| 1. |
- Vixner, Linda
(author)
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Acupuncture for labour pain
- 2015
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Doctoral thesis (other academic/artistic)abstract
- Background: Acupuncture involves puncturing the skin with thin sterile needles at defined acupuncture points. Previous studies are inconclusive regarding the effect of acupuncture on labour pain, but some studies have found a reduction in the use of pharmacological pain relief when acupuncture is administered. The appropriate dose of acupuncture treatment required to elicit a potential effect on labour pain has not been fully explored. The dose is determined by many different factors, including the number of needles used and the intensity of the stimulation. In Sweden, manual stimulation of the needles is common practice when acupuncture is used for labour pain, but electrical stimulation of the needles, which gives a higher dose, could possibly be more effective. The overall aim of this thesis was to evaluate the effectiveness of acupuncture with manual stimulation (MA) of the needles as well as acupuncture with a combination of manual and electrical stimulation (EA) in reducing labour pain, compared with standard care without any form of acupuncture (SC).Methods: The study was designed as a three-armed randomised controlled trial in which 303 nulliparous women with normal pregnancies were randomised to MA, EA, or SC. The primary outcome was labour pain, assessed using the Visual Analogue Scale (VAS). Secondary outcomes were relaxation during labour, use of obstetric pain relief, and associations between maternal characteristics and labour pain and use of epidural analgesia respectively. Also, labour and infant outcomes, recollection of labour pain, and maternal experiences, such as birth experience and experience of the midwife, were investigated two months after the birth. The sample size calculation was based on the potential to discover a difference of 15 mm on the VAS. Data were collected during labour before the interventions, the day after birth, and two months later. Besides using the VAS, information was collected by means of study specific protocol, questionnaires and medical records.Results: The mean VAS scores were 66.4 in the MA group, 68.5 in the EA group, and 69.0 in the SC group (mean differences: MA vs. SC 2.6 95% CI -1.7 to 6.9, and EA vs. SC 0.6 95% CI -3.6 to 4.8). Other methods of pain relief were used less frequently in the EA group, including epidural analgesia, MA 61.4%, EA 46%, and SC 69.9%. (EA vs. SC OR 0.4 95% CI 0.2 to 0.7). No statistically significant differences were found in the recollection of labour pain between the three groups two months after birth (mean VAS score: MA 69.3, EA 68.7 and SC 70.1). A few maternal characteristics were associated with labour pain (age, dysmenorrhea, and cervix dilatation), but none of the investigated characteristics predicted the outcome of the acupuncture treatment in MA or EA. Women in the EA group experienced acupuncture as being effective for labour pain to a higher extent than women who received MA, MA 44.4%, EA 67.1% (EA vs. MA OR 2.4 95% CI 1.2 to 4.8). Women in the EA group also spent less time in labour (mean 500 min) than those who received MA (mean 619 min) and SC (mean 615 min) (EA vs. MA HR 1.4 95% CI 1.0 to1.9, EA vs. SC HR 1.4, 95% CI 1.1 to 2.0), and had less blood loss than women receiving SC, (EA vs. SC OR 0.1 95% CI 0.3 to 0.7). The women’s assessment of the midwife as being supportive during labour (MA 77.2%, EA 83.5%, SC 80%), overall satisfaction with midwife care (MA 100%, EA 97.5%, SC 98.7%), and having an overall positive childbirth experience (MA 64.6%, EA 61.0%, SC 54.3%) did not differ statistically. No serious side effects of the acupuncture treatment were reported.Conclusion: Acupuncture, regardless of type of stimulation, did not differ from standard care without acupuncture in terms of reducing women’s experience of pain during labour, or their memory of pain and childbirth overall two months after the birth. However, other forms of obstetric pain relief were less frequent in women receiving a combination of manual and electrical stimulation, suggesting that this method could facilitate coping with labour pain.
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| 2. |
- Holmlund, Lena, 1967-
(author)
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Patients’ experiences of atrial fibrillation and an evaluation of a nurse-led person-centred clinic
- 2024
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Doctoral thesis (other academic/artistic)abstract
- Background: Living with and managing atrial fibrillation (AF) can be complex. Some people have no symptoms, while others have a significant symptom burden. Health-related quality of life (HRQoL) is often low and partly associated with symptom burden. However, the impact of the condition on daily life differs between those affected and is not fully understood. Therefore, more knowledge is needed about patients’ experiences of AF and factors influencing HRQoL. Research indicates that the care of patients with AF needs to change and be more based on personal preferences and values.Aim: The overall aim of this thesis was to explore patients’ experiences of AF and to evaluate the effects of a nurse-led, person-centred clinic.Methods: The thesis contains four studies. Study I was based on interviews with 15 patients about their experiences of living with symptomatic AF. Studies II and III were based on data from questionnaires completed before and 6 months after scheduled electrical cardioversion. Study II was a cross-sectional study with 52 women and 115 men describing illness perceptions and HRQoL and exploring their relationship. Study III was a longitudinal study comparing 53 newly diagnosed (<6 months) and 76 previously diagnosed patients with AF (≥6 months) regarding HRQoL, illness perceptions, symptoms, symptom burden, anxiety and depression. Study IV was a randomised controlled trial evaluating the effects of a nurse-led, person-centred clinic on patient-reported outcomes measures in patients with AF. Patients were randomly assigned to a nurse-led intervention group (n=50) or a control group with a physician visit (n=53) and completed questionnaires on the same subjects as in Study III at baseline before the visit to the clinic and 6 months after. Study I were analysed with qualitative content analysis. The other studies are quantitative and were analysed with descriptive statistics (Studies II–IV), comparative statistics (Studies II–IV), and correlation analysis and multiple linear regression analysis (Study II).Results: In Study I, three themes (striving for illness control, becoming a receiver or an active partner in care, and dealing with a changed self-image) were reflected in the main theme, balancing life. The participants described their struggles in understanding AF, preventing recurrence and managing anxiety. Some were not involved in decision-making, lacked continuity of care, felt that most information focused on medical issues and requested more support and self-care advice. Study II showed that HRQoL was related to and negatively affected by attributing more symptoms, severe consequences, and negative emotions (e.g., anxiety, anger) to AF and perceiving AF as recurrent. Women reported worse HRQoL and lower personal control than men. Study III showed that newly diagnosed (vs. previously diagnosed) patients at baseline reported AF as a more temporary condition to a greater extent and had stronger belief that the illness was controllable. After 6 months, newly diagnosed patients reported better HRQoL, higher personal control, and lower symptom burden than previously diagnosed patients. Over time, HRQoL improved and AF symptom burden and symptoms of anxiety decreased in newly diagnosed patients, who viewed the illness as chronic to a greater extent than at baseline. Study IV showed that, in the nurse-led intervention group, the patients’ negative emotions towards AF decreased more than in the control group. In addition, their concerns regarding AF decreased and their personal control increased. In both groups, HRQoL and patients’ understanding of AF improved.Conclusions: This thesis demonstrates that for many, AF meant a change in life in which they had to manage anxiety and symptoms and oscillate between being strong and weak and a changed self-image. Men (vs. women) and newly diagnosed (vs. previously diagnosed) patients reported more positive outcomes, such as better HRQoL and greater belief in their ability to control AF. Worse HRQoL was associated with negative illness perceptions, such as more perceived recurrences, symptoms, severe consequences, and negative emotions. The findings in Study IV suggest that the support from a nurse-led person-centred clinic may reduce patients’ negative emotions and concerns attributed to AF and improve their personal control.
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| 3. |
- Häsänen, Lars, 1973-
(author)
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Organizational death and employee motivation : Investigating a plant closure in a multi-plant organization
- 2010
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Doctoral thesis (other academic/artistic)abstract
- Major organizational changes are often connected with a variety of negative outcomes for both employees and the organization alike. As a contrast to this, organizational deaths have instead been associated with increased productivity and motivation to perform, despite certainty of job loss. These results have been regarded as counter-intuitive, since employment and job security are regarded as a foundation for work motivation. Consequently, this thesis aims at investigating the motivational aspects of organizational deaths in terms of change in motivation as individuals adjust to changing realities. The thesis rests on three empirical studies.The first study's results showed (contrary to theoretical postulations) that goal setting was able to influence employees' in-role and extra-role performance, job-induced tension, commitment to the closure, and job satisfaction. The second study showed that organizational productivity, efficiency, performance, motivation and psychological climate increased for both blue-collar and white-collar employees'. The results of the third study lend support to the anecdotal reports that high-performers stop performing during organizational deaths. However, this study also found that low-performers perceiving low justice increased their effort which may show that they have a personal gain in performing (e.g., positive self-perception). The results of the empirical studies support the notion that organizational productivity increases along with employees' motivation to perform. Finally, a common pattern in the data was that most positive variables increased and the negative variables decreased. These results are explained by the adoption of new goals, which creates horizontal coherence (harmony) among goals, which gives rise to goal proximity (motivation increases due to moving closer to the goal).
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| 4. |
- Ohlander, Ulrika, 1965-
(author)
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Towards Enhanced Tactical Support Systems
- 2016
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Licentiate thesis (other academic/artistic)abstract
- Fighter pilots operate high-performing powerful aircraft, equipped with complex sensor systems, in a dynamic and hostile environment. The pilots need to have control over their own aircraft as well as the developing situation surrounding them. Moreover, the fighter pilot rarely is on a mission by himself, but collaborates with teammates to achieve the goals jointly. This collaboration between fighter aircraft cannot take place without technology in the form of a tactical support system (TSS) that aids the pilots with information retrieval and decision-making. A TSS in a fighter aircraft fuses data from different sources and organizes the information in order to assist the pilot in building situation awareness and support in the decision-making during missions. The capabilities of the aircraft and its sensors, as well as the design of the TSS will directly affect how the pilots can perform the missions. The technology and the design at the same time enable and constrain the possible acting space, such that the tactics and plans for the missions will be a consequence of these factors. Hence, the design and development of such a complex system requires deep knowledge about the users and understanding of how they will operate the system. High usability is among the requirements for such a specialized and advanced system as the TSS, and in order to achieve this there is a need to understand the circumstances the system will be used in. Due to the complex nature of the military operations and the difficulties to access the domain for others than pilots, it is challenging for designers of the TSSs to obtain this needed knowledge. Therefore, this thesis aims at investigating the nature of the operations, as well as the practice of user participation in the domain, in order to increase the designers’ knowledge and give guidance to how users should participate in the development of the systems. Several methods that aim to design efficient and usable systems are available. User-centered design is a holistic philosophy that prescribes that the interests and needs of the users should be in focus through the whole development process in order to achieve better systems. At the core of user-centered design is to increase the knowledge about the users and their needs. This thesis applies two perspectives, which both contributes to fulfill the goal of user-centered design of the TSSs by obtaining more knowledge about the users. The two perspectives are: a better understanding of how the users/pilots utilize the TSS to perform teamwork during missions, and an insight into how the users/pilots participate during the development process of the TSSs. The teamwork perspective is motivated by the fact that fighter pilots perform a majority of their missions collaborating in teams. Their teamwork is depending on technology since the pilots are separated from each other in their fighter airplanes. Understanding this teamwork is hence a key to understanding the users in this domain. This thesis investigates the nature of teamwork between fighter pilots based on a theoretical teamwork model, the “Big Five” of effective teamwork proposed by Salas, Sims, and Burke (2005). The “Big Five” model contains eight elements that Salas et al. identified as necessary for effective teamwork: adaptability, backup behavior, closed-loop communication, shared mental models, mutual performance monitoring, team orientation, mutual trust, and team leadership. The user-participation perspective is based on the notion that involving the users in different stages through the development process will benefit the results. However, user participation can take many different forms. The users can have different roles during the process, and the impact their opinions will have on the product can vary. This thesis investigates user participation and the roles the users, i.e. pilots, have in the development process of fighter aircraft of TSSs and cockpit interfaces. These two perspectives are each assigned an aim in the investigation. For the first aim, Increase the knowledge about how fighter pilots collaborate in teams during missions with the current systems, ten fighter pilots were interviewed about their views on teamwork. The teamwork elements of the “Big Five” model are explored and described for the military fighter context. With this knowledge, a task performance cycle is proposed which shows were in the cycle of a mission each teamwork element is most important. Finally, a modified teamwork model adapted for mission performance for fighter pilots is suggested.For the second aim, Increase the knowledge about how pilots can and should participate in the design process of fighter aircraft interfaces, a study on how pilots participate in the design work of cockpit interfaces is conducted. The inquiry is based on a questionnaire, which was distributed to designers of fighter cockpit interfaces. The results indicate that the designers think the pilots have and should have many different roles in the design process. The designers wish to be able to observe pilots at work to a greater extent and to obtain more information and ideas from them. They also think that pilots should be more involved as examiners and testers. However, pilots should not be designers or decision-makers regarding design, according to the majority of respondents. The presented contributions of the team-related research in this thesis are a deeper understanding and rich descriptions of how fighter pilots perform missions from a teamwork perspective. The teamwork elements are examined, and their relations and their importance during mission performance are described. For example, it was found that the abilities to monitor each other, to adapt, and to communicate were the most important factors for effective teamwork during a mission. For the investigation of how designers of pilot interfaces work with user representatives in the design process, the contribution is a description of the different roles the users can have during the development process in this domain. The results are primarily intended to inform designers of tactical support systems and cockpit interfaces. However, other domains where team members are distributed, and are highly dependent on technology for their teamwork, should benefit from the findings.
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| 5. |
- Rignér, Johan, 1964-
(author)
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Adapting to increased automation in the aviation industry through performance measurement and training : Barriers and potential
- 2020
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Doctoral thesis (other academic/artistic)abstract
- The increased use of automation has affected the work on the flight deck. The Single European Sky ATM Research (SESAR), deployed with the purpose to increase the European ATM system performance, identifies automation as a key enabler to increase future system performance. The aviation system is a complex large socio-technical system. The system is affected by internal and external stressors at all system levels. At a work process level of this system, the flight deck represents a Joint Cognitive System. When accidents or incidents do occur, the importance to look beyond the label of flight crew error to understand what happened is widely recognized. As flight safety improves, there are fewer incidents and accidents to learn from, which increases the importance to look at normal operations data for improvement.The flight crew training environment is increasingly relying on collected data about an individual airline’s flight operational environment and performance. Through airlines’ performance measurement system, a large amount of performance data is collected. However, this data is not in a format immediately useful for studies of neither complex socio-technical, nor joint cognitive systems. In addition, regulatory, financial, and other constraints limit airlines’ use of collected data as well as how they perform training.The purpose of this research is to increase knowledge about how training content and learning opportunities for flight crew relates to airline performance monitoring and measurement processes, given a highly automated dynamic environment. Against this background, barriers and potential for improvements to support the flight crew for the operation of the highly automated aircraft are identified.This research has been conducted using a mixed method approach for collecting and analyzing data. The overall research approach is conducted in an applied research tradition. The empirical data in this thesis are primarily based on two research projects, HILAS and Brantare, both with explicit goals of knowledge generation and learning among participating organizations. The results are based on the following methods: 1) System analysis using Rasmussen’s model for a socio-technical system involved in risk management as the framework, to describe the aviation system, primarily with a perspective from the flight crew and their automated work environment, 2) Interviews of pilots, 3) Workshops with groups of pilots and safety office staff, 4) Implementation attempt of a proposed method how to use data and 5) Collection of flight operational data.Based on Rasmussen’s model of a dynamic socio-technical system, the aviation system of interest ranges from “A single European Sky” to regulators, national legislation to flight operations, training, and the work on flight deck as well as political and financial pressures on the airline. The conclusions drawn from this comprehensive scope is reliant on the author’s domain knowledge acquired from some 30 years of experience in the aviation industry.Several barriers against the use of performance data for knowledge and learning improvements are identified. The airline monitoring systems are not ideal for specifically measuring automation related problems and flight crew – automation interactions. Due to the already high flight safety levels, new performance measurement processes and activities are neither prioritized, invested in nor explored. When a proposed data-use method was attempted to be implemented it showed difficulties in finding causalities and relationships between available airline parameters. With unclear causality between various parameters recorded and actual outcomes, it is difficult for airlines to use data available as a source for confident training design. This is also the case for the selection of Safety Performance Indicators, that often are outcome based at a high level. More cross-system integration may render the current measurement systems insufficient to understand difficulties and possibilities in the greater aviation system.Potential for improvement related to the use of data, knowledge and learning are also identified. Flight crew show a high acceptability towards a proposed learning concept based on normal flight data. A greater emphasis of using indicators showing airline adaptability and flexibility is proposed. Also, moving from a scheduled training activity mindset to a wider learning and knowledge management and sharing concept is suggested as a cost-efficient way forward. Increased utilization of normal operational flight data should be used for this purpose and have potential to contribute to both efficiency and safety in aviation.This thesis contributes to airline performance measurement and flight crew training knowledge. Results from this research is valuable in other highly automated safety critical domains with a high acceptance of performance being measured and analyzed.
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