| 1. |
- Borgström, Birgit, et al.
(författare)
-
Fertility preservation in girls with turner syndrome : prognostic signs of the presence of ovarian follicles
- 2009
-
Ingår i: Journal of Clinical Endocrinology and Metabolism. - : The Endocrine Society. - 0021-972X .- 1945-7197. ; 94:1, s. 74-80
-
Tidskriftsartikel (refereegranskat)abstract
- CONTEXT: Many girls with Turner syndrome have follicles in their ovaries at adolescence. Objective: Our objective was to study which girls might benefit from ovarian tissue freezing for fertility preservation. Design: Clinical and laboratory parameters and ovarian follicle counts were analyzed among girls referred by 25 pediatric endocrinologists. SUBJECTS AND SETTING: Fifty-seven girls with Turner syndrome, aged 8-19.8 yr, were studied at a university hospital. Interventions: Ovarian tissue was biopsied laparoscopically, studied for the presence of follicles, and cryopreserved. Blood samples were drawn for hormone measurements. MAIN OUTCOME MEASURES: Presence of follicles in the biopsied tissue related to age, signs of spontaneous puberty, karyotype, and serum concentrations of gonadotropins and anti-Müllerian hormone were assessed. RESULTS: Ovarian biopsy was feasible in 47 of the 57 girls. In 15 of the 57 girls (26%), there were follicles in the tissue piece analyzed histologically. Six of seven girls (86%) with mosaicism, six of 22 (27%) with structural chromosomal abnormalities, and three of 28 with karyotype 45X (10.7%) had follicles. Eight of the 13 girls (62%) with spontaneous menarche had follicles, and 11 of the 19 girls (58%) who had signs of spontaneous puberty had follicles. The age group 12-16 yr had the highest proportion of girls with follicles. Normal FSH and anti-Müllerian hormone concentrations for age and pubertal stage were more frequent in girls with follicles. CONCLUSIONS: Signs of spontaneous puberty, mosaicism, and normal hormone concentrations were positive and statistically significant but not exclusive prognostic factors as regards finding follicles.
|
|
| 2. |
- Dalheim-Englund, Ann-Charlotte
(författare)
-
Skydda och frigöra : en studie av föräldrar till barn med astma och av professionella vårdare
- 2005
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The overall aim of this thesis is, from the point of view of parents of a child with asthma, to describe meanings of being a parent, parents’ quality of life, and to describe how family relations are influenced by their child’s disease. The aim is also to increase the understanding of what strategies professional caregivers use in their work with teenagers suffering from asthma. Methods: Informants in the three qualitative studies were 29 parents (17 mothers and 12 fathers) of children with asthma and 7 professional caregivers. Informants in a quantitative quality of life study were 371 parents. The data collections were undertaken by means of interviews, observations and a questionnaire. The data was analysed by means of a phenomenological-hermeneutic method, grounded theory and statistics. Results: A meaning of being a parent of a child with asthma is to live a strenuous life and to fear that the child might die during a severe asthma attack. The parents’ actions involve both protecting and liberating and their feelings involve sadness as well as acceptance. Mostly the mothers act in a protecting manner and express feelings of sadness. The fathers mostly act in a liberating manner and express feelings of acceptance. The core concern in families of a child with asthma was found to be disease-engendered uncertainty. The mothers describe that feelings of uncertainty always are present owing to the unpredictability of the disease. These feelings make the mothers more or less available for family members. For the child with asthma the mothers’ experience that they are always available. Thus, control and tight bonds characterize the mother-child relationships. The mothers’ constant availability for the child with asthma is experienced to lead to a decreased availability for other family members and theses relationships are characterised by feelings of forsakenness and lack of understanding. However, when parents of children with asthma estimate their quality of life by a questionnaire, they estimate it as comparatively high. In the same family the parents scoring of separate items was to a large extent similar. The result also shows that professional caregivers’ central concern is to assist teenagers with asthma to conquer life. This gives rise to five strategies: showing respect, being at hand, promoting personal sense of responsibility, promoting exceeding boundaries, and promoting reflections. In professional caregivers’ attempt to assist teenagers to conquer life some differences are seen in the way they support boys and girls. Conclusion: One conclusion drawn from this thesis is that being a parent of a child with asthma involves feelings of uncertainty. In meeting the parents in question, caregivers should reflect upon these feelings and consider how the parents could be assisted. As mothers and fathers describe different attitudes in relation to the care of the child, it is also important to reflect upon how professional caregivers can assist the balance between the mothers’ protecting and the fathers’ liberating attitudes. It is also important for professional caregivers to reflect upon how they meet teenage girls and boys with asthma respectively, and to take their needs and understanding of the situation into consideration.
|
|
| 3. |
- Edvardsson, David, 1973-
(författare)
-
Atmosphere in care settings : Towards a broader understanding of the phenomenon
- 2005
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of the study is to understand and describe the phenomenon ‘atmosphere in care settings’ as experienced by patients, significant others and health care staff. The study consists of four papers, each of which illuminates various aspects of the phenomenon. Data consisted of observations and interviews with patients, significant others and staff (n=126) within a hospice, a geriatric, a medical and an oncology setting, and community care settings for older people. Narrative analysis, grounded theory, and phenomenological hermeneutics were used in a triangular fashion to analyse the data. The findings illuminate the phenomenon ‘atmosphere in care settings’ as being constituted by two interacting and interwoven dimensions: the physical environment and people’s doing and being in the environment. The physical environment is the first dimension, and five aspects were illuminated, namely the physical environment as a symbol; as containing symbols; as influencing interaction; as facilitating a shift of focus from oneself to the environment, and; as containing scents and sounds influencing experiences of at-homeness or alienation. People’s doing and being in the environment is the other dimension, and five aspects were illuminated, namely the experience (or absence of experience) of a welcoming; of seeing and being seen; of a willingness to serve; of a calm pace; and of safety. It was understood that people’s doing and being influences experiences of the physical environment and that the physical environment influences experiences of people’s doing and being. The comprehensive understanding illuminated that the phenomenon is not merely subtle qualities of the place for care, but an active part of care. Both the physical environment and peoples doing and being conveys messages of caring and uncaring. The atmosphere of a care setting can at best support experiences of at-homeness in relation to oneself, others and the surrounding world.
|
|
| 4. |
- Edvardsson, David, et al.
(författare)
-
Caring or uncaring - meanings of being in an oncology environment.
- 2006
-
Ingår i: Journal of Advanced Nursing. - : Wiley. - 0309-2402 .- 1365-2648. ; 55:2, s. 188-197
-
Tidskriftsartikel (refereegranskat)abstract
- AIM: This paper reports a study illuminating meanings of being in the physical environment of an oncology centre as narrated by patients, significant others and staff. BACKGROUND: The physical environment of hospitals can convey different messages. For example, landscape pictures, plants and comfortable chairs can convey positive messages, while sparsely decorated and run-down environments can convey negative values. Traditional healthcare environments may be experienced as unfamiliar, strange and alienating, fostering feelings of stress and vulnerability. The majority of research on care environments has employed experimental designs to test different environmental variables, for example sound, colour and architecture, in relation to patient outcomes such as recovery, pain and blood pressure. There is, however, little research-based understanding of the meanings of being in these environments. METHODS: A phenomenological hermeneutic approach was applied to analyse 17 interviews with patients, significant others and staff carried out during the spring of 2004 at an oncology centre in Sweden. FINDINGS: The physical environment was found to influence experiences of care in four ways: first, by being a symbol expressing messages of death and dying, danger, shame and stigma, less social value and worth; second by containing symbols expressing messages of caring and uncaring, life and death; third, by influencing interaction and the balance between being involved and finding privacy; and fourth, by containing objects that could facilitate a shift of focus away from the self: being able to escape the world of cancer, and finding light in the midst of darkness. The comprehensive understanding illuminates the physical environment as not merely a place for caring, but as an important part of caring that needs to be accounted for in nursing care. CONCLUSION: To promote well-being among patients, we need to ask ourselves if the environment imposes rather than eases suffering. Our findings also suggest the importance of not limiting our conceptions of nursing to nurse-patient relationships, but of using the therapeutic potential of the total environment in nursing care.
|
|
| 5. |
- Edvardsson, David, et al.
(författare)
-
Construction and psychometric evaluation of the Swedish language person-centred climate questionnaire : staff version
- 2009
-
Ingår i: Journal of Nursing Management. - : Hindawi Limited. - 0966-0429 .- 1365-2834. ; 17:7, s. 790-795
-
Tidskriftsartikel (refereegranskat)abstract
- AIM: The aim of the study was to construct and evaluate psychometric properties of the Swedish language Person-centred Climate Questionnaire - staff version. BACKGROUND: Person-centred care is often quoted but ill defined, and the literature warrants the development of valid and reliable measurement tools. METHODS: During 2006, a questionnaire was constructed and distributed to a sample of Swedish hospital staff (n = 600). Questionnaire data was subjected to item analysis and reduction. Psychometrical properties of the questionnaire were evaluated. RESULTS: The 14-item Person-centred Climate Questionnaire showed satisfactory psychometric properties. Measures of validity were good, internal consistency was high, Cronbach's alpha was satisfactory for the total scale (0.88) and test-retest reliability was adequate. CONCLUSION: The results indicate that the staff Person-centred Climate Questionnaire is a valid and reliable tool for assessing staff perceptions of the person centredness of hospital environments. IMPLICATIONS FOR NURSING MANAGEMENT: This instrument makes it possible to study the degree of person-centredness in relation to different organizational systems, environments, staff groups and managerial styles. In addition, staff variables such as turnover rates, health outcomes and efficacy can be related to staff perceived person centredness of the organization.
|
|
| 6. |
- Edvardsson, David, et al.
(författare)
-
Swedish language Person-centred Climate Questionnaire - patient version : construction and psychometric evaluation
- 2008
-
Ingår i: Journal of Advanced Nursing. - Malden : Wiley-Blackwell. - 0309-2402 .- 1365-2648. ; 63:3, s. 302-309
-
Tidskriftsartikel (refereegranskat)abstract
- AIM: This paper is a report of a study to construct and evaluate psychometric properties of the Swedish language patient version Person-centred Climate Questionnaire.BACKGROUND: Person-centred care is widely described as a preferred model of care as it uses the individual person's perspective as point of departure. However, the concept is elusive and lacks definition and a means of measurement.METHOD: A preliminary item pool generated from qualitative studies was distributed to a sample of hospital patients (n = 544) and subjected to item analysis and reduction using exploratory and confirmatory factor analysis. The psychometrical properties of the final questionnaire were evaluated using statistical estimates of validity and reliability.RESULTS: The final 17-item questionnaire consists of three factors explaining 65.1% of the total variance in data, and shows satisfactory goodness-of-fit in confirmative factor analyses. The factors were labelled safety, everydayness and hospitality. Content and construct validity was estimated as satisfactory by Delphi assessment, factor and item analysis. Cronbach's alpha was satisfactory for the total scale (0.93), and also for the three subscales: safety 0.94, everydayness 0.82 and generosity 0.64.CONCLUSION: The Person-centred Climate Questionnaire is a valid and reliable contribution for assessing to what extent the climate of hospital environments is person-centred. The instrument enables descriptions and comparisons of environments, exploration of correlates between person-centredness and patient outcomes and/or measure results of various interventions.
|
|
| 7. |
|
|
| 8. |
- Edvardsson, J David, et al.
(författare)
-
Sensing an atmosphere of ease : a tentative theory of supportive care settings.
- 2005
-
Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 19:4, s. 344-353
-
Tidskriftsartikel (refereegranskat)abstract
- Nightingale saw the art of nursing as providing an environment in which patients were offered the best conditions for nature to act upon them. However, we still have limited research-based understandings of care settings experienced as supportive by patients, significant others and staff. The aim of this study was to construct a theoretical understanding of processes contributing to supportive care settings. The authors used grounded theory design and the constant comparative method to analyse theoretically sampled interview and observational data from three different contexts of care. The tentative theory conceptualizes supportive care settings as sensing an atmosphere of ease, and five categories were recognized: experiencing welcoming; recognizing oneself in the environment; creating and maintaining social relations; experiencing a willingness to serve; and experiencing safety. Having one's expectations of the environment exceeded was a mediating factor in sensing an atmosphere of ease. Sensing an atmosphere of ease facilitated experiences of being able to locate oneself in familiar and safe surroundings; being able to follow one's own rhythm; being seen, acknowledged and cared about; and having possibilities of benefiting from beauty and contacts with others.
|
|
| 9. |
- Efraimsson, Eva, et al.
(författare)
-
How to get one's voice heard : the problems of the discharge planning conference.
- 2006
-
Ingår i: Journal of Advanced Nursing. - : Wiley. - 0309-2402 .- 1365-2648. ; 53:6, s. 646-655
-
Tidskriftsartikel (refereegranskat)abstract
- AIMS: This paper reports a study describing how patients, relatives and healthcare professionals dealt with the variety of problems and responsibilities that occur in discharge planning conferences and especially how they managed to do this given the institutional frame that surrounded the meeting. BACKGROUND: In Sweden, the aim of a discharge planning conference is to co-ordinate social and healthcare resources as patients are discharged from hospitals. Patients, relatives and hospital staff, along with healthcare professionals responsible for outpatient care, assemble to achieve an individual care plan. One of the explicit principles informing the discharge planning conference is to increase patients' influence on decision-making. However, research points at shortcomings in this respect. METHOD: A discourse analysis was conducted using transcriptions of eight video-recorded discharge planning conferences. The selected patients were eight older women expected to be discharged from hospital. Other participants were staff nurses, social workers and occasionally relatives, an occupational therapist, district nurse or home care aide. FINDINGS: Participants adopted different roles as persons/patients, relative/next of kin and healthcare professionals/institutional representatives during the discharge planning conference, which they simultaneously struggled to act upon. The findings are presented under the categories 'Clashing roles and perspectives' and 'Facing the institutional frame'. CONCLUSIONS: The performance of the discharge planning conference in its present form interferes with a caring perspective that protects patients' integrity and gives prominence to their life worlds. Moreover, it does not satisfy patients' and relatives' right to expect proceedings that enhance their possibility to express their personal wishes in a dignified manner.
|
|
| 10. |
- Efraimsson, Eva, et al.
(författare)
-
"They were talking about me"--elderly women's experiences of taking part in a discharge planning conference.
- 2006
-
Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 20:1, s. 68-78
-
Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Discharge planning procedures needs improving to make transition to care settings in the community smooth, safe and secure. Research about discharge planning that involves a patient perspective is limited. The intention of this study was to focus on the patients' (elderly women) experiences of taking part in discharge planning conferences (DPCs) to deepen our understanding of the meaning of facing "the world of the institution" from a life-world perspective. AIM: This study aims at describing elderly women's experience of taking part in a DPC as they are about to be discharged from hospital. METHODOLOGICAL DESIGN: To illuminate the phenomenon from a life-world perspective, an interview study was chosen. Eight follow-up interviews with seven elderly women were carried out. The interviews were analysed using a qualitative content analysis methodology. FINDINGS: The interpretation of data was that the women's future was as in suspense as they got ill or were hit by accidents. The analysis revealed four themes that reflected the women's experiences of taking part in the DPCs: Being affiliated; Being in focus, Standing outside; and finally Being unprepared. STUDY LIMITATIONS AND CONCLUSION: The limitations of the study are related to: selection of participants; participation in the interview was connected to a video recording study; gap in time between participation in the DPC and the interview. The findings are still seen as trustworthy as the experiences expressed by the participating women in data are to be seen as a contribution to an emerging understanding of the meaning of the phenomenon from a life world perspective. The findings make clear that the institutional world easily and without much resistance from the patients transgresses the border of their life worlds. This awakes a need to reconsider how a caring perspective can be established in practice.
|
|
