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- Markström, Ida, 1978-
(författare)
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On skin preparation : The Operating Room Nurse Perspective
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Surgical site infections (SSIs) present severe risks to patients undergoing surgery, causing suffering, health complications, and financial burdens to society. Orthopaedic patients, especially those undergoing joint procedures, are particularly vulnerable to SSIs due to the use of implants. Preventing SSIs involves collaborative efforts among healthcare teams and includes skin preparation to reduce bacterial colonisation. Effective and patient-safe skin preparation is an important part of the preventive work. Internationally, there are variations in the responsibility for infection control and skin preparation in the operating room (OR). Swedish OR nurses are uniquely educated in infection prevention and hold responsibility for the prevention of SSIs during the perioperative phase. For patient safety it is important to investigate skin preparation from the perspective of OR nurses. This thesis investigate and compares skin preparation practices used by OR nurses from various perspectives, which may identify vulnerabilities in practices and contribute to enhanced patient safety. Aim: The overall aim of this thesis was to investigate and compare skin preparation practices as performed by OR nurses to decrease bacterial colonisation and prevent SSIs. Methods: Four studies with varying designs were conducted. A cross-sectional survey investigated the prevalence, utilization patterns and knowledge of different skin preparation methods. A focus group study, guided by Kreuger & Casey's principles, explored skin preparation practices from the perspective of OR nurses. An integrative review synthesized existing research on SSI prevention prerequisites as seen by OR nurses. Finally, a randomized controlled study compared the efficacy of two skin preparation methods for cleaning and disinfecting around sutured wounds. Results: The main findings of this thesis address skin preparation in the perioperative phase at both fundamental and operational levels. On the operational level, the results reveal practices with variations and deviations from manufacturers' recommendations and existing scientific evidence, influenced by fundamental factors such as evidence, demands, traditions, routines, authorities' preferences, and OR conditions. OR nurses requested more scientific evidence for skin preparation. Unfortunately, the RCT study could not contribute significant results for cleaning/disinfection around sutured wounds. The OR nurse's responsibility and leadership in SSI prevention were experienced as essential aspects of the profession, although this responsibility was not fully respected by the other OR team members. Adequate resources were considered important for SSI prevention, including sufficient time for safe person-centred care, which was often perceived as lacking. Conclusions: Influential fundamental factors such as scientific evidence, traditions, OR conditions, demands, resources and hierarchy impacted skin preparation during the perioperative phase. Addressing these fundamental issues is essential to ensure evidence-based practices and enhance patient safety. Large multi-centre studies on skin preparation including local cleaning and the cleaning of sutured wounds are needed. The fundamental level affected the operational level, where findings of tradition-based care, potential low-value care, and inefficient use of resources underscore the need for further scientific evidence and de-implantation of tradition-based nursing. OR nurses must advocate for their central role in SSI prevention and use safe, evidence-based nursing practices. Improved patient safety stresses the need for respect and understanding of SSI prevention from the OR team and the management as well as ensuring the provision of adequate resources, including sufficient time for person-centred care.
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| 2. |
- Lovén Wickman, Ulrica, 1966-
(författare)
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Self-care: the way to find balance in life : development and evaluation of a self-care questionnaire for patients with inflammatory bowel disease
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Inflammatory bowel disease (IBD), ulcerative colitis (UC), and Crohn’s disease (CD) occur worldwide and are life-long chronic conditions. The symptoms, which include abdominal pain and frequent diarrhea, cause limitations in life. Thus, patients with IBD need self-care in accordance with their symptoms, their own commitment to maintaining health, and decisions on symptom management. To strengthen self-care, there is a need for a tool that assesses self-care in patients with IBD, which aims to support the patient dialogue about self-care.The overall aim of this thesis was to develop and evaluate a questionnaire for the clinical assessment of self-care, and to explore self-care in relation to disease activity and to health-related quality of life (HRQOL) in patients with IBD.Design and method: The thesis includes four studies, where studies I, II and IV were conducted in Sweden, and study III was conducted in the United States (U.S.). In study I, a descriptive design, interviews were conducted with twenty adult patients, in order to explore self-care in patients with IBD. In study II, the self-care questionnaire was developed and tested with 193 patients with IBD in Sweden. In study III, a crosssectional descriptive design, the self-care questionnaire was translated into English, and the responses of 67 patients in the U.S. were evaluated. Finally, in study IV, a cross-sectional exploratory design was used to explore self-care in relation to patient characteristics, disease activity, and HRQOL among 234 patients. For a total of 421 patients, the data was analyzed using content analysis, and descriptive and analytic statistics (studies I, II, III and IV).Results: Among patients with IBD, self-care relates to symptom recognition, handling of symptoms, planning life, and seeking new options. Self-care varied according to how the patient managed daily life with regard to the symptoms of the disease (study I). Based on the results from study I, the self-care questionnaire was developed in Swedish, resulting in a valid and reliable questionnaire comprising 22 items (study II). The questionnaire was translated to English, and performed self-care activities were associated with a lower degree of well-being in relation to age and gender (study III). The patients were taking medication for IBD, paying attention to their intestinal symptoms, adapting their diet, managing their stress, planning their day and avoiding activities (studies III and IV). Self-care was more frequent in patients with CD when it came to paying attention to psychological symptoms; diet adaption; avoiding various activities including sex; and looking for new approaches to living with IBD. A greater degree of self-care activities was associated with a lower degree of HRQOL (IV).Conclusion: The results indicate the importance of identifying the total symptom experience, and of the patient’s need to discuss self-care, in order to strengthen selfcare and achieve better treatment. The self-care questionnaire can be a useful tool to benefit the discussion of self-care for the patient, and to secure health literacy, medication adherence, and HRQOL. The valid and reliable self-care questionnaire is available for patients with IBD at gastroenterology clinics or out-patient clinics, as primary care. Disease activity affects self-care, and consequently the self-care activities.
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| 3. |
- Ahlberg, Mona, 1966-
(författare)
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Being cared for in an Intensive Care Unit – family functioning and support
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- When COVID-19 came as an uninvited guest into our everyday lives, nursing in intensive care was affected and thus the studies contain data from both before and during the COVID-19 pandemic.Before the pandemic, most intensive care units, which care for patients with critical illness in a technical setting, allowed family members to visit the patient 24 hours a day. The intensive care unit is a stressful and frightening environment for both the patient and their family. They can be affected both mentally and physically, showing symptoms such as difficulty sleeping, stress and depression. The intensive cared patient often does not remember anything from the time they were cared for in the intensive care unit, and the family needs to explain and recount this unconscious time. During the pandemic, this changed, with restrictions and limited opportunities to visit the hospital and patient due to virus outbreaks. Family members received information about the patient's medical condition by phone from a physician. The overall aim of this thesis was to explore and conceptualise the family functioning of families with a family member treated in the intensive care unit. There was also an intention to describe and evaluate how an intervention affects the family and individual family members in families where a family member received intensive care.In these studies, qualitative, quantitative, as well as mixed methods were utilised. Participants were adult intensive cared patients from seven intensive care clinics, and their families. The results examined between families are based on the patient and family characteristics. The results from study I show that families who have experienced COVID-19 and with a family member who was cared for in an intensive care unit, have existential thoughts. Study II shows no major impact on family function between families, but the answers differ within the families who experienced intensive care. In study III, concerning families experiencing intensive care and attending family health conversations, there was an awareness of family function. The conversations brought the family closer together, through improved understanding of each other. In study IV family functioning, hope and sense of coherence were com-pared among the participants in two intervention groups: Family health conversations and support group conversations. Family functioning and hope were higher in the group that participated in the family health conversations and comprehensibility, meaningfulness and vitality were higher among the participants in the support group conversation. By exploring how family function affects the individual family member and the family as a unit during critical illness and intensive care, new ways of working can be strengthened in the care of patients and their families.
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