shh.sePublikationer
Ändra sökning
Avgränsa sökresultatet
1 - 27 av 27
RefereraExporteraLänk till träfflistan
Permanent länk
Referera
Referensformat
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Annat format
Fler format
Språk
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Annat språk
Fler språk
Utmatningsformat
  • html
  • text
  • asciidoc
  • rtf
Träffar per sida
  • 5
  • 10
  • 20
  • 50
  • 100
  • 250
Sortering
  • Standard (Relevans)
  • Författare A-Ö
  • Författare Ö-A
  • Titel A-Ö
  • Titel Ö-A
  • Publikationstyp A-Ö
  • Publikationstyp Ö-A
  • Äldst först
  • Nyast först
  • Skapad (Äldst först)
  • Skapad (Nyast först)
  • Senast uppdaterad (Äldst först)
  • Senast uppdaterad (Nyast först)
  • Standard (Relevans)
  • Författare A-Ö
  • Författare Ö-A
  • Titel A-Ö
  • Titel Ö-A
  • Publikationstyp A-Ö
  • Publikationstyp Ö-A
  • Äldst först
  • Nyast först
  • Skapad (Äldst först)
  • Skapad (Nyast först)
  • Senast uppdaterad (Äldst först)
  • Senast uppdaterad (Nyast först)
Markera
Maxantalet träffar du kan exportera från sökgränssnittet är 250. Vid större uttag använd dig av utsökningar.
  • 1.
    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.

  • 2.
    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

  • 3.
    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

  • 4.
    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

  • 5.
    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.

  • 6.
    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.

  • 7.
    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.

  • 8.
    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.

  • 9.
    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

  • 10.
    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.

  • 11.
    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.

  • 12.
    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.

  • 13.
    Hansson, Anna
    Sophiahemmet Högskola.
    Subjective Well-being in an Adult Swedish Population: Findings from a Population-based Study2009Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    This doctoral thesis examines various factors associated with subjective well-being (SWB) in an adult Swedish population, aged 20-64 years, using cross-sectional and longitudinal data. The thesis includes four studies based on the PART study, a current population-based study on mental health, work, and relations in Stockholm County, Sweden. Research has shown that there is a relationship between mental health problems such as depression and low well-being. It is therefore of great interest to investigate various factors associated with SWB in order to promote or increase mental health. We also examined if the well-being scale used in all studies could be used as a screening instrument for depression.

    The specific aim of Study I was to examine if age, gender, foreign background (i.e. not born in Sweden), cohabitation, education, financial strain, social support, childhood conditions and negative life events and their associations with SWB could be replicated in our data. In Study II we investigated strategies people chose to employ in order to improve or maintain their well-being and whether these were associated with SWB. Study III examined if changes in cohabiting, social support or the financial situation influenced SWB, after controlling for neuroticism at a 3-year follow-up. The change in the study sample’s SWB was also studied during the same time period. In Study IV the aim was to investigate whether the well-being scale, the (WHO) Ten Well-being index, could be used as a screening instrument for depression.

    Results from Study I showed that men had higher SWB than women, and that positive childhood conditions, cohabiting, greater age, sound financial situation, absence of negative life events, and support from friends were all positively associated with SWB. Social support had the strongest relationship. Together, these factors explained 20 % of the variance in SWB and the findings replicated earlier research. The strategies reported in Study II were physical exercise, physical health,engaging in pleasurable activities, relaxation, plan/set limits, social support, professional contacts, positive thinking, and work. Of these, social support, relaxation, physical exercise and physical health were associated with higher SWB. Social support showed the strongest association. In Study III changes in financial situation, social support, or cohabiting influenced SWB after controlling for neuroticism. The results also suggested that SWB was relatively stable over a period of three years. Preliminary findings from Study IV indicate that the (WHO) Ten Well-being index can work as a screening instrument for depression in populationbased samples.

    In summary, the findings suggest that demographics and psychosocial factors explain only a small part of the variance in SWB, replicating previous data. Certain self-care strategies are positively associated with SWB. In addition, changes in life circumstances influence SWB, even after controlling for neuroticism over a period of three years despite the stability of SWB. Furthermore, the preliminary findings indicate that the well-being scale can work as a screening instrument for depression in a population-based sample. The overall conclusion from the results of this thesis suggests that it is important for the health care services to be aware that negative life events/circumstances may affect people’s SWB over several years. Furthermore, selfhelp interventions might be important in order to maintain or increase SWB.

  • 14.
    Hillerås, Pernilla
    Sophiahemmet Högskola.
    Well-being among the very old: a survey on a sample aged 90 years and above2000Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    This thesis examines well-being among the very old and the factors believed to influence the three components of well-being called life satisfaction, positive affect and negative affect. It also examines activity patterns, the factors related to activity and the consequences of different types of activity for well-being. The study is part of the Kungsholmen project which involved all inhabitants aged 75 years and over, living in a specific part of the inner city of Stockholm. This thesis covers 105 subjects who were 90 years and older, scoring 24 points or above on the Mini-Mental State Examination. Well-being was assessed with the Positive and Negative Affect Schedule, the Life Satisfaction Index-B and the Life Satisfaction Index-Z.

    Study I examined fife satisfaction among the very old and the factors believed to influence life satisfaction. Life satisfaction was slightly lower than in other studies, which involved samples of younger elderly. In addition, factors such as life events, activities, personality and social contacts were assessed in order to determine their relative influence on life satisfaction. The very elderly tended to have higher life satisfaction if they had an extraverted and emotionally stable personality, excellent subjective health, good social relationships, and if they did pleasurable activities. The factors associated with life satisfaction were also investigated qualitatively. With this approach we found out what the elderly themselves believe gives them life satisfaction, The quantitative and qualitative data came up with some factors in common (e.g., health, family contacts), but there were some differences as well.

    Study II examined Positive Affect and Negative Affect among the very old and the factors, which might influence these. Results showed that Positive Affect and Negative Affect were virtually uncorrelated. Comparing the results with studies of younger age groups, Positive Affect appears to decrease with age, while Negative Affect shows no clear age trend. The very elderly tended to have higher Positive Affect during the past year if they had excellent health, an extraverted personality, a definite religious or non religious belief, lived with another person, had good social relationships, read a lot, were well educated and followed radio/TV news. They seemed to have higher Negative Affect during the past year if they scored high on neuroticism, had many adverse life events, did not read, and did not participate in group activities.

    Study III examined activity patterns among the very old, the factors related to activity and the consequences for well-being. Activities over the previous day were rated for degree of intellectual, social and physical activity. This age group tended to have variable but relatively low activity levels over the day. Good health and not moving house were associated with greater intellectual activity. Extraversion and negative life events (such as death of close friend or family member) were associated with greater social activity, while younger age and better health were associated with greater physical activity. There was also a positive association between physical activity and well-being.

    Study IV examined whether there is an association between objective health, measured as clinical medical diagnoses, and well-being among the very old. Subjects were given a medical examination covering eye diseases, osteoarticular diseases, cancer, cerebrovascular diseases, bronchopulmonary diseases, heart diseases, and endocrine diseases. The data suggested there is no association of physical diagnoses with well-being, despite the fact that a self-rated health measure was found to be associated with life-satisfaction.

    Study V focused on the subjective experience of extreme old age for people scoring high and low respectively on well-being measures. The purpose was to illustrate and expand upon the quantitatively derived findings from previous studies using a qualitative approach inspired by Grounded Theory. The results suggested that 'outlook on life', 'social and emotional ties', engagement with the outside world' and 'physical capability' are important contributors to subjectively experienced well-being in this age group.

    In these studies, personality emerged as the major determinant of well-being. In addition, the results showed that this age group has a low activity level which is affected by factors such as health, personality and life events.

  • 15.
    Klarare, Anna
    Sophiahemmet Högskola.
    Specialized palliative home care teams: Complementary perspectives of team functions and influences on patients and families2016Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Persons with life-threatening illness are increasingly being cared for and dying at home. Palliative care strives to cater to multiple dimensions such as physical, psychosocial and spiritual or existential, and meeting these needs in patients and families requires multiple competencies. Palliative care organizations propose organization and delivery of care in teamwork models; however, teamwork is complex and can be approached from various perspectives. Previous research has identified gaps in palliative care regarding which components of teamwork are most effective. The overall aim of this thesis was to explore perspectives of team function in specialized palliative care teams, among health care professionals, families and patients. Study I entailed translation and cultural adaptation of a research questionnaire. Study II entailed qualitative interviews with health care professionals (n=15) working in specialized palliative home care and Study III interviews with patients (n=6) and family members (n=7). In Study IV, an exploratory design was used. Initially team leaders (n=77) in palliative care reported team function. Next, health care professionals (n=61) reported team development in the group development questionnaire, patients (n=43) reported symptoms in the Edmonton Symptom Assessment System and family members (n=45) reported satisfaction with care in the translated and culturally adapted FAMCARE-2 questionnaire. Results of the studies are: (I) a translated culturally adapted and initially tested Swedish language version of the FAMCARE-2 scale, (II) health care professionals report that competence, communication and organization are crucial components of teamwork in specialized palliative homecare, (III) patients and families report that they experience security and continuity of care due to 24/7 care, sensitivity to changing needs and demonstrating caring, and (IV) specialized palliative home care teams have a core of registered nurses, physicians and social workers. Positive associations were found between team maturity and team effectiveness.

  • 16.
    Lachmann, Hanna
    Sophiahemmet Högskola. Karolinska Institutet.
    Contextual activity sampling: a method to develop clinical interprofessional education2013Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Higher health care education in interprofessional settings is evaluated and developed continuously. The aim of clinical interprofessional education is to provide healthcare students opportunities to develop their professional roles, and understanding of other professions, as well as to develop their teamwork and communication skills. However, there is still a need to improve understanding of how students experience their learning. Most often, post-course questionnaires and interviews are used to investigate students’ experiences of their learning activities. When using such approaches the respondents generalize about their experiences in retrospect instead of reporting on learning as it occurs. The Contextual Activity Sampling System (CASS) is a methodology inspired by ideas from the Experience Sampling Method (ESM). CASS was designed to collect frequent data from the participants’ ongoing learning activities by using mobile phones, which was the main methodology used in this thesis.The overall aim of this thesis was to investigate the potential of contextual activity sampling as an approach for studying students’ experiences connected to learning activities during clinical interprofessional education.Eighty-one students from six interprofessional training ward courses conducted during 2009 agreed to participate. For each course, students from two teams of three were randomly assigned to be included in an intervention group (using CASS, n=54) and from one team in a control group (not using CASS, n=27). The students’ learning experiences in the intervention group were collected via CASS and, for both groups, via interviews after the conducted courses and also RIPLS questionnaires both before and after the conducted courses. Study I was a study aiming at investigating the usability of CASS as a methodology in a clinical interprofessional context. Study II focused on the students’ experiences of clinical learning and Study III on the students’ experiences of collaboration. Study IV investigated whether students using CASS experienced their learning activities in different ways compared to students not using CASS.In Study I it was shown that the translated and cross-culturally adapted Swedish version of CASS was usable in a clinical learning environment and that it helped students to structure their study days and reflect on their learning activities. Study II demonstrated that students reported optimal experiences (flow) when they were engaged in knowledge creation activities and collaborated with their fellow students. A significant correlation was identified between positive emotions and how important the activities were considered to be. Study III showed that CASS provided possibilities to identify the student teams’ need of support to attain the intended learning outcomes and highlighted the importance of structure, interaction and insight in clinical interprofessional collaboration. In Study IV differences between the intervention and control groups were noted. The students who had used CASS rated their experience of ‘teamwork and collaboration’ significantly higher after the course than before the course, which was not the case for the control group. On the other hand, students in the control group rated stress higher than those who had used CASS.In conclusion, this thesis showed that the CASS methodology is suitable for collecting contextual data in clinical settings and can help students to structure their days and reflect on their learning activities. When interprofessional collaboration was working well it was associated with knowledge creation and an increased feeling of ‘flow’. CASS is an innovative methodology, which can be useful for stimulating reflection on clinical learning activities and development of clinical interprofessional education.

  • 17.
    Löfvenmark, Caroline
    Sophiahemmet Högskola.
    Living with heart failure: effects of an educational programme on patients and family members2011Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Chronic heart failure (CHF) is a syndrome with various underlying causes and when an individual is diagnosed with CHF it affects daily life of both him/her and family members. An educational programme may have the capability to increase the knowledge and understanding of family members and improve their possibility to support the patient with CHF. In paper I the aim was to investigate perceived loneliness and social support in 149 patients with CHF and whether there was an association with gender, age, health care utilization and mortality. Loneliness was reported by 20% of the patients, who were younger and more often women. Those who perceived loneliness had fewer social contacts and emotional contacts and were less satisfied with close relationships and available social contacts. Despite not having more severe CHF, those feeling loneliness had more days in hospital and more readmissions during 12 months. In paper II and III 128 family members of patients with CHF were randomly assigned to an intervention group (IG) who received a multi-professional educational programme or to a control group (CG) receiving routine ward information. Family members filled in questionnaires three times during one year. Aim of paper II was to investigate if diseaserelated knowledge increased in family members through the educational programme and if there was an effect on healthcare utilization of the patient with CHF. Findings showed that disease-specific knowledge increased significantly in both groups from baseline and at second measurement and remained at third measurement. Family members in the IG had significantly higher knowledge at second and third measurement compared to family members in the CG. Frequency of readmission or number of days hospitalised during 18 months did not differ between the groups. In paper III the primary aim was to investigate if quality of life (QoL), anxiety and depression were affected in family members after attending an educational programme. The secondary aim was to investigate the impact of social support, family and patient related variables and sense of coherence on changes in QoL, anxiety and depression during the study period. Findings showed no significant differences in QoL, anxiety and depression between IG and CG due to the education. Adequacy of social network and baseline measurement of anxiety and depression predicted anxiety and depression at third measurement. Baseline measurement of QoL and family member‘s age were predictors for QoL at third measurement. Younger family members had higher QoL. In paper IV the aim was to describe family members’ experiences of attending an educational programme. Eleven family members were interviewed. Three main categories emerged: “making the disease comprehensible” deals with increased knowledge among family members and thereby attaining greater understanding of the person with CHF; “increasing involvement” comprises family members’ self-confidence and ability to become a resource for the ill person; “influencing family members’ wellness” deals with the positive experience of meeting others in the same situation and the importance of taking care of themselves. Several of the family members would have preferred to attend the education with the person with CHF. In conclusion Perceived loneliness in patients with CHF was most common among women and younger persons, and was associated with health care utilization, social network and support. The implemented educational programme for family members of patients with CHF seemed to have a subjectively experienced positive effect. The family members had increased knowledge, confidence and understanding of the disease, which made it easier for them to support the patient in their self-care management. The educational programme did not affect levels of QoL, anxiety and depression in family members nor health care utilization of the patients

  • 18.
    Lööf, Helena
    Sophiahemmet Högskola.
    Pain, fatigue and fear-avoidance beliefs in relation to physical activity and body awareness in persons diagnosed with rheumatoid arthritis2015Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Introduction: Pain and fatigue are highly common and a major concern for persons diagnosed with rheumatoid arthritis (RA). Having physical limitations, which have a significant effect on daily life, is also described as a major problem for persons with RA. Research findings show that a minority of persons with RA perform maintained health-enhancing physical activity (HEPA), and that psychosocial factors seem to be the most salient and consistent factors to explain variations in HEPA. Furthermore, fear of physical activity and exercise has been described as major barriers for persons with chronic pain. The ability to notice bodily inner sensations and stimuli (body awareness, BA) is described in the literature as having either a positive or a negative impact on a person’s health and well-being. However, the concept of BA is complex and therefore greater insight into this phenomenon is needed.

    Aim: The overall aim of this thesis was to investigate pain, fatigue and fear-avoidance beliefs in relation to physical activity and their correlates in persons with RA. A further overall aim was to develop a psychometric measurement of BA. A final overall aim was to deepen our understanding of BA in persons with RA.

    Methods: Study I was a psychometric evaluation of a Swedish version of the Body Awareness Questionnaire (BAQ) in a student population and in adults with RA. Studies II - III were a cross-sectional survey studies in adults with RA. Study IV was a phenomenological study using the empirical phenomenological psychological (EPP) method in adults with RA.

    Results: In study I, the value of Cronbach's alpha coefficients for the total score in the Swedish version of the BAQ was satisfactory. According to confirmatory factor analysis (CFA), neither a one-factor model nor a four-factor model tested in this study fulfilled the pre-specified criteria. In study II, pain was significantly associated with health-related quality of life (HRQoL) and disease activity. Fatigue was significantly associated with disease activity, BA and positive affect. The adjusted R2 was 28.6% for fatigue and 50.0% for pain. Study III showed that, for socio-demographic factors, being male and having a below average income were associated with an increased risk of high fear-avoidance beliefs about physical activity (mFABQ high). Moreover, the two disease-specific factors, which are most indicative of mFABQ high, were high level of pain and poor health. Concerning psychosocial factors, low HRQoL and low exercise self- efficacy were significantly associated with mFABQ high. The model fit was 0.27 (Nagelkerkés R2). In study IV, some general characteristics were found, which had to do with the disease giving rise to a higher degree of negatively toned BA. BA was a reactive process of searching or controlling for disease-related symptoms, or a reactive process that was triggered by emotions. In addition, BA was an active process in the sense of taking an inventory of abilities. All the participants had the ability to shift focus from BA to the outside world.

    Conclusions: This thesis showed that pain, fatigue and fear-avoidance beliefs about physical activity in persons with RA have several potential correlates, including socio-demographic, disease-specific and psychosocial factors for the variables investigated. The Swedish version of the BAQ is simple to administer and should be used as a tool to measure self-reported attentiveness to normal body processes. Cronbach’s alpha coefficient for the total score was satisfactory; nevertheless, since neither of the models fulfilled the pre-specified criteria further testing of the Swedish version of the BAQ is required. BA was found to be both positively and negatively toned in persons with RA, though RA resulted in a higher degree of negatively toned BA. Thus, the ability to shift attention, from BA to activities in the outside world, could sometimes be beneficial for the person’s general health and well-being. Having the opportunity to participate in meaningful and purposeful daily real-world activities keeps the mind busy (and distracted) and can decrease the negative BA.

  • 19.
    Niklasson, Boel
    Sophiahemmet Högskola.
    Pain relief following cesarean section: short and long term perspectives2015Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Background

    Postoperative pain treatment in women undergoing cesarean section (CS) needs to be effective to enable fast and smooth recovery without adverse outcomes and to improve breastfeeding and bonding between mother and child. It is also important that pain treatment should have minimal impact on the newborn.

    The overall aim

    The overall aim of this thesis was to investigate how to improve pain management in women undergoing cesarean section.

    Specific aims were:

    * To investigate if a single injection of bupivacaine with adrenaline close to the fascia could decrease opiate consumption and pain in patients undergoing CS in spinal anesthesia and whether the same treatment influences the need for opiates in women operated in general anesthesia (paper 1 and 3).

    * To study the overall incidence and risk factors for persistent pain after CS and to characterize the persistent pain, regarding intensity, body location and impact on daily life (paper 2).

    * To clarify whether oral oxycodone (OXY) can provide equal/better and safe postoperative pain relief after CS compared to intravenous morphine followed by oral codeine (IVM) (paper 4).

    * To study pharmacokinetic aspects of postoperative OXY treatment of mothers after CS and to investigate possible drug exposure through breast milk, including the effects on the newborn (paper 5).

    Methods and results:

    Study I: Two hundred and sixty women undergoing CS were randomized to receive injection ofeither 40 ml bupivacaine (2.5 mg/ml) with adrenaline (5 μg/ml) (n=130) or 40 ml saline solution (0.9%) (n=130), close to the fascia before closure of the wound. Morphine consumption, pain assessment by Numerical Rating Scale (NRS) and time to mobilization were recorded. Morphine requirements were significantly less for up to 12 h postoperatively and mean and maximum pain intensity lower during the first 6 h in the group receiving local anesthesia (p ≤0.05).

    Study II: A prospective follow up study of the women participating in study I. A questionnaire consisting of the Brief Pain Inventory (BPI) was posted to all women at 3, 6 and 12 months after surgery. Women rated pain intensity as well as interference with factors related to general function and quality of life. Women reported pain in one or more locations, in the CS surgical site as well as in other parts of the body. At 3 months 40% had pain and at 6 and 12 months 27% and 21%, still had pain. CS on maternal request i.e. psychological indication as well as a first CS were significant (p ≤0.05) risk factors for persistent pain at 3 months. Severe postoperative pain in the immediate postoperative period (0-48 h) or undergoing a first CS were significant independent risk factors for the development of persistent pain up to 6 months after CS. Parameters related to quality of life such as sleeping difficulties were significantly impaired in women with persistent pain.

    Study III: A retrospective study (2008-2014) was conducted at the Karolinska University Hospital, Huddinge where medical records of women who underwent CS in general anesthesia were reviewed. After applying exclusion criteria 250 medical records remained. Information 3 about women receiving local anesthesia in the surgical wound, 20 or 40 ml bupivacaine/adrenaline (36 and 42 women in each group), were collected and data from women receiving no local treatment were identified and served as controls (n=172). A significantly lower morphine consumption during the 6 first postoperative hours was seen in patients receiving 40 ml local anesthetics when compared with controls (p ≤0.05) but no difference was seen for the 20 ml group or between treatment groups.

    Study IV: Eighty women scheduled for elective CS were recruited and randomized to receive extended release tablets and short acting OXY (n=40) or IVM (n=40). All patients received a multimodal therapy with ibuprofen and paracetamol and the opiates were administered as needed. Outcome measures were safety parameters for mother and child, opioid requirements, pain intensity by NRS, time to mobilization and time consumption to administer drugs. To evaluate safety for the newborns Apgar scores, acid base status in the umbilical cord, weight development and the Neurological Adaptive Capacity Score were used. A significantly lower postoperative pain intensity measured by NRS was observed 0-6 hours and 25-48 hours in the OXY group (p ≤0.05). Opioid consumption was significantly less in the OXY than in the IVM group 0-5 days postoperatively. Total time to administer analgesics was significantly shorter in the OXY group. There was a significant difference in common opiate related adverse effects between the two groups (3 women in the OXY group compared to 15 in the IVM/codeine group). No negative effects in the newborns related to opioid treatment were observed in either of the two groups.

    Study V: The material was obtained in study IV. Maternal blood and breastmilk were sampled at 24 and 48 hours and neonatal blood was collected at 48 hours postpartum. All samples were analyzed for OXY and the metabolites noroxycodone, oxymorphone and noroxymorphone. Detectable plasma levels of OXY and its metabolites were found in all women and even if there were small quantities of breastmilk detectable levels were found also here. In most cases there were low or non-detectable levels of OXY in the plasma of the neonates.

    Conclusions: A single injection of bupivacaine with adrenaline in the surgical wound decreases the need for rescue morphine postoperatively and was demonstrated to be a safe and effective pain management in women undergoing CS both in spinal and general anesthesia. Standardized postoperative treatment with oral OXY after CS was shown to be time effective and to give a better pain control, with lower opioid intake than a protocol using IVM/codeine, both as components of a multimodal analgesic regime. Our clinical data and the pharmacokinetic analyses support the view that OXY treatment is safe for mothers and neonates. As severe postoperative pain is a risk factor for long term pain the initial pain relief is crucial and we found that experiences related to quality of life were significantly impaired in women with persistent pain. We suggest that our findings can be of clinical importance, not least in women who have their CS performed in general anesthesia.

  • 20.
    Randers, Ingrid
    Sophiahemmet Högskola.
    Upholding Older Adults' Innate and Inherent Dignity within a Caring Context2002Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    In the ethical ideals of autonomy and integrity reducing the level of abstraction is necessary in order to more easily be able to follow them in every day care practices. This is especially true concerning the effort of upholding older adult patients dignity. Creative intervention programs may help to increase health care professionals ethical competence. In the first study (I) 12 older adults experiences of care are described, with special reference to their integrity. In addition, four student nurses were interviewed and participant observations were performed in order to describe the health care professionals integrity- promoting or non-promoting behaviours. The findings confirmed, in relation to a theoretical model, which determined ten categories of integrity related to the self-concept the complexity of the concept, but they also indicated that in relation to older patients a further category should be included namely one relating to their social self Therefore, the purpose of the second study (II) was to deepen the understanding of the identified eleventh category, social self, and how it may effect the ethical care in older adult patients. Two themes were identified: Social exchange, which was described as the older adult informants wish to be respected for their needs of meaningful social and human contacts, but also for their needs of meaningful social activities. Social experiences included the older informants wish to be respected for their needs of talking about themselves, recalling and sharing memories, moreover, to be respected for their needs of being a part of the world outside the hospital. Thus, the findings indicate the relevance of the new identified category. In the third study (III) the aim was to achieve a deeper understanding of an older cognitively intact mans lived experiences of being a patient in a geriatric context, where the majority of the patients were cognitively impaired. An earlier qualitative interview from study I was used and analysed from a phenomenological approach that illustrated health care professionals lack of meeting and confirming individual patients needs to be met as unique individuals with personal preferences, own resources and the ability to take charge over their own life. The health care professionals care actions tended to depend upon the needs of the cognitively impaired. In the fourth study (IV) the aim was to teach ethics from an activating instructional approach and then to evaluate whether or not this was a practicable strategy to influence individual health care members attitudes as well as their ethical caring behaviour with a special focus on the patients autonomy and integrity. A 6 and 12 months follow up was performed including group-interviews and participant observations. The findings indicate that the attitudes of individual participants had actually changed into a more patient-centred perspective and that their caring behaviour agreed to their attitudes. Based on real- life care situations taken from the fields of geriatrics, where the majority of the patients were cognitively impaired the aim of the fifth study (V) was to examine the relationship between autonomy and integrity resulting from the interactions between the individual health care member and the patients. These findings indicate that the relationship was ethically complex and that they were inseparable for maintaining a patients dignity. Consequently, this meant that if the health care professionals respected the older adult patients autonomy their integrity was protected and thereby, their innate and inherent dignity.

  • 21.
    Rydell-Karlsson, Monica
    Sophiahemmet Högskola.
    Knowledge Acquisition in Patients with Heart Disease2007Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    The general aim was to evaluate different aspects of the knowledge acquisition process in patients with heart disease. Three different education programs were evaluated.

    In Paper I 208 patients with systolic heart failure (HF) aged >60 years, were included. They were randomized to the nurse-based outpatient clinic or to the patients´ general practitioners (GP). The aim was to assess effects of a nurse-based management program – intended to increase the knowledge of the HF disease and its self-care – and relate the results to gender and cognitive function. The results showed that the nurse-based outpatient clinic has an important role in patient education, and increases patients´ knowledge about self-care and the disease. The results indicate that females have more to gain than men from such management programs. Patients demonstrating signs of cognitive dysfunction when in hospital did also benefit.

    In Paper II 224 patients, aged <75 years suffering from an acute AMI or who had underwent coronary artery by-pass grafting, were randomized to intervention (an expanded cardiac rehabilitation program) or to control (usual care). The aim was to investigate the effect of an expanded cardiac rehabilitation program on psychosocial characteristics including depression, anxiety, and quality of life (QoL) in type D and non-type D coronary artery disease (CAD) patients. The results show that an expanded rehabilitation program significantly reduces type D score, improves QoL, and decreases self-estimated depression and anxiety in CAD patients in the highest quartile of type D score.

    In Paper III and IV 182 patients with chronic heart failure (CHF) were included and referred to the nurse-based outpatient clinic. They were randomized to intervention (patients decided on how they should be informed and by which information technique) or to control (the nurse decided according to usual routine).

    The aim in Paper III was to compare patient-based selection of information with nurse-based selection of information in patients with HF and to evaluate the effects on knowledge acquisition, QoL, visits to the outpatient clinic, drug therapy and readmissions. Patients had fewer visits to the nurse-based outpatient clinic and a trend to a more flexible diuretic regimen, if patients were involved in the decision on how to be informed. Both groups increased QoL, knowledge their doses of relevant medication, and readmissions did not differ between the two groups.

    The aim in Paper IV was to compare patient-based and nurse-based New York Heart Association (NYHA) classification and its relation to grade of depression and knowledge acquisition in patients with HF. The results show a mismatch between the NYHA classifications performed by patients respectively by the nurse. Furthermore, patients in a depressed mood at baseline had more clinical events during the first year after hospitalization due to CHF. However, there was no difference in knowledge acquisition between patients in a depressed mood as compared to patients in a normal mood.

    The conclusion is that information given at a nurse-based outpatient clinic has an important role in patient education. Females and patients with in-hospital cognitive dysfunction had the greatest gains Patients who are involved in the decision on how to be informed had fewer visits to the nurse-based outpatient clinic. The fewer visits did not affect knowledge, QoL, readmissions, or medical treatment in a negative way. Patients assessed a higher NYHA class than a nurse. Patients who were depressed had an increased incidence of clinical events during the first year after hospitalisation due to HF. There was no difference in knowledge acquisition between patients in a depressed mood as compared to patients in a normal mood. An expanded rehabilitation program significantly reduces type D score, improves quality of life, and decreases self-estimated depression and anxiety in patients with CAD in the upper quartile of type D score.

  • 22.
    Samuelsson, Bodil
    Sophiahemmet Högskola.
    Gender differences in patients with hip fracture: aspects on care and recovery2011Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Hip fractures in the elderly are common and impose a substantial burden on the healthcare system. This fracture population consists of many subgroups that often require differentiated and extensive acute and postfracture care. The aim of this thesis was to basically characterise a hip fracture population at time of admission, present postoperative results and discuss aspects that may influence recovery. Gender differences are specifically addressed.  Study I, II and IV derive from a consecutive series of 2213 patients with hip fracture admitted to four major hospitals in Stockholm, while Study III was a small pilot study.      In Study I we investigated the effect of time-to-surgery on: ability to return to own home, incidence of pressure ulcers, length of stay (LOS), and mortality. Patients who had surgery within 24, 36 or 48 hours were compared with those who had surgery later. The ability to return to own home was affected in patients who had to wait longer than 36 and 48 hours. The incidence of pressure ulcers and LOS increased at all time limits. In Study II we investigated gender differences in two subgroups, characterized by normal cognitive function versus cognitive dysfunction, and whether such differences influenced patient ability to: return to own home, regain walking ability and perform activities of daily living (ADL). Cognitive function was assessed by the Short Portable Mental Status Questionnaire (SPMSQ). Dysfunction was equally common by gender. Patients with normal function (SPMSQ 8-10) were younger and healthier, resided more often in their own homes and were able to manage ADL independently, with no gender differences. In patients with dysfunction (SPMSQ 0-7), men had more comorbidity on admission, greater loss of walking ability and higher mortality after the fracture episode. We found that cognitive status was the overarching most important factor for predicting outcome. In Study III we examined gastric emptying time of 400 ml carbohydrate rich drink in ten elderly women with acute hip fracture, and compared results with two reference groups of healthy women. The mean half gastric emptying time in the study group was 57 ± 5 (39-82) minutes, to be compared with 58 ±4 (41-106) and 58 ±5 (33-72) in the two reference groups. No adverse event was observed during anesthesia. Consequently, it should be possible to give patients a carbohydrate-rich drink before surgery instead of ordering strict fasting (NPO), which in turn could improve the patients’ chances to recover and regain prefracture status. In Study IV we focused on gender differences in complications; specifically on factors associated with common general complications. Complications were common with an incidence of 59% in men and 56% in women (ns). Most common were urinary tract infection, pressure ulcer, cardiac complications and pneumonia. Male gender emerged as an independent risk factor for suffering from pneumonia, and female gender for urinary tract infection. Besides gender, time-to-surgery, cognitive function, cardiovascular and pulmonary disease on admission were independent risk factors for suffering complication. In conclusion, there are gender differences among patients admitted to a hospital for acute hip fracture, both with regard to status on admission and outcome. Cognitive dysfunction, equally common among women and men, has a major impact on incidence of complication and functional recovery. Men with cognitive dysfunction are at greater risk. With increased awareness of risk factors and gender bias, along with reduced waiting time for surgery, it should be possible to decrease complication incidence and improve outcome. We found no evidence for prolonged gastric emptying time of a carbohydrate-rich beverage, which implies it may be possible to provide patients with a carbohydrate-rich drink before surgery instead of adhering to strict fasting

  • 23.
    Siouta, Eleni
    Sophiahemmet Högskola.
    Communication in Patient Involvement in Decision making: Examples from consultations on atrial fibrillation2016Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Abstract

    Background: Further knowledge is needed regarding communication that occurs in practice between patients with atrial fibrillation (AF) and health professionals in consultations to understand the issue of patient involvement in treatment decisions.

    Overall aim: The overall aim of this thesis is to contribute knowledge on communication between patients and health professionals (cardiology nurses and cardiologists), focussing on how they create involvement in decision making in consultations.

    Specific aims: (1) To describe (i) the topics that patients with AF discuss with cardiology nurses and cardiologists; (ii) the use of discursive space in consultations between these participants; and (iii) the frequency at which patients, cardiology nurses, and cardiologists introduce identified topics. (2) To describe the different types of resistance by patients to treatment with warfarin and how cardiologists respond to such resistance. (3) To examine how patients describe involvement and communication in decision making regarding treatment in consultations with cardiology nurses and cardiologists. (4) To examine how cardiologists describe their views on patient involvement in AF treatment decisions, their perceptions regarding efforts to involve patients, and how they handle decisions.

    Methods: A qualitative design was used. In study I, the sample consisted of 23 videotaped consultations between patients with AF and cardiology nurses and cardiologists at six nurse-led cardiology outpatient clinics. Content analysis was used to obtain a description of topics that were discussed. The patterns of dominance for the various topics and participants were examined. In study II, the sample consisted of 11 videotaped consultations between patients with AF and cardiologists. Conversation analysis was used to describe interactions concerning resistance to treatment with warfarin. In study III, 22 patients with AF were interviewed directly after their consultations with cardiology nurses and cardiologists. Content analysis was used for the resulting data. In study IV, 10 cardiologists were interviewed in cardiology clinics at four Swedish hospitals and qualitative content analysis was used.

    Findings: In study I, a medically driven agenda dominated the patient-driven agenda. However, when the patients initiated conversations about their life with AF (the topic that received the least amount of space on the agenda), involvement was created. In study II, the patients’ resistance could be viewed as a source of knowledge about patients’ real-life situations and what motivates them. In study III, despite not being actively involved in the decision-making process, the patients experienced a sense of involvement when they felt understood and were listened to. In study IV, by taking into account the patients’ feelings in the consultations, and by actively encouraging the patients to be involved, the cardiologists contributed to patient involvement.Conclusions: Patients, cardiology nurses, and cardiologists create involvement in decision making in consultations as communicative projects. Patients strive for space and create involvement by showing resistance to the decisions suggested by health professionals. However, involvement is not only an issue about obtaining space in the consultations, but is also associated with obtaining clarification, building confidence, feeling understood, trusting cardiology nurses and cardiologists, and having confidence in receiving consistent care within an established relationship. On a theoretical level, this thesis sheds light on the interaction between the concepts of communication, involvement, and decision making.

  • 24.
    Sterner, Eila
    Sophiahemmet Högskola.
    Pressure ulcers - role of the nurse to improve patient safety: prevalence, risk factors, classification and documentation in patients undergoing hip surgery2012Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Pressure ulcer is a common complication in hip fracture surgery and convalescence. Earlier prevalence studies have demonstrated a lower prevalence in Southern Europe than in Northern Europe. In patients with hip fractures, specific risk factors for developing pressure ulcers, apart from those included in standardised risk assessment are not fully understood. Correct classification of Category I pressure ulcers is a prerequisite for planning preventive measures. It is also mandatory for the reliability of prevalence studies. Until now subjective tests such as finger-press test and visual assessment have been utilised in clinical practice. An objective method has hitherto been lacking. Planning and delivering good nursing care to patients who are at risk of, or already have, manifest pressure ulcers should be built on proper documentation. Degree of documentation of pressure ulcer prevalence and risk factors in patients with hip fractures versus elective hip replacement surgery has hitherto not been investigated. Scrutiny of medical records for these diagnoses and identification of potential differences should therefore be of interest.Aim: - To investigate prevalence and incidence of pressure ulcers upon arrival and at discharge from hospital, and to identify potential intrinsic and extrinsic risk factors for the development of pressure ulcers in patients admitted for hip fracture surgery. To establish the inter-rater reliability between blanching and non-blanching erythema, assessed by two independent assessors. The secondary purpose was to investigate potential correlations between risk factors and pressure ulcers. - To explore if a non-invasive objective method could differentiate between blanching/nonblanching erythema in the sacral area of patients undergoing hip fracture surgery. - To investigate the degree of documentation regarding risk assessment, preventive measures taken, prevalence and severity of pressure ulcers, in patients undergoing surgery for hip fractures or elective hip replacements at admission and during hospital care at an orthopaedic unit.Results: The prevalence of pressure ulcers in Southern Europe was lower compared to Northern Europe. Specific risk factors such as dehydration (p=.005), moist skin (p=.004), pulmonary disease (p=.006) and diabetes (p=.005) were identified. The finger-press test and visual assessment of Category I pressure ulcers were both unreliable methods with low interrater reliability. The proportion of patients with persistent discoloration differed significantly between the assessors from Day 1 to Day 5 (p = .013). Reflectance spectrophotometer used was proven to deliver high precision regarding classification of non-blanchable erythema (Category I pressure ulcers). Documentation of pressure ulcers, risk assessment, body mass index and prevention at admittance was unsatisfactory in patients undergoing hip surgery.

  • 25.
    Swall, Anna
    Sophiahemmet Högskola.
    "Being in the present": the meaning of the interaction between older persons with Alzheimer's disease and a therapy dog2015Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    The number of persons with Alzheimer’s disease is increasing world-wide and the disease affects the persons, their families, the health care system and the economy within society worldwide. The symptoms and behaviours caused by Alzheimer’ disease may be difficult to manage for the person and their caregivers. Alternative methods are recommended before pharmacological treatment. The presence of a therapy dog has been described as beneficial, in for instance increasing well-being and alleviating symptoms and dementia behaviours. The overall aim of this thesis was to gain a deeper understanding of the influence of therapy dogs on persons with Alzheimer’s disease from the person’s and the dog handler’s perspectives. Further, adopting a longitudinal perspective, the study investigates the therapy dog’s influence on activity and sleep for persons with Alzheimer’s disease. Video observations of five persons with Alzheimer’s disease interacting with a therapy dog (I, II), as well as interviews with nine dog handlers (III) were gathered and transcribed. Data was analyzed using a phenomenological hermeneutical method (I, II, III). Registration of activity and sleep was conducted over a period of 16 weeks using an Actigraf that generated curves, and were then analysed using descriptive statistics (III). The time spent with the dog revealed memories and feelings resulting in existential thoughts of oneself and life, which then connected to the present situation (I). Distancing oneself from the symptoms of the disease when interacting with the dog showed a person functioning in the present with the dog, striving for the dog’s best and putting the dog before and above oneself (II). The therapy dog’s presence showed no pattern of effect on the patients’ daytime activity and sleep. The findings instead pointed to a great variety of possible different effects, bringing about increased activity at different time points, for example during night-time sleep (III), creating a respite from illness and contributing wordlessly to an existence but thoroughly directed by the dog handler, where the person was comfortable and took the initiative (IV). In conclusion, the therapy dog team’s presence with the person with Alzheimer’s disease induced meaning that allowed the person’s hidden qualities and abilities to develop and, when observed from a person-centred perspective, also brought out the individual in each person

  • 26.
    Wallin Lundell, Inger
    Sophiahemmet Högskola.
    Induced Abortions and Posttraumatic Stress - Is there any relation?: A Swedish multi-centre study2014Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Introduction: Induced abortion is a common medical intervention. Whether psychological sequelae might follow induced abortion has long been a subject of concern among researchers, and there is lack of knowledge about the relationship between posttraumatic disorder (PTSD) and induced abortion. Aims: To study and compare PTSD, posttraumatic stress symptoms (PTSS) and anxiety- and depressive symptoms among women seeking abortion, allowing for demographic variables. Further aims were to assess risk factors and to assess PTSD and PTSS following induced abortion in relation to experienced care at the clinic. Methods: This was a multi-centre cohort study targeting women who requested an induced abortion at the outpatient clinics of the gynaecology and obstetrics departments of six public hospitals in Sweden. All women who requested an induced abortion before the end of gestational week 12 were approached for participation. PTSD, PTSS, anxiety- and depressive symptoms, personality traits and women’s perceptions of abortion care were measured by means of questionnaires. Measurements were made at the first visit before the abortion as well as three- and six-months thereafter. Data collection was performed from September 2009 to January 2011. Results: 1,514 women filled out the questionnaire before the abortion. Abortion-seeking women did not suffer from PTSD to a greater extent than the general Swedish female population. Few women (51/720) developed PTSD or PTSS after the abortion, 11 did so due to trauma experience related to the abortion. Women at risk of posttraumatic stress were more likely to be young, having anxiety- or depressive symptoms and personality traits related to neuroticism. Furthermore, women with PTSD or PTSS were more likely to perceive certain aspects of the abortion care as deficient. Conclusions: The vast majority of women coped well with the induced abortion. Few developed posttraumatic stress post abortion. The majority did so because of trauma experiences unrelated to the induced abortion. Young women and women with mental distress are vulnerable groups that need to be paid attention to in abortion care. These women are at risk for negative experiences of the abortion care, and may be at risk of PTSD or PTSS post abortion

  • 27.
    Westerbotn, Margareta
    Sophiahemmet Högskola.
    Drug Use Among the Very Old Living in Ordinary Households: Aspects on Well-being, Cognitive and Functional Ability2007Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Background: In Sweden today a major proportion of the population survive to old ages. To a large extent, the oldest old are capable of living longer in their own households; some of them are very healthy while others have multiple diagnoses or ailments caused by a normal ageing process. This means that many elderly persons receive their health care needs in their own home, and in the future this will be even more common. Drug use of the elderly is a complex field, and many drugs have side effects complicating the medical treatment and decreasing the quality of life.

     

    Aim: This thesis aims to explore and describe the medicine use and the medical situation of very old persons (¡Ý84 years) living in ordinary households, and to obtain knowledge of their views on the use of drugs.

    Methods: This thesis combines quantitative and qualitative research methods. The quantitative studies (Study I, II and III) were based on data from the Kungsholmen Project, a population based study of elderly people living in a district of the inner city of Stockholm, Sweden. Data collection of the present studies was carried out from the third follow-up 1997-1998. The qualitative data (Study IV) was obtained 2005 through in-depth interviews with 25 elderly men and women, aged 85-97 years, living in ordinary households in Stockholm, Sweden. A pre-tested semi-structured questionnaire was used for the interviews.

    Results: The findings in Study I demonstrated that cardiovascular diseases are very frequent in this population (62%). Heart failure (47%) and hypertension (37%) were the most common conditions; and diuretics (69%), nitrates (31%) and cardiac glycosides (30%) were the most commonly prescribed drugs. Multivariate regression analyses showed that while being affected by a CV disease did not affect the emotional well-being of the participants (PANAS-PA, p=0.171; PANAS-NA, p=0.209), the use of cardiac glycosides (p=0.006) and nitrates (p=0.008) was associated with increased negative feelings. Study II revealed that 88% of the population took medicines on a regular basis, and only 23% of them received help with the handling of their medicines. Using logistic regression models controlling for sociodemographic variables, cognitive and functional status, female gender (OR: 2.8; 95% CI: 1.2-6.5) was the only variable associated with regular use of medicines. The results also showed that older age and functional disability as measured by ADL, increased the risk of receiving help with medicines, while higher cognitive status decreased the odds of receiving help. Using multiple regression models, we found that the only factor related to not receiving help from a family member was that of living alone (OR:0.05; 95% CI: 0.006-0.4). Study III showed that the prevalence of pain among very old persons was 46%, and the prevalence of pain treatment was 71%. Results from logistic regression analysis using all variables in the model indicated that pain reporting was not associated with age, gender or living conditions, but decreased with decreasing cognitive status and with increasing functional disability. Furthermore, pain treatment was not associated with age, gender, living conditions, cognitive and functional status. The qualitative data in Study IV indicated that most of the participants managed their medicines by themselves and were very content with this. Those elderly who received help with their medicines were also very pleased with this help. The findings also revealed that the most important components for the elderly to be able to remain living in their homes and to handle their medicines by themselves, were to have good cognitive ability, to be independent and to get support with their medicines from a close person as a back-up.

    Conclusions: This study revealed that a large proportion of very old people (¡Ý84 years) were living in ordinary households and used medicines regularly. Being a woman and living alone were associated with receiving help with medicines from the community help services. Cognitive and functional ability were revealed to be significant factors in the management of medicines, but also to affect the pain reporting, and type of received pain treatment. Most of the older participants managed to handle their medicines by themselves, and were very pleased by doing this. However, most of them were concerned about the risk of losing their memory, as they are getting older, because they knew that they would not be able to manage themselves any more and therefore would have to move to an institution.

1 - 27 av 27
RefereraExporteraLänk till träfflistan
Permanent länk
Referera
Referensformat
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Annat format
Fler format
Språk
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Annat språk
Fler språk
Utmatningsformat
  • html
  • text
  • asciidoc
  • rtf