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- Hälleberg-Nyman, Maria, 1968-
(author)
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Urinary catheter policies for short-term bladder drainage in hip surgery patients
- 2012
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Doctoral thesis (other academic/artistic)abstract
- The overall aim of this thesis was to evaluate methods for urinary catheter handling in patients undergoing hip surgery. The intention was to gain knowledge in order to provide optimal and cost- effective care regarding urinary catheterisation in this group of patients.In Study I , 45 of the 86 catheterised patients (52%) contracted nosocomial urinary tract infections (UTIs). Diabetes was a risk factor for developing UTI, and cloxacillin as a perioperative antibiotic prophylaxis seemed to offer a certain protection. Study II was a randomised controlled trial on the effect of clamping (n = 55) or not (n = 58) of the indwelling urinary catheter before removal. No significant differences were found between the groups with respect to time to normal bladder function, need for recatheterisation, or length of hospital stay. Study III was a randomised controlled trial among patients with hip fracture and hip arthroplasty, in which the patients were randomised to intermittent (n = 85) or indwelling (n = 85) urinary catheterisation. No significant differences in nosocomial UTIs (9% vs. 12%) or cost-effectiveness were shown. The patients in the intermittent group regained normal bladder function significantly sooner after surgery. Fourteen percent of the patients in the intermittent group did not need any catheterisation. In Study IV , 30 patients were interviewed about their experiences of bladder emptying and urinary catheterisation. The patients’ views were described through the main category ‘An issue but of varying impact’. Both bladder emptying through micturition and bladder emptying through catheterisation were described as convenient, but also as uncomfortable and an intrusion on dignity. The patients were aware of risks and complications of urinary catheterisation.In conclusion, this thesis indicates that UTI is common in hip surgery patients. Clamping of indwelling catheters seems not necessary. There is no preference for either intermittent or indwelling urinary catheterisation according to the results of this thesis, either for the development of nosocomial UTI or, for cost-effectiveness, or from the patient perspective. Nurses should be aware that catheterisation might make the patients feel exposed, and it is essential that their practice reflect the best available evidence.
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| 2. |
- Jangland, Eva, 1964-
(author)
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The Patient–Health-professional Interaction in a Hospital Setting
- 2011
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Doctoral thesis (other academic/artistic)abstract
- The overall aim of the thesis was to describe patient−health-professional interactions in a hospital setting, with a specific focus on the surgical care unit. The thesis consists of four studies and includes both qualitative and quantitative studies. Content analysis and phenomenography were used in the qualitative studies; the quantitative study was an intervention study with a three-phase quasi-experimental design. The findings of study I showed that patient complaints to a local Patients’ Advisory Committee about negative interactions with health professionals most often concerned the perceived insufficiencies of information, respect, and empathy. The findings of study II showed that experiences of negative interactions with health professionals caused long-term consequences for individual patients and reduced patients’ confidence in upcoming consultations. The findings of the phenomenographic study (III) showed that surgical nurses understand an important part of their work in qualitatively different ways, which can be presented as a hierarchy of increasing complexity and comprehensiveness. In the most restricted understanding, surgical nurses focus on the work task, whereas in the others surgical nurses demonstrate increasing degrees of patient-centeredness. Finally, the results of study IV showed that an uncomplicated intervention that invited patients to express their daily questions and concerns in writing (using the ‘Tell-us card’) improved the patients’ perceptions of participation in their care in a surgical care unit. For further implementation of the Tell-us card to succeed, it needs to be prioritized and supported by leaders in ongoing quality improvement work. The value of a patient-focused interaction needs to be the subject of ongoing discussions in surgical care units. Patients’ stories of negative interactions could be used as a starting point for discussions in professional reflection sessions. It is important to discuss and become aware of different ways of understanding professional interactions and relationships with patients; these discussions could open up new areas of professional development. Providing patients an opportunity to ask their questions and express their concerns in writing, and using this information in the patient−health-professional interaction, could be an important step towards improved patient participation.
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| 3. |
- Johansson, Maria Eiman, et al.
(author)
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Nurses' clinical reasoning concerning management of peripheral venous cannulae
- 2009
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In: Journal of Clinical Nursing. - : Blackwell. - 0962-1067 .- 1365-2702. ; 18:23, s. 3366-3375
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Journal article (peer-reviewed)abstract
- The aim was to describe nurses´clinical reasoning regarding peripheral venous cannulae management by focusing on the clinical information and circumstances considered during the decision-making process. On every shift nurses make several decisions, among others concerning the management of peripheral venous cannuae. Thrombophlebitis is a common complication associated with its use, although more severe complications can arise. There are clinical practice guidelines within the area, but they are not always adhered to. Previous studies have examined decisions related to the management of peripheral venous cannulae, but did not include observations in a naturalistic setting. A qualitative study combining observations and interviews was designed. Methods: Participant observation facilitated open interviews about the clinical reasoning behind decision-making in observed situations, as well as semi-structured interviews regarding clinical reasoning about the general management of peripheral venouscannulae. transcribed interview texts were analysed with content analysis. Three main categories describe clinical information and circumstances: the individual patient situation, the nurse´s work situation and experience of peripheral venous cannulae management. The overall theme of the interview texts was that the clinical reasoning was a balancing act between minimising patient discomfort and preventing complications from the peripheral venous cannulae. Conclusion: At all times the patients´well-being was considered, but the ways the nurses approached this differed depending on how they considered clinical information in the individual patient situation, circumstances in their own work situation and their experience of peripheral venous cannulae management. Relevance toclinical practice: Knowledge of the clinical information and circumstances considered in naturalistic settings, is valuable when implementing and adjusting clinical practice guidelines to local settings. This knowledge is also useful in nursing education as student nurses´and nurses´ability tobalance between preventing complications and avoiding discomfort is important for enhancing patient care.
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| 4. |
- Johansson, Maria Eiman, et al.
(author)
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Registered Nurses´Adherence to Clinical Guidelines Regarding Peripheral Venous Catheters : A Structured Observational Study
- 2008
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In: Worldviews on Evidence-Based Nursing. - : Blackwell. - 1545-102X .- 1741-6787. ; 5:3, s. 148-159
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Journal article (peer-reviewed)abstract
- peripheral catheterization is a common procedure, which affects numerous patients in health care today. having peripheral venous catheters in situ might lead to complications such as thrombophlebitis and sepsis, and clinical guidelines have been developed to assist nurses in their decisionmaking. Several reasons are given for clinicians not always adhering to clinical guidelines, although such adherence might lead to fewer complications. This papaer aims to describe registered nurses´adherence to national and local guidelines on peripheral venous catheters by focusing on time in situ, site, size, and documentation at the dressing. An additional aim is to describe the thrombophlebitis frequency associated with peripheral venous catheters in situ. Structured observational study of patients with peripheral venous catheters in situ, conducted from December 2004 to June 2005. data of 343 peripheral venous catheters were analyzed. Nurses partly adhered to national and local guidelines concerning size and site. Guideline adherence concerning documentation at the dressing was low. The results showed that non-adherence pertaining to time in situ varied between 5% and 26.3%. Differences between adherence to national or local guidelines were shown for size, site, and documentation at the dressing. Mild thrombophlebitis (Grades 1 and 2) was observed in 7.0%. Nurses partly adhered to clinical guidelines. Differences in guideline adherence were observed for wards with local or national guigelines, as well as for wards with different specialities. In accordance with clinical guidelines, the nurses seemed to replace or remove peripheral venous catheters before any severe complications arose. Adherence to clinical guidelines has an impact for preventing patient complications and thus it is essential that nurses are aware of their existence. Feedback and discussions of guideline adherence or of complication rates might influence nurses´clinical decision-making.
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| 5. |
- Lindgren, Maria, 1952-, et al.
(author)
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Arbetet med individuella utvecklingsplaner –rektorers syn på mentorer, utvecklingssamtal och lärande
- 2010
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In: Humanetten. - Växjö : Institutionen för kulturvetenskaper och Institutionen för språk och litteratur vid Linnéuniversitetet. - 1403-2279. ; 25, s. 45-55
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Journal article (pop. science, debate, etc.)abstract
- I denna rapport beskrivs några rektorers uppfattning om mentorskap, individuella utvecklingssamtal (IUP) och lärande. Enligt rektorernas svar har skolorna ännu inte lyckats nå intentionerna för utvecklingssamtalen, nämligen att vara något mer än informationstillfällen, men rektorerna ger uttryck för att det finns en hög grad av öppenhet, kreativa förslag och modifieringar i organisationen som ett resultat av överenskommelser i IUP. Rektorerna uppfattar att planerna i de flesta fall utgår från elevens svårigheter och att även åtgärderna utgår ifrån enskilda elevers svårigheter.
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| 6. |
- Mladenovic, Zivko, 1977-, et al.
(author)
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Silicon inhibits signaling pathways and cell-cell communication important for osteoclast formation and bone resorption in vitro
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Other publication (other academic/artistic)abstract
- Silicon containing materials are used in bone regeneration, and some of the materials, e.g. Bioactive glass 45S5 (BG), release silicon (Si) ions to the surrounding tissue after implantation. The role of Si in bone biology is debated; nevertheless findings suggest that Si is beneficial for bone formation. A majority of the experimental studies on Si and bone have focused on osteoblasts. The effects of Si on osteoclast formation and function have not been directly addressed. In the present study, we show that ionic dissolution extract from BG inhibit osteoclast bone resorption in an organ culture system as well as osteoclast formation in a mouse bone marrow system and in the RAW264.7 cell line. Si containing cell culture medium was prepared to address the issue whether or not the inhibitory effects with BG dissolution extract were Si ion dependent. The results suggest that the inhibitory effects of Si act directly on osteoclast precursors, by interactions with the RANK/RANKL/OPG signaling pathway as well as with gap junction intercellular communication. However, regulation via osteoblasts cannot be excluded. The inhibitory effect of Si on osteoclasts could be useful for future therapies or treating bone loss in patients, provided that molecular mechanisms are established.
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| 7. |
- Mladenović, Živko, et al.
(author)
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Soluble silica inhibits osteoclast formation and bone resorption in vitro
- 2014
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In: Acta Biomaterialia. - : Elsevier. - 1742-7061 .- 1878-7568. ; 10:1, s. 406-418
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Journal article (peer-reviewed)abstract
- Several studies have suggested that silicon (Si) may be essential for normal development of connective tissue and the skeleton. Positive effects of Si from the diet as well as from Si-containing biomaterials, such as Bioactive glass 45S5 (BG), have been demonstrated. Studies have reported that Si stimulates osteoblast proliferation and differentiation. However, effects of Si on osteoclasts have not been directly addressed earlier. The purpose of the present in vitro study was to clarify if Si has regulatory effects on osteoclasts formation and bone resorption. Effects of BG, BG dissolution extracts and Si containing cell culture medium were investigated in a mouse calvarial bone resorption assay and osteoclast formation assays (mouse bone marrow cultures and RAW264.7 cell cultures). We conclude from our results that Si causes significant inhibition of osteoclast phenotypic gene expressions, osteoclast formation and bone resorption in vitro. In conclusion, the present study suggests that Si has a dual nature in bone metabolism with stimulatory effects on osteoblasts and inhibitory effects on osteoclasts. This suggested property of Si might be interesting to further explore in future biomaterials for treatments of bone defects in patients.
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| 8. |
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| 9. |
- Sundbom, Magnus, et al.
(author)
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Patient-reported experience and outcome measures during treatment for gastroesophageal cancer
- 2020
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In: European Journal of Cancer Care. - : Wiley. - 0961-5423 .- 1365-2354. ; 29:2
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Journal article (peer-reviewed)abstract
- ObjectiveGastroesophageal cancer has high mortality, and continuous assessment of patient‐reported data is salient for optimisation of supportive care. We aimed to evaluate our multidisciplinary concept with respect to patient‐reported variables.MethodsAt diagnosis and later during the treatment, three areas of patient‐reported measures were evaluated: the given information and care, fatigue (Multidimensional Fatigue Inventory [MFI‐20]), dysphagia (Ogilvie dysphagia score) and weight loss.ResultsOf 130 outpatients, planned for a surgical procedure and given a contact nurse (CN), 106 responded. During treatment, 81% of the patients were satisfied with their CN. The given information was considered very good or good by >90% and easily understood. Half of the patients reported need for supportive care, which was rated good by 85%. All dimensions of the MFI‐20 test, except mental fatigue, worsened during the treatment period. At diagnosis, 61% of the patients experienced eating problems, leading to 7% weight loss. Although dysphagia improved, weight loss reached 13% at the end of treatment.ConclusionA multidisciplinary concept can be of value in giving appropriate and understandable information, leading to high satisfaction with the provided care. However, as fatigue and weight loss increased during the treatment period, patients need structured multidisciplinary support.
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| 10. |
- Willman, Ania, et al.
(author)
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Ett projekt för att implementera evidensbaserad omvårdnad
- 2003
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Reports (other academic/artistic)abstract
- För att bidra till sjuksköterskornas engagemang för en god vård startade Malmö högskola, Hälsa och samhälle, hösten 1999, Enheten för evidensbaserad omvårdnad. Efter en omorganisation i november 2002 ingår verksamheten i Enheten för biomedicinsk laboratorievetenskap, folkhälsovetenskap och omvårdnad. Ett av nio mål är att i samarbete med nyckelgrupper identifiera och implementera effektiva strategier för spridning och tillämpning av forskningsresultat. Vid Universitetssjukhuset MAS (UMAS) har ett visionsdokument kallat "Målbild 2005" utarbetats. Ett av målen för UMAS verksamhet är att en lärande organisation och en evidensbaserad vård ska införas vid sjukhuset (Enheten för verksamhetsutveckling - Informationsenheten UMAS, 2001). Som en del i att förverkliga målbilden, startades ett projekt mellan UMAS och Malmö högskola. Samarbetsprojektet syftade till att förverkliga en del av målbildsarbetet på UMAS, öka Malmö högskolas samarbete med det omgivande samhället samt utveckla projektdeltagarnas kompetens. Fyra legitimerade sjuksköterskor från tre olika vårdenheter vid UMAS har deltagit i projektet. Projektet var tidsbegränsat till sex månader, under år 2002. Varje deltagare har avsatt 20 % av sin heltidstjänstgöring, vilket innebär en arbetsdag per vecka, för projektet. Tidsfördelningen har varit lika mellan Malmö högskola och UMAS. Projektet skulle öka sjuksköterskornas möjligheter att följa utvecklingen inom omvårdnadsforskningens område, vilket i sin förlängning förväntades öka kvaliteten på verksamheten och den vård som ges till patienterna. Med hjälp av nya kunskaper har projektdeltagarna förmedlat budskapet på sjukhuset och kunnat ge arbetskamrater introduktion och vägledning i ämnet evidensbaserad omvårdnad. Genom att projektdeltagarna arbetar kliniskt finns kompetensen aktiv ute på avdelningarna och då kan också intresset spridas på ett naturligt sätt i det dagliga arbetet till andra bland personalen. Projektdeltagarnas övergripande och gemensamma erfarenhet är att det är en stor tillgång att få kombinera kliniskt arbete med forskning. Vårdenhetscheferna har positiva erfarenheter av samarbetsprojektet. De anser att målen för projektet är uppfyllda och att projektdeltagarna har fått en ökad kompetens. Intresset för evidensbaserad omvårdnad har väckts bland medarbetarna, men ännu kan det inte märkas några synbara effekter av den ökade medvetenheten om evidensbaserad omvårdnad i deras arbetssätt. Den fråga som vårdenhetscheferna nu anser vara viktig att fortsätta arbeta med är, hur implementeringen av evidensbaserad omvårdnad ska ske i framtiden.
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