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| 3. |
- de Vera, Jean Paul, et al.
(författare)
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EUROX (Europa Explorer): An astrobiology mission concept to the Jovian icy moon Europa.
- 2008
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Ingår i: Geophysical Research Abstracts. ; 10, EGU2008-A-01483, 2008
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- The discovery of so-called extremophiles indicates how robust life is. That microbial life can resist extreme and harsh environmental conditions as e.g. very high and cold temperatures, desiccation, acidity, salinity and wide ranges of radiation spectra including UV and X-rays, suggests that micro organisms are capable of surviving and maintaining essential living functions, or often thriving, in conditions previously thought impossible. Recently it seems that only liquid water and an energy source are the core prerequisites for the development of life, greatly expanding the range of potential habitats for life both on Earth and in the solar system. In light of these discoveries, the definition of the “Habitable Zone” as the region where liquid water can exist at a planetary surface may need revision. Energy in the form of heat may be found on several volcanic worlds in our solar system, and subsurface liquid water may exist there, too. One likely candidate for such a reserve of water is the jovian icy moon Europa. Imaged by the Voyager and Galileo probes, this icy body appears to have a geologically young outer surface. Spectroscopic studies from Earth have confirmed that the European crust is composed of water ice. Long cracks across its surface may be suggestive of huge ice blocks rafting upon an underlying liquid layer. Darker non ice material also covers much of the surface and is spatially associated with the cracks. Recent modeling suggests that tidal forces imparted upon the moon by Jupiter may cause heating in the depth – raising the possibility of a liquid water ocean beneath Europa’s icy crust. Further on it is supposed that a weak induced magnetic field is present on the moon. This classifies Europa as an object of great scientific interest, warranting investigation for habitability and even the presence of life within the supposed ocean of the moon. The Europa Explorer (EUROX) mission complements other proposed missions to study Europa. EUROX will characterize the habitability potential of Europa, with the aim of understanding whether life could exist there or not. The mission will address the following key questions: (i) existence or non- existence of a liquid ocean beneath the surface, (ii) the nature of the non icy material visible upon the surface cracks, (iii) the physical characteristics of the ice crust, (iv) effects by local radiation on the surface chemistry, (v) the depth of radiation penetration in the ice and probably shielding effects by a magnetic field and (vi) the presence of organic compounds on or in the Europan ice crust. Our proposed mission will operate as a fully European and further on international mission, with the aim of providing the initial information required for later, larger missions to visit Europa. EUROX will involve both remote-sensing and in-situ research. Its mission architecture sees a single space craft deployed to Europa, launched by an Ariane 5. This vehicle will use conventional propulsion and a Venus-Earth-Earth flight path to travel to the jovian system in six years. Upon arrival at Europa, the space craft will commence remote observations of the icy moon, to determine the physical nature of the ice crust, and to investigate the presence of a subsurface liquid ocean. The orbiter will carry two independent vehicles (two penetrators) that will then separate, de-orbit, and penetrate the crust nearby or in the cracks to a depth of several meters. A suite of compact instruments will address the physical and chemical properties of the crust, as well as seeking organic compounds and pre-biotic material in the ice. The use of a laser communication system removes the need for a relay spacecraft in orbit around Jupiter, decreasing overall mission cost. Expected orbiter mission duration is on the order of two months, with each penetrator functioning for approximately 24 hours.
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- Ingemansson, Richard, et al.
(författare)
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Clinical transplantation of initially rejected donor lungs after reconditioning ex vivo.
- 2009
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Ingår i: Annals of Thoracic Surgery. - : Elsevier BV. - 1552-6259 .- 0003-4975. ; 87:1, s. 255-260
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: A major problem in clinical lung transplantation is the shortage of donor lungs. Only about 20% of donor lungs are accepted for transplantation. A method to evaluate and recondition lungs ex vivo has been tested on donor lungs that have been rejected for transplantation. METHODS: The donor lungs were reconditioned ex vivo in an extracorporeal membrane oxygenation (ECMO) circuit with STEEN solution (Vitrolife AB, Kungsbacka, Sweden) mixed with erythrocytes. The hyperoncotic solution dehydrates edematous lung tissue. Functional evaluations were performed with deoxygenated perfusate by varying the inspired fraction of oxygen. After the reconditioning, the lungs were kept immersed at 8 degrees C in extracorporeal membrane oxygenation until transplantation was performed. RESULTS: Six of nine initially rejected donor lungs were reconditioned to acceptable function, and in six recipients, double lung transplantation was performed. Three-month survival was 100%. One patient has since died due to sepsis after 95 days, and one due to rejection after 9 months. Four recipients are alive and well without any sign of bronchiolitis obliterans syndrome 24 months after the transplantation. CONCLUSIONS: The result from the present study is promising, and we continue to transplant reconditioned lungs.
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| 5. |
- Johnsson, Anette
(författare)
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Creating and establishing a positive care relationship between nurses, patients and relatives : An ethnographic study of encounters at a department of medicine for older people
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background and aim: Numerous encounters take place in the healthcare sector every day. Although the encounters should be conducted in a safe and respectful manner, an increased number of complaints about communication and interaction have been reported to the Health and Social Care Inspectorate. When a nurse, patient and relative meet in a so-called triad encounter, the focus is on creating and establishing a care relationship with the facilitated by communication and interaction. Thus, if communication and interaction fail in these encounters there is a risk that the care relationship will be bad and the patient's needs not fulfilled, which can lead to poorly prepared patients with difficulties participating in their own care. The overall aim of this thesis was to explore and describe the care relationship, communication, content and social interaction in the triad encounter between nurses, patients and relatives at a department of medicine for older people.Methods: The four studies were designed using a qualitative, ethnographic approach guided by Vygotsky’s sociocultural and Goffman’s interactional perspective. Participatory observations (n=40) and informal field conversations (n=120) with patients, relatives and nurses were carried out (October 2015-September 2016) at the same time as field notes were written. Studies I, II and III were underpinned by an ethnographic analysis, while in study in IV, a thematic analysis with an abductive approach was conducted.Results: The result of study I, identified a process where patients, relatives and nurses used different strategies for navigating before, during and after a triad encounter. The process was based on the following categories: orienting in time and space, contributing to a care relationship and forming a new point of view. Study II, showed how nurses communicated, using four different voices which reinforced by body language, which formed patterns that constituted approaches that changed depending on the situation and orientation: a medical voice, a nursing voice, a pedagogical voice and a power voice. Study III, emphasized three categories of content of the communication exchanges: medical content focusing on the patient’s medical condition; personal content focusing on the patient’s life story; and explanatory content characterized by nurses attempting to increase the patient’s and relative’s knowledge about the patient’s health and nursing needs. Study IV showed that, to create social interaction, the nurses employed greetings, small talk and bodily expressions. Patients accepted the invitation with body language, while relatives employed various strategies to receive an invitation. Nurses led the conversation, patients followed and described their health problem through gestures, while relatives captured the moment to receive and give information. Nurses summarized using ritual language, patients expressed gratitude’s through verbal and non-verbal expressions and relatives verbally clarified the agreements. The synthesis of the four results showed a model with the four activities as puzzle pieces: navigating through different perspectives, being involved in the communication, being attentive to social interaction and explaining the relevant content. When the institutional environment is such that the asymmetry between the nurse, patient and relative is limited, and the norms and routines promote communication between them, it is more likely that the puzzle pieces fit together and an opportunity arises to create and establish a positive care relationship in the triad encounters.Conclusion: The nurses' role as a professional is crucial, as they start, lead and end the encounter. If nurses minimize the asymmetry and combine the medical, personal and pedagogical questions, an opportunity arises for creating and establishing a positive care relationship that enables the patients to become more active and relatives more visible. This can contribute to strengthening the patient’s position in the healthcare system and increasing patient safety.
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| 6. |
- Johnsson, Anette, 1963-, et al.
(författare)
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Manoeuvring between interplay and context : an ethnographic study of social interaction in encounters between registered nurses, older patients and their relatives
- 2021
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Ingår i: BMC Nursing. - : Springer Nature. - 1472-6955. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Social interactions between registered nurses, older patients and their relatives are essential and play a central role in developing a successful care relationship in healthcare encounters. How nurses interact with patients affects the patient’s well-being. Limited time and demands for efficiency influence the encounter and complaints from patients and relatives often concern social interactions. Therefore, the aim of this study was to explore the social interaction in encounters between registered nurses, older patients and their relatives at a department of medicine for older people.Methods: The study has an ethnographic approach including participatory observations (n = 21) and informal field conversations (n = 63), followed by a thematic analysis with an abductive approach reflecting Goffman’s interactional perspective.Result: The result revealed a pattern where the participants manoeuvred between interplay and context. By manoeuvring, they defined roles but also created a common social situation. Nurses led the conversation; patients followed and described their health problems, while relatives captured the moment to receive and provide information. Finally, nurses summarised the encounter using ritual language, patients expressed gratitude through verbal and non-verbal expressions, while relatives verbally confirmed the agreements.Conclusion: The social interaction between registered nurses, older patients and relatives was shaped by a pattern where the participants manoeuvred between interplay and context. When all participants assume responsibility for the social interaction, they become active and listen to each other. The approach adopted by nurses is crucial, thus training in communication and social interaction skills are important. When the asymmetry due to imbalance, is reduced, less misunderstanding and a satisfactory care relationship can be achieved.
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| 7. |
- Johnsson, Anette, 1963-, et al.
(författare)
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Scaffolding for learning and establishing a professional identity : A qualitative descriptive study of nursing students’ experiences of learning with a student-centered supervision model based on patient-oriented care during clinical placement
- 2023
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Ingår i: Nordic journal of nursing research. - : SAGE Open. - 2057-1585 .- 2057-1593. ; 43:3-4, s. 1-9
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Tidskriftsartikel (refereegranskat)abstract
- The nursing profession is close to clinical practice and vital to the student’s professional development. Innovative learning activities and models are sought to improve clinical placements. A student-centered supervision model based on patient-oriented care was introduced in a medical ward. The aim of this study was to describe nursing students’ experiences of learning with a student-centered supervision model based on patient-oriented care during their clinical placement. A qualitative descriptive study involving interviews with 12 nursing students analyzed through inductive qualitative content analysis was conducted in accordance with COREQ. The findings revealed that the nursing students viewed learning as personal, knowledge, and professional development. Their learning experiences can be seen as a process in which the scaffolding is gradually reduced in line with each student’s ability to act independently and establish a professional identity. The model can enhance structure and support in the practice setting to maximize learning.
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| 8. |
- Johnsson, Anette, 1963-, et al.
(författare)
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Striving to establish a care relationship -Mission possible or impossible? : Triad encounters between patients, relatives and nurses
- 2019
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Ingår i: Health Expectations. - : Wiley. - 1369-6513 .- 1369-7625. ; 22:6, s. 1304-1313
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: When patients, relatives and nurses meet, they form a triad that can ensure a good care relationship. However, hospital environments are often stressful and limited time can negatively affect the care relationship, thus decreasing patient satisfaction.OBJECTIVE: To explain the care relationship in triad encounters between patients, relatives and nurses at a department of medicine for older people.DESIGN: A qualitative explorative study with an ethnographic approach guided by a sociocultural perspective.METHOD: Participatory observations and informal field conversations with patients, relatives and nurses were carried out from October 2015-September 2016 and analysed together with field notes using ethnographic analysis.RESULT: The result identifies a process where patients, relatives and nurses use different strategies for navigating before, during and after a triad encounter. The process is based on the following categories: orienting in time and space, contributing to a care relationship and forming a new point of view.CONCLUSION: The result indicates that nurses, who are aware of the process and understand how to navigate between the different perspectives in triad encounters, can acknowledge both the patient's and relatives' stories, thus facilitating their ability to understand the information provided, ensure a quality care relationship and strengthen the patient's position in the health-care setting, therefore making the mission to establish a care relationship possible.
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| 9. |
- Johnsson, Anette, 1963-, et al.
(författare)
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Voices used by nurses when communicating with patients and relatives in a department of medicine for older people : An ethnographic study
- 2018
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Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 27:7-8, s. E1640-E1650
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To describe how nurses communicate with older patients and their relatives in a department of medicine for older people in western Sweden.BACKGROUND: Communication is an essential tool for nurses when working with older patients and their relatives but often patients and relatives experience shortcomings in the communication exchanges. They may not receive information or are not treated in a professional way. Good communication can facilitate the development of a positive meeting and improve the patient's health outcome.DESIGN: An ethnographic design informed by the sociocultural perspective was applied.METHOD: Forty participatory observations were conducted and analyzed during the period October 2015 to September 2016. The observations covered 135 hours of nurse-patient-relative interaction. Field notes were taken and 40 informal field conversations with nurses and 40 with patients and relatives were carried out. Semi-structured follow-up interviews were conducted with five nurses.RESULTS: In the result, it was found that nurses communicate with four different voices: a medical voice described as being incomplete, task-oriented and with a disease perspective; a nursing voice described as being confirmatory, process-oriented and with a holistic perspective; a pedagogical voice described as being contextualized, comprehension-oriented and with a learning perspective; and a power voice described as being distancing and excluding. The voices can be seen as context-dependent communication approaches. When nurses switch between the voices this indicates a shift in the orientation or situation.CONCLUSION: The results indicate that if nurses successfully combine the voices, while limiting the use of the power voice, the communication exchanges can become a more positive experience for all parties involved and a good nurse-patient-relative communication exchange can be achieved.RELEVANCE TO CLINICAL PRACTICE: Working for improved communication between nurses, patients and relatives is crucial for establishing a positive nurse-patient-relative relationship, which is a basis for improving patient care and healthcare outcomes. This article is protected by copyright. All rights reserved.
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| 10. |
- Johnsson, Anette, 1963-, et al.
(författare)
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What are they talking about? Content of the communication exchanges between nurses, patients and relatives in a department of medicine for older people : An ethnographic study
- 2018
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Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 27:7-8, s. E1651-E1659
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Tidskriftsartikel (refereegranskat)abstract
- AIMS AND OBJECTIVES: To explore and describe the content of the communication exchanges between nurses, patients and their relatives in a department of medicine for older people in western Sweden.BACKGROUND: Information, messages and knowledge are constantly being communicated between nurses, older patients and relatives in the healthcare sector. The quality of communication between them has a major influence on patient outcomes. A prerequisite for good care to be given and received is that there is mutual understanding between the parties involved.DESIGN: An ethnographic study was informed by a sociocultural perspective.METHOD: Data were collected through 40 participatory observations of meetings between nurses and older patients and/or relatives which covered 135 hours of nurse-patient-relative interaction, field notes, 40 field conversations with 24 nurses and 40 field conversations with patients (n=40) and relatives (n=26). Five semi-structured interviews were conducted with nurses. An ethnographic analysis was performed.RESULTS: The analysis identified three categories of content of the communication exchanges: medical content focusing on the patient's medical condition, personal content focusing on the patient's life story, and explanatory content focusing on the patient's health and nursing needs. The content is influenced by the situation and context.CONCLUSIONS: Nurses would benefit from more awareness and understanding of the importance of the communication content and of the value of asking the didactic questions (how, when, what and why) in order to improve the patients' and relatives' understanding of the information exchanges and to increase patient safety.RELEVANCE TO CLINICAL PRACTICE: Nurses can use the communication content to create conditions enabling them to obtain a holistic view of the patient's life history and to develop an appropriate person-centered care plan. This article is protected by copyright. All rights reserved.
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| 12. |
- Karlsson, Margareta, 1958-, et al.
(författare)
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Experiences of work-integrated learning in nursing education
- 2022
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Ingår i: Journal of Further and Higher Education. - : Routledge. - 0309-877X .- 0013-1326. ; 0:0, s. 1-14
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Tidskriftsartikel (refereegranskat)abstract
- Nursing education and the nursing profession have an artisanal character, which has dominated the profession for a long time. Work-integrated learning in nursing education means that theoretical studies are integrated with a clinical placement. The aim of the study was to describe how nursing students experience work-integrated learning in nursing education. The study has a qualitative descriptive design. Qualitaitive content analysis was used and the analysis focused on both the manifest and latent content of the material. The analysis resulted in the theme Sustainable learning during education and for the future profession as a nurse, revealing students' experiences of work-integrated learning during their education. The categories Different methods, Collaboration and Bringing the parts together as a whole constitute the integrated learning process during the education and depend on each other for increased understanding. When the students practice their theoretical knowledge in the clinical placement, work-integrated learning can facilitate them to bring the parts together as a whole, thus giving them an opportunity to enhance their learning process and develop professional skills.
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| 13. |
- Olszewski, Piotr, et al.
(författare)
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Review of current study methods for VRU safety. Part 1 – Main report
- 2016
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- The report presents the results of a review of the study methods related to vulnerable road user safety that are used today and aims to link accident causation factors to VRU accident risk. The review covered the following categories of study methods: epidemiological studies based on accident and injury data; in-depth accident investigations; naturalistic driving studies; behavioural observations; traffic conflict studies; and self-reported accident studies. The review consisted of two parts: a systematic literature review and a questionnaire survey. A scoping review of the available scientific literature was conducted that covered four types of safety-related studies: naturalistic driving studies, behavioural observations, traffic conflict studies and self-reported accidents. In total, over one thousand publications were included in the scoping reviews. Full reports on the results of the four reviews are published as separate parts of this report. Questionnaires were sent out to all InDeV partners to obtain information and a critical appraisal of the currently used study methods related to VRU safety. The survey results show that epidemiological studies based on accident and injury records form the basis of traffic safety assessment in every partner country. General accident reports help identify the time trends of accident occurrence and to compare the safety situation among countries and cities. Benchmarking between countries can help monitor progress towards the targets for traffic safety improvement and to assess the relative importance of problems. While the exact causes of accidents cannot be determined, the contributing factors can often be deduced. Identification of dangerous locations is performed using black spot analysis and network safety analysis. Both are important and useful for VRU safety assessment – black spots identify dangerous intersections and road crossings and network analysis identifies dangerous road links. The exposure measures used should be appropriate for VRUs and should include pedestrian and bicycle volumes in addition to motorised traffic volumes. The European CARE accident database was set up with a comprehensive structure and scope of information as defined in the CADaS glossary. The advantage of using CARE for safety research is that it is a disaggregate database, i.e. detailed cross-classification analyses can be made. However, not all countries provide all data according to the guidelines. The possibilities of safety analysis would be greatly improved if the guidelines were followed by all countries.The literature review and survey on accident data quality conducted among InDeV partners show that despite efforts to harmonise the definitions of injury road accidents and their severity at the European level, differences exist both in the definitions and their interpretation. Even in the case of the fundamental definition of “road accident/injury accident”, the definitions used by some countries differ slightly from the CARE database standard. Data on fatalities are quite comparable between the InDeV partner countries: the 30-day road accident fatality definition is used. CARE definitions of injury severity are applied in only 3 out of 7 countries. There are also considerable differences among countries in terms of accident data collection and data verification procedures, which results in varying levels of underreporting of the different accident categories. In all InDeV partner countries, accident data are collected on a paper form and transferred to a computer database. The information on injury severity is gathered from ambulances, hospitals or the road users involved in the accidents. This information is verified based on hospital information after a period ranging between 30 days and one year. In Sweden, data verification is performed automatically via the STRADA database, which links the police database with hospital registries. In almost all InDeV partner countries, data quality control is carried out after the data is transferred to a computer database. Cross-checking for consistency of information is used in some countries. The in-depth investigation study is a good tool to examine accident scenarios and to find accident/injury contributing factors. However, valid knowledge can be obtained only if the number of cases, the period of time and the number of variables are sufficient. The comparison of different in-depth databases is difficult due to the application of different investigation criteria. The drawbacks include the study’s retrospective view (compared to video-documented crashes) and the introduction of uncertainties in the process of data collection and encoding due to interpretation. In general, in-depth investigations are time- and cost-consuming, but highly effective in terms of the knowledge that can be gained from the investigation of individual accidents.A review of naturalistic studies shows that this method can provide important insights into the understanding of the causation factors of accidents with VRUs. These studies can also be used to identify the locations where vulnerable road users are involved in accidents. So far, naturalistic data from VRUs have mostly been collected via equipped motorcycles or bicycles. Accidents and critical situations were detected based on kinematic triggers such as acceleration, rotation, etc. only in few cases. The potential for such detection was shown through studies of falls among the elderly. In order to examine accident causation it is necessary to collect additional information from road users, e.g. via a questionnaire that is sent to them after the accident. Another limitation of naturalistic studies is that data is typically collected from only one of the road users involved in the accident.Behavioural observation studies are an important tool to understand the causes of accidents that involve VRUs because such studies provide insight into the situational and behavioural processes that lead to an accident. The survey that was carried out among partner countries provides an overview of the behavioural observation studies conducted there and identifies the topics that were addressed. A review of about 600 publications on road user behavioural observation studies shows that these are mainly used to monitor traffic events and to evaluate safety improvement measures. Behavioural observations seem very useful to examine how road users interact with each other or navigate through a crossing. Most studies involving VRUs were found to take place at some kind of crossing. Many studies were not adequately documented with respect to the observation periods and sample size. Certain topics were found not to have been the subject of much research, for example powered two-wheelers. The observation and analysis of traffic conflicts as surrogates for accidents has two main advantages: conflicts occur more frequently than accidents and observing them allows better understanding of the processes that may lead to accidents. The basic theory behind the use of traffic conflicts for safety analysis is the assumption of continuity in the severity of all events that take place in a traffic environment. There is a relationship between the severity and frequency of events, i.e. injury accidents are rare, while normal interactions are frequent. As severe traffic conflicts are close to real accidents in terms of the process of their development, observations of these conflicts can be used to understand the mechanism of accident development. The scoping review of literature shows an increase in the use of traffic conflict studies, in particular those that use video analysis tools. The review also shows that there is a considerable number of validation studies on the relationship between conflicts and accidents, although most of these are quite old. Recently, new indicators with high potential have been suggested and there is a clear need for new validation studies that use video analysis tools. Emerging technologies open up new possibilities for the wider use of site-based traffic conflict studies. Nevertheless, a combination of conflict studies with other types of behavioural observations and accident analyses provides better insight into road safety problems.The self-reported accident study method is highly relevant as it allows to gain knowledge on accident causation as well as the events that led to the accident. This method allows to obtain information on accidents that are not reported to the police, thus making it possible to estimate the level of underreporting. A systematic literature review shows that the practice for collecting self-reported accidents varies and most studies focus on car accidents. Self-reported accidents are used to evaluate safety measures, estimate the total number of accidents and to identify accident causation factors. Self-reported accident data are typically collected via online or paper questionnaires where respondents are asked to recall their accidents from a period ranging from one month to 5 years. A survey among InDeV partners showed that the use of the self-reporting method is not very common in their countries. While the method has relevance and seems a promising way of gaining knowledge on accident causation factors, the level of underreporting and socioeconomic factors, it is still quite untested. Careful consideration of methodological challenges and issues is required before conclusions on underreporting can be drawn based on self-reports alone.Based on the review of road safety analysis methods, several general recommendations for improving VRU safety assessment are put forward. The standard definition of injury accidents adopted by the EC (CARE database) covers virtually all traffic accidents involving VRUs with the exception of single pedestrian accidents (falls). It is recommendable to include this additional category in VRU safety assessment studies as well as in econom
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