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- Johnson, Christina, 1964-
(författare)
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Telephone advice nursing : communication, patient satisfaction and tool development
- 2018
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Telenursing has rapidly expanded in many countries. In Sweden, a national telephone advisory nursing service reaches the entire nation and receives approximately 4,5 million calls per year. The six phase nursing process – assessment, nursing diagnosis, setting goals, planning, implementation and evaluation – can be used when managing a caller’s health problem. In telenursing, a person-centred approach makes for more satisfied and appreciative callers. The core component of interaction is the verbal communication between the telenurse and caller. Several studies have revealed the need for the development of communication competence in telenursing. Structured analyses of conversations between telenurses and callers is one way to increase telenurses’ awareness of their communication and interpersonal competence. This type of analysis requires a valid formative self-assessment tool. To evaluate communicative effectiveness, the patient perspective of the interpersonal aspects of interaction are described as a necessary component, and satisfaction surveys designed for a telenursing context are recommended. Therefore, a questionnaire is needed that evaluates the effects of telenurse communication training from the caller’s perspective.Aims: The overall aim of these two studies was to develop tools to enable improvements and evaluations in communication and interpersonal competence in telenursing from the perspective of both the telenurse and the caller.Study 1: To develop a self-assessment tool aiming to raise telenurses’ awareness of their communication and interpersonal competence and highlight areas in need of improvement.Study 2: To develop and assess content validity of a theoretically anchored questionnaire that explores caller satisfaction in TAN as a result of the interaction between the caller and the telenurse.Methods: Study 1: The development and the evaluation of content validity of the Telenursing Self-Assessment Tool (TSAT) started with a literature search and domain identification, which were used to generate the items. The assessment of the content validity was performed in two steps. First, an expert group completed two rounds of assessments using Content Validity Index (CVI). Second, telenurses tested the tool and assessed the content validity using CVI. Thereafter, the telenurses participated in consensus discussions. Refinements of the tool were done after every assessment.Study 2: The development and the evaluation of content validity of the Telenursing Interaction and Satisfaction Questionnaire (TISQ) started with a literature search and domain identification, which were used to generate the items. The assessment of the content validity was performed in two steps. First, cognitive interviews were performed with the callers, the target population. Next, experts evaluated the content validity using CVI. Refinements of the tool were done after every assessment. The Interaction Model of Client Health Behavior (IMCHB) provided theoretical guidance and support.Results:Study 1: The TSAT with 58 items was developed. The items were structured according to the nursing process and the tool was judged as having good content validity.Study 2: The TISQ consisting of 60 items based on the IMCHB was developed. The questionnaire was found to exhibit good content validity.Conclusions: This thesis describes the development and assessment of content validity of two theoretically anchored tools aimed to improve and evaluate communication and interpersonal competence in telenursing from the perspective of both the telenurse and the caller. The TSAT is meant to create learning opportunities, to provide self-direction, feedback, and coaching, and to guide the telenurse through the nursing process using a person-centred approach. The TISQ aims to explore the callers’ satisfaction and the callers’ perceptions of the interaction with the telenurse. With better knowledge about this, communication improvement and education in telenursing can be tailored to enhance caller satisfaction.
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| 2. |
- Kukil, Kateryna, 1992-
(författare)
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Towards renewable chemicals production in cyanobacteria
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The intensive fossil fuel combustion by humanity resulted in the increase of atmospheric CO2 concentration creating the greenhouse effect, which in turn causes severe environmental problems. Thus, humanity should find solutions to decrease dependency on fossil hydrocarbons in order to lower CO2 emission into the atmosphere. Photosynthetic microorganisms, including cyanobacteria, exhibit great potential for this purpose, being able to fix and directly convert CO2 into organic chemicals using solar irradiation as an energy source. Establishing cyanobacteria as microbial cell factories enables the sustainable production of bulk chemicals and biofuels. In this thesis, the production of industrially relevant chemicals, i.e. succinate and aromatic compounds by the cyanobacterium Synechocystis sp. PCC 6803 was explored. Succinate is naturally formed via the tricarboxylic acid cycle (TCA cycle) in cyanobacteria. Phosphoenolpyruvate carboxylase (PEPc) is an essential enzyme in replenishing the oxaloacetate intermediate of the TCA cycle. Succinate production was investigated by introducing a new capacity for its synthesis via overexpression of heterologous glyoxylate shunt genes together with overexpression of native PEPc. The implementation of the glyoxylate shunt proved successful as succinate productivity was enhanced in certain conditions. Moreover, the formation of succinate during anaerobic darkness was explored. The enzyme L-aspartate oxidase was studied and the in vitro ability of this enzyme to reduce fumarate to succinate anaerobically was demonstrated, which contributes to the understanding of the cyanobacterial TCA cycle for future engineering purposes. The production of the first intermediates of the plant phenylpropanoid pathway, trans-cinnamic and p-coumaric acid, which derive from the aromatic amino acids phenylalanine and tyrosine, was implemented by overexpression of phenylalanine- and tyrosine ammonia lyases in Synechocystis. The subsequent metabolic engineering, such as the elimination of competing pathways of tocopherol synthesis, demonstrated increased productivity for both target molecules. Moreover, laboratory evolution of Synechocystis was performed and several metabolic mutants were selected for their ability to secrete phenylalanine in the growth medium. The laboratory-evolved mutants provide an important basis for investigating pathway regulation of aromatic amino acid synthesis. In summary, the findings in this thesis contribute to the development of cyanobacteria as microbial cell factories for the sustainable production of renewable chemicals.
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| 3. |
- Miao, Rui
(författare)
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Metabolic Engineering of Synechocystis PCC 6803 for Butanol Production
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- There is an urgent demand for renewable alternatives to fossil fuels since the extraction and utilization cause a series of environmental problems in the world. Thus, the utilization of solar energy has attracted much attention in the last decades since there is excess amount of light on Earth. Photosynthetic microorganisms, such as cyanobacteria, can be a good biological chassis to convert solar energy directly to chemical energy. It has been demonstrated that cyanobacteria can produce various compounds which can be used asfourth-generation biofuels. This thesis focuses on the photo-autotrophic production of two biofuel compounds, isobutanol and 1-butanol, in the unicellular cyanobacterial strain Synechocystis PCC 6803. In the studies of isobutanol production, the endogenous alcohol dehydrogenase of Synechocystis encoded by slr1192 showed impressive activity in isobutanol formation. In addition, a-ketoisovalerate decarboxylase (Kivd) was identified as the only heterologous enzyme needed to be introduced for isobutanol production in Synechocystis. Kivd was further recognized as a bottleneck in the isobutanol production pathway. Therefore, Kivd was engineered via rational design to shift the preferential activity towards the production of isobutanol instead of the by-product 3-methyl-1-butanol. The best strain pEEK2-ST expressing KivdS286T showed dramatically increased productivity, and the activity of Kivd was successfully shifted further towards isobutanol production. A cumulative isobutanol titer of 911 mg L-1 was observed from this strain after 46 days growth under 50 μmol photons m−2 s−1 with pH adjusted to between 7 and 8. A maximum production rate of nearly 44 mg L-1d-1was reached between days 4 and 6. Similar metabolic engineering strategies were employed to generate 1-butanol producing Synechocystis strains and then to stepwise enhance the production. By selecting the best enzymes and promotors, 836 mg L-1 in-flask 1-butanol was produced. By optimizing the cultivation condition, an in-flask titer of 2.1 g L-1 and a maximal cumulative titer of 4.7 g L-1 were observed in the long-term cultivation. This thesis demonstrates different metabolic engineering strategies for producing valuable compounds in Synechocystis, exemplified with butanol, and how to enhance production systematically.
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