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  • 1.
    Akselsson, Anna
    et al.
    Sophiahemmet Högskola.
    Georgsson, Susanne
    Sophiahemmet Högskola.
    Lindgren, H
    Pettersson, K
    Rådestad, Ingela
    Sophiahemmet Högskola.
    Women's attitudes, experiences and compliance concerning the use of Mindfetalness: A method for systematic observation of fetal movements in late pregnancy2017Konferensbidrag (Övrigt vetenskapligt)
  • 2.
    Akselsson, Anna
    et al.
    Sophiahemmet Högskola.
    Linde, Anders
    Sophiahemmet Högskola.
    Georgsson, Susanne
    Sophiahemmet Högskola.
    Lindgren, H
    Pettersson, K
    Rådestad, Ingela
    Sophiahemmet Högskola.
    Structured daily observation of fetal movements and transfer to neonatal clinic2017Konferensbidrag (Övrigt vetenskapligt)
  • 3.
    Amsberg, Susanne
    Sophiahemmet Högskola.
    Health Promotion in Diabetes Care: Studies on Adult Type 1 Diabetes Patients2008Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Introduction: A landmark report has shown that improving glycaemic control among type 1 diabetes patients markedly reduces diabetes-related complications. In clinical practice, however, many patients have problems in adhering to the treatment, and thus remain in poor glycaemic control. Research suggests a more behaviour-oriented approach to diabetes, but there is a lack of evidence on the efficacy of interventions, especially for those adult type 1 diabetes patients who are in poor glycaemic control. Diabetes-related distress has been associated with poor adherence to treatment and poor glycaemic control. There is a need for validated measures in this area, to identify patients who experience diabetes-related distress. Additionally, injection technique is crucial for the management of diabetes, and lipohypertrophy is a common side effect which deserves further attention.

    Objectives: The overall aim of this thesis was to evaluate a behavioural medicine intervention among poorly controlled adult type 1 diabetes patients, and to gain a deeper knowledge in an area of diabetes self-management.

    Methods: Quantitative design was used for the studies, and the clinical settings comprised two diabetes care units in Stockholm, Sweden. Study I: The Swedish version of the Problem Areas in Diabetes (Swe-PAID-20) scale was evaluated regarding its psychometric properties by type 1 diabetes patients, as well as by an expert panel of diabetes specialist nurses. Study II: A behavioural medicine intervention based on Cognitive Behaviour Therapy (CBT) was evaluated in a randomised controlled trial among poorly controlled adult type 1 diabetes patients. Study III: Using the same sample as in study II, descriptive statistics were produced, and predictive and comparative analyses performed, in order to find predictors of or associations with improvements in glycaemic control as a response to the intervention. Study IV: In a randomised crossover trial insulin absorption in lipohypertrophic injection sites was investigated in type 1 diabetes patients.

    Results and conclusions: Study I: A three-factor solution of the scale was found, comprising sub-dimensions of diabetes-related emotional problems, treatment-related problems and support-related problems. Cronbach’s alpha for the total score was 0.94 and varied between 0.61 and 0.94 in the three subscales. The findings also supported the convergent and content validity. The Swe-PAID-20 seems to be a reliable and valid outcome for measuring diabetes-related distress in type 1 diabetes patients. Study II: Significant differences were observed with respect to HbA1c, well-being, diabetes-related distress, frequency of blood glucose testing, fear of hypoglycaemia, perceived stress, and depression, all of which improved more in the intervention group compared with the control group. The CBT based behavioural medicine intervention appears to be a promising approach to diabetes self-management. Study III: The participation rate in the study was 41% and attrition was 24%. Of those patients who actually participated in the intervention, 13% withdrew. From the regression models no predictors or associations were found with regard to improvement in HbA1c. The programme proved to be feasible in terms of design and methods. However, no clear pattern was found regarding predictors of or associations with improved metabolic control. Study IV: Impairment of insulin absorption from lipohypertrophic injection sites was also found with analogue insulins. It is suggested that patients should be advised to refrain from injecting insulin aspart into lipohypertrophic subcutaneous tissue.

  • 4.
    Amsberg, Susanne
    et al.
    Sophiahemmet Högskola.
    Anderbro, Therese
    Sophiahemmet Högskola.
    Stöd baserat på kognitiv beteendeterapi (KBT)2012Ingår i: Omvårdnad vid diabetes / [ed] Karin Wikblad, Lund: Studentlitteratur, 2012, 2, 161-178 s.Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 5.
    Anderbro, Therese
    Sophiahemmet Högskola.
    Behavior change intervention and fear of hypoglycemia in type 1 diabetes2012Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Introduction: Individuals with type 1 diabetes require lifelong insulin supply as well as behavioral adjustments for good treatment result. Only a minority reach the goal for glycemic control set in order to reduce the risk of severe long-term complications. Interventions based on cognitive behavior therapy (CBT) have been proposed to improve diabetes-management, but evidence for its efficacy in adults with poorly controlled type 1 diabetes is sparse. One common barrier to optimal diabetes-management is fear of hypoglycemia (FOH), especially in those who have experienced severe hypoglycemic episodes. Thus there is a need for a valid and reliable instrument to assess individuals who are affected by FOH. It is also vital to identify factors associated with FOH in order to find targets for interventions to reduce fear.Aim: The overall aims of this thesis were to evaluate a CBT intervention for poorly controlled individuals with type 1 diabetes and to explore fear of hypoglycemia in an effort to gain deeper knowledge of possible targets for interventions to reduce FOH.Methods: All four studies applied quantitative designs. Study I was a randomized controlled trial in which a cognitive behavioral intervention was evaluated on poorly controlled adult persons with type 1 diabetes. Study II was a psychometric evaluation of a Swedish version of the Hypoglycemia Fear Survey (HFS) in a survey study in adult persons with type 1 diabetes. Studies III and IV were cross-sectional survey studies employed on adults with type 1 diabetes exploring disease-specific, demographic, (studies III and IV) emotional and psychosocial factors (study IV) related to FOH.Results and conclusions: Study I: The intervention group receiving CBT showed significant improvements in HbA1c, diabetes related distress, well-being, FOH, perceived stress, anxiety and depression as well as frequency in self monitoring of blood glucose. Study II: A three- factor solution was found for the Swedish version of the HFS with the dimensions Worry, Behavior and Aloneness. Cronbach’s alpha for the total scale was 0.85 and varied between 0.63 – 0.89 in the subscales. Convergent validity was also supported with moderate correlation between Swe-HFS and Swe-PAID-20. The Swe-HFS seems to be a reliable and valid instrument to measure FOH in adults with type 1 diabetes. Study III: Seven hundred and sixty- four persons (55%) responded to the questionnaire. The HFS-Worry subscale was significantly associated with frequency of severe hypoglycemia, number of symptoms during mild hypoglycemia, gender, hypoglycemic symptoms during hyperglycemia and hypoglycemic unawareness. The HFS-Aloneness subscale was significantly associated with frequency of severe hypoglycemia, number of symptoms during mild hypoglycemia, gender, frequency of mild hypoglycemia, HbA1c, hypoglycaemic unawareness and visits to the emergency room because of severe hypoglycemia. FOH proved to be more prevalent in females. Frequency of severe hypoglycemia was identified as the most important factor associated with FOH. Study IV: A total of 469 (61%) persons responded to the questionnaire. The HFS was significantly associated with The Anxiety Sensitivity Index, the Anxiety subscale of Hospital Anxiety and Depression Scale and Social Phobia Scale. Together with the disease-specific factors the regression model explained 39% of the variance. Support for a positive association between FOH and anxiety was present and previously identified gender differences were confirmed. Differences between the subgroups on factors associated with FOH were found that may have implications in developing interventions

  • 6.
    Anderbro, Therese
    et al.
    Sophiahemmet Högskola.
    Bolinder, J.
    Lins, Per-Eric
    Wredling, Regina
    Moberg, E.
    Lisspers, Jan
    Johansson, Unn-Britt
    Sophiahemmet Högskola.
    Pscyhosocial aspects of fear of hypoglycemia2012Ingår i: FEND 17th Annual Conference, 2012, 18- s.Konferensbidrag (Övrigt vetenskapligt)
  • 7. Anderbro, Therese
    et al.
    Moberg, E
    Gonder-Frederick, L
    Lins, P E
    Adamson, U
    Johansson, Unn-Britt
    Sophiahemmet Högskola.
    A longitudinal study of fear of hypoglycemia in type 1 diabetes2015Konferensbidrag (Övrigt vetenskapligt)
  • 8.
    Andersson, Helene
    Sophiahemmet Högskola.
    MRSA and other resistant bacteria: prevalence, patient and staff experiences, wounds and infection control2012Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Antibiotic resistance has become a major and serious global problem in healthcare. Limited treatment options for infections caused by these organisms can lead to increased morbidity and mortality. Sweden has a low prevalence of antibiotic resistance compared to most other countries but this presents an increasing problem for society and healthcare even in Sweden. The overall aim of this thesis was to illuminate potential problems related to antibiotic resistance from different perspectives: assessing the prevalence of resistant bacteria methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) or other resistant bacteria, and associated wound types, patient and health staff experiences when confronted with resistant bacteria infection, and the occurrence of such infections in the nursing home environment. In the first study a total of 2172 patients admitted to hospital or as out-patient visit at a University hospital during one day were examined with the purpose to identify all wounds, wound types and wound characteristics, and to identify bacteria in all wounds, particularly MRSA, VRE and multi-resistant Gramnegative rods. Four hundred and eight (19%) patients had a total of 668 wounds. Of these, 248 wounds, from 216 patients were cultured. Two unknown MRSA-patients were identified. No patient with VRE was found and there was a low prevalence of other multi-resistant bacteria. In the second study fifteen patients with MRSA infected wounds were interviewed. The aim was to ascertain and describe patients’ knowledge, perceptions and experiences of being MRSA-positive. The interviews were analyzed according to qualitative content analysis. From the analysis three categories and one overall theme were identified. Results showed that information about the MRSA diagnosis often caused a shock-like reaction. The patients’ perception of being MRSA-positive was that it was stigmatizing like the plague or leprosy; they felt dirty and a severe threat to their environment. Fears of infecting someone else and being rejected were commonly expressed. Knowledge and empathy from staff involved in their care was crucial to optimise patients’ experiences. Staff’s needs of education to meet patients’ demands for information, and to prevent spread of antibiotic contamination was essential. In the third study eight nurses and seven assistant nurses from different hospital wards and nursing homes were interviewed regarding their experiences of caring for MRSA-positive patients. Qualitative content analysis was carried out when analysing the data and three themes were identified during the process. Stress and too high workload were factors which were described to cause concerns in the caring situation. A major concern was that nurses felt at risk of becoming infected themselves and then transmitting the infection to other patients and to family members. Knowledge and ignorance about MRSA affected the nurses’ caring; ignorance made them afraid and insecure while knowledge and understanding shaped confidence in their role as caregivers. In the fourth study 560 residents in a total of 67 wards, in nine nursing homes were investigated for prevalence of MRSA, VRE and extended-spectrum β-lactamase (ESBL) - producing Enterobacteriaceae and if carriage of resistant bacteria was related to antibiotic treatment, other risk factors and/or staff´s adherence to guidelines for infection control. In all 296 staff members were interviewed and observed. No resident was positive for MRSA or VRE. Fifteen residents were found to be ESBL-positive. Usage of antibiotics was higher in wards where ESBL-positive residents were detected and there was an indication that there was transmission of ESBL between residents. Staff´s adherence to infection control guidelines sometimes revealed shortcomings but no significant difference regarding adherence to the guidelines could be found. In conclusion: Prevalence of MRSA appears low in both hospitalized patients, out-patients and nursing home residents. Adherence to infection control guidelines among healthcare staff, however, needs further improvement. MRSA colonized patients experienced psychological pressure and stigmatization. Knowledge and empathy from staff involved in their care is crucial to optimise patients’ experiences. Staff education to meet patients' demands for information and the prevention of contamination is essential

  • 9.
    Andersson, Helene
    et al.
    Sophiahemmet Högskola.
    Kalin, Mats
    Fossum, Bjöörn
    Sophiahemmet Högskola.
    Lindholm, Christina
    Ortqvist, Ake
    Är MRSA-patienter olika smittsamma i olika län?2009Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 106, nr 7, 412-3 s.Artikel i tidskrift (Övrigt vetenskapligt)
  • 10.
    Andreassen, Sissel
    Sophiahemmet Högskola.
    Life Situation, Information Needs, and Information Seeking in Patients with Oesophageal Cancer and their Family Members2006Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    This thesis explores the experiences of living with oesophageal cancer from the perspective of patients and family members. Also, their needs for information and how they seek information in relation to the illness were investigated. The thesis comprises one qualitative meta-analysis and three empirical studies including data from patients, family members, and health-care professionals.

     

    Paper I was a qualitative meta-analysis the aim of which was to extend knowledge about patients' and family members' experiences of living with oesophageal cancer and clinically similar cancer forms, mainly head and neck cancer. As a result of the thematic analysis we have shown that both patients and family members 'run into an unpredictable enemy'. Patients had to 'endure a fading body' Running into an unpredictable enemy and enduring a fading body led to -entering social silence' for patients and family members.

    The aim of paper II was to describe patients' experiences of living with oesophageal cancer and how they seek information in relation to the illness. Data was collected by qualitative interviews with thirteen patients and analysed by qualitative content analysis. The findings describe patients' experiences of receiving the diagnosis, their experiences of vague symptoms, and of existential concerns evoked by the illness. Undergoing investigations and treatment caused extreme tiredness. Patients experienced that the illness intruded upon their daily life. In order to manage the life-threatening illness- they sought information about the illness.

    The aim of paper III was to describe family members' experiences of living with a patient suffering from oesophageal cancer, their information needs and information seeking Data was collected by means of qualitative interviews with nine family members and analysed by qualitative content analysis. The findings describe that family members lacked awareness of the disease. When faced with the diagnosis, shock, stress, and disbelief were evoked . The cancer illness became intrusive into their everyday lives, routines, and life plans. Uncertainty about the course and prognosis of the disease was the main source of distress among them. In order to learn, obtain understanding for the illness, and manage this uncertainty, family members entrusted themselves to the experts and sought information from them.

    Paper IV was a pilot study the aim of which was to describe patients' and family members' information needs following a diagnosis of oesophageal cancer, their satisfaction with information obtained, and health-care professionals' perceptions concerning patients' and family members' information needs. Data was collected by means of a study-specific questionnaire and analysed with descriptive statistics. The results indicate that patients' and family members need for information following a diagnosis of oesophageal cancer was substantial and had not been adequately met by health-care professionals.

    In conclusion, the receipt of the diagnosis of oesophageal cancer was an abrupt change from feeling healthy with vague symptoms to having a life-threatening illness. The illness disrupts patients' and family members' social world and relationships, and the whole family is affected. For understanding and managing the illness, they sought information from health-care professionals, social networks, and various media

  • 11.
    Asplin, Nina
    Sophiahemmet Högskola.
    Women's experiences and reactions when a fetal malformation is detected by ultrasound examination2013Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Background: Second trimester ultrasound examination among pregnant women in Sweden is almost universal. The detection of a fetal malformation on ultrasound puts health care providers and pregnant women in a difficult and precarious situation. What information and how it is communicated is crucial to women’s decision-making about continuing or terminating at pregnancy. The main aim of this thesis was to describe and analyze women’s experiences and reactions following the detection of a fetal malformation on an ultrasound scan. Methods: Two semi-structured in-depth interviews were performed, with women informed of a fetal malformation following an ultrasound scan. A total of 27 women took part in the first round of interviews: women continuing their pregnancy were interviewed, either in gestational week 30 or three weeks after the diagnosis; those terminating their pregnancy were interviewed two to four weeks after termination (Paper I). A second interview with 11 women who terminated their pregnancy was conducted six months after termination (Paper III). Two questionnaires were also administered. The first, answered by 99 women (Paper II) and comprising 22 study- specific questions along with emotional well-being and socio-demographics variables and medical and obstetric history, was conducted at the same time as the first stage of interviews. The other questionnaire, answered by 56 women incorporated common self- report instruments and was performed three times: first in gestational week 30, and then two respectively six months postpartum (Paper IV). Qualitative data were analyzed through content analysis, and quantitative data were analyzed through descriptive statistics. Results: The timing, duration, and manner of women’s initial counseling and ongoing support were shown to be important in the interaction between women and caregivers. Positive interactions improved the women’s ability to understand the information and fostered feelings of trust and safety, which in turn reduced their anxiety. Most of the women who expected a baby with an abnormality expressed their need for information on several occasions to help them make this difficult decision. They also wished for information from different specialists and continuity of care. These needs were even stronger in women who chose to terminate their pregnancy. We found women continuing their pregnancy to be at high risk of depressive symptoms, major worries, and high anxiety levels, both in mid-pregnancy, and at two months and one year postpartum. Despite these findings, the results of the maternal-fetal attachment scale for women who continued their pregnancy with a fetus diagnosed with a malformation indicated a high level of attachment. Conclusions and Clinical Implications: Effective communication, empathy and compassion, and consistent follow-up routines are important to ensure good treatment and care of this group of women. Taking these results into account may improve caregivers’ ability to counsel these vulnerable patients and to ensure that their needs are properly met.

  • 12.
    Axelsson, Lena
    Sophiahemmet Högskola.
    Living with haemodialysis close to death - patients' and close relatives' experiences2013Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    The overall aim of this thesis is to generate  understanding and knowledge a bout the experiences of  patients living with haemodialysis, and their close relati ves, near the end of life. In studies I and II we  conducted a series of 31 qualitative interviews over a period of 12 months with 8 severely ill patients  (aged 66–87) treated with haemodialysis. For study I the text of the interviews was analysed using  phenomenological hermeneutics to describe and to el ucidate the meanings of being severely ill living  with haemodialysis when nearing end of life. For study II the text was analysed using qualitative content  analysis to describe inner thoughts and feelings  relating to death and dying of these patients. For studies III and IV, we conducted 14 retrospective qualitative interviews with close relatives of  deceased patients treated with haemodialysis about th eir experiences during end of the patient’s life.  For paper III the interview text was analysed usi ng phenomenological hermeneu tics to describe and  elucidate the meanings of being a close relative at the  end of life of a severely ill family member treated  with maintenance haemodialysis. For paper IV the text was analysed using qualitative content analysis to  describe end of life for the patients from the perspective of their close relatives. The findings of study I suggest that being severely i ll and living with haemodialysis near the end of life  means living with suffering from a deteriorating body, a high symptom burden, and dependence on  advanced medical technology, simultaneously with r econciliation and well-being. The meanings of living  with illness and dialysis are intertwined with the meanings of being old.  Study II shows that thoughts and feelings about deat h and dying are significant and complex for those  living with haemodialysis as they approach the end of life. Patients experience  a multifaceted presence of  death. Their awareness of approaching death may include their repressing of thoughts of death, not as  denial, but to allow them to focus on living as fully as possible the time they have left. Study III shows that close relatives strive to maintain balance and well-being for themselves and for  the patient, which we interpreted as their striving to regain balance, and inner equilibrium in their  changed and challenged rhythm of life. Study IV shows that after gradual deterioration and increasing  care needs, older patients in haemodialysis care with  co-morbidities follow three different main paths at  the end of life: uncertain anticipation of death; awaiting death after dialysis withdrawal; and sudden but  not unexpected death. The ends of their lives are marked by complex symptoms and existential issues  related to haemodialysis treatment and withdrawal, and  their uncertainty of what  to expect at the end of  life suggests the need for increased continuity and coordination of whole person care. Both patients and  their close relatives are often alone with their existential thoughts. In their complex lifeworlds, intertwined meanings  of living with illness and maintenance of life with  haemodialysis treatment near the end of life show that patients live in a borderland of living-dying that is  shared by the close relative. Patients and close relatives focus on living when death is close but uncertain,  with severe illness and the maintenance of life through advanced technology.  Integrating the philosophy of palliative care (with a focus on symptom relief, team work,  communication, relationships, and support of family members) into dialysis care, may support health  care professionals in haemodialysis units and other re nal contexts, to improve the care of severely ill  patients, both earlier in their illness and as they approach the end of their lives.

  • 13.
    Axelsson, Lena
    et al.
    Sophiahemmet Högskola.
    Alvariza, Anette
    Lindberg, Jenny
    Öhlén, Joakim
    Håkanson, Cecilia
    Sophiahemmet Högskola.
    Reimertz, Helene
    Fürst, Carl Johan
    Årestedt, Kristofer
    Unmet palliative care needs among patients with end-stage kidney disease: A national registry study about the last week of life2017Konferensbidrag (Övrigt vetenskapligt)
  • 14.
    Axelsson, Lena
    et al.
    Sophiahemmet Högskola.
    Benzein, Eva
    Persson, Carina
    Complexities of the processes towards palliative care for patients with end-stage kidney disease: Physicians' and nurses' perspectives2017Konferensbidrag (Övrigt vetenskapligt)
  • 15.
    Bergkvist, Karin
    Sophiahemmet Högskola.
    Hospital care or home care after allogeneic hematopoietic stem cell transplantation - patients' experiences of care and daily life during the early phase2016Konferensbidrag (Övrigt vetenskapligt)
  • 16.
    Bergkvist, Karin
    Sophiahemmet Högskola.
    Life situation in patients and their family members after allogeneic hematopoietic stem cell transplantation: aspects of health and support in different care settings2015Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Allogeneic hematopoietic stem cell transplantation (HSCT) is mainly an intensive treatment option for hematology malignancies. During the past decades, improved care and treatment have been systematically developed. One example is the possibility for patients to choose to be at home rather than in the hospital during the early neutropenic phase after HSCT. Recent studies have shown positive medical advantages with home care. The overall aim of this thesis was to describe patients and family members’ life situation after HSCT, as well their experiences from two different care setting: the patient’s home or the hospital. Data from patient-reported experiences were used in studies I and II and patient reported- outcomes in study III. In study IV data from family members experiences were used. Data from 173 (study I n=41; study II n= 15; study III n= 117) patients and 14 family members (study IV) were included in the thesis.

    In study I patients in both the hospital care group and the home care group expressed high satisfaction with the care and support during the acute post- transplantation phase.

    In study II four categories were identified from the interviews with patients To be in a safe place, To have a supportive network, My way of taking control, and My uncertain way back to normal.

    In study III, a cross-sectional survey was conducted and the majority of patients in both hospital care (77%) and home care (78%) rated their general health as ‘good’. A median of 14 symptoms were reported by patients in both hospital (0- 36) and home care (1-29). There were no significant differences regarding general health, symptom occurrence or self-efficacy between patients in hospital and those in home care.

    In study IV interviews with family members generated a main category, Being me and being us in an uncertain time was identified and five generic categories To receive the information I need, To meet a caring organization, To be in different care settings, To be a family member, and To have a caring relationship.

    In summary, numerous factors (the care routines, information, the competence and support from the health care team) related to the care were shown to influence the feeling of being safe regardless of care setting. Both patients and family members express the uncertainty associated with the HSCT. Different strategies (to have faith, being positive, hope and live in the present) were used to balancing the uncertainty. The majority of patients in both hospital care and home care rated their general health as ‘good’. A high symptom occurrence was reported in both groups in median five years post HSCT.

  • 17.
    Bergkvist, Karin
    et al.
    Sophiahemmet Högskola.
    Fossum, Bjöörn
    Sophiahemmet Högskola.
    Johansson, Unn-Britt
    Sophiahemmet Högskola.
    Mattsson, Jonas
    Larsen, Joacim
    Patients' life situation during allogeneic hematopoietic stem cell transplantation - when care is given in different care settingsManuskript (preprint) (Övrigt vetenskapligt)
  • 18.
    Bergkvist, Karin
    et al.
    Sophiahemmet Högskola.
    Larsen, Joacim
    Johansson, Unn-Britt
    Sophiahemmet Högskola.
    Mattsson, Jonas
    Fossum, Bjöörn
    Sophiahemmet Högskola.
    Being me and being us in an uncertain time: Family members' experiences during allogeneic hematopoietic stem cell transplantation when care is given in the patient's home or in hospitalManuskript (preprint) (Övrigt vetenskapligt)
  • 19.
    Bergkvist, Karin
    et al.
    Sophiahemmet Högskola.
    Larsen, Joacim
    Johansson, Unn-Britt
    Sophiahemmet Högskola.
    Mattsson, Jonas
    Fossum, Bjöörn
    Sophiahemmet Högskola.
    Family members' experiences of different caring organizations during allogeneic hematopoietic stem cells transplantation - a qualitative study2016Konferensbidrag (Övrigt vetenskapligt)
  • 20.
    Björling, Gunilla
    Sophiahemmet Högskola.
    Long-Term Tracheostomy: Outcome, Cannula care, and Material Wear2007Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Do people with long-term tracheostomy need hospital care? Which cleaning method is most appropriate for decontamination of inner cannulae? Are tracheostomy tubes changed for rational reasons? There is clearly a lack of evidence based research in this field and the clinical guidelines available are often based on local practice. A tracheostomy is a created opening in trachea to facilitate breathing. It is a direct entry to the deeper airways, e.g. for micro-organisms causing a potential risk for lung infections. Indications for long-term tracheostomy can be, e.g. upper airway obstruction, malformations, or chronic hypoventilation, when ventilation via nasal mask is not possible. The research of the present thesis was conducted at the National Respiratory Centre (NRC) at Danderyd Hospital in Stockholm, Sweden. This unit opened in 1982, with the expressed goal of supporting outpatients with long-term tracheostomy. The overall aims of the thesis were to evaluate the outcome of patients with long-term tracheostomy and to conduct evidence based studies concerning their care.

    A comparison was made for the number of days in hospital care during the 2-year periods before and after the tracheostomy was established. The life expectancy of the general population and the observed life span of a cohort of tracheostomized patients from the start of NRC in 1982 were also compared. Interestingly enough, the need for hospital care was unchanged despite of the tracheostomy. The patients’ observed life spans were remarkably high and for many patients not lower than the life expectancy of Swedish people in general.

    To find a practical and safe decontamination method for inner cannulae we compared two different cleaning methods; detergent followed by chlorhexidine-alcohol, or detergent alone. Samples for bacterial culture were taken before and after cleaning and the numbers of bacteria colonies were counted. The effectiveness of both cleaning methods was greater than expected and the results showed a nearly total elimination of organisms. Thus, the methods investigated were equivalent in achieving decontamination.

    The duration of use in our unit for polymeric tracheostomy tubes, i.e. silicone (Si), polyvinyl chloride (PVC), and polyurethane (PU) was determined and compared. We found, that Si tubes were used for longer periods (three months) than tubes made of PU or PVC (both two months).

    Whether or not surface changes could be observed on the tracheostomy tubes after 30 days’, three and six months’ exposure in the trachea were investigated in collaboration with the Royal Institute of Technology and Sophiahemmet University College in Stockholm, Sweden. The analyzing methods were Scanning Electron Microscopy, Attenuated Total Reflectance Fourier Transform Infrared Spectroscopy, and Differential Scanning Calorimetry. All tubes, except one, showed changes in the surface after 30 days’ exposure. The surface changes had progressed significantly after three and six months' exposure, compared to the changes detected after 30 days. The SF-36 questionnaire and a study specific questionnaire were used to describe the patients’ health-related quality of life and experiences of long-term tracheostomy. The results show that all patients were satisfied with their tracheostomy and demonstrated a numerically mean mental health status score above that of the general population.

    In summary, long-term tracheostomy does not increase the need for hospital care nor does it reduce a patient’s life span. Cleaning the tracheostomy inner cannula with detergent and water is sufficient to achieve decontamination. Si tracheostomy tubes are used longer compared to those made of PVC or PU. The polymeric material investigated suffered evident surface changes after 30 days’ use. Clinical use of polymeric tracheostomy tubes beyond three months cannot be recommended, as we found extensive surface changes and degradation of the polymeric chains. All patients were, in general content, with their tracheostomy. The findings from the present thesis contribute to making the care of long-term tracheostomized patients’ evidence based.

  • 21. Bos, Elisabeth
    et al.
    Craftman, Åsa
    Sophiahemmet Högskola.
    Följsamhet till läkemedelsordinationerna2010Ingår i: Äldre, läkemedel och specifik omvårdnad / [ed] Margareta Grafström & J. Lars G. Nilsson, Lund: Studentlitteratur AB, 2010, 1, 93-101 s.Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 22. Boström, Anne-Marie
    et al.
    Lachmann, Hanna
    Sophiahemmet Högskola.
    Studenttät avdelning: personcentrerat förhållningssätt2016Konferensbidrag (Övrigt vetenskapligt)
  • 23. Broberger, Eva
    et al.
    Lundh Hagelin, Carina
    Sophiahemmet Högskola.
    Symtomskattningsinstrument minskar patientens besvär2011Ingår i: Onkologi i Sverige, ISSN 1653-1582, Vol. 7, nr 3, 42-46 s.Artikel i tidskrift (Övrigt vetenskapligt)
  • 24. Carlsson, Christina
    et al.
    Wennman-Larsen, Agneta
    Sophiahemmet Högskola.
    Ideellt engagemang och närståendes insatser2014Ingår i: Omvårdnadens grunder: ansvar och utveckling, Lund: Studentlitteratur AB, 2014, 2, 197-223 s.Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 25. Contro, Nancy
    et al.
    Kreicbergs, Ulrika
    Sophiahemmet Högskola.
    Reichard, Wilma J
    Sourkes, Barbara M
    Anticipatory grief and bereavement2011Ingår i: Textbook of interdisciplinary pediatric palliative care / [ed] Joanne Wolfe, Pamela S. Hinds, Barbara M. Sourkes, Philadelphia: Saunders Elsevier, 2011, 1, 41-54 s.Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 26.
    Craftman, Åsa
    Sophiahemmet Högskola.
    Delegering i hälso- och sjukvård2010Ingår i: Äldre, läkemedel och specifik omvårdnad / [ed] Margareta Grafström & J. Lars G. Nilsson, Lund: Studentlitteratur AB, 2010, 1, 165-169 s.Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 27. Dahlén, Sven-Eric
    et al.
    Kumlin, Maria
    Sophiahemmet Högskola.
    Monitoring mast cell activation by prostaglandin D2 in vivo2004Ingår i: Thorax, ISSN 0040-6376, E-ISSN 1468-3296, Vol. 59, nr 6, 453-5 s.Artikel i tidskrift (Övrigt vetenskapligt)
  • 28. Domeisen Benedetti, Franzisca
    et al.
    Raijmakers, Natasja JH
    Bragg, Colin
    Galushko, Maren
    Jorge, Margarita
    Lundh Hagelin, Carina
    Sophiahemmet Högskola.
    Popa Velea, Ovidiu
    Romotzky, Vanessa
    Schuler, Stefanie
    Mason, Stephen
    Lindqvist, Olav
    OPCARE9: how to develop junior researchers in palliative care projects2012Ingår i: European Journal of Palliative Care, ISSN 1352-2779, E-ISSN 1479-0793, Vol. 19, nr 3, 127-130 s.Artikel i tidskrift (Övrigt vetenskapligt)
  • 29. Eeg-Olofsson, Katarina
    et al.
    Svedbo Engström, Maria
    Borg, Sixten
    Palaszewski, Bo
    Lexell, Janeth
    Johansson, Unn-Britt
    Sophiahemmet Högskola.
    Gudbjörnsdottir, Soffia
    Glycaemic control and patient-reported outcome measures (PROMs) in type 1 diabetes2016Konferensbidrag (Övrigt vetenskapligt)
  • 30.
    Egberg, Louise
    Sophiahemmet Högskola.
    Life situation in people with peripheral arterial disease and their family members2011Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Life with peripheral arterial disease and the resulting impaired walking ability leads to major limitations in daily life and a decreased quality of life. The overall aim of this thesis was to generate understanding about the life situation among people living with peripheral arterial disease and their family members. The outcomes after percutaneous transluminal angioplasty interventions both proximal and distal to the inguinal ligament were assessed by collecting data by means of chart review using a study specific protocol. The results show a connection between proximal intervention and age as well as proximal intervention and smoking. Patients in the proximal group were younger and more frequent smokers or former smokers and hematomas/bruises as a complication were more common among non-diabetic patients (Paper I). Health related quality of life in patients with peripheral arterial disease undergoing percutaneous transluminal angioplasty intervention was investigated using a general questionnaire (EQ5D) as well as a disease-specific questionnaire (CLAU-S) translated into Swedish for this study. The health related quality of life was improved both one month and one year after the percutaneous transluminal angioplasty compared to before the intervention (Paper II). The experiences of living with intermittent claudication were studied through qualitative interviews with individuals suffering from peripheral arterial disease. The interviews were analyzed by thematic content analysis and six themes together founded a main theme concerning adjusting to a restricted life when living with intermittent claudication (Paper III). Spouses and cohabitants were interviewed about their experiences of living together with a person suffering from intermittent claudication. The overall theme was about living a demanding life when living together with someone with intermittent claudication. The findings of this study give insight into the complexities and the difficulties of ageing and living together with someone suffering from intermittent claudication (Paper IV). In conclusion, living with intermittent claudication has a major impact on daily life and demands adjustment to a restricted life. Percutaneous transluminal angioplasty improves health related quality of life among individuals suffering from peripheral arterial disease and the effect is sustainable over time up to one year after the intervention. People who had undergone percutaneous transluminal angioplasty were younger in the proximal group and hematomas/bruises were more common among nondiabetic patients. Ageing and intermittent claudication have great impact on both the spouse’s and the ill person’s life situation

  • 31. Ek, Anna-Christina
    et al.
    Lindholm, Christina
    Sophiahemmet Högskola.
    Trycksår. Reviderad 20132013Ingår i: Vårdhandboken / [ed] Annika Ahrnstedt & Monica Andersson, Stockholm: Stockholms läns landsting , 2013Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 32.
    Eulau, Louise
    Sophiahemmet Högskola.
    Estetikens nycklar till våra inre rum2014Ingår i: Vårdmiljöns betydelse / [ed] Helle Wijk, Lund: Studentlitteratur, 2014, 1, 347-363 s.Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 33.
    Eulau, Louise
    et al.
    Sophiahemmet Högskola.
    Paulander, Ann-Sophie
    Lindholm, Christina
    Sophiahemmet Högskola.
    PC-Music: a cross disciplinary model combining nursing and music therapy as pain management2016Konferensbidrag (Övrigt vetenskapligt)
    Abstract [en]

    While nursing and music therapy have been two important disciplines in analysis of pain management, there has been little research exploring these areas from a cross disciplinary perspective. This paper highlights the importance of acknowledging and beginning to understand the role of scientific and practical cooperation between music therapists and health care professionals.

    In particular, our aim has been to initiate a dialogue about how subject-specific knowledge from both music therapy and nursing – in terms of person-centered care – can strengthen the usage of music as pain management for short-term management of acute pain during painful treatments such as dressing change procedure in wound care. On this basis, a pilot study was conducted regarding wound care. The study has been approved by the ethics committee in Stockholm. The paper is based on the result from this study where the aim was to find a model for pain management as a complementary treatment based on knowledge from nursing and music therapy.

    Philosophical starting points were the “life-world” perspective of Merleau-Ponty as well as Ricoeur’s ethical thoughts. The result has a potential reach beyond wound care that can be used in several treatments that entails acute pain.

  • 34.
    Fossum, Bjöörn
    Sophiahemmet Högskola.
    Kommunikation: samtal och bemötande i vården2013Samlingsverk (redaktörskap) (Övrigt vetenskapligt)
  • 35.
    Fossum, Bjöörn
    Sophiahemmet Högskola.
    Kommunikation: samtal och bemötande i vården2007Samlingsverk (redaktörskap) (Övrigt vetenskapligt)
  • 36.
    Franklin Larsson, Lise-Lotte
    Sophiahemmet Högskola.
    Identitetsvärdighet2013Ingår i: Palliativ vård: begrepp & perspektiv i teori och praktik / [ed] Birgitta Andershed, Britt-Marie Ternestedt, Cecilia Håkanson, Lund: Studentlitteratur, 2013, 1, 185-191 s.Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 37. Freyschuss, Bo
    et al.
    Johansson, Unn-Britt
    Sophiahemmet Högskola.
    Leksell, Janeth
    Steen Carlsson, Katarina
    Thorsén, Håkan
    Werkö, Sophie
    Wikblad, Karin
    Hammarlund, Cecilia
    Johansson, Ida
    Patientutbildning vid diabetes: en systematisk litteraturöversikt2009Rapport (Övrigt vetenskapligt)
  • 38. Gaber, Flora
    et al.
    James, Anna
    Delin, Ingrid
    Wetterholm, Anders
    Sampson, Anthony P
    Dahlén, Barbro
    Dahlén, Sven-Erik
    Kumlin, Maria
    Sophiahemmet Högskola.
    Assessment of in vivo 5-lipoxygenase activity by analysis of leukotriene B4 in saliva: effects of treatment with zileuton2007Ingår i: Journal of Allergy and Clinical Immunology, ISSN 0091-6749, E-ISSN 1097-6825, Vol. 119, nr 5, 1267-8 s.Artikel i tidskrift (Övrigt vetenskapligt)
  • 39.
    Gellerstedt, Linda
    Sophiahemmet Högskola.
    A wake up call: Patients sleep is trapped in a borderland of nurses ambiitions, common sense and a sleepy organization2016Konferensbidrag (Övrigt vetenskapligt)
  • 40.
    Gellerstedt, Linda
    et al.
    Sophiahemmet Högskola.
    Medin, Jörgen
    Sophiahemmet Högskola.
    Kumlin, Maria
    Sophiahemmet Högskola.
    Rydell Karlsson, Monica
    Sophiahemmet Högskola.
    Patients' experiences of sleep in hospital: a qualitative interview study2014Konferensbidrag (Övrigt vetenskapligt)
  • 41.
    Georgsson, Susanne
    Sophiahemmet Högskola.
    Fosterundersökningar: En självklarhet? En möjlighet? En rättighet?2017Konferensbidrag (Övrigt vetenskapligt)
  • 42.
    Georgsson, Susanne
    Sophiahemmet Högskola.
    Information och psykologiska aspekter kring fosterdiagnostik2016Ingår i: Reproduktiv hälsa: barnmorskans kompetensområde / [ed] Helena Lindgren, Kyllike Christensson & Anna-Karin Dykes, Lund: Studentlitteratur AB, 2016, 1, 289-298 s.Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 43.
    Georgsson, Susanne
    Sophiahemmet Högskola.
    Är det "mission impossible"?: information om fosterdiagnostik2016Konferensbidrag (Övrigt vetenskapligt)
  • 44.
    Georgsson, Susanne
    et al.
    Sophiahemmet Högskola.
    Stenström Bohlin, Katja
    Den gravida patienten2016Ingår i: Omvårdnad & kirurgi / [ed] Christine Kumlien & Jenny Rystedt, Lund: Studentlitteratur AB, 2016, 1, 507-520 s.Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 45.
    Georgsson, Susanne
    et al.
    Sophiahemmet Högskola.
    Stenström Bohlin, Katja
    Gynekologi2016Ingår i: Omvårdnad & kirurgi / [ed] Christine Kumlien & Jenny Rystedt, Lund: Studentlitteratur AB, 2016, 1, 477-491 s.Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 46.
    Georgsson Öhman, Susanne
    Sophiahemmet Högskola.
    Fosterdiagnostik2009 (uppl. 1)Bok (Övrigt vetenskapligt)
  • 47.
    Georgsson Öhman, Susanne
    Sophiahemmet Högskola.
    Women's Experiences of Fetal Screening for Down's Syndrome by Means of an Early Ultrasound Examination2005Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    The general aim of this thesis was to explore women's reactions to and experiences of fetal screening for Down's syndrome PS) by means of an ultrasound examination, including measurement of fetal nuchal translucency (NT). The effect of this screening on maternal worry about the baby's health was investigated, as well as reactions to a false positive test and interpretation of information about riskAlso, an instrument measuring worry during pregnancy, the Cambridge Worry Scale, was translated into Swedish and tested on a sample of pregnant women.A sub-sample of 2026 women was drawn from a larger randomised controlled trial including 39,572 women, which investigated medical outcomes of the new fetal screening policy. Of these women, 1030 were randomly allocated to the intervention group, and 996 to routine care. No statistically significant differences were found between the two groups regarding major worry about something being wrong with the baby, general anxiety and depressive symptoms m midpregnancy and two months postpartum.Twenty-four women who had received information about an increased risk according to NT were interviewed during pregnancy and after birth. Twenty of these women had false positive tests, and for 16 the risk was higher than expected considering their age. These women expressed major worry, and many said they chose to reject their pregnancy, to take "time out", while waiting for the results of fetal karyotyping. Two months after the birth, most of these women seemed to have overcome the stressful situation.In the intervention group of the above trial 796 women had a risk score for DS recorded in a clinical database. Of these women 620 said they had received information about the risk score, and 64 percent stated the figure almost correctly. The actual risk was associated with women's perception of the risk. Worry about the baby's health and depressive symptoms did not differ statistically between women who were at high risk (1:250 or higher) and at low risk. However, women who perceived that the risk was high were more worried about the baby's health and also seemed to have more depressive symptoms in mid-pregnancy compared with those who perceived the risk to be low. No differences were observed at two months after birth.The translated version of the Cambridge Worry Scale was tested on 200 Swedish pregnant women in Stockholm. The three main sources of worry were about the baby's health, giving birth and miscarriage. The internal- consistency reliability was 0.81 (Cronbach's alpha). Three items were added to the original scale to capture women's worry about the maternity services.In conclusion, the intervention with an early ultrasound examination including risk assessment for DS by measuring the NT did not affect maternal worry about the baby's health, general anxiety or depressive symptoms 'm mid-pregnancy or two months after birth. However, a false positive test could cause strong reactions of anxiety and rejection of the pregnancy for some weeks. Many had problems to recall and interpret a given risk score. An actual high risk score was not associated with major worry about the baby's health or depressive symptoms, whereas a woman's perception of being at high risk had such an association. The Swedish version of the Cambridge Worry Scale was considered to be useful and well suited for its purpose.

  • 48.
    Georgsson Öhman, Susanne
    Sophiahemmet Högskola.
    Övriga fosterdiagnostiska undersökningar samt psykologiska aspekter2009Ingår i: Lärobok för barnmorskor / [ed] Annette Kaplan et al., Lund: Studentlitteratur , 2009, 3, 214-15 s.Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 49.
    Gransjön Craftman, Åsa
    Sophiahemmet Högskola.
    Medicine management in municipal home care: delegating, administrating and receiving2015Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    The general aim of this thesis was to investigate how delegation of medication is handled in municipal home care. Specific aims were to 1) explore the prevalence of medication use in older adults over time; 2) describe district nurses’ experiences of the delegation of medication management to municipal home care personnel; 3) explore and describe how home care assistants experience receiving the actual delegation of the responsibility of medication administration; and 4) to describe how older adults, living at home, perceive receiving assistance from home care assistants to manage their own medication. Study I: Changes were explored in medication use over a period of 20 years among three cohorts of older adults aged 78+ years and living in Stockholm, Sweden (1517 participated in 1987; 1581 in 2001; and 1206 in 2007). All were included, whether living at home or in an institution. Univariate analysis was carried out, as well as multivariate logistic regression models. The mean number of drugs increased for both genders in all age groups: from 2.8 in 1987 to 5.8 in 2007 for those aged 78+ years, the corresponding figures for 96+ years was 3.6 and 7.7. Overall (1987, 2001 and 2007), drugs for the cardiovascular system were most frequent (53.1%, 60.8% and 68.7% respectively). Prevalence of polypharmacy (concurrent use of five drugs or more) increased from 27.0% (1987) to 53.9% (2001), and 65.3% (2007). Adjusting for age, gender, education and cognition, the odds of using analgesics and psychotropics were significantly higher in 2007 compared to 1987; OR (95% CI) of 3.3 (2.8-4.0) and 1.3 (1.1-1.6) respectively. Cognitively intact elderly primarily used hypnotics, whereas cognitively impaired elderly used hypnotics, sedatives and antidepressants. People living at home used fewer drugs. For those living in institutions, polypharmacy increased from 24.4% in 1987 to 95.3% in 2007. Corresponding figures for those living in service buildings were 44.6% to 82.4%. Study II: District nurses’ (DNs) perceptions of the concept of delegating the administration of medication to unlicensed personnel (home care aides, HCAs) working in municipal social care were described. Twenty DNs were interviewed and the interviews were audio taped. Data were collected from April 2009 to August 2010 and analysed using content analysis. Findings revealed that the statutes of delegation were outdated and appeared to be incompatible with day to day practice. Communication between DNs and HCAs, as well as tutoring, was regarded as important. The DNs found it imperative to be available to the HCAs and made an effort to create a trusting atmosphere. Delegation of administration of medication to a person, who lacked knowledge of medication, for example when it is proper to mix pills or blend them in a thick liquid, was reported by the DN as being stressful. This was explained by various responsible authorities and the growing number of social service groups. Despite this, the DNs did not see any major problems with the fact that the HCAs work for a separate authority (the county council vs. the municipality). Study III: The purpose was to explore and describe how HCAs experience receiving the delegation of medicine management, and how they handle the responsibility that comes with the delegation. Four focus groups consisting of 19 HCAs were conducted. Data were analysed using qualitative content analysis. According to the HCAs, health and social care depends on delegation arrangements to function effectively, but mainly it relieves a burden for DNs. Even when the delegation had expired, administration of medication continued, placing the statutes of regulation in a subordinate position. There was low awareness among HCAs of the content of the statutes of delegation. Accepting delegation to administer medication was an inevitable and a routine fact, regarded as a mandatory task that had become an implicit prerequisite for social care work in the municipality. Study IV: Finally, we wanted to describe how older people, living at home, experience the use and assistance of administration of medicines in the context of social care. Ten older adults, aged 68 to 94 years, were interviewed in their own homes. Latent content analysis was used. There were divided feelings about being dependent on assistance in handling medication, since it interfered with their autonomy at a time of health transition. On the other hand, the assistance eases daily life with regard to practical matters and improves adherence to a medicine regimen. Participants were balancing empowerment and a dubious perception of the home care assistants’ knowledge of medicine and safety. The trust in the physicians’ and DNs’ knowledge about medication routines was seen as a guarantee with regard to medicines in general and the medicine regimen in particular. The perceived strained work situation for HCAs risks placing older people in an adverse position in relation to HCAs with their heavy workload and limited schedules. This may negatively influence the care relationship and patient safety. Conclusions: This thesis reports: 1) A dramatic increase in medication use in older adults from the late 1980s to the mid- 2000s in central Stockholm, Sweden; 2) DNs cannot manage their workload without delegating the administration of medication to unlicensed personnel (HCAs) in the present organisational model of health- and social care; 3) Accepting the delegation to administer medication was inevitable and had become routine to meet the needs of a growing number of older home care recipients; and 4) Assistance with handling medication eases daily life and medicine regimen adherence. Dependence on assistance may affect older adults’ sense of autonomy. Perceived safety varied relating to HCAs’ knowledge of medicine. We believe our results may contribute to a better understanding of how health and social care, two fields spanning sociology and nursing, perceive and adjust to the given frames; in the first place by indicating how delegated administration of medication to older people living at home is perceived by the care recipients, DNs, and HCAs and also by illustrating how the possibility of delegating medical chores can give temporary tasks a manifest transition from licensed to unlicensed personnel.

  • 50.
    Grundberg, Åke
    Sophiahemmet Högskola. Karolinska Institutet.
    Mental health promotion among community-dwelling seniors with multimorbidity: perspectives of seniors, district nurses and home care assistants2015Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    The prevalence of mental illness is increasing among the older population in Sweden. One of the most vulnerable groups for mental health problems is older persons with multimorbidity, i.e. seniors with multiple chronic conditions. Many of them remain in their own homes with a comprehensive and complex need of support and healthcare, mainly provided by home care assistants (HCAs) and district nurses (DNs). However, the detection of mental health problems for adequate treatment or to promote mental health among community-dwelling seniors with multimorbidity, calls for skills and competences in this area.This thesis aimed to gain a deeper understanding of how mental health may be promoted among community-dwelling seniors with multiple chronic conditions. Four studies have been included in this thesis (I-IV). All studies had a qualitative descriptive design with either a phenomenographic approach or latent and manifest qualitative content analysis technique. The aim of study I was to describe the variations in how community-dwelling seniors with multimorbidity perceived the concept of mental health and what may influence it. The findings showed the participants conceptualised mental health as having both positive and negative facets. The participants further conceived that social contact, physical activity and optimism may improve mental health, while social isolation, ageing, and chronic pain may worsen it. Study II aimed to describe the experience of health-promoting dialogues from the perspective of community-dwelling seniors with multimorbidity, and what these seniors believed to be important for achieving a dialogue that may promote their mental health. The main finding was the necessity of being seen as a unique individual by an accessible and competent person. Further, the participants missed having friends and relatives to talk to and they especially lacked healthcare or social service providers for health-promoting dialogues that may promote mental health. The aim of study III was to describe DNs’ perspectives on detecting mental health problems and promoting mental health among community-dwelling seniors with multimorbidity. Findings revealed that the DNs’ focus was on assessment, collaboration and social support as a way of detecting mental health problems and promoting mental health. Study IV described HCAs’ perspectives on detecting mental health problems and promoting mental health among the seniors in focus. The findings revealed that continuity of care and the seniors’ own thoughts and perceptions were regarded as essential for the detection of mental health problems. Further, observation, collaboration, and social support emerged as important means of detecting mental health problems and promoting mental health.Conclusions: The results of this thesis are based on interviews and show that: 1) Seniors with multimorbidity should have an opportunity to describe how multiple chronic conditions may affect their life situation; 2) An optimal level of care can be achieved through continuity, involvement, and by providing a health-promoting dialogue based on the person’s wishes and needs; 3) Even if DNs seemed engaged in primary mental healthcare, there were no expressed goals set in the improvement of mental health, and it seemed that these DNs could not bear the primary responsibility for early detection of mental health problems and early interventions to improve mental health; 4) HCAs had knowledge about risk factors for mental health problems and it appears that they were dependent on care managers’ decision-making in granted support, as well as supervision from DNs in the detection of mental health problems and to promote mental health.In summary, the finding in the present thesis demonstrates that managing mental health problems is still an ongoing challenge for those organisations providing continuity in home care and home healthcare for homebound elderly persons with complex chronic conditions. The finding in the thesis also shows that DNs and HCAs seem to be dependent on each other in this area. Mental health promotion was expressed as an important assignment among DNs and HCAs, even though they describe different prerequisites and factors which could be seen as barriers in the detection of common mental health problems such as depression, anxiety and sleep problems. These personnel further described difficulties in collaboration and transmission of information between care- and healthcare providers from the community and primary care context. Social and physical interventions - as well as social contacts and social support to break social isolation - seemed important according to all the informants, with their different perspectives of how mental health may be promoted.

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