| 1. |
- German Millberg, Lena, 1958-
(author)
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Akademisering av specialistsjuksköterskans utbildning i Sverige : Spänningsförhållanden med anledning av utbildningsreform i enlighet med Bologna
- 2012
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Licentiate thesis (other academic/artistic)abstract
- Licentiatavhandlingens övergripande syfte var att studera konsekvenser av ökad akademisering och akademiskt lärande inom Svensk specialist-sjuksköterskeutbildning efter genomförande av ny utbildningsreform enligt Bologna.Bakgrund: Specialistsjuksköterskor förväntas i dagens hälso– och sjukvård att kunna bedriva en patientsäker och evidensbaserad vård, vilket kräver akademisk kompetens. Utbildningen till specialistsjuksköterska fördes i och med Bolognaprocessens införande i Sverige 2007 till avancerad utbildningsnivå. Både yrkesexamen och akademisk examen (magisterexamen) skulle inkluderas och integreras i samma utbildning. Detta medförde en förändring från en ämnesinriktad (samlingskodsinriktad) läroplan till en läroplan som syftar till att integrera ämnen (integrationskodsinriktad). Förutom ämnesintegrering skulle yrkesspecifika mål integreras med akademiska mål.Metod: Artikel I genomfördes i form av ett didaktiskt aktionsforskningsprojekt som pågick under 2½ år. En projektledningsgrupp (n=15-18) från fem lärosäten bildades. Denna grupp har aktivt deltagit i hela aktionsforskningsprocessen och vid projektmöten. Vid varje lärosäte utsågs en projektansvarig som ansvarade för den lokala aktionsforskningsprocessen. Dessa personer samlande in data i form av kursplaner, utbildningsplaner, studiehandledningar, minnesanteckningar från lärarmöten och möten med vårdverksamheter samt minnesanteckningar från forskargruppensmöten. Analys har gjorts med hjälp av konstant komparativ analysmetod. I artikel II användes konstruktivistisk Grounded Theory för att samla in och analysera data. Datainsamlingen påbörjades utifrån specialistsjuksköterskestudenters svar på en enkäts öppna fråga (n=120) i samband med utbildningens avslutning 2009 och 2010. Enkätsvaren reste frågor om specialistsjuksköterskans akademiska lärande. För att inhämta en djupare förståelse genomfördes intervjuer med specialistsjuksköterskor (n=12) som yrkesarbetat mellan 5 och 12 månader efter sin examen. Intervjuerna genomfördes från juni till oktober 2011. Avslutningsvis jämfördes svaren på den öppna enkätfrågan med analysen av intervjuerna.Resultat: Vid utbildningsreformens införande fanns pedagogiska motsättningar och didaktiska svårigheter som gav upphov till spänningsförhållanden mellan vårdutveckling, forskning, yrkesspecifika mål och akademiska mål. Spänningsförhållanden framkom också när specialistsjuksköterskorna inte erfor att deras akademiska kompetens tillvaratogs och värderades i vårdverksamheten. När stöd inte fanns för akademiskt lärande uppkom villrådighet och specialistsjuksköterskorna blev ambivalenta över om akademiskt lärande var meningsfullt. För att främja meningsfullt akademiskt lärande framhåller deltagarna betydelsen av samverkan och gemensamma arenor mellan lärosäten och vårdverksamhet där nyttoaspekten med akademiskt lärande tydliggörs. De spänningsförhållanden som framkommer var av både positiv och negativ karaktär.
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| 2. |
- Karlsson, Katarina
(author)
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Exploring symptom clusters in patients with lung cancer
- 2024
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Licentiate thesis (other academic/artistic)abstract
- This thesis explored symptom clusters in patients with lung cancer before, during and after oncological treatment. A literature review and an interview study was used to explore the symptom cluster experience from the patients’ perspective. A large diversity of symptom cluster constellations were identified, in which fatigue was the most commonly occurring symptom, followed by dyspnea, pain, depression, cough and nutritional impact symptoms. Many symptom assessment instruments were identified, measuring mostly the intensity-dimension alone or in combination with timing. The results also stress that living with symptom clusters during treatment is more about survival than actually living. Patients’ symptom management strategies were shaped by impacting conditions such as knowledge and earlier experience of symptoms. Symptoms were often regarded as unavoidable by the patients and something to accept. How symptoms were recognized by health care professionals further added to the normalization of symptom clusters. Subsequently, patients would not always ask for support, and their quality of life was negatively affected. Holistic person-centered care including multi-dimensional symptom assessment is considered essential to ensure adequate symptom cluster management for patients with lung cancer.
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| 3. |
- Söderman, Annika, 1980-
(author)
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Evaluating the Swedish Dignity Care Intervention within municipality healthcare : for older persons with palliative care needs
- 2021
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Doctoral thesis (other academic/artistic)abstract
- Background: Palliative care in Sweden is not equal in terms of age, disease, and place of care. An essential value within palliative care is dignity, therefore healthcare emphasizing this value must be prioritized. However, older persons are concerned their dignity would not be considered and dignity interventions are rare. The overall aim of the thesis was to evaluate the Swedish Dignity Care Intervention (DCI-SWE) and its implementation within municipal palliative healthcare in order to conserve older persons’ dignity and quality of life. Methods: Qualitative and mixed methods were used. Data were collected with an integrative review (study I), focus group and individual interviews with community nurses (CNs) (studies II, IV), healthcare professionals and managers (study IV), individual interviews with older persons and relatives (study III), reflective diaries and field notes (studies II, IV), and questionnaires measuring older persons’ dignity-related distress and quality of life (study III). Data were analysed using thematic synthesis (study I), inductive content analysis(study II), inductive thematic analysis and comparative statistical analysis (study III), directed content analysis and descriptive statistical analysis (study IV). Results: Within dignity-conserving care, broad outcomes like dignity-related distress and quality of life have been used. However, communication outcomes should also be considered (study I). The DCISWE has clear benefits if it is used with background of who the older person is and with respect of personal needs (studies II - IV). The feasibility of the DCI-SWE depends on the healthcare organization’s engagement and capacity (studies II, IV). The DCI-SWE can support CNs in communicating with older persons (studies II, IV). However, more communication training is needed, and managers leadership is an important component (studies II, IV). The implementation intervention needs further development, and the use of a behavior change model may be beneficial.
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| 4. |
- Ångström-Brännström, Charlotte
(author)
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TRÖST : beskriven av långvarigt sjuka barn, föräldrar och en sjuksköterska
- 2010
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Doctoral thesis (other academic/artistic)abstract
- Det övergripande syftet med avhandlingen är att beskriva långvarigt sjuka barns upplevelser av tröst samt vilka och vad som tröstar barn, föräldrar och en sjuksköterska. Avhandlingen omfattar fyra delstudier. Långvarigt sjuka barn, föräldrar och en sjuksköterska har intervjuats och barnen har ritat teckningar.I delstudie I var syftet att undersöka vad barn med långvariga sjukdomar berättar muntligt och i teckningar om sina upplevelser av att bli tröstade. Sju barn i åldern 4-10 år, med olika långvariga sjukdomar, beskrev under intervju sina upplevelser av tröst och ritade teckningar. Intervjuerna analyserades med innehållsanalys, vilket utmynnade i fyra teman: att vara fysiskt nära sin familj, att känna sig trygg och säker, att sjuksköterskor finns till hands för barnen och att barnen finns till hands för sina föräldrar och syskon. Resultatet visar att barnen litade på sjuksköterskors kunskap och yrkeskunnande, vilket var en förutsättning för att kunna känna sig trygg och hemma på sjukhus. Att vara nära sin familj upplevdes än mer betydelsefullt för att uppleva tröst. I delstudie II var syftet att beskriva föräldrars upplevelser av vad som tröstar dem när deras barn insjuknat i cancersjukdom. Nio föräldrar till barn i åldern 3-9 år, som var inlagda på vårdavdelning och hade genomgått sin första behandling, intervjuades. Innehållsanalys utmynnade i fem teman: att uppleva tröst genom att vara nära sitt barn, att uppleva tröst genom barnets styrka, att uppleva tröst genom att känna sig hemma på vårdavdelningen, att uppleva tröst genom att vara en familj och genom att vara hemma samt att uppleva tröst genom stöd från sociala nätverk. I kommunion, en djup känsla av gemenskap med barnet och personer i sociala nätverk, upplevde föräldrarna en ny vardag som kännetecknades av att känna sig trygg i livet trots alla svårigheter och de upplevde stunder av hopp. I delstudie III var syftet att beskriva upplevelser av vad som tröstar ett allvarligt sjukt och senare döende barn, berättat av barnet, hans mamma och hans sjuksköterska. Barnet ritade teckningar. Fältanteckningar, teckningar och intervjuer analyserades med innehållsanalys, vilket utmynnade i fyra teman: att uttrycka känslor och bli redo för tröst, att vara i kommunion, att skifta perspektiv och att finna tröst genom att vara hemma. Resultatet visar att tröst för det svårt sjuka, senare döende barnet, innebar att barnet kunde uttrycka sina känslor som barnet ville, att familjen fanns nära och var involverade i omvårdnaden av barnet, att barnet kunde vårdas hemma och att barnet upplevde en förtroendefull relation med sin sjuksköterska. I delstudie IV var syftet att beskriva vem och vad som tröstar föräldrar, syskon, sjuksköterska och andra personer som tröstade ett svårt sjukt och senare döende barn, beskrivet av mamman och barnets sjuksköterska. Intervjuer från delstudie II analyserades med innehållsanalys och utmynnade i tio teman. Resultatet visar en bild av samverkande nätverk som kan finnas runt ett svårt sjukt barn. Den svåra situationen innebar att barnets familj bar en tung börda, men omgivna av ett tröstande nätverk som de kunde luta sig mot och dela lidande och ansvar med, kunde de finna tröst och trösta varandra. Resultatet i avhandlingen visar att de långvarigt sjuka barnen och föräldrarna fann tröst i att kunna dela lidande med varandra. Föräldrar och sjuksköterska fann tröst i att kunna dela lidandet och ansvaret med personer i sina sociala nätverk. Modellen om tröst (Norberg m fl, 2001) kunde användas för att ge struktur till diskussionen.
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| 5. |
- Carlander (Goliath), Ida, 1968-
(author)
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Me-ness and we-ness in a modified everyday life close to death at home
- 2011
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Doctoral thesis (other academic/artistic)abstract
- The overarching aim of this thesis was to describe how family members experienced everyday life with life-threatening illness close to death, with focus on self-image and identity. The thesis comprises four papers, each with a specific aim to illuminate various aspects of the phenomenon under study. The study population consisted of 29 participants; ten family caregivers and five families, including five patients with life threatening illness and their family members. Data were based on retrospective single interviews (paper I), prospective individual, couple and group interviews with the families over six to eighteen month (papers II-III). Interpretive description approach (papers I, II, IV), narrative method (paper III) and secondary analysis (paper IV) were used to analyze data. The findings show how living close to death influences everyday life at home, at several levels (papers I-IV). From the perspective of the dying person, narrations of daily situations was described by four themes related to identity and everyday life; inside and outside of me, searching for togetherness, my place in space and my death and my time. The changing body, pain, fatigue, decreased physical capacity and changed appearance, appeared to influence the dying person’s need for altered knowledge and community, and as a result the patterns of interaction within the families changed. The strive for knowledge and community took place at home, an arena for identity work and the conscious search for meaning, knowledge and community; it was limited by time and inevitable death (paper III). For the family member, life close to death can mean sharing life with a changing person in a changing relationship (paper II). It may mean that everyday life needs to be modified in order for it to work (papers I-IV). New patterns of dependence and an asymmetrical relationship affect all involved (papers III-IV). Daily life close to death is about finding the space to promote the individual self-image, me-ness, at the same time as finding new ways of being a family; we-ness (paper II). Regardless of being the ill person or not, the family members we interviewed had to face impending death, which challenged earlier ways of living together (papers I-IV). From the perspective of the relatives, the everyday life of caring for the dying family member was characterized by challenged ideals, stretched limits and interdependency (paper I). Situations that challenged the caregivers’ self-image were connected to intimacy, decreasing personal space and experiences such as “forbidden thoughts”. The findings suggest that the bodily changes were of importance for the self-image, and that the former approach to the own body was important in the process of experiencing the body. The person living close to death was in transition to something new; being dead in the near future. One way of handling the struggles of everyday life was to seek togetherness, strive to find other persons with similar experiences while sharing thoughts and feelings. Togetherness was sought within the family, in the health care system and on the internet; a sense of togetherness was also sought with those who had already died. The other family members were also in transition as the future meant living on without the ill family member and changing their status to for example being a widow or being motherless. Identity work close to death denotes creating an access ramp into something new; a transition into the unknown. From a clinical perspective, this study emphasizes the significance of creating a climate that allows caregivers to express thoughts and feelings.
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| 6. |
- Hauffman, Anna
(author)
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Internet-based Psychosocial Support : Design, Effects and User Experience in the Cancer Setting
- 2020
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Doctoral thesis (other academic/artistic)abstract
- Background and Aim Being diagnosed with cancer is often described as a major loss of control leading to severe psychological distress and symptoms of anxiety and depression can continue to affect the individual in the long term. The cancer and its treatment may influence all dimensions of health, thus the psychosocial support provided needs to be multifaceted and easy accessed. Internet-based interventions may be one way to provide such support, but evidence is limited. This thesis aimed to investigate the design, effects, and experiences of internet-based psychosocial support in cancer.Methods and Results Study 1 encompassed a co-creation development process resulting in the interactive support provided as the first step in an internet-based stepped care intervention (iCAN-DO). The effects of iCAN-DO were investigated in a randomised controlled trial, targeting individuals newly diagnosed with cancer and concurrent self-reported symptoms of anxiety and depression (according to the Hospital Anxiety and Depression Scale). Step 1 had a psycho-educative content involving self-care strategies and was available to the intervention group during the ten-month study period. Step 2 comprised a guided internet-based cognitive behavior therapy (iCBT) program and was offered those without improvement in anxiety and depression after using Step 1. The results showed that iCAN-DO improved symptoms of depression compared with standard care, while symptoms of anxiety were largely unaffected. Most participants used Step 1, while only a few used Step 2.In Study 2, aspects of usefulness, relevance, and usability in iCAN-DO were explored through qualitative interviews, analysed using content analysis. Results showed that standard healthcare did not meet the individuals' needs and iCAN-DO was used as complement, providing access to relevant, trustworthy information and support. Usability was affected by the perceived usefulness and ease of use of the intervention, as well as by the user´s circumstances in life and consequences of the cancer. The co-creation process in the development of Step 1 added relevance, but both steps 1 and 2 would have gained from being provided earlier, integrated into standard healthcare and more adaptable to the individual.Conclusion The thesis concluded that the internet-based intervention had positive effects on symptoms of depression in individuals newly diagnosed with cancer. Individuals with cancer experience several unmet needs in standard healthcare and since psycho-educative support including self-care advice seems feasible in this group, efforts are needed to incorporate internet-based support in regular oncology care. Since the intervention did not target all symptoms (i.e. anxiety) further research is needed on how to enhance efficacy and how to make iCBT more feasible for this group.
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| 7. |
- Hellerstedt Börjesson, Susanne, 1956-
(author)
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Taxane-induced pain : Experiences of women with breast cancer and nurses providing their care
- 2018
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Doctoral thesis (other academic/artistic)abstract
- Breast cancer patients receiving taxane chemotherapy run a substantial risk of develop taxane-induced pain, but little is known about women’s experiences of such pain. The aim of this thesis was to explore women’s acute and longstanding experiences of taxane-induced pain, to evaluate the pain intensity and distribution using different assessment methods, and to study nurses´ perceptions of taxane-induced pain in people with breast cancer.The women experienced pain during chemotherapy with 37– 48% incidence of acute taxane-induced pain. The subjective burden of taxane-induced pain described by the women covered narratives from manageable pain to very difficult and disabling pain with a major impact on their lifeworld (Study I).Longstanding pain in the lifeworld of women with previous breast cancer, was explored through a retrospective reflection after 12 months. The descriptions of pain revealed a time perspective; as pain perceived at that specific time, currently ongoing pain, and pain expectations for the future. This resulted in the women sensing themselves of being somewhere between health and illness gazing into an uncertain future (Study II).A quantitative longitudinal assessment of taxane-induced pain using; the body image, the VAS, and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30) showed the women’s estimated pain; its intensity, distribution and occurrence - as it appeared during the actual taxane treatment and up to a year afterward. The baseline measurement on the VAS revealed low initial pain, VAS <10, which changed at treatment Cycle 1. The body image revealed intense and widespread pain, and pain after 12 months, as did the EORTC QLQ -C30 (Study III).The nurses’ estimations of taxane-induced pain varied to large extent in both prevalence and intensity. Large parts of the body were expected to be involved in the pain. Nurses lacked local and/or national guidelines reflecting a low level of generalized use of prophylaxis against taxane pain (Study IV).In conclusion, taxane-induced pain is a common debilitating symptom during taxane chemotherapy for women with breast cancer. Pain impacts women´s life during as well as long time after the completion of taxane treatment. Taxane pain can be accurately or successfully estimated using various pain assessment tools. Furthermore, guidelines for dealing with taxane-induced pain are needed.
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| 8. |
- Johansson Sundler, Annelie, 1973-
(author)
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Mitt hjärta, mitt liv : Kvinnors osäkra resa mot hälsa efter en hjärtinfarkt.
- 2008
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Doctoral thesis (other academic/artistic)abstract
- The thesis describes the phenomenon women’s health and illness experiences following a myocardial infarction (MI). The purpose of the thesis is to explore women’s experiences of their care and health processes, as well as their experiences of body, lifeworld and meaningful relationships related to the illness. A reflective lifeworld approach, based on phenomenological philosophy, is used. The thesis is comprised of four studies; three are based on interviews with a total of 26 women following an MI, followed by a fourth, theoretical, study.The first study explores women’s experiences of care and health processes following an MI, with a particular focus on well-being and participation (I). The findings show that an MI is an event that suddenly interrupts the ordinary life of the women. Participation is a sense of being involved in their own health and care processes, which may also encourage them to take responsibility for health promoting activities in a healthy and meaningful way.The second study explores women’s lifeworld experience of their bodies and lives following an MI (II). This study finds that an MI, as a major event in the women’s lives, influences and restricts their everyday activities over a long period of time. Following the illness, they live with an existential uncertainty about their life and the heart, and this feeling entails suffering for them.The third study explores the meaning of close relationships and sexuality to women’s health and well-being following an MI (III). The mmeaning of close relationships appears to be vitally intertwined with their long-term health process; both health processes and relationships are affected after an MI. The suffering following an MI can be compared to taking a fall, where meaningful close relationships can function as a safety net that catches the women in their fall.The fourth study is a concept development aimed at elucidating the meaning of the concepts uncertainty, control, secure and risk in relation to the thesis phenomenon and the findings of the empirical interview studies (IV). The existential uncertainty is an important matter in the women’s health processes. In these processes the concepts control, secure and risk play a central role. Women who have suffered an MI want to be as safe as possible in order to live well. The analysis illuminates a paradox, that the women’s ambition to achieve greater safety may lead them into an even greater experience of uncertainty.The conclusion is that women’s experiences of health and illness can be described as a journey characterized by existential uncertainty. The women’s lives go through different existential phases following an MI, which is a major event. They are not prepared for the reactions that this event causes and are in need of support and guidance to manage their illness experiences. If acknowledged and well met, the significance and meaning of the women’s reactions and experiences can give impetus and energy to their health processes.
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