| 1. |
- Mattsson, Janet
(författare)
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Uncovering pain and caring for children in the pediatric intensive care unit : nurses’ clinical approach and parent’s perspective
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: The thesis has a standpoint in a synthesis of caring science and educationscience from a clinical perspective. Children in a Pediatric Intensive Care Unit (PICU) are in an exposed position, dependent on nurses to acknowledge their needs. The alleviation of children’s pain has been investigated from various perspectives, but undertreated pain remains a problem in the PICU. There is a preponderance of empirical evidence pointing toward the role of nurses in uncovering children’s pain and suffering. How nurses interpret the child’s expressions and judge the clinical situation influences their actions in the clinical care. In a PICU, the basis for nurses’ concerns and interpretation of what is meaningful in the nursing care situation are formed by professional concern, workplace culture, traditions, habits, and workplace structures. This influences how parents interpret the meaning of care as well. Patricia Benner’s theory on clinical judgment forms a reference framework for this thesis. The assumption is that children need to be approached from a holistic perspective in the caring situation in order to acknowledge their caring needs. A nurse’s clinical education and insights allow for the possibility to enhance the quality of care for children and parents in the PICU.Aim: To uncover clinical concerns, from caring and learning perspectives, in caring for children in the Pediatric Intensive Care Unit (PICU) from nurses and parents perspective.Methods: Qualitative methods were used in all studies to unfold and explore the phenomena in the nurses’ and parents’ everyday clinical life world. In Papers I and II, a phenomenographic method was adopted. In Papers III and IV, an interpretive phenomenological approach was adopted.Findings: Nurses that have a holistic view of the child and approach the child from a multidimensional perspective, with a focus on the individual child and his/her caring needs, develop a clinical “connoisseurship” and meet the parents’ expectations of the meaning of care. The nurses express that it is only when they focus on the child that subtle signs of pain are revealed. The meaning of nursing care, in the ideal case, is a holistic care where all aspects are integrated and the child as a person has first priority.Conclusion: The meaning of caring and children’s needs must become elucidated to improve the cultural influence of what can be seen as good nursing care within the PICU.
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| 2. |
- Thernström Blomqvist, Ylva, 1974-
(författare)
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Kangaroo Mother Care : Parents’ experiences and patterns of application in two Swedish neonatal intensive care units
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Kangaroo Mother Care (KMC) is an alternative model of care that prevents parent-infant separation when preterm infants need neonatal intensive care by skin-to-skin contact between infants and their parents. KMC is also a strategy that involves parents in their infants’ care and enables them to assume the responsibility for the care. Furthermore, KMC promotes parent-infant bonding and attachment.The overall aim of this thesis was to gain a deeper understanding and knowledge about parents’ capacity, willingness, and experiences of KMC and to which extent parents choose to use KMC throughout their infants' hospital stay. These studies were conducted in the NICUs at two Swedish university hospitals (NICU A and NICU B).Mothers of infants cared for at NICU A (n=17) answered a questionnaire about their experiences of KMC (Paper I). Twenty parents of infants cared for at NICU A recorded the duration of each KMC session during a period of 24 hours and the identity the KMC provider (Paper II). Seven fathers were interviewed about their experiences of KMC (Paper III) and 76 mothers and 74 fathers completed a questionnaire about what facilitated or rendered it difficult to perform KMC (Paper IV). The time of initiation of KMC and duration in minutes, and the identity of the KMC providers was recorded continuously during the infants’ (n=104) hospital stay: 83 mothers and 80 fathers also completed a questionnaire during their infants’ hospital stay (Paper V).This thesis provides new knowledge about parents’ practice of KMC, also continuously day and night, in a high tech NICU in an affluent society, with good resources for infant care in an incubator by trained staff. The accuracy of parents’ records of KMC were comparable to nurses’ records. The results indicate that parents want to be together with their infant in the NICU and be actively involved in the infants’ care. Although parents may experience KMC as exhausting and uncomfortable, they still prefer KMC to conventional neonatal intensive care as it supports their parental role. Early initiation of KMC after birth appears to result in a longer total duration of KMC during the infants’ hospital stay.
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| 3. |
- Eriksson, Kerstin Margareta, 1955-
(författare)
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A 3-year lifestyle intervention in primary health care : effects on physical activity, cardiovascular risk factors, quality of life and cost-effectiveness
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: A sedentary lifestyle diminishes quality of life (QOL) and contributes to increasing prevalence of obesity, diabetes and cardiovascular diseases (CVD), and thus increases the economic burden on health care and society. Expensive and tightly controlled lifestyle interventions reduce cardiovascular risk and onset of diabetes. Transferring these findings to the primary care setting is of clinical importance. The primary aim of this thesis was to apply a lifestyle intervention program in the primary care setting among individuals with moderate-to-high risk for CVD, and evaluate the effects on physical activity, cardiovascular risk factor levels and QOL. A secondary aim was to investigate the cost-effectiveness. Methods: A randomized controlled trial with one intervention group (n=75) and one control group (n=76) with follow-up at 3, 12, 24 and 36 months was used. Patients with the diagnosis obesity, hypertension, dyslipidemia, type 2 diabetes or any combination thereof (mean age 54 yr, 57% female) were recruited from a primary health centre in northern Sweden. The three-month intervention period consisted of group-based supervised exercise sessions and diet counselling, followed by regular, but sparse, group meetings with a behavioural approach during three years. Clinical measurements included anthropometrics, aerobic fitness, blood pressure and metabolic traits. Questionnaires on self-reported physical activity, stages of change for physical activity, and QOL were used. In a cost-utility analysis the costs, gained quality-adjusted life years (QALY), and savings in health care were considered. Probability of cost-effectiveness was described using Net Monetary Benefit Method. Results: Overall, the lifestyle intervention generated beneficial improvements in anthropometrics, blood pressure, aerobic fitness and activity level, and QOL, compared to the control group which only received one information meeting. At 36 months, intention-to-treat analyses showed that lifestyle modification reduced waist circumference (–2.2 cm), waist-hip ratio (–0.02), systolic blood pressure (–5.1 mmHg), and diastolic blood pressure (–1.6 mmHg) and significantly improved aerobic fitness (5%). BMI, lipid or glucose values did not differ between groups. Progression to active stages of change for physical activity and increases in time spent exercising and total physical activity were reported. Both physical and mental dimensions of QOL were improved during the study period, but after 3 years differences persisted mainly in physical dimensions. Cost per gained QALY was low, 1668-4813 USD (savings not counted). Visits to family physicians significantly decreased and there was a net saving of 47 USD per participant. Probabilities of cost-effectiveness were 89-100% when 50 000 USD was used as threshold of willingness to pay for a gained QALY. Conclusions: A group-based lifestyle intervention program in a primary health care setting favourably influences cardiovascular risk-factor profiles, increases physical activity level, and improves several dimensions of QOL in high-risk individuals, at least up to 3 years. The intervention method was highly cost-effective in relation to standard care. The results emphasize the advantage of an intervention that combines supervised exercise with regular follow-ups for reaching long term effects. The study high-lights the feasibility of lifestyle interventions in the primary care setting and the importance of health care professionals supporting change in lifestyle.
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| 4. |
- Israelsson, Axel
(författare)
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Chewing gum and human hair as retrospective dosimeters
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Retrospective dosimeters are sometimes needed after radiological/nuclear (RN) exposures to determine the doses to individuals. Conventional dosimeters may not be at hand or may not be applicable calling for alternative materials.The possible exposure situations can be divided into external and internal; the radiation field stems either from outside the body or from a source within. This thesis investigates the possibility to use chewing gum and hair as retrospective dosimeters. The chewing gum would be used after an unexpected radiation event of external type whereas human hair is examined after chronic intake of uranium. Chewing gum containing xylitol and sorbitol was analyzed using electron paramagnetic resonance (EPR) and the hair was analyzed by alphaspectrometry following radiochemistry and by synchrotron radiation microbeam x-ray fluorescence (SR μ-XRF).Xylitol and chewing gum (in this particular case, V6) are in the present work found to be valuable dosimeters after unexpected radiation events. The xylitol signal linearity with dose in the interval 0-10 Gy was confirmed (r2=1.00). The doses to the coating of the chewing gums were determined 4-6 days after irradiation with an uncertainty of less than 0.2 Gy (1 SD). Spectral dependence with time after exposure was found, but was, however, minimal between 4-8 days.Hair was evaluated and compared with urine as biodosimeter after ingestion and inhalation intake of uranium. Concentrations of 234U and 238U and their activity ratios were measured in the hair, urine and drinking water sampled from 24 drilled bedrock well water users in Östergötland, Sweden, as well as among 8 workers at a nuclear fuel fabrication factory, Westinghouse Electric Sweden. The results show that there is a stronger correlation between the uranium concentrations in the drinking water of the well water and the users’ hair (r2 = 0.50) than with their urine (r2 = 0.21). There is also a stronger correlation between the 234U/238U activity ratios of water and hair (r2 = 0.91) than between water and urine (r2 = 0.56). The individual absorbed fraction of uranium, the ƒ value, calculated as the ratio between the excreted amount of uranium in urine and hair per day and the daily drinking water intake of uranium stretched from 0.002 to 0.10 with a median of 0.023. The uranium concentrations of the fuel factory workers’ hair and urine were also obtained as well as that of personal air sampler (PAS) filters for the determination of inhaled uranium activity. A large day-to-day variation (7-70 Bq d-1) of the inhaled 234U activity was seen over a 6 week period. Over a 12 week period the 234U activity concentration in urine was similarly seen to vary from 2 to 50 mBq kg-1. Four hair samples from the same subject and period showed less variation (100-240 mBq g-1). The uranium inhalation to urine and hair factors finh,u and finh,h were found to be 0.0014 and 0.0002 respectively given by calculations based on the measured PAS, urine and hair data from two individuals. The SR μ-XRF measurements showed that uranium is present in an outer layer of the hair shaft, about 10-15 μm wide. The measurements also revealed particles containing uranium being present on the surface of unwashed hair shafts. However, the washed hair shafts showed few, if any, particles.This thesis concludes that chewing gum and hair can be used as retrospective dosimeters after external radiation and after intake of uranium respectively.
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| 5. |
- Ljusegren, Gunilla, 1947-
(författare)
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Nurses' competence in pain management in children
- 2011
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: It is a well known fact that children suffer from pain due to treatment and procedures in health care and historically, their procedural pain due to medical treatment has been undertreated and under-recognized. Children’s understanding of pain and their ability to express their feelings depend on their stage of development and the nature and diversity of their prior pain experiences. The goal of pain management is to reduce pain, distress and anxiety, and the nurse is the key person to help and support the child in pain. Nurses’ professional competence form the foundation for pain management procedures, and there is a need to investigate whether the care and procedures nurses perform for children in pain lead to desired outcomes.Aim: The overall purpose was to describe nurses’ competence in pain management in children. The specific aims were to- identify and describe knowledge about and attitudes to pain and pain management- identify factors influencing pain management in children and- describe nurses’ experiences of caring for children in pain.Methods and material: Forty-two nurses participated in a survey on knowledge about and attitudes to pain management in children, and 21 nurses were interviewed about their experiences fromcaring for children in pain. All the data were analyzed using approved methods of analysis.Results: The results showed that the nurses had good knowledge about and positive attitudes to pain management in children. Collaboration with physicians was considered important in providing children with sufficient pain relief. Parents were regarded as a resource, and the nurses described communication with parents as important. The nurses’ own experience led to a better understanding of the children’s situation.The nurses stated that pain is a subjective experience and that if a child says he or she is in pain they should be believed. Pain was seen as a complex phenomenon, and the nurses had difficulty distinguishing between pain of different origins. In predictable situations, when the child had a clear medical diagnosis with physical pain and the child’s pain followed an expected pattern, the nurses trusted their knowledge and knew how to act. On the other hand, in unpredictable situations, when the child did not respond to the treatment despite all efforts, this created feelings of insufficiency, fear and abandonment, and even distrust.Conclusions: The conclusions of this thesis are that pain management in children is a challenge for clinical nurses in unpredictable situations. Professional competence in nursing deals with both personal abilities and the organization. Reflective practices and dialogues with colleagues would improve nurses’ work satisfaction, and guidelines and better routines would improve nurses’ pain management when caring for children.
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| 6. |
- Moren, Jan, 1965-
(författare)
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Om reformer : En studie av Kvalitetsreformen, Politireform 2000 og Kunnskapsløftet
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis studies three major reforms in the public sector of Norway. The sectors studied are the police, higher education, and primary schools. The main motive for studying these reforms are of a theoretical nature, the reason to study them is to produce general knowledge about reforms. The study aims to answer two main questions. One is about the possibilities and limitations contained in using reforms to change organizations. The second is about how organizations can promote the ideals of representative democracy. In its efforts to attain answers to these questions the thesis blends empirically-oriented research with aspects of organization theory and political theory. The thesis is divided into four different parts. First, there is a descriptive presentation of the three reforms. Secondly, there is a discussion of various theories of reforms and organizations. The primary aim of this analysis is to illuminate and explain the empirical data, but this discussion should also provide its own answers to the main questions asked in the thesis. Thirdly, these theories are applied to analyze data from the three reforms. And finally, the study concludes with a summary of what general insights about the reforms we are left with after studying the Quality Reform, The Police Reform 2000, and the Knowledge Reform. The study shows that reforms have both policy and content aspects, and that it is important to distinguish between the two in order to analyse and understand them. The policy aspect is that reforms are a strategy for change - they are tools for implementing change in organizations. The content aspect is that reforms have a specific content - they have certain objectives that they want to realize. The study concludes that in order to understand this complex and fascinating phenomenon, we need to understand reforms both as instrumental tools, institutional adaptations and symbols.
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| 7. |
- Stjernschantz Forsberg, Joanna, 1972-
(författare)
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Biobank Research : Individual Rights and Public Benefit
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis is to investigate the relationship between individuals and society in the context of healthcare and medical research, more specifically concerning the rights and duties of individuals in regard to biobank-based research. My starting point is that we all have a strong vested interest in improved healthcare, and therefore the possibilities to conduct important research should be optimized. In the first article, I investigate whether individual results from research using samples in large-scale biobanks should be returned. I conclude that there is good reason not to implement such policies, and instead to allocate available resources to pursuing medical advances. In the second article, I compare consent for using stored samples in research with consent for organ donation, whereby many countries have adopted opt-out strategies in order to increase the number of organs available. I claim that the default position should be changed in biobank research as well, i.e. it should be presumed that individuals want to contribute rather than that they do not. In the third article, I argue that safeguarding autonomy by requiring informed consent for using samples in research not only defeats the interests of society but also runs counter to the interests of the individuals the policy purports to protect. Finally, in the fourth article I suggest that it is reasonable to view participation in medical research from the perspective of a social contract, built on our mutual need for medical advances, and that this implies that there is a moral duty to adhere to the contract by allowing one’s samples to be used in research. A central conclusion in this thesis is that biobank research should be viewed as a natural part of healthcare, like quality control, method development and teaching, and that as such, it ought to be endorsed and facilitated.
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| 8. |
- Söderberg, Inga-Lill, 1962-
(författare)
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Financial Advisory Services : Exploring relationships between consumers and financial advisors
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The need for more knowledge about different aspects of financial advisory services has been highlighted by scholars of many disciplines, and calls for more in-depth studies of this practice have been put forward. The purpose of this thesis is to answer this call and, thereby, enhance knowledge about financial advisory services and the provision and receipt of advice occurring in a face-to-face encounter between a professional advisor and a consumer. The thesis consists of five papers in which different methodological and theoretical lenses are applied to the study of the practice. A mixed methods approach is applied to the object of study—financial advisory services. This approach entails using qualitative methods to analyze video-recorded interviews and quantitative methods to analyze survey data. The qualitative methods are used primarily to generate new constructs and ideas, whereas quantitative methods are used more to confirm and deepen the knowledge of constructs and relationships.The findings show that there are important aspects of financial advisory services that have been previously neglected. The characteristics of both consumers and advisors, as tested from the aspect of gender, are shown to have importance for both consumer and advisor perceptions of different aspects of core elements of financial advisory services. Focusing on the micro-foundations of the relationship between customer and advisor in financial advisory services reveals the importance of mirroring for customers in perceiving a relationship. Two types of interactions that customers do not consider to be relationships are identified. Scholars have referred to occasions in which customers are too trusting as “the dark side of trust”, meaning that the customer becomes less actively involved in the relationship with increasing advisor trust. Applying a concept borrowed from psychotherapy—working alliance—has opened up possibilities for further exploration of the inner workings of the financial advisory session. This thesis proposes and tests the concept of a working alliance as a way of enhancing theory and, thereby, the understanding of relationships between consumers and service providers.The results of this thesis have implications for theory by contributing to the understanding of relationships. The implications for policymakers, the industry, and advisors and customers are many. Exploring the practice of financial advisory services lays the groundwork for discussions on, and elaborations of, regulations, educational programs, and hiring practices within the industry, as well as on financial literacy programs directed toward consumers.
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