| 1. |
- Snögren, Maria
(author)
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Munhälsa – Äldre personers upplevelser och vårdpersonals attityder och kunskaper
- 2024
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Doctoral thesis (other academic/artistic)abstract
- Bakgrund: Det är känt att äldre personer har bättre munhälsa i dag och fler kvarvarande tänder än tidigare generationer. Det är en komplex uppgift att utföra munvård för att förebygga nedsatt munhälsa på någon annan. Nedsatt munhälsa kan påverka allmänhälsan på olika sätt, till exempel genom smärta och nedsatt aptit. Nedsatt munhälsa kan också vara en bidragande orsak till infektioner lokalt i munnen, men även i andra delar av kroppen. Det har dock visat sig att vårdpersonal (sjuksköterskor, undersköterskor och vårdbiträden) inom kommunal äldreomsorg försummar utförandet av munvård hos äldre personer av olika skäl, däribland tidsbrist, okunskap och bristande rutiner. Vårdpersonal värdesätter kunskap om munhälsa och efterfrågar utbildning om munhälsa och munvård. Kompetensutveckling för vårdpersonal tar tid samtidigt som den digitala utvecklingen och tillgången till digitala tjänster ökar. Digital utbildning kan vara en lösning till att sprida kunskap i en hel arbetsgrupp. Studier har visat på stort värde av möjligheten till interaktivitet, repetition och feedback som tydligt förknippas med ett ökat lärande vid användande av digitala utbildningar. Studier visar även att vårdpersonal som kompetensutvecklas genom utbildning om munhälsa tillhandahåller bättre munvård till äldre personer efter utbildning.Syfte: Det övergripande syftet var att studera äldre personers uppfattning om munhälsa och vårdpersonals attityder till och kunskaper om omvårdnad relaterat till munhälsa. Ytterligare ett syfte var att beskriva vårdpersonals attityder och kunskaper före och efter en digital utbildning i munhälsa och användbarheten av denna.Metod: Avhandlingen inkluderar fyra delstudier varav två har en kvalitativ design, delstudie I och IV, en med kvantitativ design, delstudie II och en med mixad metod, delstudie III. Delstudie I inkluderar äldre personer och delstudie II-IV inkluderar vårdpersonal. Data har samlats in med hjälp av frågeformulär, individuella intervjuer och fokusgruppsintervjuer. Kvalitativ analys genomfördes med hjälp av kvalitativ innehållsanalys i delstudie I och IV. Kvantitativa analyser genomfördes med Psykometrisk utvärdering med klassisk testteori (CTT) kompletterad med Item Response Theory (IRT) i delstudie II och beskrivande statistik och Wilcoxon signed-rank test i delstudie III.Resultat: Resultaten visar att det är komplext att utföra munvård på någon annan och kräver att tid ges till att bygga personkännedom mellan vårdpersonalen och den äldre personen som får hjälp med munvård. Personkännedom beskrivs av vårdpersonal främja och ge trygghet i utförandet av munvård. Äldre personer beskriver att de är experter på sina egna upplevelser av munhälsan och att denna kunskap behöver delas med vårdpersonalen. Personkännedom etableras och uppnås genom att vårdpersonalen skapar förtroende, är närvarande, förutser behov, är pålästa och genom att reflektera över vården. Det är ett förtroende att utföra munvård på någon annan, vilket underlättas av personkännedom. Det ger vårdpersonalen information och bättre förutsättningarna att utföra god munvård och att synliggöra hinder som tids-, personal- och kunskapsbrist. Äldre personer värdesätter en god munhälsa och vårdpersonalen värdesätter kunskap relaterad till munhälsa. Ett sätt att sprida kunskap om munhälsa bland vårdpersonalen är genom digitala utbildningsinterventioner. Kombinationen av teoretisk kunskap med hjälp av digital utbildning och praktiska övningar beskrivs av vårdpersonalen som ett sätt att ge både teoretisk och praktisk kunskap. Att arbeta tillsammans över professionsgränser i omvårdnad kring munvården beskrivs ofta brista inom kommunal äldreomsorg. Arbetet tillsammans upplevs dock fungera bra vid palliativ omvårdnad. Äldre personer beskriver en önskan om hjälp med sin munhälsa när behov uppstår.Slutsatser: Äldre personer värdesätter en god munhälsa och vårdpersonalen värdesätter kunskap relaterad till munhälsa. Munvård är komplex och förutsätter att vårdpersonalen erhåller kunskap, rutiner, tid och samarbetar för att utföra den med god personkännedom om den äldre person. Digital utbildning är ett sätt att öka kunskapen om munhälsa bland vårdpersonalen. En kombination av teori med hjälp av digital utbildning och praktiska övningar bidrar till både teoretisk och praktisk kunskap. Samarbetet kring munvård mellan sjuksköterskor, undersköterskor och vårdbiträden fungerade inte alltid optimalt, däremot fungerade samarbetet bra vid palliativ omvårdnad. Samarbete, tid och kunskap samt reflektion anses vara viktiga faktorer för vårdverksamheter att beakta i framtiden för att god munvård ska kunna utföras inom kommunal äldreomsorg.
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| 2. |
- Wu, Eline
(author)
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Enhanced external counterpulsation treatment in patients with refractory angina pectoris with emphasis on physical capacity, health-related quality of life and safety : An explorative and interventional study
- 2021
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Doctoral thesis (other academic/artistic)abstract
- Background: Patients with refractory angina pectoris (RAP) suffer from debilitating symptoms with considerable limitation of functional capacity and impaired health-related quality of life (HRQoL) despite optimised medical therapy. In addition, frequent angina symptoms are strongly associated with psychological distress. The challenging management of RAP and the severe limitations and symptomatology experienced by these patients underscore the need for further research in more novel treatment approaches. Enhanced external counterpulsation (EECP) is a potential non-invasive treatment that can decrease limiting symptoms in patients with RAP and is generally given as 35 one-hour sessions (i.e., one course) over seven weeks.Aim: The overall aim was to obtain a deeper understanding of patients’ experiences undergoing EECP treatment and to evaluate the effects of the treatment with focus on physical capacity, HRQoL and safety.Methods: An explorative and interventional study comprising both qualitative (paper I) and quantitative (papers II, III, and IV) study designs were performed. In paper I, semi-structured interviews took place with 15 strategically selected patients who had finished an EECP course at the two existing EECP clinics in Sweden. Data were analysed using inductive qualitative content analysis. In paper II, a quasi-experimental study with one-group pre-test/post-test design with a six-month follow-up was performed with 50 patients who had undergone one EECP course. The following pre- and post-treatment data were collected: medication use, six-minute walk test (6MWT), functional class according to the Canadian Cardiovascular Society (CCS), self-reported (i.e., questionnaire data) cardiac anxiety, and HRQoL. The questionnaires were also completed at a six-month follow-up. In paper III and IV, sociodemographic, medical, and clinical data related to EECP were collected by reviewing medical records of 119 patients with RAP who had undergone one EECP course and a 6MWT pre- and post-treatment. An increased walking distance by 10% post treatment, measured with 6MWT, was considered an adequate treatment response.Results: In paper I, the findings were divided into four content areas, each comprising three categories: (1) experiences before EECP was initiated comprised of uncharted territory, be given a new opportunity and gain insight; (2) experiences during EECP sessions comprised physical discomfort, need of distraction, and sense of security; (3) experiences between EECP sessions comprised physical changes, socializing, and coordinating everyday life; and (4) experiences after one course of EECP treatment comprised improved physical well-being, improved mental well-being and maintaining angina in check. In paper II, patients used significantly less short-acting nitrates (p <. 001), walking distance increased on average by 46 m (p < .001), and CCS class improved after one EECP course (p < .001). In addition, all but one subscale of cardiac anxiety and all HRQoL components improved significantly, and the positive effects were maintained at the six-month follow-up (p < .05). In paper III, 49 (41.2%) of the 119 patients, were responders to EECP. CCS class ≥ 3, left ventricle ejection fraction < 50%, and previous revascularisation (i.e., ≤ one type of intervention) were predictors of response (p < .05). In paper IV, the treatment completion rate was high, and the occurrence of adverse events (AE) was low. Most device-related AE required nursing actions, while medical actions were needed more in the non-device-related AE. The AE distribution did not differ between responders and non-responders. Skin lesion/blister occurred mostly in responders and paraesthesia occurred mostly in non-responders.Conclusions: The EECP treatment was perceived as an unknown option among these patients but also as be given a new opportunity to get better. The presence and care provided by the cardiac nurse contributed to a sense of security during treatment. The treatment resulted in reduced symptom burden, improved physical capacity and HRQoL, and less cardiac anxiety, leading to increased physical activity and enhanced life satisfaction for patients with RAP. Moreover, the EECP should be considered preferentially for patients who have a greater functional impairment, evidence of systolic left ventricular dysfunction, and exposure to fewer types of revascularisation. The EECP treatment appears to be a safe and well-tolerated treatment option in patients with RAP.
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| 3. |
- Ehrenberg, Anna, et al.
(author)
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Evidensbaserad praktik i omvårdnad.
- 2021. - 2
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In: Omvårdnad på avancerad nivå – kärnkompetenser inom sjuksköterskans specialistområden. - Lund : Studentlitteratur AB. - 9789144136240 ; , s. 261-284
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Book chapter (other academic/artistic)
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| 4. |
- Ehrenberg, Anna, 1956-, et al.
(author)
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Evidensbaserad vård
- 2021. - 2
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In: Omvårdnad på avancerad nivå – kärnkompetenser inom sjuksköterskans specialistområden. - Lund : Studentlitteratur AB. - 9789144136240 ; , s. 225-260
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Book chapter (other academic/artistic)
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| 5. |
- Göras, Camilla, 1969-, et al.
(author)
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Managing complexity in the operating room : a group interview study
- 2020
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In: BMC Health Services Research. - : BioMed Central. - 1472-6963. ; 20:1, s. 1-12
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Journal article (peer-reviewed)abstract
- Background Clinical work in the operating room (OR) is considered challenging as it is complex, dynamic, and often time- and resource-constrained. Important characteristics for successful management of complexity include adaptations and adaptive coordination when managing expected and unexpected events. However, there is a lack of explorative research addressing what makes things go well and how OR staff describe they do when responding to challenges and compensating for constraints. The aim of this study was therefore to explore how complexity is managed as expressed by operating room nurses, registered nurse anesthetists, and surgeons, and how these professionals adapt to create safe care in the OR. Method Data for this qualitative explorative study were collected via group interviews with three professional groups of the OR-team, including operating room nurses, registered nurse anesthetists and operating and assisting surgeons in four group interview sessions, one for each profession except for ORNs for which two separate interviews were performed. The audio-taped transcripts were transcribed verbatim and analyzed by inductive qualitative content analysis. Results The findings revealed three generic categories covering ways of creating safe care in the OR: preconditions and resources, planning and preparing for the expected and unexpected, and adapting to the unexpected. In each generic category, one sub-category emerged that was common to all three professions: coordinating and reaffirming information, creating a plan for the patient and undergoing mental preparation, and prioritizing and solving upcoming problems, respectively. Conclusion Creating safe care in the OR should be understood as a process of planning and preparing in order to manage challenging and complex work processes. OR staff need preconditions and resources such as having experience and coordinating and reaffirming information, to make sense of different situations. This requires a mental model, which is created through planning and preparing in different ways. Some situations are repetitive and easier to plan for but planning for the unexpected requires anticipation from experience. The main results strengthen that abilities described in the theory of resilience are used by OR staff as a strategy to manage complexity in the OR.
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| 6. |
- Olin, Karolina, et al.
(author)
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Mapping registered nurse anaesthetists' intraoperative work : tasks, multitasking, interruptions and their causes, and interactions: a prospective observational study
- 2022
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In: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 12:1
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Journal article (peer-reviewed)abstract
- Introduction Safe anaesthesia care is a fundamental part of healthcare. In a previous study, registered nurse anaesthetists (RNAs) had the highest task frequency, with the largest amount of multitasking and interruptions among all professionals working in a surgical team. There is a lack of knowledge on how these factors are distributed during the intraoperative anaesthesia care process, and what implications they might have on safety and quality of care.Objective To map the RNAs' work as done in practice, including tasks, multitasking, interruptions and their causes, and interactions, during all phases of the intraoperative anaesthesia work process.Methods Structured observations of RNAs (n=8) conducted during 30 procedures lasting a total of 73 hours in an operating department at a county hospital in Sweden, using the Work Observation Method By Activity Timing tool.Results High task intensity and multitasking were revealed during preparation for anaesthesia induction (79 tasks/hour, 61.9% of task time spent multitasking), anaesthesia induction (98 tasks/hour, 50.7%) and preparation for anaesthesia maintenance (86 tasks/hour, 80.2%). Frequent interruptions took place during preoperative preparation (4.7 /hour), anaesthesia induction (6.2 /hour) and preparation for anaesthesia maintenance (4.3 /hour). The interruptions were most often related to medication care (n=54, 19.8%), equipment issues (n=40, 14.7%) or the procedure itself (n=39, 14.3%). RNAs' work was conducted mostly independently (58.4%), but RNAs interacted with multiple professionals in and outside the operating room during anaesthesia.Conclusion The tasks, multitasking, interruptions and their causes, and interactions during different phases illustrated the RNAs' work as done, as part of a complex adaptive system. Management of safety in the most intense phases-preparing for anaesthesia induction, induction and preparing for anaesthesia maintenance-should be investigated further. The complexity and adaptivity of the nature of RNAs' work should be taken into consideration in future management, development, research and education.
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