethical dilemmas, different approaches and what consequences they had among health HCPs; the data was analysed using content analysis. The result inspired the design and conduct of the following studies.Paper II is a quantitative comparative study based on a retrospectively registered questionnaire from the Swedish Registry of Palliative Care (SRPC). Patients dying of stroke (n =1626) were compared with patients dying from cancer (n=1626), according to symptoms, symptom management and communication with the patient and family members during the last week of life. Data was statistically calculated using OR.Paper III is a mixed-method study employing a sequential explanatory design. In the first, quantitative, part, 995 stroke patients who died in hospital were compared with 631 stroke patients who died at nursing homes, according to symptoms, symptom management and communication with the patient and family members during the last week of life. The quantitative data was statistically calculated using OR and the qualitative data was analysed using content analysis. Nine significant differences drawn from the quantitative results regarding care were chosen to be discussed by twelve nurses working in stroke units.Paper IV is a qualitative interview study with the aim to study the family member descriptions of the trajectory from admission to the hospital until their loved one died. A semi-structured interview guide was used, and data was analysed using thematic analyses.ResultsFactors that had an impact on EoLC were consequences related to the difficulties around decision-making about withholding or withdrawing life-sustaining treatment. Non-decisions or not holding to the decision generated communication barriers causing obstacles in inter-professional collaboration and ethical dilemmas within the team (Study I). The absence of a mutual approach to care resulted in underprovided palliation, undignified medical treatment and ambiguity in care, generating feelings of distrust among the family members. The results described in Study I of underprovided palliation were further investigated in Study II. The differences in knowledge about whether symptoms were present or not in patients afflicted by stroke compared to patients with cancer were significant. For example, the HCPs in the stroke group did not know if pain was present nine times more frequently than in the cancer group. These differences in knowledge about whether symptoms were present of not were also identified in Study III. Here, HCPs at the nursing home more often had knowledge about whether a symptom was present in patients dying of stroke or not, compared to HCPs at hospitals. This study also identifies differences in the presence of the symptoms being compared and whether the patient’s suffering was fully relieved. The nurses working at stroke units explained that these differences were a consequence of the stroke unit’s aim (saving lives), no previous relationship to the patient and ambiguity in the evaluation of symptoms. The patient’s altered levels of consciousness increased the difficulties in evaluation. In addition, the hospital setting’s aim increased the risk of prolonged treatment, for example nutrition supplied during the last day of life, and underprovided palliation of for example, pain compared to nursing homes. In Study IV, family members were seeking trust through mutual collaboration and creating relationships with the HCPs. If the family did not feel that their search for trust was taken care of, it generated feelings of distrust allied with anxiety and memories of failing to do the best for their loved one at in the end of life. During the trajectory at the hospital, family members were “seeking trust in chaos”, “seeking clarity when deciding about living or dying” and finally they were “seeking trust in care as a final act of love”.Conclusions:The results of this thesis suggest that the absence of a coherent approach contributes to developing ethical dilemmas within the HCPs. The ambiguity in care had an impact on the quality on EoLC, with an increased risk of unnecessary suffering and questionable symptom management. The prevailing culture at acute-care hospitals affected the HCPs’ attitudes towards EoLC, with attention being predominantly on life-sustaining treatments. There is an increasing recognition of the need for improvement in the PC approach at acute-care hospitals in order to create equal quality of care during end of life, irrespective of the place of death for patients dying of stroke. Furthermore, family members need to feel trust, which is achieved through relationships and collaboration with HCPs. In the striving to accomplish a wholly compensatory care of quality during the trajectory, this thesis can be a source of knowledge and guidance for nurses and for teams at the stroke unit.
|
|
| 2. |
- Phoosuwan, Nitikorn, 1982-
(författare)
-
Perinatal Depressive Symptoms among Women in North-Eastern Thailand : Risk Factors, Support and Prevention
- 2020
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Perinatal depressive symptoms among women remain a global burden. Improvements in self-efficacy among public health professionals (PHPs) in primary healthcare settings to detect and manage perinatal depressive symptoms among women are needed.The aims of this thesis were to: identify prevalence and risk factors associated with perinatal depressive symptoms among women; to explore and describe life situation and support among women with antenatal depressive symptoms (ADS) and their partners; and to improve self-efficacy of PHPs in detection and management of perinatal depressive symptoms in Sakonnakhon province in Thailand. Qualitative and quantitative studies with different types of data collection methods were used.Study I determined prevalence of ADS and associated risk factors among 449 Thai women in late pregnancy using the Edinburgh Postnatal Depression Scale (EPDS). The prevalence was 46.8% and associated risk factors were insufficient money, being a teenager, low psychological well-being, low self-esteem and low sense of coherence.Study II explored and described life situation and support during pregnancy among women with ADS and their partners using semi-structured interviews. Four categories emerged: Having obstacles in life, Facing life situation, Enhancing confidence and Dissatisfaction with help.Study III determined risk factors associated with postpartum depressive symptoms at one month among 319 women and at three months among 276 women. Risk factors at one month were antenatal psychological well-being, non-exclusive breastfeeding, low personal income and caregiver not a mother; risk factors at three months were unintended pregnancy, low personal income/month, low self-esteem, low psychological well-being and low maternal competence.Study IV evaluated a self-efficacy improvement programme (SIP) intended to increase PHPs’ self-efficacy in efforts to detect and manage perinatal depressive symptoms among women. After the SIP, PHPs in the intervention group (n=33) had higher self-efficacy scores than PHPs in the control group (n=33). Four categories emerged in qualitative evaluation: Having confidence, Changing knowledge and attitudes, Increasing perception of an important role, and Increasing awareness of performed function.Women who are at increased risk for perinatal depressive symptoms should be screened using the EPDS. Health care professionals should involve expectant fathers in ANC process. The SIP enhances PHPs’ ability to detect and manage perinatal depressive symptoms.
|
|
| 3. |
- Blomgren, Per-Ola
(författare)
-
Clean work, the pursuit of increased adherence to hand hygiene routines : a descriptive study
- 2022
-
Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Healthcare-associated infections (HAI) are a problem in health care worldwide. In Sweden 7-8% of all patients treated in hospital suffer from an adverse event of varying severity, of which approximately 60,000 from a HAI. Proper hand hygiene is considered the single most important measure to reduce HAI. Despite the importance, adherence to correct hand hygiene routines are lacking among healthcare workers (HCWs). The World Health Organizations (WHO) multimodal promotion strategy promotes areas that need to be addressed in order to change the behaviour of individual HCWs to optimise adherence to hand hygiene and to improve patient safety. These areas include feedback, education, reminders at the workplace and institutional safety climate. The overall aim of this study was to examine the possibility of adherence to hand hygiene routines and to explore factors that might influence the HCWs adherence. The study used a descriptive research design made through qualitative method, with focus group interviews, and quantitative method, using a questionnaire survey. Eight focus group interviews were conducted with assistant nurses (n=18), nurses (n=15) and physicians (n=5) and analysed with abductive qualitative content analysis. The questionnaire survey was answered by nurses (n=84) and nursing students in their first semester (n=71) and last semester (n=46) and the data was statistically analysed.The main findings show that there are barriers to hand hygiene adherence and measures to improve these. HCWs highlighted discrepancies regarding how the organisation was supposed to give feedback and how it actually was at the workplace and expressed needs for more direct feedback to improve adherence. The study also found that hygienic knowledge gaps exists among nurses and nursing students regarding causes of HAI and how the risk of contamination of patients and HCWs can be minimized among others. Students at the beginning of the education had a lower level of knowledge than last semester students and registered nurses. The last semester students tended to have the highest level of hand hygiene knowledge. In conclusion, the key areas presented by WHO’s multimodal promotion strategy to improve adherence all lack the appropriate measures, in some extent. The use of an electronic reminder system could give the means to improve a behaviour as long as the individual integrity is protected and development of curriculums for nursing students and continuing education of nurses is needed to further develop and maintaining knowledge.
|
|
| 4. |
- Lundin, Christina, 1961-
(författare)
-
Organizing Language Interpreting Services in Elderly and Emergency Healthcare
- 2018
-
Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- With an increasing migrant population there is a growing need to organize interpreting practices in healthcare in order to deliver equitable high-quality care.This thesis focuses on healthcare institutions’ organization of interpreting services. The aim of the study was to explore interpreting practices in a healthcare context by comparing two different healthcare areas – elderly and emergency healthcare. The study aimed to highlight the impact of the organizational and institutional context.This study was designed as an explorative and descriptive qualitative study including 79 healthcare professionals with experience of interpreting practices recruited via purposeful sampling in elderly and emergency healthcare. Data were collected through individual and focus-group interviews and analysed with inductive qualitative content analysis.The main findings show that the processes and structures around interpreting practices were complex and mainly linked to individual and interpersonal levels and, to a limited extent, to the institutional level. On the institutional level the Public Procurement Act was the only formal policy to follow. On individual and interpersonal level interpreting practices were structured by self-established informal workplace routines developed by the professional groups. The norms and routines used was determined by access to interpreters, time aspects, characteristics of the care given, health conditions and the person’s problem, expectations and requests from the person and also from healthcare professionals. There were wishes for improvement, with better flexibility in access to professional interpreters, training for users and interpreters, and also better technical solutions and equipment.In conclusion, the use of interpreters was rooted in the organizational environment of interpreting practice, including the availability of laws, policy and guidelines, and closely related to individuals’ language skills, cultural values and social factors. The use of professional interpreters was based on the nature of care in context and access to interpreters and determined by health professionals’ estimation of the person’s current health status in order to deliver fast and individualized care based on humanistic values.Thus, it is important to consider organizational framework and cultural awareness when formulating interpreting practices adapted to the context, and formal guidelines in order to achieve the aim of personcentered and equal health care.
|
|
