1.
2.
Nilsson, Thomas, 1954, et al.
(author)
The precarious practice of forensic psychiatric risk assessments
2009
In: International Journal of Law and Psychiatry. - : Elsevier BV. - 0160-2527. ; 32:6, s. 400-407
Journal article (peer-reviewed) abstract
The development of forensic psychiatric risk assessments is discussed from a clinical point of view using the example of Sweden. A central task in forensic psychiatry has traditionally been to identify dangerous, mentally disordered subjects considered to be prone to commit violent acts. Over time, “dangerousness” has been reworded into “risk”. Nevertheless, such assessments have generally been based on the psychiatric factors characterising the individual patient, while group interaction, situational factors, or social and cultural circumstances, such as the availability of alcohol and drugs, have been largely overlooked. That risk assessments have a focused on people with a diagnosis of “mental disorder” and been used as grounds for coercive measures and integrity violations has somehow been accepted as a matter of course in the public and political debate. Even the basic question whether offenders with a mental disorder are really more prone to criminal recidivism than other offenders seems to have been treated light-handedly and dealt with merely by epidemiological comparisons between groups of persons with broad ranges of psychosocial vulnerability and the general population. Legal texts, instructions and guidelines from the authorities in charge are often vague and general, while actors in the judicial system seem to put their trust in psychiatric opinions. The exchange of professional opinions, general public expectations, and judicial decision processes poses a huge risk for misunderstandings based on divergent expectations and uses of terminology.
3.
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6.
Lindholm, Marina, et al.
(author)
Personal assistants' conceptions of their cooperation in the rehabilitation of disabled persons.
2005
In: Scandinavian journal of occupational therapy. - London : Informa Healthcare. - 1103-8128 .- 1651-2014. ; 12:2, s. 72-80
Journal article (peer-reviewed) abstract
Personal assistants assist persons with severe disability in the performance of their daily activities. The law that covers the right to personal assistance is intended to strengthen the disabled individual's position as a member of society. The aim of the study was to describe personal assistants' conceptions of their cooperation in the rehabilitation of disabled persons. A qualitative method with a phenomenographic approach was used. Six personal assistants were interviewed. Strategic selection of the participants was carried out in order to obtain as wide a variation in conceptions as possible. The results showed that, apart from the factors related to the assistants, factors related to the disabled persons and the environment were of major significance for rehabilitation. The conceptions generated by the study were presented in the form of main categories and subcategories. Four main categories were developed: the meaning of will; the professional role; to consider ability; and awareness of the environment.
7.
Öresland, Stina, et al.
(author)
Patients as 'safeguard' and nurses as 'substitute' in home health care
2009
In: Nursing Ethics. - : Sage Publications. - 0969-7330 .- 1477-0989. ; 16:2, s. 219-230
Journal article (peer-reviewed) abstract
One aim of this study was to explore the role, or subject position, patients take in the care they receive from nurses in their own home. Another was to examine the subject position that patients say the nurses take when giving care to them in their own home. Ten interviews were analysed and interpreted according to a discourse analytical method. The findings show that patients constructed their subject position as 'safeguard', and the nurses' subject position as 'substitute' for themselves. These subject positions provided the opportunities, and the obstacles, for the patients' possibilities to receive care in their home. The subject positions described have ethical repercussions and illuminate that the patients put great demands on tailored care.
8.
Piltén, Carina, et al.
(author)
Lung recruitment--a nurse and/or physician task. A national survey on requirements for education, regulations and guidelines.
2009
In: Intensive & Critical Care Nursing. - : Elsevier BV. - 0964-3397 .- 1532-4036. ; 25:1, s. 4-9
Journal article (peer-reviewed) abstract
International and national guidelines on requirements for performing lung recruitment manoeuvres are lacking. This paper presents a nationwide descriptive survey of the occurrence of and conditions for lung recruitment in adult patients treated with mechanical ventilation in intensive care units (ICUs) in Sweden. All ICUs except neurological, cardiac, paediatric and neonatal ICUs were invited (N=73); of these, 60 ICUs participated in the study (82%). The main outcome measures were prevalence of lung recruitment, whether ICU nurses and/or physicians carried out lung recruitment, requirements for nurses to perform lung recruitment and the existence of local guidelines. Lung recruitment was performed at 92% of the ICUs. Only physicians performed lung recruitment at 27 ICUs (49%), and in 28 units (51%) both physicians and nurses performed this treatment. Lung recruitment was performed more often in units where both physicians and nurses performed lung recruitment than in units where only physicians performed the manoeuvres (46% vs. 12%, p=0.03). Further, local guidelines on lung recruitment manoeuvres were more common in units where both physicians and nurses performed this treatment (71% vs. 41%, p=0.02). The results suggest that recommendations of repeated and prompt lung recruitment manoeuvres are better met if nurses, along with physicians, perform lung recruitment.
9.
Dellve, Lotta, 1965, et al.
(author)
“Making it work in the frontline” explains female home care workers´ defining, recognising, communicating and reporting of occupational disorders.
2008
In: Qualitative Studies On Health And Wellbeing. - Abingdon : Informa UK Limited. - 1748-2623 .- 1748-2631. ; 3:3, s. 176-184
Journal article (peer-reviewed) abstract
Epidemiological research has so far failed to explain the high incidence of occupational disorders among home care workers (HCWs) and the great differences in organizational incidence rate. A qualitative approach may contribute to a deeper understanding of work group reasoning and handling in a more contextual manner. The aim of this grounded theory study was to gain a deeper understanding of the main concern in the processes of recognizing, communicating and reporting occupational disorders among HCWs. Focus group interviews were conducted with 40 HCWs in 9 focus groups. The selected municipalities represented variations in municipality type and incidence rate of occupational disorders. Making it work in the frontline was identified as the core category explaining that the perceived work situation in home care work was the main concern but interacted with work-group socialising processes as well as with the communicability and derivability of the occupational disorder when defining and reporting occupational disorders. Complex problems could be reformulated and agreed within the workgroup to increase communicability. Described significances for reporting/non-reporting were related to financial compensation, to a part of organizational political game or to an existential uncertainty, i.e. questioning if it belonged to their chosen work and life. Our conclusion is that working situation and work group attitudes have importance for reporting of occupational disorders. To support work-related health for HCWs, integrating communication should be developed about work-related challenges in work situation, as well as about attitudes, culture and efficiency within work-group.
10.
11.
Machado Des Johansson, Nora, 1953
(author)
Discretionary Death: Conditions, Dilemmas, and Normative Regulation
2005
In: Death Studies. - : Informa UK Limited. - 0748-1187 .- 1091-7683. ; 29:9, s. 791-809
Journal article (peer-reviewed) abstract
The author examines a major shift in the conceptualization and practices relating to death and dying in Western and other societies with advanced medicine. This shift is the result of socio-technical and cultural developments characterized by but not limited to the routine widespread application of life support technologies in the hospital together with notions of increased patient rights. It has resulted in a class of end-of-life situations, which the author defines as ‘‘discretionary death.’’ The concept of discretionary death underscores the role of contextual and discretionary factors in end-of-life decision-making. The author identifies and discusses the necessary and complex process of norm formation that informs and regulates end-of-life medical practice and establishes societal consensus across society with respect to legitimizing ‘‘discretionary death.’’
12.
13.
Wisten, Aase, et al.
(author)
Sudden cardiac death in the young in Sweden : electrocardiogram in relation to forensic diagnosis.
2004
In: Journal of Internal Medicine. - : Wiley. - 0954-6820 .- 1365-2796. ; 255:2, s. 213-220
Journal article (peer-reviewed) abstract
OBJECTIVES: To study electrocardiogram (ECG) in relation to forensic diagnosis in young persons who suffered a sudden cardiac death (SCD) in Sweden during 1992-99. DESIGN: A register study of a national database of forensic medicine in Sweden, selecting all cases of SCD 15-35 years of age. In this group, 12-lead ECGs and clinical data were searched for in military conscription and medical records. The ECGs were re-analysed and classified according to the Minnesota code criteria. SETTING: The whole nation of Sweden. SUBJECTS: Sudden cardiac death victims (66 individuals), 15-35 years of age, where it was possible to obtain an ECG recording. RESULTS: We observed major or minor ECG abnormalities in 82% of the subjects. The most common changes were T wave abnormalities (35%), ST segment changes (32%) and conduction defects (20%). The ECGs were evaluated as pathological in 50% of the cases, more often in arrhythmogenic right ventricular cardiomyopathy (88%) and hypertrophic cardiomyopathy (82%). Cardiac-related symptoms were seen in 76% of the total group and there was a family history of a similar cardiac condition in 18%. CONCLUSIONS: Pathological ECGs were common in young SCD victims, in spite of being taken many years before death. An ECG could help identify prospective victims of SCD, and should always be taken in cases with possible cardiac-related symptoms or a family history of SCD. The pathological ECGs were often found in connection with routine screening at military enlistment for men, which raises the question of a routine screening in the young, including women.
14.
Ahlgren, Åsa, et al.
(author)
Disability pension despite vocational rehabilitation : A study from six social insurance offices of a county
2005
In: International Journal of Rehabilitation Reserch. - : Ovid Technologies (Wolters Kluwer Health). - 0342-5282 .- 1473-5660. ; 28:1, s. 33-42
Journal article (peer-reviewed) abstract
Many long-term sick-listed individuals move from vocational rehabilitation to pension, rather than reaching the goal of return to work. There is thus reason to consider whether rehabilitation resources are being used optimally. Individuals receiving disability pensions are consuming financial and personnel resources at the insurance offices and also consume a large amount of health care. The general objective of the study was to evaluate the proportion of individuals granted vocational rehabilitation but then obtaining temporary or permanent disability pensions. All persons receiving any kind of rehabilitation and attending one of six local national insurance offices in a county in Sweden in 1998 and 1999 were studied. A 2-year follow-up was carried out to assess changes in status among those who had received temporary disability pensions. Of all individuals receiving rehabilitation, 46.2% ended up with a disability pension allowance. In addition, a large portion of the temporary disability pensions was transformed to permanent disability pensions within 2 years. For clients with a temporary disability pension, the rate of resuming work was close to nil. Among rehabilitation measures, investigation showed the lowest figures of work resumption while job training showed the best outcome in this respect. The study concluded that a large portion of the financial and personnel resources allocated by the national insurance offices to rehabilitation resulted in disability pensions.
15.
16.
17.
18.
19.
Dehlin, Lena, et al.
(author)
Adolescents’ experiences of a parent’s serious illness
2009
In: Palliative and Supportive Care. - Cambridge : Cambridge University Press. - 1478-9515 .- 1478-9523. ; 7:1, s. 13-25
Journal article (peer-reviewed) abstract
Objective: Adolescence is characterized by increasing liberation from parents as the young person evolves into an independent individual. Experiencing the serious illness and death of a parent during this phase implies great stress. Serious illness involves uncertainty, worry, and hope at the same time that it is necessary for everyday life to function. This study sought to describe adolescents’ experiences in the serious illness and death of a parent. Methods: The study was carried out using a qualitative method. Data were collected in interviews with five adolescents who were 14–17 years of age when one of their parents died. Results: The results show that the parent’s illness was a strong threat, as the adolescents understood that their own and the family’s lives would be greatly changed by the illness/death. The incomprehensibility of the parent’s serious illness and deathwas a threatening condition on its own. The adolescents strived to make the inconceivable more conceivable to understand what was happening. They also described the necessity of finding different ways of relating to and managing the threat, such as restoring order, seeking closeness, adapting, gaining control, avoiding talking about the illness, not accepting and counting the parent out. The adolescents described feelings of being alone and alienated, even though they were close to family and friends and they did not actively seek support. The lives of the adolescentswere changed by their experiences, beyond their bereavement over the parent. They felt that they had become more mature than their friends and that there had been a change in their thinking about life, changes in values, and changes in their views of relationships with other people. Significance of results: The results of the present study can form a basis for developing a support program whose purpose would be to prevent effects on health.
20.
Dellve, Lotta, 1965, et al.
(author)
Managing complex workplace stress in health care organisations: Leaders' perceived legitimacy conflicts
2009
In: International Journal of Nursing Management. - : Wiley-Blackwell Publishing Ltd.. - 0966-0429 .- 1365-2834. ; 17:8, s. 931-941
Journal article (peer-reviewed) abstract
Aim To conceptualize how health care leaders’ strategies to increase their influence in their psychosocial work environment are experienced and handled, and may be supported. Background The complex nature of the psychosocial work environment with increased stress creates significant challenges for leaders in today’s health care organizations. Method Interviews with health care leaders (n = 39) were analysed in accordance with constructivist grounded theory. Results Compound identities, loyalty commitments and professional interests shape conditions for leaders’ influence. Strategies to achieve legitimacy were either to retain clinical skills and a strong occupational identity or to take a full leadership role. Ethical stress was experienced when organizational procedural or consequential legitimacy norms were in conflict with the leaders’ own values. Leadership support through socializing processes and strategic support structures may be complementary or counteractive. Conclusions Support programmes need to have a clear message related to decision-making processes and should facilitate communication between top management, human resource departments and subordinate leaders. Ethical stress from conflicting legitimacy principles may be moderated by clear policies for decision-making processes, strengthened sound networks and improved communication. Implications for nursing management Supportive programmes should include: (1) sequential and strategic systems for introducing new leaders and mentoring; (2) reflective dialogue and feedback; (3) team development; and (4) decision-making policies and processes.
21.
22.
Mårtensson, Lena, 1953, et al.
(author)
Long-term influences of a biopsychosocial rehabilitation programme for chronic pain patients.
2004
In: Musculoskeletal care. - : Wiley. - 1478-2189 .- 1557-0681. ; 2, s. 152-64
Journal article (peer-reviewed) abstract
OBJECTIVE: Chronic pain leads to high costs in the form of compensation for absence from work due to illness, production loss and health care utilization. Multidisciplinary treatment programmes at pain clinics can result in return to work and a decrease in doctor visits. The aim of this study was to evaluate the long-term influences of a rehabilitation programme in primary health care for chronic pain patients with regard to doctor visits, frequency of sick-leave and level of disability. DESIGN: A longitudinal, intervention study design was used over a three-year period. METHODS: A biopsychosocial rehabilitation programme based on ego-strengthening psychotherapy was used. An occupational therapist and a physiotherapist led the intervention, which comprised two meetings per week for six weeks. The study was performed in a primary health care area in the southwest of Sweden with 54 chronic pain patients. RESULTS: The results showed a significant decrease in the number of doctor visits as well as sick-leave days. The level of absenteeism due to occupational disability changed significantly from being on sick leave to receiving a disability pension. CONCLUSIONS: The rehabilitation programme reduced patient attendance at health care facilities but did not increase the numbers of patients returning to work.
23.
Skarin, Monica, et al.
(author)
Acute stroke patient mobilisation practices and concerns. A survey of 202 stroke professionals
2009
In: European Stroke Conference, Stockholm, Sweden, May.
Conference paper (peer-reviewed) abstract
Background Stroke unit care is proven to improve outcome for patients. One component responsible for this may be that patients are mobilised earlier and more intensively, but there is lack of unambiguous scientific evidence. Therefore current practices may be driven by historical precedent and/or clinical opinion, and varying approaches to mobilisation are likely. This study sought to determine different health professionals´ beliefs regarding early mobilisation (EM) in acute stroke. EM was defined as intensive out of bed activities within the first 24 hours after stroke onset. Methods A 9 item anonymous questionnaire on benefits and harms with early mobilisation after stroke was used to interview stroke care professionals during the integrated Stroke Society of Australasia (SSA) and Australasian Nursing and Allied Health Conference in Sydney in August 2008. Data were collected using personal digital assistants. Five point Likert scales sought levels of agreement with harm and benefit of EM. Results The survey was completed by 202 professionals, representing 38% of all conference attendees. 65% were females, 50% under 40 years old, 46% worked in an acute stroke unit and 31% in rehabilitation, 35% were nurses, 26% were medical doctors, 19% were physiotherapists and 12% were occupational therapists. Two thirds had less than 10 years experience in stroke care overall. Sixty percent of professionals had concerns about possible harm of early mobilisation and more so for hemorrhagic (59%) than ischemic (23%) stroke (p<0.001). Cardiovascular stability was the major concern (12% ischemic, 34% hemorrhagic). Conclusion Our results show that most professionals had concerns about early mobilisation of stroke patients and these concerns were stronger for hemorrhagic than for ischemic stroke patients. This is surprising given the lack of evidence to support such a dichotomy and the potential harms of bed-confining hemorrhagic stroke patients.
24.
Carlsson, Gunilla, et al.
(author)
Patients longing for authentic personal care: A phenomenological study of violent encounters in psychiatric settings
2006
In: Issues in Mental Health Nursing. - : Informa UK Limited. - 0161-2840 .- 1096-4673. ; 27:3, s. 287-305
Journal article (peer-reviewed) abstract
This article focuses on patients' violence against caregivers. Several studies show that violence and threats within the health care setting are an increasing problem. Encounters that become violent have been the issue of many debates but the phenomenon is still not fully understood. It is important to understand the course of events in violent encounters, both for the sake of the patients and the caregivers' well-being. The aim of this study was to describe the essence of violent encounters, as experienced by nine patients within psychiatric care. Guided by a phenomenological method, data were analyzed within a reflective lifeworld approach. The findings explicate violent encounters characterized by a tension between "authentic personal" and "detached impersonal" caring. "Authentic personal" patients are encountered in an undisguised, straightforward, and open way, and they sense unrestricted respect that caregivers would show another human being. In these encounters violence does not develop well. However, in caring that is "detached impersonal," the encounters are experienced by the patients as uncontrolled and insecure. These encounters are full of risks and potential violence. Copyright © Taylor & Francis Group, LLC.
25.
Dahlberg, Karin, et al.
(author)
To use a method without being ruled by it: Learning supported by drama in the integrations of theory with healthcare practice.
2008
In: Indo-Pacific Journal of Phenomenology. - : NISC (Pty) Ltd. - 2079-7222 .- 1445-7377. ; 8:Special edition: Phenomenology in Education - February, s. 1-20
Journal article (peer-reviewed) abstract
The study reported in this paper focused on nursing students' learning and, in particular, their integration of caring science in theory and practice. An educational model incorporating educational drama was developed for implementation in three different teaching contexts within the nursing and midwifery study programmes at a Swedish college. A central aim was to understand the dynamics of educational drama in the healthcare context and its impact on learning and teaching. Using a phenomenological approach, seventeen students and six teachers were interviewed and their experience of drama as an educational method explored.The research findings illustrate the meaning of learning and teaching that is sensitive to students' lifeworld experiences. In order to be a successful method for closing the gap between caring science theory and practice, not only the educational drama, but teaching in general, must be anchored in the lived world of the students - that is, their experiences of health and care. While embodied reflection, as a key factor in integrating theory and practice, was shown to be well supported by educational drama, it was also found that "the method" tends too readily to take over and govern teaching and learning. The findings of this study further indicate how learning in practice and embodied reflection can be supported by the inclusion of well-chosen caring science theory to cast light on caring practice dilemmas.
26.
Umefjord, Göran, et al.
(author)
Primary care phycians’ experiences of carrying out consultations on the Internet
2004
In: Informatics in Primary Care. - : Portico. - 1476-0320 .- 1475-9985. ; 12:2, s. 85-90
Journal article (peer-reviewed) abstract
BACKGROUND: The internet is increasingly used for health matters, including consulting a doctor. Primary care physicians (general practitioners) will probably be involved in performing text-based consultations on the internet as a complement to physical meetings. In the present study, we explored the experiences of GPs already performing consultations on the internet: the challenges, worries and educational demands of the task. MATERIALS AND METHODS: A questionnaire was given to 21 GPs performing consultations on the internet for a public, non-commercial 'ask the doctor' service. The questionnaire was carried out at a meeting or sent by mail. The doctors answered a total of 28 questions, 12 of which included graded alternatives. RESULTS: The participating GPs were stimulated and challenged by performing consultations on the internet with previously unknown enquirers, in spite of limitations caused by the lack of personal meetings and physical examinations. The participants experienced a high educational value as a result of the problem-based learning situation induced by unfamiliar questions. The asynchronous feature was appreciated as it allowed time to reflect and perform relevant information searches before replying. Prior training and long-term experience as a family doctor were recommended before embarking on this method of consultation. CONCLUSIONS: We conclude that the GPs studied experienced their new role as internet doctors mainly in a positive way, with some limitations. With the increase in consultations on the internet, training in this technique should be integrated into the curricula of medical schools and of continuous professional development (CPD).
27.
Wamala, Sarah, et al.
(author)
Socioeconomic disadvantage and primary non-adherence with medication in Sweden
2007
In: International Journal for Quality in Health Care. - Karolinska Inst, Stockholm, Sweden. Lund Univ, Fac Med, S-22100 Lund, Sweden. Swedish Natl Inst Publ Hlth, Stockholm, Sweden. : OXFORD UNIV PRESS. - 1353-4505 .- 1464-3677. ; 19:3, s. 134-140
Journal article (peer-reviewed) abstract
Objective. Lack of adherence with pharmacological therapy is a public health concern that compels tremendous costs for the health care system and the community. To analyse the association between socioeconomic disadvantage and primary nonadherence with medication, and to explore possible mediating effects of trust in health care and lifestyle profile. Design. Cross-sectional population-based study based on data from the Swedish national public health surveys 2004-2005. Participants. The study comprised 13603 men and 18292 women aged 21-84 years who had any contact with a physician at a hospital or primary care centre. Measures. Primary non-adherence with medication based on whether respondents reported that they refrained from purchasing at the pharmacy prescribed medication. Socioeconomic Disadvantage Index was based on four different indicators of economic deprivation. Results. Socioeconomic disadvantage was associated with primary non-adherence with medication independent of long-term illness, risky lifestyle, low education, living alone and low trust for health care. This association increased with older age, particularly among women. Among individuals aged 21-34 years, severe compared with no socioeconomic disadvantage, was associated with two-fold increased odds for non-adherence with medication. The: corresponding odds among individuals aged 65-84 years were three-fold increase among elderly men (OR = 3.3, 95% CI: 1.4-7.8) and six-fold increase among elderly women (OR = 6.2, 95% CI: 2.5-15.3). Yet every seventh elderly woman aged 65-84 years suffered from long-term illness. Conclusions. Results indicate that health policies for 'care on equal terms' in Sweden have been less successful in relation to equitable access to prescribed medication, especially among the elderly.
28.
29.
Håkansson, Anders, et al.
(author)
Romanfigurer ger liv åt tentans patientfall
2003
In: Läkartidningen. - 0023-7205. ; 100:43, s. 7-3425
Journal article (other academic/artistic) abstract
I Lund avslutas läkarutbildningens tionde termin med en MEQ-skrivning (Modified Essay Questions). Höstterminen 2002 hämtade vi bakgrundsmiljö och persongalleri till frågornas fallbeskrivningar från ett skönlitterärt verk. Initiativet föll väl ut hos studenterna – de tyckte att boken var bra och att upplägget var utmärkt. Också författaren var nöjd – efter vår »medikalisering« lärde han känna sina romanfigurer på ett nytt och annorlunda sätt.
30.
Sjölander, Per, et al.
(author)
Stroke and acute myocardial infarction in the Swedish Sami population : incidence and mortality in relation to income and level of education
2008
In: Scandinavian Journal of Public Health. - : SAGE. - 1403-4948 .- 1651-1905. ; 36:1, s. 84-91
Journal article (peer-reviewed) abstract
Background: Gender differences in cardiovascular diseases (CVD) among the Sami have been reported previously. The aim of the present study was to investigate the incidence of and mortality from stroke, subarachnoid haemorrhage (SAH), and acute myocardial infarction (AMI) in the Swedish Sami population between 1985 and 2002, and to analyse the potential impact of income and level of education on cardiovascular morbidity and mortality. Methods: A Sami cohort of 15,914 persons (4,465 reindeer herding and 11,449 non-herding Sami) were followed up from 1985 to 2002 with regard to incidence and mortality rates of AMI, stroke, and SAH. Incidence and mortality ratios were calculated using a demographically matched non-Sami control population (DMC) as the standard (71,550 persons). Results: There was no elevated risk of developing AMI among the Sami compared with the DMC. However, the mortality ratio of AMI was significantly higher for Sami women. Higher incidence rates of stroke and SAH for both Sami men and women was observed, but no differences in mortality rates. Apart from the reindeer-herding men who demonstrated lower levels of income and education, the income and education levels among Sami were similar to the DMC. Conclusions: High mortality rates from AMI rather than stroke explain the excess mortality for CVD previously shown among Sami women. The results suggest that the differences in incidence of stroke between herding and non-herding Sami men, and between Sami women and non-Sami women, are caused by behavioural and psychosocial risk factors rather than by traditional socioeconomic ones.
31.
32.
Ahl, Caroline, et al.
(author)
Making up one's mind : patients' experiences of calling an ambulance
2006
In: Accident and Emergency Nursing. - : Elsevier. - 0965-2302 .- 1532-9267 .- 1755-599X .- 1878-013X. ; 14:1, s. 11-19
Journal article (peer-reviewed) abstract
The issue of the inappropriate use of ambulance transport and care has mainly been studied from the professionals' and caregivers' perspective, with few studies focusing on the patient and his/her experiences. To further understand whether patients use ambulance care in an inappropriate manner and, if so, why, it is important to obtain an overall picture of the patients' existential situation at the time they call an ambulance. The aim of this study was to analyse and describe patients' experiences related to the decision to call an ambulance and the wait for it to arrive. The design was explorative, and twenty informants aged between 34 and 82 years were interviewed. Qualitative content analyses were performed. The findings showed that calling for an ambulance is a major decision that is preceded by hesitation and attempts to handle the situation by oneself. Our conclusion is that the definition of inappropriate use of valuable health care resources should not be based solely on the professionals' point of view but also take account of the patients' reactions when they experience a threat to their life and health.
33.
Ahlborg, Tone, 1950, et al.
(author)
Perception of marital quality by parents with small children: a follow-up study when the firstborn is 4 years old.
2009
In: Journal of family nursing. - : SAGE Publications. - 1074-8407 .- 1552-549X. ; 15:2, s. 237-63
Journal article (peer-reviewed) abstract
Swedish couples' perceptions of their marital quality when their firstborn was 6 months old and then 4 years later were studied in 2002 and 2006, respectively. The results show that almost half of the 368 responding parents were satisfied with their marital relationship both in 2002 and 2006 as assessed by a modified Dyadic Adjustment Scale. However, a study of the various dimensions showed a significant decrease in marital quality. Housework and child care were perceived as having a greater strain on the relationship between couples who had had additional children during this period. Dyadic Sexuality and Dyadic Cohesion were the most significant predictors of marital quality. Covariates of marital quality in the group with additional children were "partner relation and parenthood perceived as a strain" and "perceived social support." The results emphasize the need for supportive interventions for parents with children aged 0 to 4 years.
34.
Ahlborg, Tone, 1950, et al.
(author)
Sensual and sexual marital contentment in parents of small children--a follow-up study when the first child is four years old.
2008
In: Journal of sex research. - : Informa UK Limited. - 0022-4499 .- 1559-8519. ; 45:3, s. 295-304
Journal article (peer-reviewed) abstract
This follow-up study explored parents' (N=452) intimate relationships when their firstborn child was 6 months old and then 4 years later. The measurement used was a modified version of the Dyadic Adjustment Scale, DAS. The present results show that most parents responding were content sensually at 6 months postpartum in 2002 and 4 years later, in 2006. More parents had changed from being sensually content in 2002 to discontent in 2006, than the contrary, however, and the sexual contentment remained low. The average sexual frequency was low both at 6 months and at 4 years for both parents with and without additional children. Experiencing tiredness as a hindrance to having sex was perceived as a greater problem among those parents without additional children. Prospective regression analyses indicated that sexuality was significantly related to both sensual and sexual contentment 4 years later. Sexuality was also one of the most significant covariates in the cross-sectional regression analysis for sensual contentment. Since sexuality plays a central role in partner well-being, it may be an important target for helping parents with small children.
35.
Ahlström, Gerd
(author)
Integrating improvement learning into health professional educational curricula
2008
In: International Forum on Quality Improvement in Healthcare. - France, April 24 2008 : International Forum on QI. ; , s. 1-
Conference paper (peer-reviewed) abstract
We all need to start where we are and also wanting to go further all the time. This is the essence in quality improvement. The leader and the teachers must own this attitude themselves in order to have the ability to be trustworthy for the students. There is evidence in the literature about the impact of education on the professional attitude and role. This means that it is important to work with better professional development for better outcomes in the faculty. One starting point for us in the planning of our different programs are that improvement knowledge will be a streak through the whole education in order to establish a professional attitude of daily inspiration to produce the best practise. We have applied all curricula to Boologna declaration and in this system progression in learning is a key point. We have four levels in the basic education (3-years education which lead to Bachelor degree) where we start to introduce 1) Concepts and models in health improvement. Then let our students make a 2) Personal improvement in their everyday life. Later in the education we teach about 3) Evidence practise and systematic literature reviews. Finally the students are 4) Making health improvements in collaboration with the staff during one clinical education. All educational programmes on basic level since 2007 include aim descriptions about quality improvement. The aim of the learning is to have the competence to initiate and participate in work about health care improvements. Finally, besides the mentions aspects in improvement education there are some other factors that needs for better system performance.
36.
Almerud, Sofia, et al.
(author)
Beleaguered by technology : care in technologically intense environments.
2008
In: Nursing Philosophy. - : Wiley-Blackwell Publishing Ltd.. - 1466-7681 .- 1466-769X. ; 9:1, s. 55-61
Journal article (peer-reviewed) abstract
Modern technology has enabled the use of new forms of information in the care of critically ill patients. In intensive care units (ICUs), technology can simultaneously reduce the lived experience of illness and magnify the objective dimensions of patient care. The aim of this study, based upon two empirical studies, is to find from a philosophical point of view a more comprehensive understanding for the dominance of technology within intensive care. Along with caring for critically ill patients, technology is part of the ICU staff's everyday life. Both technology and caring relationships are of indispensable value. Tools are useful, but technology can never replace the closeness and empathy of the human touch. It is a question of harmonizing the demands of subjectivity with objective signs. The challenge for caregivers in ICU is to know when to heighten the importance of the objective and measurable dimensions provided by technology and when to magnify the patients' lived experiences, and to live and deal with the ambiguity of the technical dimension of care and the human side of nursing.
37.
38.
Andersson Bäck, Monica, 1969
(author)
Callcenter + omvårdnad = sjukvårdsrådgivning – det bästa av två världar?
2008
In: Telefonrådgivning inom Hälso- och sjukvård/red Inger Holmström. - Lund : Studentlitteratur. - 9789144047768 ; , s. 163-186
Book chapter (other academic/artistic) abstract
Telefonrådgivning inom hälso- och sjukvård ger en bred översikt över olika aspekter av telefonrådgivnings-verksamhet i Sverige. Innehållet fokuserar på samtal som arbetsverktyg snarare än på medicinska bedömningar och symtom. Några av kapitlen tar upp organisatoriska aspekter medan andra utgår från sjuksköterskans respektive uppringarens perspektiv. Med hjälp av illustrativa exempel visar författarna på såväl samtalets olika faser som etiska dilemman vid specifika samtal i t.ex. en akut situation. Boken vänder sig främst till dem som arbetar med eller vill börja arbeta med hälso- och sjukvårdsrådgivning per telefon samt till studerande i olika vårdutbildningar. Den lämpar sig även för andra yrkesgrupper som arbetar med rådgivning per telefon, t.ex. apotekspersonal, sjukgymnaster, barnmorskor, allmänläkare och kuratorer.
39.
Andersson Bäck, Monica, 1969
(author)
Conceptions, conflicts and contradictions in the introduction of a Swedish Health Call Centre
2008
Doctoral thesis (other academic/artistic) abstract
Call centres have been called the industrialisation of the service sector, characterised by mon¬o¬¬tonous, highly controlled work and standardised procedures performed in an old-fashion¬ed, Tayloristic spirit. Stress and work intensification are known implications of such work. Healthcare on the other hand, is based on bureaucracy, but has professional staff. Nurses describe their occupation in terms of caring, cherishing, educating the sick, being de¬dicat¬ed and genuinely concerned for the patient, while assessing and treating individual reactions to health problems. But what happens in a health call centre (HCC)? The call centre is aimed at mass-production, the monitoring of work, performance targets and control. The overall aim of the thesis regards how can this be combined with the nursing profession and the consciousness of taking care of people in vulnerable states of pain and anxiety? The thesis draws on a study of an HCC in western Sweden, covering the period from 2002 to 2006, based on more than 80 semi-structured interviews with key actors, 400 struc¬tur¬ed interviews with care-seekers, repeated observations, written documents and other sources. The results shows how HCC work and work organisation are concieved based on social relations, which are shaped and influenced by institutions and social actors. In a Swedish context, the organisation of HCCs have been introduced on a broad scale since the late 1990s, and it catches the characteristics of the Swedish healthcare system in the horns of a dilemma, i.e. the ambition to simultanously address (1) equality (2) high quality (3) effic¬¬iency and cost control and (4) freedom of choice. Designed to solve healthcare problems HCCs imply new ways to organis¬e work within healthcare, based on new techno¬logy, a kind of Swedish New Public Management practices and rethoric, control mechanisms and new work relations. Yet the HCC strongly emphasises the continuity of Swedish health¬care connected to overall institutional features in political, economic, regulatory and cultural terms. Accordlingly, the case-study also shows a process of tensions, conflicts and resistance. Visualised as operating in a battlefield, the actors expressed strong and divergent concep¬tions towards the HCC. The tensions consider focus on primary care versus resources to secon¬dary care, meeting demands for access and immediate care versus steering healthcare, adapting versus changing demands, the responsible care-seeker versus the exigent healthcare consumer, rationalising human service versus more calls on the phone, control versus coordi¬na¬tion. For the telenurses the contradictions are also to full¬fill both quantity and quality imperatives and to work in line with ethics and socialised convictions, while wanting care-seekers as well as physicians to be satisfied. The HCC confirms both a positive and negative picture of call centres embracing contradictions such as control versus autonomy, participation versus exclusion, professional responsibility versus professional vulnerability, upskilling versus deskilling, younger versus older nursing generations, work intensification versus less physical work, isolation versus freedom and different aspects of emotional labour. The concept of HCC might be interpreted as a movement in the direction of a more liberal, Anglo-Saxion model of economy, but with distinct tendency toward divergency characterised by Swedish industrial relations and work organisation for the healthcare sector and related to the continuous professionalisation project within nursing.
40.
Andréasson, Sven, et al.
(author)
Behandling av alkohol- och narkotikaproblem : En evidensbaserad kunskapssammanställning
2001
Reports (other academic/artistic) abstract
Utvärderingens syfteMissbruk och beroende av alkohol är ett av de största folkhälsoproblemen. Narkotikamissbruk är mindre vanligt men har stora medicinska konsekvenser för de berörda. De sociala och juridiska aspekterna är betydande. En kritisk genomgång av litteraturen vad avser behandling av abstinens, protraherad abstinens, behandling i syfte att förhindra återfall, psykologiska och sociala behandlingar för att minska återfallsrisken, behandlingsprogram och institutionsvårdens roll, samt behandling av missbruk under graviditet. Dessutom en granskning av mini-intervention i primärvård och annan vård vars syfte är att minska konsumtionen hos högkonsumenter av alkohol. Nyligen gjorda meta-analyser inom området värderas och särskild vikt fästs vid interventioner som finns eller lätt kan introduceras i den svenska vårdorganisationen. Behandlingsprogram för patienter med samtidig annan psykisk störning värderas.Så kallat lågdosberoende av bensodiazepiner och andra lugnande medel eller sömnmedel behandlas inte. Inte heller belyses effekten av behandlingar vars primära mål är kroppsliga komplikationer av missbruket, och inte heller granskas metoder att minska tillgänglighet.TillvägagångssättStrukturerad översikt, kostnadsanalyser.Insamling av primärdataSystematisk sökning i relevanta databaser, litteraturlistor i påträffade studier samt i aktuella monografier. Ingen bakre tidsbegränsning och sökning i databaser till och med februari 1999.Utgångspunkt för urval av dataHuvudsakligen randomiserade, kontrollerade, dubbelblinda studier, samt metaanalyser som baseras på sådana studier. Vad gäller långtidsförlopp och ekonomiska analyser även kohortstudier och andra naturalistiska studier.Genomgång av publikationenSamtliga studier värderas med hjälp av en i gruppen utarbetad, och med övriga psykiatriprojekt gemensam, kvalitetsmall. Alla centrala studier läses av minst två i gruppen.Färdiga manuskript värderas av styrelse, expertgrupp samt externa granskare.
41.
Arman, Rebecka, 1976, et al.
(author)
What health care managers do : Applying Mintzberg’s structured observation method
2009
In: Journal of Nursing Management. - : Hindawi Limited. - 0966-0429 .- 1365-2834. ; 17:6, s. 718-729
Journal article (peer-reviewed) abstract
Aim The aim of the present study was to explore and describe what characterizes first-and second-line health care managers' use of time. Background Many Swedish health care managers experience difficulties managing their time. Methods Structured and unstructured observations were used. Ten first-and second-line managers in different health care settings were studied in detail from 3.5 and 4 days each. Duration and frequency of different types of work activities were analysed. Results The individual variation was considerable. The managers' days consisted to a large degree of short activities (<9 minutes). On average, nearly half of the managers' time was spent in meetings. Most of the managers' time was spent with subordinates and <1% was spent alone with their superiors. Sixteen per cent of their time was spent on administration and only a small fraction on explicit strategic work. Conclusions The individual variations in time use patterns suggest the possibility of interventions to support changes in time use patterns. Implications for nursing management A reliable description of what managers do paves the way for analyses of what they should do to be effective.
42.
Axelsson Landberg, Tove, et al.
(author)
Hälsoprojekt ökar barns lust att röra på sig
2005
In: Svensk Idrottsforskning. ; 4, s. 1-6
Journal article (other academic/artistic) abstract
Många skolor driver glädjande nog hälsoprojekt idag, bland annat som följd av Handslaget. Få har dock utvärderats ännu. Påverkas barnens attityder och vanor? Ett nyligen avslutat hälsoprojekt i Partille kommun tyder på detta. Det Bunkeflo-inspirerande hälsoprojektet löpte under en tvåårsperiod, ht 2002 till vt 2004, och innefattade utökad fysisk aktivitet i olika former samt massage och avslappning för de minsta barnen. Projektet följdes upp med enkäter till barnen före och efter projektet samt en fokusgruppintervju med nyckelpersonal. Resultatet har redovisats i form av en C-uppsats vid Göteborgs universitet, vilket sammanfattas i nedanstående artikel.
43.
Berbyuk Lindström, Nataliya, 1978
(author)
Interkulturell ledarskap i sjukvården
2009
In: KFi (Kommunforskning i Västsverige):s Chefsdag, 25 maj 2009, Förvaltningshögskolan, Göteborg.
Conference paper (other academic/artistic)
44.
Berbyuk Lindström, Nataliya, 1978
(author)
Using corpus for studying intercultural communication:Some comments on communication in Swedish health care system between non-Swedish physicians and Swedish patients and colleagues
2006
In: Abstracts for IPRA (International Pragmatics Association) 10th International Pragmatics Conference, 8-10 July, 2007, Gothenburg, Sweden.
Conference paper (peer-reviewed) abstract
This presentation is based on results obtained in the project Communication and Interaction in Multicultural Health Care initiated in 2003 at the Department of Linguistics, Gothenburg University, Sweden. The purpose of the project is to describe and analyse communication between non-Swedish physicians and their Swedish communicative partners, patients and colleagues, i.e. other physicians, nurses and assistant nurses, focusing on different kinds of difficulties and on positive effects of cultural differences and foreign language usage. A general overview of the results of the study will be presented. Special emphasis in the presentation will be made on the results of analysis and comparison of two corpora included in the study, the one comprising the transcriptions of video recorded interactions between the non-Swedish physicians and their Swedish patients and the other the transcriptions of interactions between the Swedish physicians and their Swedish patients.
45.
Berbyuk, Nataliya, 1978
(author)
Health Care in Europe
2005
In: EIW (European Intercultural Workplace) Transnational Partner Meeting, June 15-19, Rostock, germany.
Conference paper (other academic/artistic)
46.
47.
48.
49.
Berlin, Johan, 1975, et al.
(author)
Team i hälso- och sjukvården.
2005
In: Nordic Conference on Business Studies. School of Business, Århus. 18-20 Augusti 2005..
Conference paper (peer-reviewed) abstract
I denna studie ställs frågan: Vad karaktäriserar team inom hälso- och sjukvård? För att besvara frågan har såväl konsultlitteratur som empirisk litteratur granskats. Detta har bidragit till att ett teams karaktär kan beskrivas på två sätt. Dels har team karaktären av förväntade egenskaper, dels har det karaktären av uppvisade egenskaper. Förväntade egenskaper återges i management litteratur som idealiserade förväntningar av vad team kan åstadkomma, uppvisade egenskaper återges i empirisk och kritisk litteratur där team och teams utveckling beskrivits. I studien sammanfattas dessa egenskaper som dikotomier fördelade på externa karaktärsdrag, karaktärsdrag hos ledning, uttryck för mål, inci-tament som driver teamarbetet och interna karaktärsdrag. De begrepp som deducerats fram prövas på tre hälso- och sjukvårdsteam. Dessa utgörs av ett tandvårdsteam, ett vårdcentralsteam och ett traumateam. Resultatet pekar på att de granskade hälso- och sjukvårdsteamen hade fler av de förväntade egenskaperna än de uppvisade. Dominerande egenskaper hos dessa team var att de var normativt motiverade och uppgiftsfokuserade. Detta tolkas som att hälso- och sjukvårdsteamens medlemmar bär ett gemensamt intresse av att behandla och vårda patienter. Denna normativa motivation bidrar till flexibla och synkrona arbetsformer. Hälso- och sjukvårdsteamens medlemmar har också individuella incitament för att arbeta i team. Det finns ett inslag av status och glamour att arbeta i dessa team. Detta incitament bidrar också till flexibla och synkrona beteenden eftersom det upprätthåller en bild av teamet gentemot en omgivande publik. Resultatet pekar på att hälso- och sjukvårdsteam inte har svårt att hävda sig, de är inte enkelriktade, de är inte utilitaristiskt motiverade, och medlemmarna betraktar det inte som en eftergift att vara medlem i teamen.
50.
Berlin, Johan, 1975, et al.
(author)
The 20-minute team : a critical case study from the emergency room
2008
In: Journal of Evaluation in Clinical Practice. - : Wiley. - 1356-1294 .- 1365-2753. ; 14:4, s. 569-576
Journal article (peer-reviewed) abstract
Rationale: In this article, the difference between team and group is tested empirically. The research question posed is How are teams formed? Three theoretical concepts that distinguish groups from teams are presented: sequentiality, parallelism and synchronicity. The presumption is that groups cooperate sequentially and teams synchronously, while parallel cooperation is a transition between group and team. Methods: To answer the question, a longitudinal case study has been made of a trauma team at a university hospital. Data have been collected through interviews and direct observations. Altogether the work of the trauma team has been studied for a period of 5 years (2002–2006). Results: The results indicate that two factors are of central importance for the creation of a team. The first is related to its management and the other to the forms of cooperation. To allow for a team to act rapidly and to reduce friction between different members, clear leadership is required. Conclusions: The studied team developed cooperation with synchronous elements but never attained a level that corresponds to idealized conceptions of teams. This is used as a basis for challenging ideas that teams are harmonious and free from conflicts and that cooperation takes place without friction.
