| 1. |
- Rosengren, Kristina, 1963-
(författare)
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Hälso- och sjukvårdsorganisation i förändring : Från distanserat till delat ledarskap
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Syfte: Avhandlingen syftar till att följa upp, beskriva samt generera tentativ teori om pågående förändringsprocesser inom hälso- och sjukvården på såväl makronivå genom studier av sjukhusfusioner som mikronivå genom studier av delat ledarskap. Metod: ”Sjukhusfusioner” beskriver två genomförda sjukhussammanslagningar utifrån en kvalitativ ansats, Grounded Theory med intervjuer av vårdpersonal (I, II). ”Delat ledarskap” utgår från en förändrad ledarskapsmodell på en intensivvårdsavdelning med intervjuer (III-IV) samt frågeformulär (V) som datainsamlingsmetod. Vårdpersonalens uppfattningar av ledarskap redovisas genom en fenomenografisk ansats (III). Vidare beskrivs två avdelningschefers upplevelser av att ha arbetat i ett delat ledarskap genom Grounded Theory (IV). I den sista delstudien (V) används en kvantitativ metod i form av ett frågeformulär. En del av dessa frågor ingår i instrumentet QPSNordic som belyser vårdpersonalens åsikter om arbete, ledarskap och delat ledarskap. Resultat: Vårdpersonalen uttryckte behov av delaktighet och balans mellan olika behov och krav i ett förändringsarbete. Ledarskapets betydelse lyftes fram som en framgångsfaktor för att utveckla hälso- och sjukvårdsorganisationer i förändring. Vårdpersonalens idealbild av sjuksköterskans ledarskap utgjordes av en chef som var närvarande och tillgänglig i den dagliga verksamheten. Begreppet stödjande tvåsamhet lyftes fram som kärnan i delat ledarskap. Stödjande tvåsamhet, en tillitsfull relation mellan avdelningscheferna, bidrog till en god arbetsmiljö då ansvar och befogenheter delades av aktuellt ledarpar. Vårdpersonalen hade en positiv syn på sitt arbete och ledarskapet. De ansåg att det delade ledarskapet ökade avdelningschefernas möjligheter att vara engagerade och tillgängliga i det dagliga arbetet. Konklusion: Resultatet har bildat underlag för två empiriskt grundade modeller; engagerat ledarskap och stödjande tvåsamhet. Engagerat ledarskap utgår från begreppen delaktighet och stöd i en vårdande kultur. Stödjande tvåsamhet bygger på en gemensam värdegrund och olikheter i kompetens hos ledarparet som ligger till grund för utveckling av en tillitsfull relation. Vidare har teorin om det caritativa ledarskapet vidareutvecklats genom begreppet stödjande tvåsamhet som belyser relationen chef till chef i en vårdande kultur.
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| 2. |
- Linddahl, Iréne
(författare)
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Validity and Reliability of the Instrument DOA : A Dialogue about Working Ability
- 2007
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to examine the construct validity and the reliability of the instrument DOA; Dialogue about working ability. The theoretical foundation for DOA is the Model of Human Occupation. The instrument is divided into two sections; client self-assessment and professional assessment focusing on the individual’s working ability. The assessments are followed by a dialogue to distinguish goals for the return to-work process based on the client’s own preferences. In line with the theoretical base, the concept ‘work’ refers to both paid work and other productive activities related to work. In Study I, 21 professionals and 126 clients participated from three clinics in Sweden. All clients were involved as outpatients in psychiatric work rehabilitation in county councils or community services. The results from the Rasch analysis test indicated that items are well separated from each other and generally work together in five unidimensional continuums with the objective to measure abilities related to work. Twenty-nine of 34 items showed goodness-of-fit statistics, which means acceptable infit MnSq values from >0.6 to <1.4 in association with Z values from –2 to 2, and that the five misfit items have to be revised. Thirty-four outpatient clients and 14 professionals from four clinics within psychiatric work rehabilitation in Sweden participated in Study II. Two reliability aspects were studied: test-retest and inter rater reliability. The statistical analyses used were Spearman Rank Correlation test and Percentage of agreement (PA). Generally, the Spearman Rank Correlation test showed acceptable significant correlations between test retest since a greater part of items correlated “moderate to good” (r = 0.51 – 0.75). In the inter raters´ test PA was good, ranging from 93.1 % to 96.5 %, which is well above the acceptable criteria of 80 %. There were no significance differences between the raters. The study has shown that one item has to revised. The findings verify that DOA has potential as a means of making valid and reliable assessments of working ability, as described by the Model of Human Occupation, out of both clients´ and occupational therapists´ perspective.
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| 3. |
- Widäng, Ingrid
(författare)
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Patients' Conceptions of Integrity within Health Care Illuminated from a Gender and a Personal Space Boundary Perspective
- 2007
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aims of this licentiate thesis were to explore and describe female and male patients’ conceptions of integrity within health care and to illuminate the conceptions from a gender as well as a personal space boundary perspective. A qualitative design with a phenomenographic approach was used. The participants, 17 male (Study I) and 15 female patients (Study II), all of whom had undergone medical or surgical care, were strategically selected and interviewed. The identified conceptions were also analysed from a gender as well as a personal space boundary perspective. Three description categories emerged among the male patients (Study I); self-respect, dignity and confidence, while maintaining the self, dignity and confidence were the description categories found among the female patients (Study II). Male patients’ description of self-respect and female patients’ description of maintaining the self were for the most part similar although there were some differences. The conceptions revealed that integrity involves having the courage to set boundaries and having control over the private sphere, one’s self and one’s situation. While the male patients emphasised selfbelief and being alone, their female counterparts stressed that preserving one’s identity was essential in order to maintain the self. Dignity concerned being respected, and the male patients also described dignity as being seen as a trustworthy and whole person, while the women described it as not being exposed. Both male and female patients described confidence, which was related to handling patient information in a confidential way, trusting the professional caregivers, participating as well as balancing or changing the boundaries of integrity if necessary. The male patients also described confidence as being free. The personal space boundary perspective was useful for explaining the process of respecting the self by opening or closing outgoing and incoming boundaries around the self. The patients had to consider who, when and to what degree others should have access to their personal spaces. The way in which the professional caregivers interacted with the patient influenced the openness of the boundaries.
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| 4. |
- Almborg, Ann-Helene
(författare)
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Perceived Participation in Discharge Planning and Health Related Quality of Life after Stroke
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to investigate the patients’ and their relatives’ perceived participation in discharge planning after stroke and the patients’ health-related quality of life, depressive symptoms, performance of personal daily activities and social activities in connection with discharge. Another aim was to evaluate the psychometric assumptions of the SF-36 for Swedish stroke patients.Prospective, descriptive and cross-sectional designs were used to study all patients with stroke admitted to the stroke unit at a hospital in southern Sweden from October 1, 2003 to November 30, 2005 each with one close relative. The total sample consisted of 188 patients (mean age=74.0 years) and 152 relatives (mean age=60.1 years). Data were collected during interviews, 2-3 weeks after discharge.The results showed that less depressive symptoms, more outdoor activities and performance of interests are important variables that related to higher HRQoL. SF-36 functions well as a measure of health related quality of life in Swedish stroke patients, but the two summary scales have shortcomings. Compared to a Swedish normal population, scores on all scales/components of the SF-36 were lower among stroke patients especially in the middle-aged group. Most of the patients perceived that they received information, but fewer perceived participation in the planning of medical treatment and needs of care/service/rehabilitation and goal setting. The relatives perceived that they need more information and they perceived low participation in goal setting and needs assessment. The professionals seem to lack effective practices for involving patients and their relatives to perceive participation in discharge planning. It is essential to develop and to implement methods for discharge planning, including sharing information, needs assessment with goal setting that facilitate patients’ and relatives’ perceived participation. The results suggest that ICF can be used in goal setting and needs assessment in discharge planning after acute stroke.
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| 5. |
- Dahl, Anna, 1975-
(författare)
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Body mass index, cognitive ability, and dementia : prospective associations and methodological issues in late life
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aims of the present study were to investigate the association between overweight and cognitive ability and dementia, and to evaluate the usefulness of self-reported body mass index (BMI) in late life and various data sources commonly used in epidemiological studies to identify persons with dementia. Data were drawn from three population-based studies: the Swedish Adoption/Twin Study of Aging (SATSA), Aging in Women and Men: A Longitudinal Study of Gender Differences in Health Behaviour and Health among Elderly (the Gender Study), and the Finnish Lieto Study. In Study I, the agreement between self-reported and measured BMI over time was evaluated among 774 men and women, ages 40 to 88 years at baseline (mean age 63.9) participating in both the questionnaire phase and in-person testing of SATSA. Latent growth curve (LGC) modeling showed a small but significant increase between self-reported and measured BMI (0.02 kg/m2/y) over time, which would probably not affect the results if self-reported BMI were used as a continuous variable in longitudinal research. In Study II, the agreement between dementia diagnoses from various sources and dementia diagnoses set at a consensus conference was evaluated. Among the 498 elderly people ages 70 to 81 at baseline (mean age 74.5) enrolled in the Gender Study, 87 were diagnosed with dementia during an eight-year period. Review of medical records and nurse evaluations yielded the highest sensitivity (0.83 and 0.80, respectively) and a high specificity (0.98 and 0.96), indicating that these sources might be good proxies of dementia, while data extraction from the Swedish Inpatient Discharge Registry underestimated the prevalence of dementia (sensitivity 0.26). In Study III, the association between being overweight in midlife and cognitive ability in late life was examined in SATSA. The 781 participants ages 25 to 63 at baseline (mean age 41.6) in 1963 or 1973 self-reported their height and weight. From 1986 until 2002, they were assessed five times using a cognitive test battery. LGC models showed that people with higher midlife BMI scores had significantly lower cognitive ability and a significantly steeper decline than their thinner counterparts, an association that persisted when those who developed dementia during the study period were excluded from the analysis. This finding indicates that being overweight might affect cognitive ability independently of dementia. In Study IV, the association between BMI and dementia risk in older persons was described among 605 persons without dementia and ages 65 to 92 at baseline (mean age 70.8) in the Lieto Study. Among these, 86 persons were diagnosed with dementia during eight years of follow-up. Cox regression analyses indicated that for each unit increase in BMI score, the risk of dementia decreased 8% (hazard ratio = 0.92, 95% confidence interval = 0.87–0.97) and the association remained significant when individuals who developed dementia during the first four years of follow-up were excluded from the analyses. This result suggests that low BMI scores are present almost a decade before clinical dementia onset.
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| 6. |
- Einarson, Susanne, 1958-
(författare)
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Oral health-related quality ofl ife in an adult population
- 2009
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim: The overall aim of this licentiate thesis was to describe and analyze oral health-related quality of life measured with OHIP-14. The thesis comprises two studies, each with a specific aim. Study I: To describe oral health-related quality of life measured with OHIP-14 in an Swedish adult population Study II: To study the relationship between oral health-related quality of life, measured with OHIP-14, and subjective as well as objective dry mouth conditions in fragile old people. Furthermore, the aim was to study the reliability and validity of a new instrument (VAS) to measure dry mouth Material and methods: Study I comprised a stratified random sample of 519 individuals 20-80 years of age. In Study II, 41 randomly selected fragile old people, residents at three different community care centers, participated. In both studies, the questionnaire OHIP-14 was used for measurement of oral health-related quality of life. The participants in Study II answered a questionnaire for subjectively experienced dry mouth (VAS). For objective dry mouth measurements, saliva was absorbed into a preweighted cotton roll. Results: In Study I, 21% of the respondents stated that they had no oral problems that had a negative impact on their well-being. In Study II, the corresponding figure was 71%. In study I the mean value for OHIP-14 was 6.4 (SD=7.1) for the entire population; 5.9 (SD=7.1) for men and 6.8 (SD=7.2) for women in. Subjects, who frequently experienced problems related to oral health, with scores ranging from 16 to 41 points, accounted for 10% of the study group. In Study II, significant associations were identified between both objectively measured respective subjectively experienced dry mouth and oral health-related quality of life. The validity of the VAS instrument was good for subjective mouth dryness, but poor for objectively measured dry mouth in fragile old people. Conclusion: From Study I it can be concluded that, in this Swedish population, a number of individuals, both young and old, experience oral problems that have a negative impact on their well-being. From Study II, the conclusion is that dry mouth (both objective and subjective) is significantly associated with poorer oral health-related quality of life, underlining the value of monitoring dry mouth conditions in the care of fraigile old people.
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| 7. |
- Ernsth Bravell, Marie
(författare)
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Care Trajectories in the Oldest Old
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis demonstrates relations among health, social network, ADL and patterns of care in the oldest old guided by a resource theoretical model. The analyzed data are based on two studies: the Nona study, a longitudinal study of 157 individuals aged 86 to 94 years, and the H70 study, a longitudinal study of 964 individuals aged 70 at baseline. Data were collected by interviews and to some extent in the H70 study, medical exams and medical records. The results demonstrate that perceived resources seem to affect patterns of care to a higher extent than the more objective resources in the sample of the oldest old. On the other hand, sociodemographic variables such as gender, marital status and SES, in addition to the more objective resources of having children nearby and the number of symptoms of illness predicted institutionalization during a subsequent 30-year period from the age of 70. The proportion of elderly persons’ institutionalization was further significantly higher than that generally found in cross-sectional studies. ADL was one of the strongest predictors for both use of formal care and institutionalization in both samples, indicating an effective targeting of the formal care system in Sweden. The care at end of life in the oldest old is challenged by the problems with progressive declines in ADL and health, which makes it hard to fit in the dying oldest old in the palliative care system. There is a need to increase the knowledge and the possibility for care staff to support and encourage social network factors and for decision-making staff to consider factors beyond ADL.
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| 8. |
- Wallin, Anne-Marie
(författare)
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Living with diabetes within the framework of Swedish primary health care : Somalian and professional perspectives
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to provide knowledge on the one handSomalian-born immigrants´ experiences of living with diabetes mellitus (DM)in a new cultural environment, on the other hand their encounter with Swedishdiabetic care – this from both their own point of view and that of the health-care professionals. There was an endeavour to describe methodological aspectsof the interpreter´s role in respect of the trustworthiness of research performedin multicultural societies. A descriptive design was used, involving threequalitative interview studies with an interpreter (Studies II-IV) and onesystematic literature review (Study I). The latter served as a foundation forconducting the interviews with an interpreter and the Matrix Method was used.The same 19 patients with diabetes of Somalian origin participated in StudiesII-IV, joined by five health-care professionals in Study IV. The interviews weresubjected to qualitative content analysis in the case of Studies II and III, and to phenomenograpic analysis in the case of Study IV. In Study I, 13 empirical cross-cultural interview studies with aninterpreter involved were scrutinized. The findings showed that the interpreter’srole in the research process was given little attention. There was usually noaccount either of the style of interpreting, the interpreter’s previous experienceor the seating arrangements for the interviews. On the other hand most of thestudies offered direct or indirect information about the interpreter’s knowledgeof the aim of the research or participation in the transcription of the text or data analysis. The most frequent techniques used to established trustworthiness were prolonged engagement and member checks. A prominent problem for the participants in Study II was to give uptraditional eating habits. Difficulty in managing everyday life was mentionedespecially by women in connection with the need to keep to the diet regimebecause of a lack of understanding and support from family and friends. Tochanging lifestyle was considered as a hard work and a number of barriers wasmentioned especially when it comes to eating habits. The findings showed avariation how the participants managed the fasting month of Ramadan. Thosewho fasted did not see the diabetes as an obstacle, others did so and indicated that fasting was not compulsory for a sick person. In study III the findings showed that women used more supernaturalbeliefs than men when they described their experiences in connection with thediagnosis and their health beliefs. Most of the experiences of receiving thediagnosis consisted of ways of managing this information. Commonlymentioned by the participants, irrespective of gender, when they receiving thediagnosis was a attempt to find some advantages, or positive comparison. Other participants tried to repress the diagnosis and doubted it. Most of theparticipants, irrespective of gender, did not immediately respond with shock orother strong emotion when they received the diagnosis. In study IV the patients conceived the diabetes care as being of highquality but they also conceived limitation with the care. They conceived unmetneeds such as too long waiting times for appointments, not encountering thesame physician every time, lack of contact with specialists and failure toculturally adapt dietary advice. Health-care professionals conceived severalcultural challenges in the encounter such as managing language barriers,illiteracy and traditions such as fasting during Ramadan. In conclusion, this thesis generate knowledge which can serve as afoundation to securing the quality of diabetes care for this patient group andcontribute to working out local diabetic programmes for patients with anotherbackground than the Swedish. In addition the thesis can contribute to makingimprovements when it comes to working with an interpreter in qualitativeinterview studies as well as in clinical settings.
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