| 1. |
- Strömberg, Sara, et al.
(författare)
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A high-throughput strategy for protein profiling in cell microarrays using automated image analysis
- 2007
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Ingår i: Proteomics. - : Wiley. - 1615-9853 .- 1615-9861. ; 7:13, s. 2142-2150
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Tidskriftsartikel (refereegranskat)abstract
- Advances in antibody production render a growing supply of affinity reagents for immunohistochemistry (IHC), and tissue microarray (TMA) technologies facilitate simultaneous analysis of protein expression in a multitude of tissues. However, collecting validated IHC data remains a bottleneck problem, as the standard method is manual microscopical analysis. Here we present a high-throughput strategy combining IHC on a recently developed cell microarray with a novel, automated image-analysis application (TMAx). The software was evaluated on 200 digital images of IHC-stained cell spots, by comparing TMAx annotation with manual annotation performed by seven human experts. A high concordance between automated and manual annotation of staining intensity and fraction of IHC-positive cells was found. in a limited study, we also investigated the possibility to assess the correlation between mRNA and protein levels, by using TMAx output results for relative protein quantification and quantitative real-time PCR for the quantification of corresponding transcript levels. In conclusion, automated analysis of immunohistochemically stained in vitro-cultured cells in a microarray format can be used for high-throughput protein profiling, and extraction of RNA from the same cell lines provides a basis for comparing transcription and protein expression on a global scale.
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| 2. |
- Uhlén, Mathias, et al.
(författare)
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A human protein atlas for normal and cancer tissues based on antibody proteomics
- 2005
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Ingår i: Molecular & Cellular Proteomics. - 1535-9476 .- 1535-9484. ; 4:12, s. 1920-1932
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Tidskriftsartikel (refereegranskat)abstract
- Antibody-based proteomics provides a powerful approach for the functional study of the human proteome involving the systematic generation of protein-specific affinity reagents. We used this strategy to construct a comprehensive, antibody-based protein atlas for expression and localization profiles in 48 normal human tissues and 20 different cancers. Here we report a new publicly available database containing, in the first version, similar to 400,000 high resolution images corresponding to more than 700 antibodies toward human proteins. Each image has been annotated by a certified pathologist to provide a knowledge base for functional studies and to allow queries about protein profiles in normal and disease tissues. Our results suggest it should be possible to extend this analysis to the majority of all human proteins thus providing a valuable tool for medical and biological research.
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| 3. |
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| 4. |
- Audulv, Åsa, 1980-, et al.
(författare)
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An ongoing process of inner negotiation – a Grounded Theory study of self-management among people living with chronic illness
- 2009
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Ingår i: Journal of Nursing and Healthcare of Chronic Illness. - : Wiley. - 1752-9816 .- 1752-9824. ; 1:4, s. 283-293
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Tidskriftsartikel (refereegranskat)abstract
- Aim. The aim of this study was to better understand the main concern of self-management processes among people with chronic illness.Background. One aspect of living with chronic illness is self-management that can reduce the illness impact on daily life and promote future health. Although factors that influence self-management have been identified in previous research, little attention has been brought to the process of making self-management decisions. In clinical settings, use of a theory could facilitate patient-empowering approaches.Method. The data collection for this Grounded Theory was mostly conducted in 2006. Data were collected by interviews with 26 adults with a variety of chronic illnesses, including rheumatoid arthritis, diabetes mellitus, inflammatory bowel syndrome, multiple sclerosis, ischaemic heart disease and chronic kidney failure.Results. Individuals are conflicted by competing preferences when taking decisions about self-management. Consequently, the decision-making process can be understood as an ongoing inner negotiation between different incompatible perspectives, e.g. social needs vs. medical needs. The process of negotiating self-management starts with the individual’s considering beliefs about health and illness, which make the individual face illness threats and the need for self-management. Several aspects influence negotiating self-management namely, assessing effects of self-management; evaluating own capacity; perceiving normality or stigmatisation; and experiencing support and external resources. The process has been demonstrated in a model.Conclusions. The process of negotiating self-management is an ongoing inner debate rather than a one-time decision. This opens up new ways of understanding, and communicating with, patients. The described model also links behavioural theories and research findings in a comprehensive understanding.Relevance to clinical practice. This model could be applicable as a communication tool for health-care providers in identifying barriers to, and resources in, self-management behaviour among individuals with chronic illness.
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| 5. |
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| 6. |
- Augutis, Marika, et al.
(författare)
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Psychosocial aspects of traumatic spinal cord injury with onset during adolescence : A qualitative study
- 2007
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Ingår i: Journal of Spinal Cord Medicine (JSCM). - : Informa UK Limited. - 1079-0268 .- 2045-7723. ; 30:Suppl1, s. 55-64
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND/OBJECTIVE: Spinal cord injury (SCI) occurring during adolescence poses additional challenges because of the concurrent age-specific bio-psychosocial development. Full understanding of the psychosocial dimensions of rehabilitation requires exploration of the patient perspective. The objective of this study was to focus on psychosocial factors from the patient perspective in persons who had previously sustained a SCI during early and mid-adolescence (11-15 years of age).METHODS: Twenty-four of the 28 persons who had sustained a SCI in Sweden from 1985 to 1996 participated in the study. Semistructured interviews were made an average of 10 years after injury. Narratives were analyzed qualitatively according to content analysis.RESULTS: Parents and peers were found to have formed a crucial network. Parents frequently acted as advocates in interactions with health care providers, as supporters, and as containers of sorrow, frustration, and anger. Peers acted as promoters of activity and identity development. However, health care providers were perceived as not making sufficient use of this network.CONCLUSIONS: Rehabilitation professionals might be encouraged to increase their knowledge of adolescence medicine to better meet the specific needs and demands of persons in this age group. It is further suggested that parents and peers be considered important partners in the joint rehabilitation effort.
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| 7. |
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| 8. |
- Berglund, Lisa, et al.
(författare)
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A genecentric Human Protein Atlas for expression profiles based on antibodies
- 2008
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Ingår i: Molecular & Cellular Proteomics. - 1535-9476 .- 1535-9484. ; 7:10, s. 2019-2027
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Forskningsöversikt (refereegranskat)abstract
- An attractive path forward in proteomics is to experimentally annotate the human protein complement of the genome in a genecentric manner. Using antibodies, it might be possible to design protein-specific probes for a representative protein from every protein-coding gene and to subsequently use the antibodies for systematical analysis of cellular distribution and subcellular localization of proteins in normal and disease tissues. A new version (4.0) of the Human Protein Atlas has been developed in a genecentric manner with the inclusion of all human genes and splice variants predicted from genome efforts together with a visualization of each protein with characteristics such as predicted membrane regions, signal peptide, and protein domains and new plots showing the uniqueness (sequence similarity) of every fraction of each protein toward all other human proteins. The new version is based on tissue profiles generated from 6120 antibodies with more than five million immunohistochemistry-based images covering 5067 human genes, corresponding to approximately 25% of the human genome. Version 4.0 includes a putative list of members in various protein classes, both functional classes, such as kinases, transcription factors, G-protein-coupled receptors, etc., and project-related classes, such as candidate genes for cancer or cardiovascular diseases. The exact antigen sequence for the internally generated antibodies has also been released together with a visualization of the application-specific validation performed for each antibody, including a protein array assay, Western blot analysis, immunohistochemistry, and, for a large fraction, immunofluorescence-based confocal microscopy. New search functionalities have been added to allow complex queries regarding protein expression profiles, protein classes, and chromosome location. The new version of the protein atlas thus is a resource for many areas of biomedical research, including protein science and biomarker discovery.
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| 9. |
- Erdner, Anette, 1946-
(författare)
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Berättelser om ensamhetens vardag hos människor med psykiska funktionshinder
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This dissertation deals with people with mental illness that currently live in their own accommodation in the community. Common to all mentally ill people is their serious difficulties in carrying out activities and meeting needs in important areas of life. Terms such as "normalisation" and "integration" into the community of this group were important words full of promise at the time the psychiatric reform was carried out. However, there is some strong evidence that the psychiatric reform has not been completely successful. Despite the knowledge that loneliness and social isolation commonly occur among people with mental illness, there is little research that describes how mentally ill people themselves experience their life situation. The overall aim of the dissertation was to gain deeper understanding of the life situation of peop with mental illness via their own narratives on how their day-to-day life appears to them, ar through this gain knowledge of the type of support needed for them to live a satisfactory life. Various data acquisition methods were applied. Study I involved in-depth interview of two men and two women on their daily life. Data acquisition in Study II was via participant observations, an activity unit for people with mental illness. Photographs were used for Studies III and IV Eight informants were issued with disposable cameras and asked to take approximately 10 pictures of objects, situations and/or individuals. These photographs were then used as a basis for follow-up interviews. Results from Study I showed that informants were aware both of their illness and their psychosocial disadvantages, and that they had insight into what was required of them to influence their situation, while simultaneously having insight into their poor ability to tak initiatives. Informants in Study II experienced themselves as unwelcome, vulnerable and marginalised individuals with little hope of a change in existence, resulting in anxiety over the future. They felt trust was lacking in relation to other people and experienced themselves as not accepted in the company of others or by society. Study III provided description of informants occupied with themselves and their existence. The informants tell of a form of spirituality giving them a sense of peace and tranquillity, but which only exists for them at the beginning and end ol life. Animals are more loyal than people and make no demands, but are however, according to the informants, in a position of dependence on humans. Possessions are of significance to the informants, meaning they see their possessions as part of themselves. In Study IV informants related how they would like their future to appear. They also told what having an identity meant to them, how identity is formed in individuals, what having a mental illness and feeling good means. The informants showed a longing to be seen, but at the same time not wanting to be seen. Finding a meaning with life was important since it could end at any moment.In summary, the findings point to an existential loneliness that consists of a life pattern consisting of an interaction between the impact of the mental illness and the identity as a mentally ill person feelings of marginalisation and abandonment. Experiencing that life has a meaning, possibility o social exchange and a sense of control seem to be important for the persons with mental illness in this study. Consequently, it can be inferred that if the care of people with mental illness pays attention to the dimensions of existential loneliness persons with mental illness may be helped to experience that life has a meaning despite their disability.
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| 10. |
- Eriksson, Monica, 1960-, et al.
(författare)
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Patients´and their partners´experiences of returning home after hospital discharge following acute myocardial infarction
- 2009
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Ingår i: European Journal of Cardiovascular Nursing. - : Elsevier. - 1474-5151 .- 1873-1953. ; 8:4, s. 267-273
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Tidskriftsartikel (refereegranskat)abstract
- Background: Returning home from hospital after an acute myocardial infarction [AMI] can be a period of vulnerability both for the patient and his/her partner. This study focuses on the time immediately after discharge. Aims: The aim of this study was to describe the patient’s and his/her partner’s experiences after hospital discharge following AMI. Methods: 15 couples took part in individual interviews, 4- 8 weeks after discharge. Data were analysed using qualitative content analysis. Results: The results are presented by means of three themes, ´ at home in one’s own home`, ´ at home within oneself ` and ´having normality in sight`, comprising ten categories that describe the experiences of both the patient and his/her partner. Conclusions: The patients as well as partners described the period after discharge from hospital comprising ambitions of feeling safety in their home, an inner sense of security and seeking normalisation.The results of this study could be useful for nurses when planning for patient discharge. During hospitalization nurses can prepare both the patient and their partner for what to expect when the patient returns home.
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| 11. |
- Hellzén, Ove, et al.
(författare)
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Nurses' narratives about their residents when caring for people with long-term mental illness in municipal group dwellings
- 2006
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Ingår i: International Journal of Mental Health Nursing. - : Wiley. - 1445-8330 .- 1447-0349. ; 15:1, s. 60-69
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Tidskriftsartikel (refereegranskat)abstract
- Nurses working in community psychiatric care are expected to spend time with the residents, in a genuine, professional way, irrespective of their own feelings towards them. Fourteen nurses at two group dwellings in Sweden were interviewed about their experiences when caring for people with long-term mental illness. Narrative interviews were conducted and interpreted using a method inspired by Ricoeur. The analyses were performed in two steps: the first shows that residents could be divided into four different typologies or patterns--the good, the disabled, the invisible, and the bad residents, of which the nurses liked the first two and disliked the last two. In the second analysis, two themes were formulated to describe the nurses' experiences of 'replenishing one's self-worth and self-esteem' and 'giving up the caring role'. These results were interpreted and reflected on in the light of a theoretical framework in order to obtain a deeper understanding of the text. The study indicates that the question of whether nurses liked or disliked the residents appears to be closely related to whether or not the individual resident confirmed the nurse. Residents who confirmed nurses were liked and given attention, whereas those who did not were disliked and given a minimum of time together with the nurse.
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| 12. |
- Häggström, Marie, et al.
(författare)
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Struggle with a gap between intensive care units and general wards
- 2009
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Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : Informa UK Limited. - 1748-2623 .- 1748-2631. ; 4:3, s. 181-192
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Tidskriftsartikel (refereegranskat)abstract
- Nursing critically ill patients includes planning and performing safe discharges from Intensive Care Units (ICU) to the general wards. The aim of this study was to obtain a deeper understanding of the main concern in the ICU transitional process-the care before, during, and after the transfer of ICU patients. Interviews were conducted with 35 Swedish nurses and analysed according to grounded theory. The main concern was the nurses' "struggling with a gap." The "gap" was caused by differences in the altered level of care and contributed to difficulties for nurses encountering an overlap during the transitional care. The categories: Sheltering, seeking organizational intertwining and striving for control are related to the core category and were used to generate a theory. The nurses sought improved collaboration, and employed patient-centred routines. They wanted access to necessary tools; they relayed or questioned their own competence and sought assurance of the patients' ability to be transferred. If the nurses felt a loss of control, lack of intertwining and lack of collaboration, they sheltered their patients and themselves. Intertwining was more difficult to perform, but actually even more important to do. With knowledge about ICU transitional care, collaboration, routines, and with an organization that provides an educational environment, the process could be improved.
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| 13. |
- Hörberg, Ulrica, 1968-
(författare)
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Att vårdas eller fostras. Det rättspsykiatriska vårdandet och traditionens grepp
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- To be sentenced to care in the forensic psychiatric services can be seen as one of the most comprehensive encroachments society can make on a person's life and being, as it entails a limitation of the individual's freedom but with no time limit. The aim of this dissertation is to describe caring in forensic psychiatry based on how it is experienced by those who perform the caring and by those are cared for in a maximum secure unit. A reflective lifeworld approach, based on phenomenological philosophy, has been applied. The data has been collected in interviews that have been analyzed by use of a meaning analysis searching for the essence of the phenomenon. The results of the research are presented in two empirical studies and a general structure based on the empirical findings. The dissertation also contains an excursus, a philosophical intermediate chapter containing further analysis of the results of the studies. The results show how the forensic psychiatric care is experienced as being non-caring by the patients with only small "pockets" of good care. Caring consists of corrective techniques that are unreflected and contradictory, where the conditions are determined by the caregivers and the ward culture. The correcting takes place through the modification of the patients' behaviour with the aim of the patients having to adapt themselves to the terms of the care provision. This care results in the patients trying, by use of different strategies, to adapt them-selves to the demands of the caregivers in order to gain privileges. At the same time the patients long to get away from the care system and are lacking real, meaningful and close relationships. To be the subject of care entails struggling against an approaching overwhelming sense of resignation and to care entails experiencing both power and powerlessness in performing the care. A destructive power struggle is being waged within forensic psychiatric care that suppresses the caring potential and true caring is thus elusive. The characteristics of forensic psychiatric care, based on the results of the research, are clarified in the dissertation's excursus. These include the corrective and disciplinary nature of forensic psychiatric care, its power and how this is materialized in care situations as well as the influence of tradition on current forensic psychiatric care in the light of the work of the French philosopher Michel Foucault. The dissertation shows that if the caring potential is to be able to be developed and form a caring nucleus for forensic psychiatric care then education levels need to be further developed. A caring culture and caring environment is needed where true caring can gain a foothold. In order for this to become a possibility the current caring culture and environment must be clarified, questioned and examined. The prevalent fundamental ideas in forensic psychiatric care have to be "jeopardized" and challenged by new scientifically based ideas on what constitutes true caring in this context.
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| 14. |
- Isaksson, Ulf, 1959-
(författare)
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Våld mot vårdare i sjukhemsvård
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis aimed to explore factors related to the prevalence of violence towards caregivers working in a nursing home context. The aim was also to describe caregivers’ perceptions and experiences of violence in a nursing home context. The thesis comprises four studies. Study I includes data regarding environmental and organizational factors, residents’ and caregivers’ characteristics, and violence. Data concerning job satisfaction and working climate were also obtained. In study II, questionnaires were used to collect data concerning caregivers’ exposure to violence and their personal characteristics. Data concerning personality traits, coping resources, and burnout were collected by means of instruments. In order to illuminate caregivers’ perceptions of violence (III) and experiences of being exposed to violence (IV) interviews were performed. Quantitative data were analyzed by means of comparative and descriptive statistics. The interviews were transcribed and interpreted using a qualitative content analysis method. The results showed that 15 percent of the residents exhibited violent behaviour during the week of in-vestigation. A significant higher proportion of male residents were assessed by the caregivers to present violent behaviour compared to female residents. A discriminate analysis showed that the prevalence of behavioural symptoms and psychiatric symptoms, residents needing assistance with dressing, the caregivers’ psychological workload, and job satisfaction were the strongest discriminators between nursing home wards with a high versus low proportion of residents with violent behaviour (I). The results from study II showed that among the 196 caregivers participating in the study, 68 % re-ported exposure to violence during the previous year. Twenty-two percent reported exposure several times per week, and 51 % reported exposure at least once during the previous month. A higher proportion of caregivers 50 years or younger were exposed to violence compared to older caregivers. A higher proportion of caregivers with a work experience of three years or more reported exposure to violence compared to less experienced caregivers. A higher proportion caregivers who reported exposure to violence assessed symptoms on burnout and motherly rejection. No significant differences between the two groups were found concerning coping resources, defence mechanisms, temperament, and character. Study III showed that caregivers’ perceptions of violence are subjective and in the eye of the beholder. The caregivers perceive violence as challenging and expressed that caring situations had to be solved even though their own safety is perceived to be in danger. The caregivers perceive violence as intentional when the residents are judged to have a good cognitive capacity and are perceived to be conscious. However, the care-givers perceive violence as excusable when the residents are described as old and sick. The caregivers perceive violence as ordinary and as a part of the work situation. The caregivers also perceive violence as contextual since similar violence is accepted at the work place but not outside it. The result from study IV showed that the caregivers’ experiences of exposure to violence range be-tween being overwhelmed by contradictory emotions and being resigned. The caregivers have preconceived ideas towards the violent behaviour and describe being on guard in order to avoid being exposed to violence. The caregivers experience that they lose the control over a violent situation and strive to regain the control. They are overwhelmed by emotions such as surprise, anger, and repulsiveness and describe a resignation hav-ing to care for violent residents. Caring for violent residents is described as a constant struggle and the care-givers express a disappointment over insufficient support. The caregivers strive to regain the control by means of seeking excuses for the violent behaviour or by support from colleagues. The conclusions from this thesis are that the prevalence of violence is related to factors among the residents as well as the caregivers, that caregivers’ perceptions of violence are subjective and caregivers’ experi-ences varies between being overwhelmed by contradictory emotions and resignation. There is a risk that vio-lence in nursing homes becomes a norm, is accepted, and in this way is maintained. The boundary between what is acceptable and what is not acceptable becomes erased, the caregiver resigns, and the violence is not looked upon as a divergence but becomes a part of the working situation. It is therefore important that the problems with violence at nursing homes are attended to and that the caregivers are supported in their work.
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| 15. |
- Karlsson, Staffan, 1959-
(författare)
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Older people`s public health care and social services : Functional ability, health complaints, agreement in needs assessment and care satisfaction
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim was to describe and compare functional ability and health complaints of older people receiving municipal care in relation to housing and informal care, and factors associated with medical health care, municipal care and informal care. Further, the aim was to investigate agreement in needs assessments between personnel and older people and to investigate care satisfaction and health-related quality of life among older people receiving municipal care and services. Study I and II included 1958 persons aged 65 years and above, who were assessed for functional ability, health complaints, and level of informal and municipal care and service. Study II in addition included data from a register including medical health care. In study III (n=152), standardised needs assessments were performed by the staff. Later, the older person’s view was collected in a personal interview concerning functional ability, health complaints, public and informal care. In addition (Study IV, n=166), SF-12 was used for measuring health-related quality of life and for measuring care satisfaction. Cohabitation was a predictor of a combination of municipal and informal care at home (OR: 5.935), while assistance with Instrumental Activities of Daily Living (IADL) provided by municipal home care and services predicted municipal care only (OR: 0.344). Care in special accommodation was predicted by advanced age (OR: 1.051), dependency in IADL (OR: 19.883), Personal Activities of Daily Living (PADL) (OR: 02.695), and impaired cognitive ability (OR: 3.849) with receiving municipal care only as a reference. Living alone (OR: 0.106), dependency in IADL (OR: 11.348) and PADL (OR: 2.506), impaired cognitive ability (OR: 3.448), impaired vision or blindness (OR: 1.812) and the absence of slowly healing wounds (OR: 0.407) were predictors of special accommodation with a combination of informal and municipal care at home as a reference. 35% of those with public care at home were admitted to hospital and 76% had contact with outpatient care by physician compared to 26% and 87% respectively of those in special accommodation. Living in special accommodation was associated with more contacts with primary health care (B=0.643) and fewer contacts with specialist care (B=-0.722). Informal care was associated with more contacts with primary health care (B=0.413), specialist care (B=0.787), admissions to (B=0.265) and days in hospital (B=1.573). Agreement for dependency in IADL and PADL varied between good (κ=0.78) and moderate (κ=0.43). Poor agreement was found for dizziness (κw=0.17) and fair agreement for impaired hearing, urinary incontinence, pain, anxiety and depressed mood (κw between 0.21 and 0.37). Older persons reported more health complaints than were found in the personnel’s assessments, although significantly lower estimation was found only for incontinence and vision. Agreement for provided public care at home was poor, while for informal care it varied between very good and moderate. Low care satisfaction was associated with dependency in IADL (B=-1.338 and B=-1.630), impaired mobility (B=-12.579), blindness (B=-26.143), faeces incontinence (B=-11.898 and B=-17.529) and anxiety (B=-6.105 and B=-27.197), while high care satisfaction was associated with dependency in PADL (B=2.109) and receiving informal care with IADL from spouse (B=8.738). In special accommodation, low care satisfaction had to do with continuity, timing, the staff’s personal characteristics and with their ability to give service. At home, the older people were the least satisfied with the staff’s ability to do housework and to give medical care, with the staff’s amount of time and with their own influence over their care.
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| 16. |
- Kristiansen, Lisbeth, et al.
(författare)
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Swedish assistant nurses´experiences of job satisfaction when caring for persons suffering from dementia and behavioural disturbances : An interview study
- 2006
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Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : Informa UK Limited. - 1748-2623 .- 1748-2631. ; 1:4, s. 245-256
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Tidskriftsartikel (refereegranskat)abstract
- Job satisfaction is complex and is an important component in facilitating high quality nursing care. Behavioural and psychological symptoms of dementia (BPSD) can be clustered into one of five syndromes: psychosis, aggression, psychomotor agitation, depression and apathy, and comprise signs and symptoms of disturbed perception, thought content, mood or behaviour that frequently occur in patients with dementia. BPSD can cause tremendous distress both for the patients and for their caregivers and they have been seen as the most stressful aspect of care giving. Two registered nurses, 16 assistant nurses and two nursing assistants in Sweden talked about their job satisfaction when caring for residents suffering from dementia and BPSD. Thematic content analysis was conducted. The nurses' narrations indicate exposure, insufficiency, not being valued and doubt, as well as respect and importance and devotion towards the residents. One core theme was formulated: "Job satisfaction as a process moving between breaking down and occasionally building up the working person". A positive relationship with colleagues was the primary reason for nurses continuing to work at the group dwellings. The organization and resident behaviours were seen as very negative. Some nurses described insecurity in terms of how long they could continue to take rudeness, being spat at, being scratched or physically hit by residents, without "hitting back". In order to increase the well-being of the nurses, the pressure on them needs to be relieved. The development of leadership, education, supervision and reflection might be one possible way of reducing the prevalence of BPSD-related violence, enhancing job satisfaction and handling moral stress.
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| 17. |
- Kristiansen, Lisbeth, et al.
(författare)
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The impact of nurses' opinion of client behaviour and level of social functioning on the amount of time they spend with clients
- 2005
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Ingår i: Journal of Psychiatric and Mental Health Nursing. - : Wiley. - 1351-0126 .- 1365-2850. ; 12:6, s. 719-727
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Tidskriftsartikel (refereegranskat)abstract
- The impact of nurses' opinion of client behaviour and level of social functioning on the amount of time they spend with clients For people afflicted with different kinds of psychiatric disorder, suffering is a common denominator. The time the nurses spend with psychiatric clients may mirror their attitudes towards and feelings for these clients. The aim of this study was to investigate the connections between the time spent together and the nurses' opinion of client behaviour and social functioning in community-based psychiatry. In this quantitative study, 29 clients were assessed by 30 nurses, who answered the Global Assessment of Functioning Scale (GAF) and the Positive and Negative Syndrome Scale (PANSS). At the same time, 11,200 non-participant observations of clients were registered using the Patient Activity Classification (PAC) to investigate how they spent their time at two psychiatric group dwellings. The PAC instrument revealed that clients spent an average of 60.8% of time alone, while only 20% of their daily time was spent with the nurses. Based on a factor analysis, indices were made by setting cut-off points for the PANSS and the GAF scores, and four small groups of clients were generated: a relatively high level of social functioning and a low degree of psychiatric symptoms (A); a relatively high level of social functioning and a high degree of psychiatric symptoms (B); a low level of social functioning and a low degree of psychiatric symptoms (C); and, finally, a low level of social functioning and a high degree of psychiatric symptoms (D). The clients judged as having a low level of social functioning in combination with high degrees of psychiatric symptoms, that is, the most vulnerable and dependent individuals, receive less staff attention (18%) and are the clients who spend the most time alone (71.4%). It might be possible to interpret the results of this study in the light of a process of dehumanization.
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| 18. |
- Landstedt, Everlina, et al.
(författare)
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Enhancing adolescent mental health - understanding the significance of contextual factors and a gender perspective.
- 2006
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Konferensbidrag (refereegranskat)abstract
- BACKGROUND: Existing studies show a negative trend in adolescent mental health and a gender pattern where girls in general report more mental health problems. There is a knowledge gap regarding the significance of contextual factors and a lack of qualitative studies. The aim was to explore what conditions upper secondary school adolescents perceive as significant for mental health, analysed from a gender perspective. METHODS: The study was conducted according to grounded theory and consisted of 29 semi-structured, focus group interviews with 16-19 years old adolescents. Data was analysed by constant comparative method. RESULTS: Significant conditions for mental health were identified in three processes comprising what the participants perceived as positive and negative for mental health. These were processes of (i) social interactions, ranging from supportive relations to assault, (ii) performance, ranging from encouraging success to demands and heavy work load, (iii) responsibility, when processes of interaction and performance are intertwined and reinforced. The category of responsibility included processes ranging from limited responsibility taking to responsibility as a burden and lack of control. Mainly girls had experiences of negative aspects of these conditions. CONCLUSION: The adolescents emphasised the significance of contextual factors in general and specifically those concerning relations, treatment, expectations, demands and assault. A gender perspective can contribute to a deeper understanding of gender patterns in adolescent mental health. Different experiences among girls and boys in their everyday life may affect their mental health.Contextual factors, gendered power relations and cultural norms of masculinity and femininity should be acknowledged in mental health promotion and preventive work among adolescents.
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| 19. |
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| 20. |
- Landstedt, Evelina, et al.
(författare)
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Understanding adolescent mental health: the influence of social processes, doing gender and gendered power relations
- 2009
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Ingår i: Sociology of Health and Illness. - : Wiley-Blackwell. - 0141-9889 .- 1467-9566. ; 31:7, s. 962-978
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Tidskriftsartikel (refereegranskat)abstract
- Despite a well-documented gender pattern in adolescent mental health, research investigating possible explanatory factors from a gender-theoretical approach is scarce. This paper reports a grounded theory study based on 29 focus groups. The aim was to explore 16- to 19-year-old students' perceptions of what is significant for mental health, and to apply a gender analysis to the findings in order to advance understanding of the gender pattern in adolescent mental health. Significant factors were identified in three social processes categories, including both positive and negative aspects: (1) social interactions, (2) performance and (3) responsibility. Girls more often experienced negative aspects of these processes, placing them at greater risk for mental health problems. Boys' more positive mental health appeared to be associated with their low degree of responsibility-taking and beneficial positions relative to girls. Negotiating cultural norms of femininity and masculinity seemed to be more strenuous for girls, which could place them at a disadvantage with regard to mental health. Social factors and processes (particularly responsibility), gendered power relations and constructions of masculinities and femininities should be acknowledged as important for adolescent mental health.
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| 21. |
- Lehtinen, Ullaliina, et al.
(författare)
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Some remarks on the relevance of basic research in nursing inquiry
- 2005
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Ingår i: Nursing Philosophy. - 1466-7681 .- 1466-769X. ; 6:1, s. 43-50
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this article was to illuminate the issue of basic research in nursing and to problematize its relevance for our discipline. First, we asked leading nursing scholars in the Nordic countries to share their views on basic research in nursing. Thereafter, the ideas, views and suggestions of the scholars were amalgamated with insights from the literature and from the discussions in our project team. Our two guiding questions were: What role can basic research be assigned? Which, if any, forms of basic research can be identified? We found that basic nursing research may be seen as a necessary basis for applied research, as a contribution to applied research, or that the whole issue is seen as a pseudo-issue. We further found that basic nursing research can be seen as either contextual or general as well as either intradisciplinary or multidisciplinary in form. We conclude by the following three succinct remarks or assertions: that basic nursing research is not to be equated with biomedical conceptions of basic research; that basic nursing research may take place on several theoretical levels; and finally, that an indiscriminate dismissal of basic research in nursing may affect the cognitive autonomy of our discipline.
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| 22. |
- Norbergh, Karl-Gustaf, et al.
(författare)
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Nurses' attitudes towards people with dementia : the semantic differential technique
- 2006
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Ingår i: Nursing Ethics. - : SAGE Publications. - 0969-7330 .- 1477-0989. ; 13:3, s. 264-274
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Tidskriftsartikel (refereegranskat)abstract
- One important aspect of the nurse-patient relationship is the nurses' attitudes towards their patients. Nurses' attitudes towards people with dementia have been studied from a wide range of approaches, but few of them have focused on the structure in nurses' attitudes. This study aimed to identify a structure in licensed practical nurses' attitudes towards people with dementia. Twenty-one group dwelling units for people with dementia at eleven nursing homes participated in the study. In all, 1,577 assessments of 178 patients were sent out to 181 respondents and 1,237 answers were returned. The semantic differential technique was used. The scale has 57 bipolar pairs of adjectives, which estimate an unknown number of dimensions of nurses' attitudes towards an identified patient. The assessments were analysed using entropy-based measures of association combined with structural plots. The analysis revealed four dimensions. These four dimensions related to licensed practical nurses' opinion of the patients; from an ethical and aesthetic dimension; their ability to understand; their ability to experience; their ability for social interaction. The study indicates that, on the positive to negative attitude continuum, attitudes fall at the positive to neutral end of the continuum. This is an important finding due to the personhood perspective. From this perspective, it is reasonable to assume that with a more positive attitude to people with dementia, the prerequisites for person-centred care will improve.
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| 23. |
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| 24. |
- Normann, Hans Ketil, et al.
(författare)
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People with severe dementia exhibit episodes of lucidity : A population-based study
- 2006
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Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 15:11, s. 1413-1417
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Tidskriftsartikel (refereegranskat)abstract
- Aims and objectives. To describe frequency and characteristics of people with severe dementia who according to care providers, exhibit ELs in a population of those with dementia in institutional care.Background. There are reports in the literature concerning episodes when the resident unexpectedly says or acts in a way that surprises the care provider because the resident seems to be much more aware of her/his situation than usual. This is labelled ‘episodes of lucidity’ (ELs).Design. The study is based on data from a point prevalence study from institutions for the older people in northern Sweden in May 2000.Methods. Out of 3804 residents, assessed by key care providers, by means of the Multi-Dimensional Dementia Assessment Scale (MDDAS) with questions about ELs added, 92 residents were found to have severe dementia and difficulties with verbal communication. The key care providers’ competence in assessing severe dementia was not evaluated. An ethics committee approved the study.Results. Fifty-two residents (57%) were assessed as exhibiting ELs. Residents who showed ELs had higher orientation scores and expressed more emotions than residents who did not show ELs. More residents who exhibited ELs took outdoor walks with their care providers exhibited ELs than those who did not (P = 0·001).Conclusions. Every second resident with severe dementia and difficulties with verbal communication showed ELs.Relevance for clinical practice. The fact that every second resident with severe dementia and difficulties with verbal communication showed ELs and that this was noticed especially when care providers took outdoor walks with the residents imply that closer contact between care providers and residents with severe dementia could change the care providers’ expectations and enhance communication between the parties.
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| 25. |
- Pejlert, Anita, et al.
(författare)
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How Family Members of a Person Suffering from Mental Illness Experience Psychiatric Care
- 2008
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Ingår i: International Journal of Psychiatric Nursing Research. - 0968-0624. ; 13:3
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Tidskriftsartikel (refereegranskat)abstract
- ABSTRACT Objective The aim of this study was to describe the experience of contact with formal psychiatric care, as narrated by family members of a person suffering from mental illness. Method The study was based on a qualitative design. Focus-groups with 16 family members were transcribed and interpreted using qualitative content analysis. Findings The findings present four themes; being disappointed with formal psychiatric care, being in need of understanding from and collaboration with formal psychiatric care, being positive about the care and the own contribution to the care and being subjected to preconceived ideas. The findings were interpreted as the families� relationship with formal psychiatric care being characterized by a struggle for power. Conclusion To create a healthy situation for the families and thereby improve the situation for the patient, representatives of formal care should carefully consider how the families should be involved. Key words Family, focus groups, mental health, nursing, qualitative research
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| 26. |
- Pontén, Fredrik, et al.
(författare)
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A global view of protein expression in human cells, tissues, and organs
- 2009
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Ingår i: Molecular Systems Biology. - : EMBO. - 1744-4292 .- 1744-4292. ; 5
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Tidskriftsartikel (refereegranskat)abstract
- Defining the protein profiles of tissues and organs is critical to understanding the unique characteristics of the various cell types in the human body. In this study, we report on an anatomically comprehensive analysis of 4842 protein profiles in 48 human tissues and 45 human cell lines. A detailed analysis of over 2 million manually annotated, high-resolution, immunohistochemistry- based images showed a high fraction (>65%) of expressed proteins in most cells and tissues, with very few proteins (<2%) detected in any single cell type. Similarly, confocal microscopy in three human cell lines detected expression of more than 70% of the analyzed proteins. Despite this ubiquitous expression, hierarchical clustering analysis, based on global protein expression patterns, shows that the analyzed cells can be still subdivided into groups according to the current concepts of histology and cellular differentiation. This study suggests that tissue specificity is achieved by precise regulation of protein levels in space and time, and that different tissues in the body acquire their unique characteristics by controlling not which proteins are expressed but how much of each is produced. Molecular Systems Biology 5: 337; published online 22 December 2009; doi:10.1038/msb.2009.93
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| 27. |
- Sjöblom, Lena-Mari, et al.
(författare)
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How Family Members of a Person Suffering from Mental Illness Experience Psychiatric Care
- 2008
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Ingår i: International Journal of Psychiatric Nursing Research. - 0968-0624. ; 13:3, s. 1-13
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Tidskriftsartikel (refereegranskat)abstract
- Aim: The aim of this study was to describe how family members of a person suffering from mental illness experienced contact with formal psychiatric care.Background: When coming in contact with formal psychiatric care families experience complications such as social isolation and stigmatisation. In order to co-operate with and support families adequately it is important to investigate how they experience their contact with formal psychiatric care.Method: The study was based on a qualitative design. Focus groups were transcribed and interpreted using qualitative content analysis. Findings: The findings present four themes; disappointment in formal psychiatric care; the need for understanding from and collaboration with formal psychiatric care; feeling positive about the care provided and how they personally contribute to it; and being subjected to preconceived ideas. The findings were interpreted as showing the families’ relationship to formal psychiatric care as being characterised by a struggle for power.Conclusion: In order to create a healthy situation for the families and consequently improve the situation for the patient, representatives of formal care must meticulously consider families’ involvement. Meetings between formal and informal care, with the objective of sharing knowledge and influence, are suggested as one way of resolving the situation.
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| 28. |
- Sjöblom, Lena-Mari, et al.
(författare)
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Nurses' view of the family in psychiatric care
- 2005
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Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 14:5, s. 562-569
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: The aim of this study is to examine nurses' view of the family in psychiatric care.BACKGROUND: The families of people who are mentally ill carry a heavy burden. Research has shown that they experience sorrow, shame and guilt. They are often involved in informal caring and there is evidence of families playing an important role in the recovery of the patient. In spite of this, a great deal could still be made to create more family-oriented care. This development depends to a large extent on nurses' view of involving families in the care and the perceived value of family-oriented work.METHOD: Four focus groups, with four to six carers in each group, were conducted. The recorded focus groups lasted 75-90 minutes and the data were transcribed and interpreted using content analysis.RESULTS: The results present four themes: compassion for and understanding of close relatives, the carer as the recipient of negative feelings, difficulties and dilemmas in the meeting with close relatives and preconceptions of mental illnesses in the family and in society. The results were interpreted as meaning that the carers found themselves in something that can be described as a double-bind situation.CONCLUSION: From analysis and interpretation, the conclusion is drawn that improved communication between nurses, patients and families could be a way to resolve the double-bind situation.RELEVANCE TO CLINICAL PRACTICE: To promote family health and also improve things for the patient, it can be argued, from the results of this study, that nurses should carefully consider whether and how to involve family members in care.
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| 29. |
- Sjöling, Mats, 1968-
(författare)
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Experiences of abandonment and anonymity among arthroplastic surgery patients in the perioperative period : some issues concerning communication, pain and suffering
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Det övergripande syftet med avhandlingsarbetet är att illustrera och belysa upplevelsen av att vara patient med behov av ledprotes, avseende aspekterna kommunikation, smärtupplevelse, lidande och tillfredsställelse med vård och behandling. Under väntetiden för ledprotesoperation upplever deltagarna i studierna lidande i olika former, tillika att vården är otillgänglig och onåbar i ett ansiktslöst system (I). Att få information om sin sjukdom vad man kan/får/ska göra är nästan omöjligt. Kontakten med sjukvården är svår att upprätta och det är mestadels patientens ansvar att söka information om vad som händer (II). Den bristfälliga kommunikationen som deltagarna i delstudie I upplever, leder till att de känner sig missförstådda och nedvärderade av sjukvårdssystemet, och därmed befinner sig i en ständig kamp för att få sitt vårdbehov bekräftat. Under deltagarnas vandring i sjukvårdssystemet förändras deras negativa uppfattning om vården till att bli mer positiv när en reell kommunikation och personlig kontakt etablerats (IIV). Fynden i arbetena (I-IV) tolkas inom ramen för Katie Erikssons och Lennart Fredrikssons beskrivningar av lidande och det vårdande samtalet. En del deltagare i studierna har av egen kraft, eller till följd av personliga egenskaper uppnått insikter om sig själva och försonats med sitt lidande, på så sätt har de kunnat bibehålla eller uppnå mening i sin tillvaro. Av egen kraft, eller med hjälp av anhöriga kan individerna få sitt lidande bekräftat och därmed möjligheten att kunna lida ut och försonas med sig själv och den förändrade tillvaron. Så länge som sjukvården upplevs som ett ansiktslöst system finns det deltagare i avhandlingen som inte klarar av att ta itu med sitt lidande. Under patientens vandring i sjukvårdssystemet blir det uppenbart att systemet får ett ansikte först när deltagarna kan relatera till vården i form av en reell person. Vården får inte ett ansikte så länge som patienten upplever sig dåligt bemött utan detta sker när det med Fredrikssons termer uppstår ett vårdande samtal. Under väntetiden för operation finns det relativt få tillfällen där ett vårdande samtal har möjlighet att uppstå. Möjligheten för detta är dock större när patienten väl är inlagd på sjukhuset för att bli opererad, vilket återspeglas i den höga grad av tillfredsställelse med vården som uttrycks i delstudie II-IV. Patienterna är tillfredsställda med vård och behandling, trots att de har upplevt postoperativ smärta i en hög grad. I delstudie III var det 68% (n=40) och i delstudie IV 83.5% (n=50) som hade upplevt smärtor motsvarande ≥ 4 på Visuell Analog Skala (VAS). Under sjukhusvistelsen upplever sig patienten bekräftad och synlig i systemet. Synligheten är ömsesidig då även vården (systemet) får ett ansikte på patienten. I ett vårdande samtal uppstår en känsla av tillit och när detta sker vågar patienten och vårdaren kommunicera på ett öppet sätt där de båda är närvarande i situationen
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| 30. |
- Sjöling, Mats, et al.
(författare)
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Waiting for surgery; living a life on hold : A continuous struggle against a faceless system
- 2005
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Ingår i: International Journal of Nursing Studies. - : Elsevier BV. - 0020-7489 .- 1873-491X. ; 42:5, s. 539-547
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Tidskriftsartikel (refereegranskat)abstract
- This interpretive-phenomenological study examined the lived experience of being on the waiting list for arthroplastic surgery of the knee or hip and its impact on daily life. The interviews reveal that respondents experience suffering from different points of view; illness-, caring- and life- suffering. Suffering leads to a struggle in order to have their caring needs met and the struggle is often fruitless - against a faceless enemy - "the system". No one is there to answer their plea or to address the frustration that then arises and, in combination with their present life situation, this may lead to a disrupted self-image. Finding or creating meaning in suffering appears to be a crucial issue in the struggling process. Respondents who are able to preserve or create meaning in life may find it easier to accept the waiting times and wait for their turn in the queue. They are able to reformulate their life-world and live a full life, in spite of severe pain and disability.
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| 31. |
- Sjöling, Mats, et al.
(författare)
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What information do patients waiting for and undergoing arthroplastic surgery want? Their side of the story
- 2006
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Ingår i: Journal of Orthopaedic Nursing. - : Elsevier BV. - 1361-3111 .- 1873-4839. ; 10:1, s. 5-14
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Tidskriftsartikel (refereegranskat)abstract
- This nurse-led focus-group study investigated information needs of patients waiting for arthroplastic surgery – how did they obtain the information and advice they needed? The content analysis of the interview transcripts revealed two main categories – ways of obtaining information and advice and what is needed – what patients want. In the picture emerging from the findings, it is evident that the content of the information that is given does not solely determine whether the respondents’ information needs are met. The way the information is given and whether the respondent is confirmed as a human being and taken seriously by the staff, is believed to be more important in the mutual process of communicating information. On a concrete level, respondents ask for information and advice on what they can do to manage their present life situation while waiting for surgery; this includes pain management, advice on self-training and contact with physiotherapists. They want to know “when” surgery will be performed and to be given opportunities to ask questions. This study serves as another piece in the puzzle investigating patients’ information needs. Implications for nursing are discussed, together with suggestions for future areas of research.
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| 32. |
- Storli, Sissel, et al.
(författare)
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A journey in quest of meaning : a hermeneutic-phenomenological study on living with memories from intensive care
- 2008
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Ingår i: Nursing in Critical Care. - : Wiley. - 1362-1017 .- 1478-5153. ; 13:2, s. 86-96
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: In a short-term perspective, a high incidence of psychological problems linked to memories from intensive care has been found in survivors of critical illness. Little is known about what kinds of memories patients might carry with them and what it is like to live with memories from intensive care as years go by. AIM: The aim of this study was to explore the meaning of living with memories from intensive care. METHODS: A hermeneutic-phenomenological approach. In-depth interviews with ten former intensive care patients 10 years after their admission. FINDINGS: Memories of bodily sensations and memories containing strong emotions were surprisingly well kept. Memories residing in the body at a prereflective level and that could be awakened without being triggered by will or conscious thought comprised an important segment of the memory spectrum. Complaints such as panic attacks and anxiety were strongly linked to these kinds of memories and experienced as flashbacks of frightening experiences that entailed strong emotions. Some informants still strove to understand experiences and reactions. Living with these memories and flashbacks was interpreted as a journey in quest of meaning. Having someone and something to live for implied strength on the journey. The presence of close relatives at the bedside provided strength to go on and someone with whom to share experiences afterwards. CONCLUSION: A period of critical illness and intensive care stay for treatment may leave durable traces in the patient's life. Finding meaning of existential and ontological nature seems to be of decisive significance for how people fare in their lives after having lived through intensive care treatment. The identified journey in quest of meaning points to the need for follow-up programmes, and we must acknowledge close relatives as important resources for the patient both at the bedside and in the subsequent process of discovering meaning in lived experience.
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| 33. |
- Storli, Sissel L., et al.
(författare)
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Being somwhere else - delusion or relevant experience : A phenomenological investigation into the meaning of lived experience from being in intensive care
- 2007
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Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : Informa UK Limited. - 1748-2623 .- 1748-2631. ; 2:3, s. 144-159
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Tidskriftsartikel (refereegranskat)abstract
- Patients' experiences of having been “elsewhere” during intensive care than in the intensive care unit (ICU) has traditionally been placed in a context with described pathological circumstances, such as brain dysfunction, and labeled with terms such as “unreal” and “delusional”. The aim of the study was to look more closely into this type of experience by turning to its meaning as reflected on by patients themselves. Through a phenomenological investigation based on follow-up and interviews with three patients, we found that the “delusions” were in fact filled with meaning. They mattered to the patients and were not to be dismissed as unreal because they were so inherently real in the lived body. The experiences were grounded in the patient's lifeworld and could be interpreted as expressions of basic aspects related to being human in the world. The phenomenological term “lived mood” emerged as one such aspect to which intensive care patients appear to surrender more readily than man does in daily existence. The notion of “being somewhere else” as meaningful and relevant experience challenges the explanatory model whereby such experiences are placed in a context with brain dysfunction.
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| 34. |
- Westerbotn, Margareta
(författare)
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Drug Use Among the Very Old Living in Ordinary Households : Aspects on Well-being, Cognitive and Functional Ability
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: In Sweden today a major proportion of the population survive to old ages. To a large extent, the oldest old are capable of living longer in their own households; some of them are very healthy while others have multiple diagnoses or ailments caused by a normal ageing process. This means that many elderly persons receive their health care needs in their own home, and in the future this will be even more common. Drug use of the elderly is a complex field, and many drugs have side effects complicating the medical treatment and decreasing the quality of life. Aim: This thesis aims to explore and describe the medicine use and the medical situation of very old persons (¡Ý84 years) living in ordinary households, and to obtain knowledge of their views on the use of drugs.Methods: This thesis combines quantitative and qualitative research methods. The quantitative studies (Study I, II and III) were based on data from the Kungsholmen Project, a population based study of elderly people living in a district of the inner city of Stockholm, Sweden. Data collection of the present studies was carried out from the third follow-up 1997-1998. The qualitative data (Study IV) was obtained 2005 through in-depth interviews with 25 elderly men and women, aged 85-97 years, living in ordinary households in Stockholm, Sweden. A pre-tested semi-structured questionnaire was used for the interviews.Results: The findings in Study I demonstrated that cardiovascular diseases are very frequent in this population (62%). Heart failure (47%) and hypertension (37%) were the most common conditions; and diuretics (69%), nitrates (31%) and cardiac glycosides (30%) were the most commonly prescribed drugs. Multivariate regression analyses showed that while being affected by a CV disease did not affect the emotional well-being of the participants (PANAS-PA, p=0.171; PANAS-NA, p=0.209), the use of cardiac glycosides (p=0.006) and nitrates (p=0.008) was associated with increased negative feelings. Study II revealed that 88% of the population took medicines on a regular basis, and only 23% of them received help with the handling of their medicines. Using logistic regression models controlling for sociodemographic variables, cognitive and functional status, female gender (OR: 2.8; 95% CI: 1.2-6.5) was the only variable associated with regular use of medicines. The results also showed that older age and functional disability as measured by ADL, increased the risk of receiving help with medicines, while higher cognitive status decreased the odds of receiving help. Using multiple regression models, we found that the only factor related to not receiving help from a family member was that of living alone (OR:0.05; 95% CI: 0.006-0.4). Study III showed that the prevalence of pain among very old persons was 46%, and the prevalence of pain treatment was 71%. Results from logistic regression analysis using all variables in the model indicated that pain reporting was not associated with age, gender or living conditions, but decreased with decreasing cognitive status and with increasing functional disability. Furthermore, pain treatment was not associated with age, gender, living conditions, cognitive and functional status. The qualitative data in Study IV indicated that most of the participants managed their medicines by themselves and were very content with this. Those elderly who received help with their medicines were also very pleased with this help. The findings also revealed that the most important components for the elderly to be able to remain living in their homes and to handle their medicines by themselves, were to have good cognitive ability, to be independent and to get support with their medicines from a close person as a back-up.Conclusions: This study revealed that a large proportion of very old people (¡Ý84 years) were living in ordinary households and used medicines regularly. Being a woman and living alone were associated with receiving help with medicines from the community help services. Cognitive and functional ability were revealed to be significant factors in the management of medicines, but also to affect the pain reporting, and type of received pain treatment. Most of the older participants managed to handle their medicines by themselves, and were very pleased by doing this. However, most of them were concerned about the risk of losing their memory, as they are getting older, because they knew that they would not be able to manage themselves any more and therefore would have to move to an institution.
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| 35. |
- Wälivaara, Britt-Marie
(författare)
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Mobile distance-spanning technology in home care : views and reasoning among persons in need of health care and general practitioners
- 2009
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this licentiate thesis was to describe views and reasoning about the use of mobile distance-spanning technology (MDST) in health care at home, from the perspectives of persons in need of health care and general practitioners (GP). A descriptive qualitative approach was chosen to achieve the overall aim. Individual qualitative research interviews and qualitative group research interviews were used for data collection. Qualitative content analysis and qualitative thematic content analysis were used for data analysis.The findings show that persons in need of health care at home recognized MDST as being similar to the technology used at hospital. They described the MDST at home as acceptable but still in its infancy. The limited experiences in using MDST led to some persons doubting the reliability of the examinations routinely carried out at home instead of at hospital. When using the MDST, more examinations can be performed at home but there was some overconfidence concerning the possibility of what MDST can achieve. They saw the staff as users of the MDST, and the MDST should not be used by the persons or their family members. The MDST was seen as possible for distance communication but personal meetings with a GP or a nurse also have to be possible. The GPs must know the person concerned before making decisions at a distance. The persons felt that as long as it is easy to go to the healthcare centre or to the hospital the examinations should be done there, but if they are in a bad condition and there are long distances, then examinations at home become relevant. In an emergency situation, going to hospital rather than staying at home was inevitable and obvious. The MDST at home was described as a part of a chain which can be efficient only when other parts of the chain are taken good care of. When the MDST was assumed to be safe and secure then it could be used on a permanent basis at home, but this decision had to be made by DNs and GPs. The GPs reasoned that the MDST should be used with caution. There is a professional caution, which is based on the GPs' professional experiences, responsibilities and skills. Human meetings were seen as important for performing secure judgments and as the basis for health care, but some meetings can be replaced by virtual meetings. A virtual meeting could be useful for the patients and their families but it depends on their expectations. It could benefit them but there is also an overconfidence concerning what MDST can do. The GPs reasoned about the MDST in general and the usability of different diagnostic tools. The MDST was described as being not yet fully developed. Sometimes the MDST could support the GPs' decisions, but when handling very complicated cases, meeting the patient and understanding his or her context was seen as highly important. Expanded access to patient records facilitates the GPs work but the patient's integrity has to be ensured. It is easy for nurses to do more during home visits, but there must be an agreement between the nurse and the GP regarding how to handle the responsibility.The results in this thesis indicate that the participants attach both positive values about MDST as well as believing that some tools have no value at all. This is important when attempting to understand what is important for persons in need of health care and for GPs benefit when planning health care at home for the future.
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