| 1. |
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| 2. |
- Andreae, Christina, 1969-
(författare)
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Appetite in patients with heart failure : Assessment, prevalence and related factors
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Appetite is an important component in nutrition for maintaining the food intake needed by the body. Decreased appetite is a common clinical problem in patients with heart failure. It has a negative impact on food intake and possibly on malnutrition and health outcomes. There is a lack of evidence on how to assess appetite in heart failure. Furthermore, there are knowledge gaps about factors associated with appetite and which role appetite plays for health status in heart failure. Aim: The overall aim of the thesis was to investigate appetite in patients with heart failure. Four studies were conducted with the goal to evaluate the psychometric properties of the Council on Nutrition Appetite Questionnaire (CNAQ) (I) and to explore the prevalence of decreased appetite and related factors associated with appetite in patients with heart failure (II-IV). Methods: A multicenter study was conducted in three outpatient heart failure clinics in the center of Sweden during 2009-2012. Data were collected through a baseline measurement (I-IV) and an 18-month follow-up (IV). The first study was a psychometric evaluation study (I), while the other studies had an observational cross-sectional design (II-III) and an observational prospective design (IV). One hundred and eighty-six patients diagnosed with heart failure and experiencing heart failure symptoms participated at baseline. At the 18-month follow-up study (IV), one hundred and sixteen participants from the baseline participated. Data were collected from medical records (pharmacological treatment, comorbidity, left ventricle ejection fraction, time of diagnosis), self-reported questionnaires (demographic background data, appetite, symptoms of depression, health status, sleep, self-reported physical activity), objective measurements (anthropometric assessment of body size, blood samples, six minutes’ walk test, and physical activity measured with an actigraph) and clinical assessment (New York Heart Association (NYHA) functional classification, and cognitive assessment). The main outcome variables included appetite (I, II and IV) and health status (III). Descriptive and inferential statistics were used in the studies (I-IV). Results: The majority of the participants had moderate heart failure symptoms, i.e., NYHA class II (n=114, 61%). Most of the participants were men (n=130, 70%). Mean age was 70,7 years, (SD=11,0), and mean BMI was 28.7 (SD=5.3). The CNAQ showed acceptable psychometric properties for assessing appetite in patients with heart failure (I). This thesis shows that 38% of the participants experienced an appetite level that put them at risk of weight loss (I). It was shown that factors such as biological, medical, psychological (II) and physical activity/exercise capacity (IV) are associated with appetite. Also, appetite was associated with impaired health status. However, this association was found to be moderated by symptoms of depression (III). Neither appetite nor physical activity changed during the 18-month follow-up (IV). Conclusion: Decreased appetite is a serious phenomenon that needs attention in the care of patients with heart failure. Health care professionals can now use a validated and simple appetite instrument to assess appetite in heart failure. In addition, attention should be paid to elderly patients and those who have symptoms of depression, sleep problems, impaired cognitive function and impaired physical activity, as well as to patients on suboptimal medical treatment. Higher appetite was shown to contribute to a better health status, but this was only evident in patients without symptoms of depression. Therefore, special attention should be paid to symptoms of depression, as this risk factor affected the association between appetite and health status. This thesis enhances the understanding of the magnitude of the problem with decreased appetite in heart failure both in numbers and factors. New priorities in nutrition care and new ideas can be established, both in practice and in research, in order to improve a nutrition care that is vital for patients with heart failure.
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| 3. |
- Gyllén, Jenny, 1968, et al.
(författare)
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Important sources of information to support self-management for families of children with pediatric cataracts – based on PECARE Sweden/Sahlgrenska University Hospital
- 2015
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Ingår i: International Journal of Ophthalmic Practice. - : Mark Allen Group. - 2044-5504 .- 2052-2851. ; 6:1, s. 23-29
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Tidskriftsartikel (refereegranskat)abstract
- ABSTRACT Purpose The aim of this study was to improve treatment concordance by investigating important sources of information on self-management for families of children with pediatric cataracts, from the perspective of parents and ophthalmologists. Methods This mixed-method study involved a deductive approach using a questionnaire administered to 69 families of children operated on and registered with the Swedish Pediatric Cataract Register (PECARE Sweden) in southern Sweden, as well as 30 pediatric ophthalmologists who monitored the patients upon their return to the local health care facility. An inductive approach was applied using analysis of open-ended questions about self-management. Both groups were asked about their perception of the value of strategies for providing information, and the timing of this. Results The response rate was 68% for families and 93% for ophthalmologists. Both groups agreed that ophthalmology visits were the most important source of information, followed by information in writing and online. Parents of children diagnosed before the age of 3 months were more likely to prefer written information. Content analysis revealed that a person-centred care is important. Conclusion Parents, particularly of the youngest children, requested more and directed information. By promoting self-management, a person-centred care may play a decisive role in treatment outcome.
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| 4. |
- Göras, Camilla, 1969-
(författare)
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Open the door to complexity : Safety climate and work processes in the operating room
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- A complex adaptive system such as the operating room (OR), consists of different safety cultures, sub-cultures and ways of working. When measuring, a strong safety climate has been associated with lower rates of surgical complications. Teamwork is an important factor of safety climate. Discrepancies among professionals’ perceptions of teamwork climate exists. Hence it seems crucial to explore if diversity exists in the perception of factors related to safety climate and between managers and front-line staff in the OR. Complex work processes including multitasking and interruptions are other challenges with potential effect on patient safety. However, multitasking and interruptions may have positive impact on patient safety, but are not well understood in clinical work. Despite challenges a lot of things go well in the OR. Thus, the overall aim of this thesis was to evaluate an instrument for assessing safety climate, to describe and compare perceptions of safety climate, and to explore the complexity of work processes in the OR.To evaluate the Safety Attitudes Questionnaire-operating room (SAQ-OR) version and elicit estimations of the surgical team a cross-sectional study design was used. How work was done was studied by observations using the Work Observation Method by Activity Timing and by group interviews with OR professionals.The results show that the SAQ-OR is a relatively acceptable instrument to assess perceptions of safety climate within Swedish ORs. OR professionals´ perceptions of safety climate showed variations and some weak areas which cohered fairly well with managers' estimations. Work in the OR was found to be complex and consisting of multiple tasks where communication was most frequent. Multitasking and interruptions, mostly followed by communication, were common. This reflects interactions and adaptations common for a complex adaptive system. Managing complexity and creating safe care in the OR was described as a process of planning and preparing for the expected and preparedness to be able to adapt to the unexpected.
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| 5. |
- Andersson, Thomas, et al.
(författare)
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Health is belonging: Lived experiences during recovery after pancreaticoduodenectomy.
- 2012
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Ingår i: ISRN nursing. - : Hindawi Limited. - 2090-5483 .- 2090-5491. ; :Article ID 602323
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to explore the lived experience of the symptoms, health, and illness reported by patients recovering after pancreaticoduodenectomy ad modum Whipple due to pancreatic or periampullary cancer. Thirteen patients with pancreatic or periampullary cancer who underwent pancreaticoduodenectomy ad modum Whipple between 2006 and 2008 were interviewed during postoperative recovery. Data were analysed using the phenomenological-hermeneutic method. The structural analysis of patient experiences revealed that recovery after pancreaticoduodenectomy was described as recapturing everyday life, being healthy, and looking to the future. Participants experienced symptoms but did not dwell on them, instead they stated that their general health was good. They strived to regain their former precancer selves and be a part of as well as contribute to the social context. Overall, the participants’ view of the future was positive, and improvement in their health generated further confidence and encouragement. This study suggests that persons recovering from pancreaticoduodenectomy ad modum Whipple due to a pancreatic or periampullary tumour experience health despite postoperative symptoms. They manage their symptoms by means of different strategies and express a positive view of the future. Nurses working with such patients should adopt a person-centred approach focusing on patient perspectives, participation, and possibilities.
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| 6. |
- Bjerså, Kristofer, et al.
(författare)
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Perceptions of complementary therapies among Swedish registered professions in surgical care.
- 2011
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Ingår i: Complementary therapies in clinical practice. - London, UK : Elsevier BV. - 1873-6947 .- 1744-3881. ; 17:1, s. 44-9
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Tidskriftsartikel (refereegranskat)abstract
- There is increasing interest in complementary and alternative medicine (CAM) among healthcare professions. However, no studies have been conducted in Sweden or in a surgical context. The aim of this study is to describe different perceptions of complementary therapies among registered healthcare professions in Swedish surgical care. Sixteen interviews were conducted with registered physicians, nurses, physiotherapists and clinical dieticians at a Swedish university hospital. Analysis was made with a phenomenographic research approach. The findings showed variations in perceptions of the definition of complementary therapies. A constructive approach toward use was observed, but there was a conflict in matters of indications and contraindications, and also criticism over a lack of knowledge. There was seen to be a need for education to be able to act professionally. Scepticism over high costs of treatment was highlighted. In conclusion, a need for policies on management, education and research in the field of CAM should be addressed.
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| 7. |
- Engström, My, 1977, et al.
(författare)
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The meaning of awaiting bariatric surgery due to morbid obesity.
- 2011
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Ingår i: The open nursing journal. - : Bentham Science Publishers Ltd.. - 1874-4346. ; 5, s. 1-8
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Tidskriftsartikel (refereegranskat)abstract
- The understanding of the association between the objective conditions of health and the subjective perceptions of morbidly obese patients appears to be poor. The use of objective indicators alone produces results totally unrelated to the feelings and experiences of the bariatric patients studied. No study has approached the bariatric patient from both an inside and a preoperative perspective.
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| 8. |
- Engström, My, 1977, et al.
(författare)
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Wishing for deburdening through a sustainable control after bariatric surgery.
- 2011
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Ingår i: International journal of qualitative studies on health and well-being. - : Informa UK Limited. - 1748-2631. ; 6:1
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was an in-depth investigation of the change process experienced by patients undergoing bariatric surgery. A prospective interview study was performed prior to as well as 1 and 2 years after surgery. Data analyses of the transcribed interviews were performed by means of the Grounded Theory method. A core category was identified: Wishing for deburdening through a sustainable control over eating and weight, comprising three related categories: hoping for deburdening and control through surgery, feeling deburdened and practising control through physical restriction, and feeling deburdened and trying to maintain control by own willpower. Before surgery, the participants experienced little or no control in relation to food and eating and hoped that the bariatric procedure would be the first brick in the building of a foundation that would lead to control in this area. The control thus achieved in turn affected the participants' relationship to themselves, their roles in society, and the family as well as to health care. One year after surgery they reported established routines regarding eating as well as higher self-esteem due to weight loss. In family and society they set limits and in relation to health care staff they felt their concern and reported satisfaction with the surgery. After 2 years, fear of weight gain resurfaced and their self-image was modified to be more realistic. They were no longer totally self-confident about their condition, but realised that maintaining control was a matter of struggle to obtaining a foundation of sustainable control. Between 1 and 2 years after surgery, the physical control mechanism over eating habits started to more or less fade for all participants. An implication is that when this occurs, health care professionals need to provide interventions that help to maintain the weight loss in order to achieve a good long-term outcome.
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| 9. |
- Flodén, Anne, 1957, et al.
(författare)
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A phenomenographic study of ICU-nurses' perceptions of and attitudes to organ donation and care of potential donors.
- 2009
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Ingår i: Intensive & critical care nursing : the official journal of the British Association of Critical Care Nurses. - : Elsevier BV. - 1532-4036. ; 25:6, s. 306-13
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Tidskriftsartikel (refereegranskat)abstract
- There is a lack of organs for transplantation and the number of potential organ donors is limited. Several studies indicate that the most crucial factor is the attitude to organ donation among intensive care staff. The aim of this study was to describe intensive and critical care nurses' (ICU-nurses) perceptions of organ donation based on their experience of caring for potential organ donors. A phenomenographic method was chosen. Nine nurses from three different Swedish hospitals were interviewed. All were women; aged 36-53 years, with 3-27 years' ICU experience. The analysis revealed the crucial perception "nothing must go wrong". The findings can be described in three parts: organ donation as a situation, organ donation as a phenomenon and different attitudes to organ donation. In conclusion: various perceptions adopted by ICU nurses might influence the chances of a potential donor becoming an actual donor. This study demonstrates that nurses who promote organ donation strive to fulfil the will of the potential donor by taking responsibility for the perception that "nothing must go wrong".
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| 10. |
- Flodén, Anne, 1957, et al.
(författare)
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Attitudes to organ donation among Swedish ICU nurses.
- 2011
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Ingår i: Journal of clinical nursing. - : Wiley. - 1365-2702 .- 0962-1067. ; 20:21-22, s. 3183-95
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Tidskriftsartikel (refereegranskat)abstract
- To present data on Swedish ICU nurses' attitudes to brain death and organ donation and to test a questionnaire designed to explore these issues in terms of validity and reliability.
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| 11. |
- Flodén, Anne, 1957, et al.
(författare)
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Development and Psychometric Evaluation of the Instrument: Attitudes Towards Organ Donor Advocacy Scale (ATODAS).
- 2011
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Ingår i: The open nursing journal. - : Bentham Science Publishers Ltd.. - 1874-4346. ; 5, s. 65-73
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Tidskriftsartikel (refereegranskat)abstract
- The consequences of advocacy in nursing are critical when caring for a potential organ donor. No specific instrument has been available to measure attitudes toward organ donor advocacy. The aim of this study was to develop and psychometrically evaluate an instrument for measuring intensive and critical care (ICU) nurses' attitudes toward organ donor advocacy. The study was conducted in two stages: instrument development and instrument evaluation and refinement. A questionnaire was developed (Attitude Toward Organ Donor Advocacy Scale (ATODAS)), which was sent to half of all nurses working in ICUs (general-, neuro-, thoracic- or paediatric-) in Sweden (n=1180). The final response rate was 42.5% (n=502). In order to explore validity and reliability, the expected scale dimensionality of the questionnaire was examined both by explorative principal component analysis (with oblique, varimax rotation) and by confirmatory multi-trait analysis. The confirmatory factor analysis indicated that the ATODAS could best be explained by five factors; Attitudes toward championing organ donation at a structural hospital level; Attitudes toward championing organ donation at a political and research level; Attitudes toward actively and personally safeguarding the will and wishes of the potential organ donor, Attitudes toward safeguarding the potential donor's will and wishes by a professional approach and Attitudes toward safeguarding the will and wishes of the relatives. This initial testing indicated that the ATODAS has good psychometric properties and can be used in future research to explore if interventions may influence attitudes and behaviors related to organ donor advocacy.
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| 12. |
- Flodén, Anne, 1957, et al.
(författare)
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ICU nurses perceptions of responsibilities and organisation in relation to organ donation - A phenomenographic study
- 2011
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Ingår i: Intensive and Critical Care Nursing. - : Elsevier BV. - 0964-3397. ; 27:6, s. 305-316
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: According to the Istanbul declaration, health services should create better routines for identifying potential donors. A previous study involving 702 intensive and critical care (ICU) nurses revealed that only 48% trusted clinical diagnosis of brain death without a confirmatory cerebral angiography. The aim was to study ICU nurses' perceptions of their experiences of professional responsibilities and organisational aspects in relation to organ donation and how they understand and perceive brain death. METHODS: A phenomenographic method was chosen. Data collection (interviews) took place in Sweden and included fifteen nurses; one man and fourteen women, from six hospitals serving different geographic areas. RESULTS: The findings pertain to three domains: ICU nurses' perceptions of (1) their professional responsibility, (2) the role of the organisation regarding organ donation and (3) death and the diagnosis of brain death. CONCLUSION: The ambiguity and various perceptions of brain death diagnosis seem to be a crucial aspect when caring for a brain dead patient. The lack of structured and sufficient organisation also appears to be a limiting factor. Both these aspects are essential for the ICU nurses' opportunities to fulfil their professional responsibility during the organ donation process.
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| 13. |
- Forsberg, Anna, 1969, et al.
(författare)
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Experiencing liver transplantation: a phenomenological approach.
- 2000
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Ingår i: Journal of advanced nursing. - 0309-2402. ; 32:2, s. 327-34
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Tidskriftsartikel (refereegranskat)abstract
- In order to promote health, nurses and other health care professionals need to discover and articulate the meaning that is implicit in experiencing life after liver transplantation. From such an understanding, appropriate nursing interventions can be based. The aim of this study was to investigate the subjective experiences of the meaning of having a liver transplant, 1 year after the transplantation. After approval from the ethics committee at Goteborg University, 12 patients, nine women and three men, were interviewed. The study sample was chosen strategically to represent common diagnoses preceding liver transplantation. A phenomenological approach was chosen for the study. Analyses of the interviews were based on a modified version of a phenomenological method by Karlsson. Seven categories emerged: facing the inevitable; recapturing the body; emotional chaos; leaving the experts; family and friends; the threat of graft rejection; and honouring the donor. Having undergone a liver transplant meant living in a paradoxical situation. Knowing that you survived, it was a struggle to regain physical strength under great emotional stress. The recipients had to self-administer life-long medication, recognize symptoms indicating a potential problem and monitor for the possibility of graft rejection. Social support was essential for recovery. Meeting others with the same experience helped liver-transplanted patients to deal with their identity crises as well as undergo a transformation from being utterly unique to a survivor among others. The clinical implications from this study are that interventions, such as patient education, and social and mental support, are important tools to optimize both self-care capacity and the ability to maintain a healthy perception of identity after having a liver transplant at least up to 12 months post-transplant.
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| 14. |
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| 15. |
- Forsberg, Anna, 1969
(författare)
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Health related quality of life and coping in liver transplant recipients
- 2001
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Health related quality of life (HRQOL) and coping after liver transplantation (LTX) is the result from different factors, which are not clearly defined.Aim: The aim of this thesis was to explore health related quality of life, coping style and coping strategies before as well as after liver transplantation.Methods: Both an inductive and deductive approach has been used and the research methods were both quantitative and qualitative. The study group consisted of 1) 120 liver transplant recipients 2) 76 patients that had undergone heart-, kidney- or liver transplantation 3) 12 patients liver transplant recipients surviving 12 months and 4) 21 liver transplant recipients. The instruments used for data collection were SF-36, HAD-scale, the Pain-O-Meter, the Jalowiec Coping Scale (JCS-40) and Sense of Coherence-scale. Data were collected 1996-1999. Analysis of the data was performed mainly by descriptive and non-parametrical statistic methods (Mann-Whitney U, Kruskal-Wallis, Monotonic Agreement) and by qualitive phenomenological method according to Karlsson.Results: The results showed that liver transplant recipients reported HRQOL equal to a Swedish normative sample in the area of social functioning and mental health. However physical functioning was impaired many years after LTX. There were a significant difference in HRQOL between employed/students and patients on disability pension, retired or unemployed. Pain was a strong obstacle to reach HRQOL. Pain was prevalent after liver- and kidney transplantation as well as in the heart transplant group in patients with good graft function. The most common pain locations were hands, feet and back with often more than one pain location. It limited physical function, vitality and general health. There was a positive relationship between number of rejections and total pain intensity score. The patients experienced LTX as a process of adaptation from "facing the inevitable" to "honouring the donor". After LTX the patients were supposed to recapture a broken body and handle various stages of emotional chaos. To leave the experts were considered to be stressful and family and friends were important support. The meaning of LTX was to live by the threat of rejection and trying to find an identity beyond the results of the liver tests. In a longitudinal perspective confrontative coping were the most common coping strategy. The sense of meaning changed individually during the first 3 postoperative months as well as 6-12 months after surgery. During the second half postoperative year sense of comprehensibility changed at an individual level as well as the ability to confront stressful events. Conclusion: The overall HRQOL was good after liver transplantation, with a low prevalence of anxiety and depression. Pain was a common problem among patients with good graft function. The meaning of liver transplantation was a process of adaptation and finding an identity beyond the results of the liver tests. Confrontative coping was the most common strategy used in this group. Structured pain assessment, patient education and psychosocial support programme are important interventions to meet the results in this thesis.
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| 16. |
- Forsberg, Anna, 1969, et al.
(författare)
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Liver transplant recipients' ability to cope during the first 12 months after transplantation--a prospective study.
- 2002
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Ingår i: Scandinavian journal of caring sciences. - 0283-9318 .- 1471-6712. ; 16:4, s. 345-52
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Tidskriftsartikel (refereegranskat)abstract
- Little is known about the coping style and coping strategies among liver transplant recipients. The aim of this study was to evaluate the change in the sense of coherence and coping strategies among liver transplant recipients before and during the first year after liver transplantation. The aim was also to study whether or not there was any relationship between the sense of coherence and the coping strategies. Thirty-five patients met the inclusion criteria. Twenty-six-patients gave their verbal consent to participate in this longitudinal study and 21 patients (80%) completed the follow-up study. The Sense of Coherence scale (SOC) was used for investigation of coping style. The Jalowiec Coping Scale (JCS-40) was used to assess general coping behaviour. The Ethics Committee gave approval to perform this study. The group was heterogeneous regarding the change in the sense of coherence with pronounced individual changes in meaningfulness during the first 3 months and in comprehensibility 6-12 months after liver transplantation. The group showed a homogeneous pattern of change in coping strategies. Confrontational coping strategy was commonly used during the period. A relationship was found between comprehensibility and palliative coping. This prospective study indicated that coping style, assessed by the SOC scale, changed primarily at an individual level during the first year after liver transplantation while changes in coping strategies, according to JSC-40, were in common for the group. The usual coping strategy during the first posttransplant year was confrontational coping.
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| 17. |
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| 18. |
- Forsberg, Anna, 1969, et al.
(författare)
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Pain and health related quality of life after heart, kidney, and liver transplantation.
- 1999
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Ingår i: Clinical transplantation. - 0902-0063. ; 13:6, s. 453-60
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Tidskriftsartikel (refereegranskat)abstract
- No study has focused particularly on the sensory and affective experience of bodily pain among transplanted patients. The aim of this study was to explore pain and other factors that influence health related quality of life (HRQOL) in heart, kidney, and liver transplant recipients during the first 2 yr after transplantation, and to define similarities and/or differences in the three groups. A total of 76 patients, 18-60 yr old, undergoing heart, kidney, or liver transplantation between 1995 and 1997 with a follow-up of 6-24 months were included. HRQOL and pain were investigated by using the Short-Form-36 items (SF-36), the Hospital Anxiety and Depression Scale (HAD), and the Pain-O-Meter (POM). Overall, the patients show satisfactory HRQOL. There were no differences in experienced HRQOL 6 24 months after transplantation between kidney, liver, and heart transplant recipients except in the area of Role-Physical (RP). Fifty-three percent of all patients reported bodily pain. The most common locations were the hands, feet, and back, and sensory experiences were burning, stabbing, or dull pain. There was a correlation between number of rejections and total score for POM-VAS (p < 0.05) (rho = 0.47). There was also a correlation between the number of rejection episodes and the total pain intensity score for POM-WDS (p < 0.05) (rho = 0.48). Patients with pain scored higher in the area of depression (p < 0.05). Bodily pain is an important problem after organ transplantation, affecting daily living even in patients with good allograft function and it limits physical function. vitality, and general health.
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| 19. |
- Forsberg, Anna, 1969, et al.
(författare)
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The core of social function after solid organ transplantation.
- 2016
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Ingår i: Scandinavian journal of caring sciences. - : Wiley. - 1471-6712 .- 0283-9318. ; 30:3, s. 458-65
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Tidskriftsartikel (refereegranskat)abstract
- Background Social function is a key aspect of health‐related quality of life after solid organ transplantation (SOT). The focus of this study was to report how solid organ‐transplanted patients change their social function after transplantation. Aim To investigate the main concerns associated with social function after SOT and how solid organ transplant recipients (SOTRs) deal with these concerns. Method Twenty SOTRs, 13 men and 7 women, with a mean age of 54 years (range 22–75 years) and due for their first‐year follow‐up were included in this study. The informants had received various types of solid organs. Data were collected through in‐depth interviews, which were recorded and transcribed verbatim for analysis by the method of grounded theory (GT) developed by Charmaz. Result The GT of this study describes the efforts by the 20 SOTRs to adapt socially in order to maintain their social functioning and leading a normal life. The efforts summaries a process wherein the generated GT is present through three main categories: deconstruction, restriction and reconstruction, showing various ways to socially adapt. Through this process, a clear path of transition through adaptation is evident, starting before transplantation and continues beyond the first year after transplantation. Conclusion Social functions improved through a process of adaptation during the first year after transplantation. Working and travelling were the two most important aspects of social function. All the informants emphasised the importance of regaining a normal life, which was the outcome of a successful adaptation.
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| 20. |
- Forsberg, Anna, 1969, et al.
(författare)
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The essence of living parental liver donation--donors' lived experiences of donation to their children.
- 2004
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Ingår i: Pediatric transplantation. - : Wiley. - 1397-3142 .- 1399-3046. ; 8:4, s. 372-80
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Tidskriftsartikel (refereegranskat)abstract
- The use of living parental liver donors will continue and probably increase because of lack of cadaveric livers for paediatric transplantation and the excellent graft survival of parental livers. Therefore, it is important for the health care professionals involved in living parental liver donation to understand the experience of being a liver donor. The aim of this study was to investigate the expressed deeper feelings of parents who donated a part of their liver to their own child. The study took the form of in-depth interviews with 11 donors. All donors were biological parents of the recipient, nine fathers and two mothers. The interpretive phenomenology method was used, and interpretive analysis was carried out in three interrelated processes in line with Benner. Data collection was guided by the researcher's preliminary understanding of the donor experience from being involved in the surgery and care of the donors as well as the paediatric recipients. However, the research question was approached from the perspective of holistic care for the donor. In this study, the essence of living parental liver donation was found to be the struggle for holistic confirmation. There were three categories leading to this central theme; the total lack of choice, facing the fear of death and the transition from health to illness. There was total agreement among the respondents that there is no choice when it comes to the question of donation. The findings in this study stress the importance of organizing the parental liver donation programme with as much focus on the donor as on the child. Based on the results of this study, several clinical implications are suggested for the formation of guidelines for living parental liver donation.
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| 21. |
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| 22. |
- Fridh, Isabell, 1954, et al.
(författare)
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Close relatives' experiences of caring and of the physical environment when a loved one dies in an ICU.
- 2009
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Ingår i: Intensive & critical care nursing : the official journal of the British Association of Critical Care Nurses. - : Elsevier BV. - 1532-4036 .- 0964-3397. ; 25:3, s. 111-9
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Tidskriftsartikel (refereegranskat)abstract
- AIM: The aim of this study was to explore close relatives' experiences of caring and the physical environment when a loved one dies in an intensive care unit (ICU). METHOD: Interviews were conducted with 17 close relatives of 15 patients who had died in three adult ICUs. The interviews were analysed using a phenomenological-hermeneutic method. FINDINGS: The analysis resulted in seven themes; Being confronted with the threat of loss, Maintaining a vigil, Trusting the care, Adapting and trying to understand, Facing death, The need for privacy and togetherness and Experiencing reconciliation. The experience of a caring relationship was central, which meant that the carers piloted the close relatives past the hidden reefs and through the dark waters of the strange environment, unfamiliar technology, distressing information and waiting characterised by uncertainty. Not being piloted meant not being invited to enter into a caring relationship, not being allowed access to the dying loved one and not being assisted in interpreting information. CONCLUSION: The participants showed forbearance with the ICU-environment. Their dying loved one's serious condition and his or her dependence on the medical-technical equipment were experienced as more frightening than the equipment as such. Returning for a follow-up-visit provided an opportunity for reconciliation and relief from guilt.
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| 23. |
- Fridh, Isabell, 1954, et al.
(författare)
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Doing one's utmost: nurses' descriptions of caring for dying patients in an intensive care environment.
- 2009
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Ingår i: Intensive & critical care nursing : the official journal of the British Association of Critical Care Nurses. - : Elsevier BV. - 1532-4036 .- 0964-3397. ; 25:5, s. 233-41
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Tidskriftsartikel (refereegranskat)abstract
- AIM: The aim of this study was to explore nurses' experiences and perceptions of caring for dying patients in an intensive care unit (ICU) with focus on unaccompanied patients, the proximity of family members and environmental aspects. METHOD: Interviews were conducted with nine experienced ICU nurses. A qualitative descriptive approach was employed. The analysis was performed by means of conventional content analysis [Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res 2005;15:1277-88] following the steps described by e.g. Elo and Kyngas [Elo S, Kyngas H. The qualitative content analysis process. J Adv Nurs 2008;62:107-15]. FINDINGS: The analysis resulted in a main category; Doing one's utmost, described by four generic categories and 15 sub-categories, comprising a common vision of the patients' last hours and dying process. This description was dominated by the nurses' endeavour to provide dignified end-of-life care (EOLC) and, when relatives were present, to give them an enduring memory of their loved one's death as a calm and dignified event despite his/her previous suffering and death in a high-technological environment. CONCLUSION: This study contributes new knowledge about what ICU nurses focus on when providing EOLC to unaccompanied patients but also to those whose relatives were present. Nurses' EOLC was mainly described as their relationship and interaction with the dying patient's relatives, while patients who died alone were considered tragic but left a lesser impression in the nurses' memory.
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| 24. |
- Fridh, Isabell, 1954, et al.
(författare)
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End-of-life care in intensive care units: family routines and environmental factors.
- 2007
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Ingår i: Scandinavian journal of caring sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 21:1, s. 25-31
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this study was to describe family care routines and to explore environmental factors when patients die in Swedish intensive care units (ICUs). The main research questions were: what are the physical environmental circumstances and facilities when caring for patients in end-of-life and are there any routines or guidelines when caring for dying patients and their families? A questionnaire was sent to 79 eligible Swedish ICUs in December 2003, addressed to the unit managers. The response rate was 94% (n = 74 units). The findings show that, despite recommendations highlighting the importance of privacy for dying ICU patients and their families, only 11% of the respondents stated that patients never died in shared rooms in their ICU. If a patient dies in a shared room, nurses strive to ensure a dignified goodbye by moving the body to an empty room or to one specially designated for this purpose. The majority (76%) of the units had waiting rooms within the ICU. The study also revealed that there is a need for improvements in the follow-up routines for bereaved families. Many units reported (51%) that they often or almost always offer a follow-up visit, although in most cases the bereaved family had to initiate the follow-up by contacting the ICU. Guidelines in the area of end-of-life care were used by 25% of the ICUs. Further research is necessary to acquire a deeper knowledge of the circumstances under which patients die in ICUs and what impact the ICU environment has on bereaved families.
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| 25. |
- Fridh, Isabell, 1954, et al.
(författare)
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Family presence and environmental factors at the time of a patient's death in an ICU.
- 2007
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Ingår i: Acta anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 51:4, s. 395-401
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: In an intensive care unit (ICU), privacy and proximity are reported to be important needs of dying patients and their family members. It is assumed that good communication between the ICU team and families about end-of-life decisions improves the possibilities of meeting families' needs, thus guaranteeing a dignified and peaceful death in accordance with end-of-life care guidelines. The aim of this study was to explore the circumstances under which patients die in Swedish ICUs by reporting on the presence of family and whether patients die in private or shared rooms. An additional aim was to investigate the frequency of end-of-life decisions and whether nurses and family members were informed about such decisions. METHODS: A questionnaire based on the research questions was completed when a patient died in the 10 ICUs included in the study. Data were collected on 192 deaths. RESULTS: Forty per cent of the patients died without a next of kin at the bedside and 46% of deaths occurred in a shared room. This number decreased to 37% if a family member was present. Patients without a family member at their bedside received less analgesics and sedatives. There was a significant relationship between family presence, expected death and end-of-life decisions. CONCLUSIONS: The results indicate the necessity of improving the ICU environment to promote the need for proximity and privacy for dying patients and their families. The study also highlights the risk of underestimating the needs of patients without a next of kin at their bedside at the time of death.
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| 26. |
- Granström, Therese, 1969-
(författare)
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Patient-reported and medical outcomes in patients treated for diabetic macular edema : A real-world longitudinal study
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background Diabetes mellitus can lead to complications, when the complication affects the eyes it is called retinopathy. This can affect the macula and lead to severe loss of vision, diabetic macular edema (DME). This condition has traditionally been treated with laser. However, in 2011, anti-vascular endothelial growth factor (anti-VEGF) injections in the eye were approved as a treatment for diabetic macular edema, and started to be used in eye clinics.Aim The overall aim of this thesis was to describe patient-reported outcomes and medical outcomes (PRO) in people treated for diabetic macular edema in a real-world setting in a long-time follow-up study in Sweden.Methods Participants were enrolled at two eye clinics at two county hospitals in Sweden between 2012 and 2014. Patient-reported outcomes were measured using a vision-specific questionnaire, the 25-question National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) and a generic questionnaire, the Short Form-36 Health Survey (SF-36). Completed questionnaires, medical data such as visual acuity (EDRS), macula swelling (OCT) and social background characteristics were collected before treatment start, at one-year and four-year follow up points. The data was analyzed, descriptive statistics developed and comparative analyses were performed. Interviews were performed before treatment start and were analyzed using qualitative content analysis.Results A total of 59 participants were included at baseline. The mean age was 69 years, with an equal gender distribution. At baseline, the participants scored a low general health with the vision-specific questionnaire. In total, 21 participants were interviewed, and a theme emerged of ‘being at a crossroads and a crucial phase in life with an uncertain outcome’. The participants expressed thoughts and concerns at different levels, including practical concerns about the treatment procedure and more existential thoughts about hope for improved visual acuity or fear of deterioration. The results at the one-year follow up showed that 30 patients had improved visual acuity and reported an improvement in several subscales in the NEI VFQ-25. The remaining 27 participants had no improvement in visual acuity or in the vision specific questionnaire. The four-year follow-up involved 37 people, and the result showed significant improvement in subjective near-vision activities and improved distance visual acuity.Conclusion: Before treatment, the participants reported low general health and expressed concerns about the injection treatment and their vision. One year after treatment started, the results showed significant improvement in several NEI VFQ-25 subscales, decreased macula swelling and improved visual acuity. These positive results remained at the four-year follow-up point.
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| 27. |
- Jansson, Inger, 1964-, et al.
(författare)
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Evaluation of documented nursing care plans by the use of nursing-sensitive outcome indicators
- 2010
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Ingår i: Journal of Evaluation In Clinical Practice. - Oxford : Blackwell Publishing. - 1356-1294 .- 1365-2753. ; 16:3, s. 611-618
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Rationale and aim: There is a lack of evidence that nursing care plans affect patient outcomes. The aim of the present study was to evaluate whether documented nursing care plans affect patient outcomes by the use of nursing-sensitive outcome indicators. Method: A retrospective, cross-sectional design with patients surveyed at time of discharge from two hospital units for patients with stroke and after 2-3 weeks at home. The control unit (A) did not employ care plans. The intervention unit (B) used care plans on a daily basis. Outcome was measured by 'the National Stroke Register' and the two questionnaires: 'Quality of patients' perspective' and 'Euroquol five dimensions'. Data were collected over a 5-month period (October 2007-February 2008). Results: In total, 87 patients were included in the study. Patient characteristics in the two groups at admission and the health-related quality of life 2 to 3 weeks after discharge were similar. The patients from unit B were more satisfied with individual care (P = 0.03) and participation (P = 0.007). Unit B also had a shorter length of stay (P = 0.004). Conclusions: The effects of documented care plans are difficult to evaluate from a patient perspective, as many factors can improve the outcome. However, documentation of care plans is a prerequisite for measuring the quality and outcome of the care provided. This small study indicates that documented care plans may affect patient satisfaction regarding individual care, participation and length of hospital stay.
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| 28. |
- Jansson, Inger, et al.
(författare)
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Factors and Conditions That Have an Impact in Relation to the Successful Implementation and Maintenance of Individual Care Plans
- 2011
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Ingår i: Worldviews on Evidence-Based Nursing. - Oxford : Blackwell Publishing. - 1545-102X .- 1741-6787. ; 8:2, s. 66-75
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Tidskriftsartikel (refereegranskat)abstract
- Background: The gap between what is stated in legislation about written individualized nursing care plans (ICP) and how they are used in practice is still too wide. Aim: To explore attitudes and experiences among nurses and managers in order to capture which factors and conditions impact on the successful implementation of individual care plans within hospital care, as well as the strategies that were adopted to ensure continued use. Method: The study was carried out through directed content analysis guided by the Promoting Action on Research Implementation in Health Services framework. Interviews were conducted with 15 informants on different operational and decision levels at a hospital that is well known in Sweden for its work in the ICP area. Findings: Important factors for implementation on the wards were clear instructions from the hospital management at the start of implementation as well as clear roles and mandates for those involved. The work of internal facilitators was crucial for the continuation of the process. Clinical experience was important as the long-term driving force. Implications: On the basis of the findings of this study, we argue that it is important for hospital managers to recruit leaders that focus on individual nursing care and can highlight needs and instigate change. It seems also important that the organization takes advantage of the potential of skilled facilitators.
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| 29. |
- Jansson, Inger, et al.
(författare)
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Obtaining a Foundation for Nursing Care at the Time of Patient Admission : A Grounded Theory Study
- 2009
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Ingår i: Open Nursing Journal. - Hilversum : Bentham Science Publishers. - 1874-4346. ; 3, s. 56-64
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Tidskriftsartikel (refereegranskat)abstract
- The nursing process can be viewed as a problem-solving model, but we do not know whether use of the whole process including care plans with interventions based on nursing diagnoses improves nurses' ability to carry out assessments. Therefore, the aim of this study was to illuminate and describe the assessment and decision-making process performed by nurses who formulated individual care plans including nursing diagnosis, goals and interventions or who used standardized care plans when a patient was admitted to their ward for care, and those who did not. Data collection and analysis were carried out by means of Grounded theory. Nurses were observed while assessing patients, after which they were interviewed. The main concern of all nurses was to obtain a foundation for nursing care based on four strategies; building pre-understanding, creating a caring environment, collecting information on symptoms and signs and performing an analysis from different perspectives. It appeared that the most important aspect for nurses who did not employ care plans was the medical reason for the patient's admission. The nurses who employed care plans discussed their decisions in terms of nursing problems, needs and risks. The results indicate that nurses who formulated care plans were more aware of their professional role.
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| 30. |
- Karlsson, Veronika, 1972, et al.
(författare)
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Communication when patients are conscious during respirator treatment : A hermeneutic observation study
- 2012
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Ingår i: Intensive & Critical Care Nursing. - : Elsevier. - 0964-3397 .- 1532-4036. ; 28:4, s. 197-207
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Tidskriftsartikel (refereegranskat)abstract
- Aim: The aim of this study was to observe, interpret and describe nurses' communication with conscious patients receiving mechanical ventilation treatment (MVT) in an intensive care unit(ICU), and to examine if such communication could be interpreted as caring. Design: Hermeneutic observational study inspired by the philosophy of Gadamer. Method: Nineteen patients were observed on several occasions for a total of 66 hours, when conscious during MVT. Findings: A form of caring communication was identified and interpreted as comprising seven themes: being attentive and watchful, being inclusive and involving, being connected, remaining close, being reassuring and providing security, keeping company and using humour and using a friendly approach. Communication that mediated a non-caring approach was also identified and described under two thematic headings, i.e. being neglectful and being absent. Conclusions: Caring is communicated by the caring act of ''standing-by'' the patient. Caring or non-caring is communicated in non-verbal and verbal communication, in the words used, the tone of voice and behaviour, as well as in the performance of nursing care activities.
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| 31. |
- Karlsson, Veronika, 1972, et al.
(författare)
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Health is yearning--experiences of being conscious during ventilator treatment in a critical care unit.
- 2008
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Ingår i: Intensive & critical care nursing : the official journal of the British Association of Critical Care Nurses. - Edinburgh : Elsevier BV. - 0964-3397 .- 1532-4036. ; 24:1, s. 41-50
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to investigate experiences of being conscious during ventilator treatment in the ICU from a patient perspective. Hermeneutic, phenomenological methods were used. Eight patients who had received ventilator treatment were interviewed. The time on a ventilator varied from 1 day to several months. Some patients had been more heavily sedated during the acute phase while some were only lightly sedated and others had no sedation at all. The motor activity assessment scale was used to rate the sedation level. The patients had been sufficiently conscious to communicate with the help of the alphabet board, by means of facial expression or by nodding or shaking their head. The results show that the experience of care by patients who were conscious during ventilator treatment was described under the headings of: memories, mastering the situation and individual consequences. Health in the ICU is associated with yearning. The patient undergoes different stages of yearning as part of his or her recovery process. The patient who is conscious during ventilator treatment views him/herself and his/her worth on the basis of the attitude and behaviour of the caregivers, where the value of caring consists of the holistic confirmation of individual suffering.
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| 32. |
- Karlsson, Veronika, 1972, et al.
(författare)
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Relatives' experiences of visiting a conscious, mechanically ventilated patient-A hermeneutic study.
- 2010
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Ingår i: Intensive & critical care nursing : the official journal of the British Association of Critical Care Nurses. - : Elsevier BV. - 1532-4036 .- 0964-3397. ; 26:2, s. 91-100
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: In recent years, light or no sedation has become a common approach to invasive mechanical ventilation in patients with respiratory distress. The experience of visiting a conscious patient receiving mechanical ventilation in the ICU has to our knowledge not yet been investigated. AIM: The aim of the study was to describe the meaning attributed by relatives to their experiences of meeting, seeing and communicating with a patient cared for on a mechanical ventilator while conscious. METHOD: This study used a prospective, exploratory design comprising interviews with ten relatives conducted on two occasions; in connection with their visits to a patient cared for on a ventilator while conscious and approximately a week after the end of intensive care. The data were analysed by means of hermeneutic interpretation to obtain a deeper understanding of relatives' experiences. RESULTS: Striving to achieve contact with the patient was the most important aspect of being a close relative of a patient receiving ventilator treatment while conscious and was described by four main themes: feeling ambivalent towards consciousness; feeling ambivalent towards sedation; feeling dependent on the carer and being disappointed; and suppressing own suffering and sadness. CONCLUSION: The patients' consciousness enabled the relatives to judge their condition for themselves and enter into contact. This resulted in a sense of being in control but also efforts to suppress own suffering.
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| 33. |
- Karlsson, Veronika, 1972, et al.
(författare)
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The lived experiences of adult intensive care patients who were conscious during mechanical ventilation : A phenomenological-hermeneutic study
- 2012
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Ingår i: Intensive & Critical Care Nursing. - : Elsevier. - 0964-3397 .- 1532-4036. ; 28:1, s. 6-15
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Tidskriftsartikel (refereegranskat)abstract
- Aim: The aim of this study was to illuminate the lived experience of patients who were conscious during mechanical ventilation in an intensive care unit (ICU).Method: Interviews with 12 patients assessed as being conscious during mechanical ventilation were conducted approximately one week after discharge from an ICU. The text was analyse dusing a phenomenological-hermeneutic method inspired by Ricoeur. Results: Apart from breathlessness, voicelessness was considered the worst experience. The discomfort and pain caused by the tracheal tube was considerable. A feeling of being helpless,deserted and powerless because of their serious physical condition and inability to talk prompted the patients to strive for independence and recovery and made them willing to 'flowwith' the treatment and care. Comments from the patients suggest that their suffering can be alleviated by communication, participation in care activities and companionship. Conclusion: A patient's endurance whilst conscious during mechanical ventilation seems to be facilitated by the presence of nurses, who mediate hope and belief in recovery, strengthening the patient's will to fight for recovery and survival.
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| 34. |
- Lennerling, Annette, 1963, et al.
(författare)
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Becoming a living kidney donor
- 2003
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Ingår i: Transplantation. - 0041-1337. ; 76:8, s. 1443-7
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Tidskriftsartikel (refereegranskat)abstract
- Earlier investigations of attitudes of living kidney donors have been performed in retrospect. We saw a need to investigate in depth those motives and feelings that are relevant in potential kidney donors. With a phenomenologic approach, interviews were performed with 12 potential donors. Seven categories of motives were identified: a desire to help, increased self-esteem from doing good deeds, identification with the recipient, self-benefit from the relative's improved health, mere logic, external pressure, and a feeling of moral duty. In the individual, these categories interacted to create a perception of donation being the only option. PMID: 14578765 [PubMed - indexed for MEDLINE]
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| 35. |
- Lennerling, Annette, 1963, et al.
(författare)
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Donors self-reported experiences of live kidney donation--a prospective study.
- 2012
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Ingår i: Journal of renal care. - : Wiley. - 1755-6686 .- 1755-6678. ; 38:4, s. 207-12
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Tidskriftsartikel (refereegranskat)abstract
- Many reports on living kidney donation describe rapid recovery. In our experience rehabilitation is rather slow. This study aimed to explore self-reported health status among living donors (LDs) three to four weeks and six months post-donation with a longitudinal design. In this study. LDs (n = 112) reported their physical and mental health by responding to a questionnaire before surgery, after three to four weeks and after six months. Points could range from 1 (normal) to 5 (severe trouble), total score 7-35. Age (n = 112) was 50 years (median) and 52% were females. Before surgery, the total score was 9 (7-21). After three to four weeks, the score was 15 (7-31), with a rise in all measured variables. Women noted higher score rises than men (p = 0.01). The majority showed complete recovery after six months. It is clear that professional nursing support in the recuperation period is needed. Nursing interventions should aim at preventing delay and setbacks in the donors' recovery process.
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| 36. |
- Lennerling, Annette, 1963, et al.
(författare)
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Motives for becoming a living kidney donor
- 2004
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Ingår i: Nephrology Dialysis Transplantation. - : Oxford University Press (OUP). - 0931-0509 .- 1460-2385. ; 19:6, s. 1600-5
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Recruitment of living donors represents a medical and moral responsibility. Their motives are often complex. Categories of motives and factors causing concern were identified from a previous in-depth interview study and from the literature. The aim of the present study was to evaluate these motives. METHODS: A questionnaire was sent to 207 potential kidney donors undergoing evaluation for donation in Norway and Sweden. They were asked to mark on a visual analogue scale, 0-10, the importance given to each of nine motives and five factors of concern. Questions were also asked about who took the initiative and the source of information. RESULTS: The response rate was 74%; 154 questionnaires were returned. The strongest motives to become a donor were a wish to help (median 9.3), self-benefit from the recipient's improved health (median 9.2) and identification with the recipient (median 9.1). In contrast, a sense of guilt regarding past relationships (median 0.9), pressure from others (median 0.8), a religious motive (median 0.8) and increased self-esteem (median 0.7) were rare or weak incentives for donation. There were large individual variations in the mix, particularly regarding moral duty (5.6, range 0.1-10.0). Most potential donors (64%) had taken the initiative for the assessment themselves, but in 22% it was the recipient's physician. Physicians were the dominant source of information. The potential donors expressed much more concern for the recipient than for themselves. CONCLUSIONS: Living kidney donor assessment includes an exploration of the individuals' mixed feelings. An analysis of the motive enables individualized treatment and support for non-donors.
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| 37. |
- Lennerling, Annette, 1963, et al.
(författare)
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Self-reported non-adherence and beliefs about medication in a Swedish kidney transplant population.
- 2012
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Ingår i: The open nursing journal. - : Bentham Science Publishers Ltd.. - 1874-4346. ; 6, s. 41-6
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Tidskriftsartikel (refereegranskat)abstract
- Patients' non-adherence to immunosuppressant treatment after organ transplantation may lead to organ failure, graft loss and death. Non-adherence among Swedish kidney transplant recipients has not previously been studied. Hence the aim of this study was to explore non-adherence among Swedish kidney transplant recipients by using self-report instruments as well as testing the hypothesis that there is a difference in self-reported symptoms, beliefs about medicine and social support between respondents with or without self reported non-adherence.
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| 38. |
- Lillienberg, Linnea, 1942, et al.
(författare)
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Occupational Exposure and New-onset Asthma in a Population-based Study in Northern Europe (RHINE)
- 2013
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Ingår i: Annals of Occupational Hygiene. - Oxford : Oxford University Press (OUP). - 0003-4878 .- 1475-3162. ; 57:4, s. 482-492
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Tidskriftsartikel (refereegranskat)abstract
- In a large population-based study among adults in northern Europe the relation between occupational exposure and new-onset asthma was studied. The study comprised 13 284 subjects born between 1945 and 1973, who answered a questionnaire 19891992 and again 19992001. Asthma was defined as Asthma diagnosed by a physician with reported year of diagnose. Hazard ratios (HR), for new-onset adult asthma during 19802000, were calculated using a modified job-exposure matrix as well as high-risk occupations in Cox regression models. The analyses were made separately for men and women and were also stratified for atopy. During the observation period there were 429 subjects with new-onset asthma with an asthma incidence of 1.3 cases per 1000 person-years for men and 2.4 for women. A significant increase in new-onset asthma was seen for men exposed to plant-associated antigens (HR 3.6; 95% CI [confidence interval] 1.49.0), epoxy (HR 2.4; 95% CI 1.34.5), diisocyanates (HR 2.1; 95% CI 1.23.7) and accidental peak exposures to irritants (HR 2.4; 95% CI 1.34.7). Both men and women exposed to cleaning agents had an increased asthma risk. When stratifying for atopy an increased asthma risk were seen in non-atopic men exposed to acrylates (HR 3.3; 95% CI 1.47.5), epoxy compounds (HR 3.6; 95% CI 1.67.9), diisocyanates and accidental peak exposures to irritants (HR 3.0; 95% CI 1.27.2). Population attributable risk for occupational asthma was 14% for men and 7% for women. This population-based study showed that men exposed to epoxy, diisocyanates and acrylates had an increased risk of new-onset asthma. Non-atopics seemed to be at higher risk than atopics, except for exposure to high molecular weight agents. Increased asthma risks among cleaners, spray painters, plumbers, and hairdressers were confirmed.
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| 39. |
- Nilsson, Madeleine, 1964, et al.
(författare)
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Perceptions of experiences of graft rejection among organ transplant recipients striving to control the uncontrollable.
- 2008
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Ingår i: Journal of clinical nursing. - : Wiley. - 1365-2702 .- 0962-1067. ; 17:18, s. 2408-17
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To investigate perceptions of graft rejection and different methods to obtain knowledge about graft rejection among adult organ transplant recipients. BACKGROUND: Rejection is the most common cause of graft loss and graft dysfunction in clinical transplantation. Little is known about the recipients' own explanation models related to graft rejection. DESIGN: Phenomenography. METHOD: A strategic selection included patients who had undergone a kidney, liver, heart or lung transplant. Sixteen patients, six males and 10 females, aged 21-63 years with a follow-up time of between three months and 10 years were interviewed. RESULTS: The result comprised five domains of variations in perceptions of graft rejection: the abstract threat to life; the concrete threat to health; trust in the body; striving to control the threat; and one's identity. The inner perspective and personal explanation models involved threat, fear, trust, control and identity adjustment. Different approaches had the same purpose; 'striving to control the uncontrollable'. CONCLUSION: Learning about graft rejection revealed security, lack of security and uncertainty. RELEVANCE TO CLINICAL PRACTICE: The inner perspective of graft rejection in this result leads to several clinical implications in terms of patient education and recipients' differing ways of obtaining knowledge about graft rejection. We suggest that patient's education should be tailored in a different way, offering support and advice in line with their personal models of explanation of graft rejection as a complement to the explanation from the biomedical model of disease.
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| 40. |
- Nilsson, Madeleine, et al.
(författare)
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The perceived threat of the risk for graft rejection and health-related quality of life among organ transplant recipients
- 2011
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Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 20:1-2, s. 274-282
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Tidskriftsartikel (refereegranskat)abstract
- Aims. This study was primarily aimed for developing and testing a valid and reliable instrument that measures perceived threat of the risk for graft rejection after organ transplantation. A second aim was to report descriptive data regarding graft rejection and Health-Related Quality of Life. Background. The most serious risk connected with transplantations besides infection is graft rejection. Design. Non experimental, descriptive involving instrument development and psychometric assessment. Method. Questionnaires about perceived threat of the risk for graft rejection and Health-Related Quality of Life were mailed to 229 OTRs between 19-65 years old. The items were formed from a previous interview study. Patients were transplanted with a kidney, a liver or a heart and/or a lung. All patients with follow-up time of one year +/- three months and three years +/- three months were included. Results. With an 81% response rate, the study comprised of 185 OTRs, who had received either a kidney (n = 117), a liver (n = 39) or heart or lung (n = 29). Three homogenous factors of perceived threat for graft rejection were revealed, labelled 'intrusive anxiety', 'graft-related threat' and 'lack of control'. Tests of internal consistency showed good item-scale convergent and discriminatory validity. A majority of the OTRs scored low levels for 'intrusive anxiety'. The kidney transplant recipients experienced more 'graft-related threat' by acute graft rejection than those transplanted with a liver, heart or lung. Conclusion. In conclusion, this study suggests that it is possible to measure the perceived threat of the risk for graft rejection in three homogenous factors. Relevance to clinical practice. The instrument perceived threat of the risk for graft rejection, might be usable to measure the impact of fear of graft rejection, to predict needs of pedagogical intervention strategies to reduce fear and to improve Health-Related Quality of Life related to graft rejection.
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