| 1. |
- Engqvist, Inger, et al.
(författare)
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Strategies in caring for women with postpartum psychosis--an interview study with psychiatric nurses.
- 2007
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Ingår i: Journal of clinical nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 16:7, s. 1333-42
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Tidskriftsartikel (refereegranskat)abstract
- AIM AND OBJECTIVE: The aim of this study was to explore strategies in caring for women with postpartum psychosis used by nurses. BACKGROUND: The most serious type of psychiatric illness in connection with childbirth is postpartum psychosis. Nearly two in 1000 newly delivered women are stricken by postpartum psychosis. Most of these patients need psychiatric care to recover. While earlier studies point to the need for psychiatric care, knowledge of specific nursing strategies in caring for postpartum psychosis patients remains limited. METHODS: Interviews with 10 experienced psychiatric nurses were carried out, transcribed verbatim and an inductive content analysis was made. RESULT: The main strategies for care found in this study were: (i) To create a patient-nurse relationship and (ii) To apply nursing therapeutic interventions. Presence, continuity and nurse-patient partnership contributed to create a relationship and incorporate the rest of the care team. To satisfy the patients' basic needs and feeling of security was the foundation of the nursing therapeutic interventions. Confirmation and giving hope were also used as nursing therapeutics as well as information to the patient and her relatives about her illness. CONCLUSION: The conclusion of the study is that strategies used by nurses are a combination of general and psychiatric nursing approaches but the specificity in caring knowledge for caring patients with postpartum psychosis requires further development. RELEVANCE TO CLINICAL PRACTICE: The result of the study indicates that it is important to organize patient care for postpartum psychosis with continuity and consistency and to support the nurse to create a relationship and therapeutic intervention with the patient. The present study shows the importance of further developing specific nursing theories that can be applied when caring for patients with postpartum psychosis. It also shows the need for further pedagogical education for mental health nurses.
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| 2. |
- Carlsson, Christina, et al.
(författare)
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Captured voices in cancer: experiences from networking between individuals with experiential and professional knowledge.
- 2007
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Ingår i: BMC health services research. - : Springer Science and Business Media LLC. - 1472-6963. ; 7
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Patients needs and experiences attract increasing attention within health care. In order to generate knowledge about the voices that emerge from collaborative experiences between members of patient associations for cancer patients (PACP) and health care professionals (HCPs), we studied a permanent network aimed at improving cancer care through increased attention to the cancer patients' view and experiences. METHODS: Open-ended interviews were carried out with 16 individuals; 6 PACP members and 10 HCPs, and after transcription the texts were analysed by inductive content analysis. RESULTS: Four voices, which represent various experiences from networking, were identified; the hesitant voice, the enlightened voice, the liberated voice, and the representative voice. The hesitant voice reflects uncertainty experienced when the participants were exposed to different views and opinions within the network. The enlightened voice reflects new points of view and gain of knowledge. The liberated voice signifies trust, balance, and confidence related to individual experiences and responsibilities being viewed in a broader perspective. The representative voice is derived from the transformation of experiences and responsibilities through insight, understanding, and new perspectives. CONCLUSION: Networking between representatives for PACPs and HCPs may help the participants manage uncertainty, strengthen the patient's perspective and provide new views on common issues. The different voices identified in this study demonstrate that both PACP members and HCPs distanced themselves from their individual experiences in order to be perceived as unselfish and knowledgeable within the network. Although the climate was characterized by trustfulness, the members' unique positions need to be defined in order to obtain an optimal balance between the groups and prevent members' patient experiences of losing their character by learning to much from the HCPs. Increased understanding of the hesitant, the enlightened, the liberated, and the representative voices, and awareness of experiential versus professional knowledge of cancer may facilitate and probably improve future networking efforts.
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| 3. |
- Hertting, Anna, 1947, et al.
(författare)
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Downsizing and reorganization: demands, challenges and ambiguity for registered nurses
- 2004
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Ingår i: Journal of Advanced Nursing. - 1365-2648. ; 45:2, s. 145-54
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The 1990s were characterized by substantial financial cuts, and related staff redundancies and reorganizations in the Swedish health care sector. A large hospital in Sweden was selected for the study, in which downsizing had occurred between 1995 and 1997. The number of staff in the hospital was reduced by an average of 20%, and 10% were relocated to other departments. OBJECTIVE: The aims of this study were to explore registered nurses' experiences of psychosocial 'stressors' and 'motivators', and how they handled their work situations, following a period of personnel reductions and ongoing reorganization. METHOD: Interviews were undertaken with 14 nurses working in one Swedish hospital. Nurses were interviewed in 1997 about the recent and last round of redundancies, and were followed up 1 year later in 1998 and again in 2001. Interviews were audiotaped, transcribed and analysed for thematic content. RESULTS: Five themes emerged in relation to nurses' perceived stressors, motivators, and coping options: 'distrust towards the employer', 'concurrent demands and challenges', 'professional ambiguity, 'a wish for collaboration', and 'efforts to gain control'. A common feature was duality and ambiguity in nurses' descriptions of the phenomena studied, meaning that identified themes had underlying sub-themes with both negative and positive dimensions. CONCLUSIONS: The concurrence of 'ever-growing job demands' and 'work going unrewarded' contributed to a feeling of being taken advantage of by the employer. The 'waste of human resources' and 'competence drain' that followed redundancies provoked anger. Unfulfilled collaboration with doctors was a major stress producer, which related to both the downsized work organization, and the complex 'deference-dominance' doctor-nurse relationship. The well-being of nurses depends on being an equal/parallel health professional in a comprehensive team that shares knowledge and improves collaborative care of patients. A consciously formulated nursing philosophy emerged as a health-promoting resource. This study demonstrates the importance of analysing feelings relating to professional ambiguity and gaining influence in a gender-related, hierarchical environment, and the need to support professional assertiveness in relation to superiors and doctors. It is also important to stress considerations that relate to differences in the age, care philosophy, and psychosocial health conditions of nurses. PMID: 14705999 [PubMed - indexed for MEDLINE]
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| 4. |
- Hertting, Anna, 1947, et al.
(författare)
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Personnel reductions and structural changes in health care: work-life experiences of medical secretaries
- 2003
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Ingår i: Journal Psychosomatic Research. - : Elsevier BV. - 0022-3999. ; 54:2, s. 161-70
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To explore the experiential aspects of 'psychosocial stressors and motivators' for medical secretaries, following a period of personnel reductions and structural changes in Swedish health care. The focus was to understand and describe work-life experiences for this specific group of women and how they managed in what can be presumed to be a more demanding work situation. METHOD: A descriptive qualitative study with repeated in-depth interviews of six medical secretaries (mean age: 45 years) in a large hospital in Sweden. The first interview took place in the autumn of 1997 (in connection with the last round of the 20% staff redundancies), 1998 and 2000. Thematic content analysis from audiotaped and transcribed interviews was used to obtain understanding. RESULTS: The study provided three main themes from the women's perceived stressors, motivators and coping options. The descriptions of their stressors provided the metaphor, 'energy thieves' with three underlying subthemes: 'too much work,' 'lack of recognition' and 'the dilemma of health, family and finances.' Experienced motivators, labeled as 'energy givers' had two subthemes: 'professional pride' and 'the comprehensive whole.' The women's descriptions about managing increasing demands were thematized as altering between 'being submissive and taking actions' with three subthemes: 'unequal communication,' 'resigned and passive reactions' versus 'cautious and solution-oriented coping.' Expressions concerned mainly 'energy thieves,' inclusively worries about 'lacking energy' (intrinsic stressor), combined with passive and cautious coping behavior. However, the descriptions became somewhat more varied and balanced with enriching and solution oriented factors in the follow-up interviews. CONCLUSIONS: There is an evident contrast between a demanding reality of work, described by medical secretaries in this study, and their expressed desire to have a more reasonable work environment that allowed them to be able to complete their work. They also wanted to be heard regarding their requests about work options and decent salaries. This study demonstrates the importance of making feelings of inferiority and injustice visible as well as to support professional pride and more assertive coping behavior. This is also valid for the need to enhance equal/congruent communication between interdependent workers. The study has implications for managers and health workers supporting and empowering women, providing administrative service in a clinical health care context. The subthemes being identified within the metaphor 'energy thieves,' in relation to resigned/passive reactions and cautious coping styles, could be used in stress prevention, while the understanding of 'energy givers' and the support of active and solution-oriented coping conducts could be used in health promotion work. Copyright 2003 Elsevier Science Inc. PMID: 12573738 [PubMed - indexed for MEDLINE]
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| 7. |
- Kriström, Berit, et al.
(författare)
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Growth hormone (GH) dosing during catch-up growth guided by individual responsiveness decreases growth response variability in prepubertal children with GH deficiency or idiopathic short stature
- 2009
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Ingår i: Journal of Clinical Endocrinology and Metabolism. - : The Endocrine Society. - 0021-972X .- 1945-7197. ; 94:2, s. 483-490
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Tidskriftsartikel (refereegranskat)abstract
- CONTEXT: Weight-based GH dosing results in a wide variation in growth response in children with GH deficiency (GHD) or idiopathic short stature (ISS). OBJECTIVE: The hypothesis tested was whether individualized GH doses, based on variation in GH responsiveness estimated by a prediction model, reduced variability in growth response around a set height target compared with a standardized weight-based dose. SETTING: A total of 153 short prepubertal children diagnosed with isolated GHD or ISS (n = 43) and at least 1 SD score (SDS) below midparental height SDS (MPH(SDS)) were included in this 2-yr multicenter study. INTERVENTION: The children were randomized to either a standard (43 microg/kg.d) or individualized (17-100 microg/kg.d) GH dose. MAIN OUTCOME MEASURE: We measured the deviation of height(SDS) from individual MPH(SDS) (diffMPH(SDS)). The primary endpoint was the difference in the range of diffMPH(SDS) between the two groups. RESULTS: The diffMPH(SDS) range was reduced by 32% in the individualized-dose group relative to the standard-dose group (P < 0.003), whereas the mean diffMPH(SDS) was equal: -0.42 +/- 0.46 and -0.48 +/- 0.67, respectively. Gain in height(SDS) 0-2 yr was equal for the GH-deficient and ISS groups: 1.31 +/- 0.47 and 1.36 +/- 0.47, respectively, when ISS was classified on the basis of maximum GH peak on the arginine-insulin tolerance test or 24-h profile. CONCLUSION: Individualized GH doses during catch-up growth significantly reduce the proportion of unexpectedly good and poor responders around a predefined individual growth target and result in equal growth responses in children with GHD and ISS.
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| 8. |
- Nilsson, Kerstin, 1947, et al.
(författare)
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Confidence and Pride: potential predictors of occupational health in a changing hospital setting
- 2006
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Ingår i: Work, Health and Stress Conference, March 2006, Miami, Florida USA.
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Konferensbidrag (refereegranskat)abstract
- Background: This study focuses on determinants of a healthy work environment in two departments in a Swedish university hospital. The study is based on previously conducted longitudinal studies at the hospital (1994–2001), concerning working conditions and health outcomes among health care personnel in conjunction with downsizing processes. Overall, there was a general negative trend in relation to mental health, as well as long-term sick leave during the study period. The two departments chosen for the current study differed from the general hospital trend in that they showed stable health development. The aim of the study was to identify and analyse experiential determinants of healthy working conditions. Methods: Thematic open-ended interviews were carried out with seventeen managers and key informants, representing different groups of co-workers in the two departments. The interviews were transcribed verbatim and an inductive content analysis was made. Results: In the two studied departments the respondents perceived that it was advantageous to belong to a small department, and to work in cooperation-oriented care. The management approaches described by both managers and co-workers could be interpreted as transformational, due to a strain of visionary, delegating, motivating, confirmative, supportive attitudes and a strongly expressed solution-oriented attitude. The daily work included integrated learning activities. The existing organisational conditions, approaches and attitudes promoted tendencies towards a work climate characterised by trust, team spirit and professionalism. In the description of the themes organisational conditions, approaches and climate, two core determinants, work-pride and confidence, for healthy working conditions were interpreted. Our core determinants augment the well-established concepts: manageability, comprehensiveness and meaningfulness. These favourable conditions seem to function as a buffer against the general negative effects of downsizing observed elsewhere in the hospital, and in the literature. Conclusion: Research illuminating health-promoting aspects is rather unusual. This study could be seen as explorative. The themes and core dimensions we found could be used as a basis for further intervention studies in similar health-care settings. The result could also be used in future health promotion studies in larger populations. One of the first steps in such a strategy is to formulate relevant questions, and we consider that this study contributes to this.
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| 9. |
- Nilsson, Kerstin, 1948-, et al.
(författare)
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Småföretag i flerpartssamverkan : en studie av aktörer, byggstenar och fogmassa vid nätverksbyggande
- 1992
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The environment for business enterprises and other organizations is changing rapidly and profoundly. These changes generate threats as well as possibilities. The threats are especially pronounced for small enterprises since they lack the large firm's resources to stand up to increasing international competition. One way for small enterprises to deal with this situation is to co-operate with other small enterprises. By pooling resources they may be able to maintain their positions and even move forward. An Multibusiness Co-operation System, MCS, includes many autonomous enterprises and is characterized by voluntary, long-term agreements, flexibility and commitment to a joint goal.The purpose of this dissertation is to answer the questions of why an MCS is established, what it should be based on, how to keep it together and who should establish the MCS.To answer these questions we have used a research strategy which can be described as multi-methodological. While starting out with an inductive approach, the theory thus generated has allowed an element of deduction at later stages.The inductive approach was used in an Experience study and in an In-Depth study. The Experience study showed that it was possible to identify promoting and obstructing factors for forming an MCS. The study also pointed out an existing MCS to be worthy an in-depth study.This MCS had existed for 20 years and consisted of 15 small enterprises within the joinery-industry. After having interviewed all managers including those who had left the MCS, and after analysing our results through interorganizational theories, we were able to generate a theory of Multibusiness Co-operation Systems. This theory can be divided into three different phases showing an MCS's lifecycle and what is important to consider during the three phases with respect to the Environment, what Bricks to use to form an MCS, the Concrete to use to keep the bricks together and, finally, who should be the Master Builder.The generated theory has an empirical as well as a theoretical basis but in our opinion it was not yet sufficiently grounded. One way to make it more grounded was to participate in a co-operation process and to learn by acquaintance and, thus, develop the theory.At this stage our research strategy has got an element of deduction while implementing the generated theory by action research within two different groups of small enterprises. The implementation was successful in both cases showing that the theory worked and even was developed. These two cases also brought some methodological experiences. We found that the dialogue method was fruitful and that different arenas for developmental work can be used during the three different phases of an MCS's lifecycle.
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| 10. |
- Nilsson, Maria Skyvell, 1961, et al.
(författare)
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Clinical Course Content As A Dynamic Variable In Supervision Of Medical Students
- 2010
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Ingår i: The Internet Journal of Medical Education. - 2155-6725. ; 1:2
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundDuring clinical supervision, medical students are expected to gain experience through clinical work, with the support of their clinical supervisor. What each supervisor chooses to emphasize and considers important will have a decisive impact on students’ understanding of what is content necessary to master in order to gain clinical skills. Therefore, in this study, the focus of attention is on what supervisors choose to emphasise during clinical supervision of fourth year medical students during a surgical course. MethodAn ethnographic approach was used, including a selective intermittent time mode, where observation and informal interviews were conducted. Twelve supervisors and nine medical students at a teaching hospital in Sweden participated. Field notes were made during observation; these were transcribed and analysed qualitatively. ResultsThe analysis resulted in six topic areas describing what was emphasized during supervision. The topic areas were: 1) Identifying, collecting and combining information, 2) Problem-solving and decision-making, 3) Handling treatment of disease, 4) Practical skills and illustration of technical equipment, 5) Communicating with patients, and 6) Handling organisational demands.ConclusionsThe findings of this study show the existence of several areas that are focused on in supervision. In authentic clinical situations, these topic areas were intertwined and overlapped and often appeared simultaneously. The clinical situations were adjusted neither to the students’ clinical experience nor to the needs of the students. Consequently, the students may find it difficult to determine what to learn and what to achieve during supervision. They may also find it difficult to understand the situations in the same way as their supervisors, because students focus on handling situations with a more theoretical and declarative approach to a larger extent than do their supervisors. The students therefore need supervisor support to develop and integrate theoretical knowledge. One conclusion that can be made is that supervisor awareness of students’ understanding is of crucial significance for the effective supervision. Regarding the nature of the content chosen in supervised situations, research in other settings and specialties would be required to map and to determine a more general theory of what is focused during medical supervision.
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