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  • 151.
    Arnesen, Rebecca
    Sophiahemmet University.
    Patienters upplevelser av omhändertagandet på akutrum i samband med trauma: en intervjustudie2015Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    ABSTRACT

    In Sweden trauma is the most common cause of death in people under the age of 45.

    More than 4500 people each year die as a result of external injuries. On a demographic level preventive measures are being taken to reduce morbidity and mortality caused by trauma.

    During the year of 2005 the costs added up to 21 billion Swedish crowns, and this figure only covers the costs of traffic accidents. In Stockholm County there's one main trauma center which is situated at Karolinska University hospital. This hospital handles the treatment of the most severe traumas, called trauma- one and trauma- two. Remaining hospitals in the county are capable of treating minor trauma, so called trauma- three. The care and treatment plan of a patient injured by trauma is built on the structure called ABCDE (Airway-Breathing-Circulation-Disability-Exposure) which is a part of ATLS. This structure is used to quickly discover, estimate and treat possible injuries. It also provides a way for the entire traumateam to work together from concise guidelines. With all personnel using the same tool/structure for examination and prioritizing the treatment of the patient it not only secures that each profession acts their part, but also increases patient safety. Each hospital relies on their own traumateam, however the constitution of the professions included in the team may differ between hospitals. Within the team communication is of the essence, both within the team and with the patient. In this team the nurse's competence of person-centered care and patient safety comes well to use. When the care provided is person-centered the traumateam can use the patient’s own knowledge and recourses which increases safety for both patient and personnel.

    The aim of the study was to describe the experience of patients receiving nursing care in the emergency room after injury by trauma.

    This study is a qualitative descriptive interview study where semi structured interviews were conducted. In total there were six interviews. The interviews were audio recorded and transcribed before they were analyzed. Content analysis was performed in which meaning units were condensed, coded and divided into subthemes, themes and general theme.

    The result showed one general theme, two themes and five subthemes. The general theme was Patient´s experiences of the nursing care in the emergency room after trauma. The themes were Being a patient in an emergency room and To feel included and experiences of personal treatment. The experiences of communication and the way information was given were mixed. Patients experienced being in focus but not receiving eye contact from the personnel. Emotions that emerged were such as safety and anxiety along with tranquility. The severity of the situation was amplified by the large number of personnel present in the emergency room during nursing care. Some equipment’s and examinations were experienced as more emotional, these were the stiff neck collar and the log-roll. The stiff neck collar for some, felt uncomfortable and unpleasant. The log-roll though was pursued in a very secure and well-practiced manner which resulted in a feeling of routine and safety.

    The result showed in this study indicates that personal treatment, communication and a high degree of inclusion are the three most important aspects regarding patients experiences of nursing care in the emergency room after trauma. These three aspects are formulated in that the patients experiences being in focus, receiving information about present and future actions and examinations and also given the opportunity to feel included in the situation.

  • 152.
    Aronsdottir, Kolbrun
    et al.
    Sophiahemmet University College.
    Björklöf, Ulla
    Sophiahemmet University College.
    Förebyggande och lindring av cytostatikainducerat illamående och kräkningar hos patienter med cancer: en forskningsöversikt2007Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 153.
    Aronsson, Anna
    et al.
    Sophiahemmet University College.
    Meredith, Sara
    Sophiahemmet University College.
    Föräldrars behov i samband med omvårdnad av det för tidigt födda barnet2007Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 154.
    Aronsson, Evelina
    et al.
    Sophiahemmet University College.
    Eriksson, Linda
    Sophiahemmet University College.
    Den bröstcancerrelaterade mastektomins inverkan på unga kvinnors kroppsuppfattning och sexualitet2012Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    SAMMANFATTNING

    Bakgrund

    Bröstcancer är i västvärlden en vanlig cancerform hos kvinnor och behandlas bland annat med hjälp av kirurgi. Det finns olika typer av kirurgisk behandling av bröstcancer och vilken som blir aktuell bestäms utifrån indikation och i samråd med patienten. Bland dessa kirurgiska metoder återfinns mastektomin, som innebär ett avlägsnande av hela bröstet. Brösten är en central del i både den psykiska och den fysiska sexualiteten hos de flesta kvinnor och symboliserar i många kulturer kvinnlighet och moderskap.

    Syfte

    Studiens syfte var att beskriva vilken effekt en mastektomi till följd av en bröstcancerdiagnos kan ha på den unga kvinnans kroppsuppfattning och sexualitet.MetodStudien genomfördes som en forskningsöversikt. Sökningar i tre databaser resulterade i fjorton artiklar som inkluderas i resultatet. Forskningsetiska överväganden har gjorts.

    Resultat

    En bröstcancerdiagnos innebar ofta förändringar till det sämre vad gäller den drabbades upplevelse av kvinnlighet och sexualitet. De drabbade kvinnorna kände saknad och sorg över sitt förlorade bröst och de kände sig bekymrade över sin kropp som de ofta upplevde hade förändrats till det sämre. Den sexuella funktionen till följd av cancerbehandlingen som sådan uppgavs också vara försämrad vilket bidrog till ett försämrat sexliv.

    Slutsats

    Efter en bröstcancerrelaterad mastektomi drabbas kvinnor ofta av en försämrad kroppsuppfattning och sexualitet jämfört med före ingreppet. En eventuell partners åsikter har betydelse för kvinnans välbefinnande och förnöjsamhet relaterad till kroppsuppfattning och sexualitet. En förändrad kroppsuppfattning till följd av en mastektomi är den vanligaste orsaken till sexuell dysfunktion. Det är viktigt att vårdpersonal ser till individen, eftersom det är hon som kommer att få leva med konsekvenserna av en mastektomi.

  • 155.
    Aronsson, Jeanette
    Sophiahemmet University College.
    Kunskap som sjuksköterskan behöver i mötet med barn i samband med en förälders svåra sjukdom och död2002Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 156.
    Arrue, Michelle
    et al.
    Sophiahemmet University.
    Larsson, Frida
    Sophiahemmet University.
    God handhygien, en varierande omvårdnadshandling: en litteraturöversikt om hälso- och sjukvårdspersonalens följsamhet till riktlinjer för handhygien inom slutenvård2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    BAKGRUND

    Handhygien innebär handtvätt samt användning av handdesinfektionsmedel för att få bort smuts och mikroorganismer från händer. Vidare innebär basal handhygien riktlinjer och rutiner för skötsel av handtvätt och användning av handdesinfektionsmedel inom hälsooch sjukvården. Riktlinjerna och rutinerna ska tillämpas av hälso- och sjukvårdspersonal inom all hälso- och sjukvård världen över. Hälso- och sjukvårdspersonalens förmåga att utföra arbetsuppgifter enligt riktlinjerna är en faktor som påverkar förekomsten av vårdrelaterade infektioner. Vårdrelaterade infektioner är ett problem för patientsäkerheten inom hälso- och sjukvården som kan leda till ökat lidande för patienten.

    SYFTE

    Syftet med studien var att beskriva hälso- och sjukvårdspersonalens följsamhet till handhygien inom slutenvård.

    METOD

    En allmän litteraturöversikt valdes som metod. Litteratursökningar gjordes i databaserna CINAHL Complete och PubMed. Sökorden som användes till litteraturöversikten var “hand hygiene”, “handwashing”, “compliance”, “nurses”, “nursing staff, hospital”, “professional compliance”, och “guideline adherence”. 15 artiklar har inkluderats i resultatet.

    RESULTAT

    Huvudfynden från resultatet innefattade en variation av följsamhet till handhygien samt brist på resurser och faciliteter. Hudproblem relaterat till handhygien samt varierande riktlinjer för handhygien, var ytterligare huvudfynd. Resultaten baserades på observations-, enkät- och intervjustudier.

    SLUTSATS

    Det finns ingen entydighet kring hur hälso- och sjukvårdspersonalens följsamhet till handhygien inom slutenvård ser ut. Variationen av följsamhet till handhygien visar att WHO:s globala riktlinjer inte lyckas omsättas i praktiken i den mån det behövs. Riktlinjer behöver anpassas för att gynna alla länder oberoende av landets socioekonomiska ställning. Därmed kan patientsäkerheten öka och vårdlidandet minska.

    Nyckelord: Basal handhygien, Följsamhet, Handhygien, Slutenvård, Vårdrelaterade infektioner. 

  • 157.
    Arvidsson, Filippa
    et al.
    Sophiahemmet University.
    Nordahl, Lisa
    Sophiahemmet University.
    Sjuksköterskans professionella förhållningssätt i mötet med den alkoholberoende patienten: en litteraturöversikt2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Alkoholberoende innebär konsekvenser på hälsan utifrån både den fysiska och psykiska aspekten. Alkoholberoende patienter upplever vården som positiv när sjuksköterskorna är engagerade, uppmärksamma och ärliga vilket bidrar till säkerhet, säkert stöd och värdighet. Opålitlighet och oärlighet från både sjuksköterskor och patienter utgör en negativ aspekt på vården. De senaste 30 åren har sjuksköterskans attityd gentemot alkoholberoende patienter förbättrats. Det är bevisat att alkoholberoende patienter får idag annorlunda omsorg jämfört med andra patientgrupper.

    Syfte: Syftet med denna litteraturöversikt var att beskriva sjuksköterskans professionella förhållningssätt i mötet med patienter med alkoholberoende.

    Metod: Metoden i detta arbete var en allmän litteraturöversikt. Vetenskapliga artiklar söktes från tre olika databaser, CINAHL Complete, PsycINFO och PubMed. Totalt 16 stycken vetenskapliga artiklar inkluderades efter en kvalitetsgranskning till resultatet i detta arbete.

    Resultat: Till resultatet framkom ett huvudtema: Sjuksköterskans professionella förhållningssätt med tillhörande underteman. Sjuksköterskan anser att de är i behov av mer kunskap kring alkoholberoende. De negativa attityderna grundar sig på erfarenheter och personliga förutfattade meningar. Positiva aspekter speglar en god relation, bra kunskap inom området och en patient som är villig att implementera en förändring.

    Slutsats: Känslan av skuld och skam kan påverka sjuksköterskan att våga ställa frågan om alkoholvanor. Sjuksköterskorna ansåg att deras kunskap inom rådgivning inte var tillräcklig. Tid- och resursbrist påverkar sjuksköterskan trots medvetenheten om alkoholens konsekvenser. Med en engagerad roll i vårdrelationen ska stöd visas för att patienten ska känna sig trygg, med detta behövs även kontinuerlig uppdatering av kunskap och kompetens för att kunna arbeta utifrån ett evidensbaserat förhållningssätt.

  • 158.
    Arvidsson, Ivonne
    et al.
    Sophiahemmet University.
    Östensson, Sofie
    Sophiahemmet University.
    Patienters uppfattning om sjuksköterskeledd hjärtsviktsmottagning: en enkätstudie2017Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Hjärtsvikt är ett tillstånd som i hög grad påverkar patientens liv. Sjuksköterskeledd hjärtsviktsmottagning kan vara en viktig del i vården för personer med hjärtsvikt. Vidare har personcentrerad vård de senaste åren visat god evidens, inte minst inom vården sjuksköterskeledd mottagning.

    Syftet med denna studie var att beskriva patienters uppfattning av sjuksköterskeledd hjärtsviktsmottagning med fokus på personcentrerad vård.

    Studien genomfördes med kvantitativ metod där författarna med hjälp av enkäter besvarade syfte och frågeställningar. Studiens generaliserbarhet var låg då svarsfrekvensen endast blev 31 procent. Datainsamling genomfördes med konsekutivt urval.

    Resultatet visar att patienter i stor utsträckning uppfattar att de får tillfälle att berätta om sig själva och att hjärtsviktssjuksköterskan lyssnar till berättelsen. Vidare visar studien i hög utsträckning att patienterna anser att vården vid mottagningen ökade deras trygghet, att de bemöttes med respekt samt fick utrymme att ställa frågor. Informationen som patienterna tog del av under besöken vid hjärtsviktsmottagningen uppfattades i hög utsträckning som lätt att förstå. Patienterna ansåg i betydande utsträckning att vården vid den sjuksköterskeledda hjärtsviktsmottagningen ökade deras förmåga att hantera sina symtom, att beslut gällande deras vård togs i dialog med dem och eventuella anhöriga samt att de gavs möjlighet att ta med anhörig/vän till mottagningsbesök. Patienterna uppfattade sig även i stor utsträckning vara delaktiga i sin vård.

    Slutsatsen som drogs var att patienterna i stor utsträckning uppfattade att vården vid de sjuksköterskeledda hjärtsviktsmottagningarna bedrevs i enlighet med personcentrerad vård som den beskrivs i denna studie. Detta då frågorna som ställdes med bakgrund i personcentrerad vård besvarades instämmande av majoriteten av patienterna. Dock kan mer utveckling och fokus läggas på att öka patienternas delaktighet och delat beslutsfattande ytterligare gällande vården vid sjuksköterskeledd hjärtsviktsmottagning. Vidare kan resultatet i studien belysa ett behov av att hjärtsviktssjuksköterskor behöver fokusera mer på att involvera närstående i vård

  • 159.
    Arvidsson, Lena
    Sophiahemmet University College.
    Sjuksköterskans dokumentation av postoperativ smärta: en journalgranskningsstudie2013Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
  • 160.
    Arvidsson, Tobias
    et al.
    Sophiahemmet University College.
    Pettersson, Tommy
    Sophiahemmet University College.
    Omhändertagande av patienter med höftfrakturer: en forskningsöversikt2009Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 161.
    Askling, Catarina
    et al.
    Sophiahemmet University College.
    Viita, Susanna
    Sophiahemmet University College.
    Vårdpersonals handhygien2008Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 162.
    Asmelash, Semainesh
    et al.
    Sophiahemmet University College.
    Baltra, Marlene
    Sophiahemmet University College.
    Transkutan elektrisk nervstimulering (TENS) och akupressur som komplementära alternativa smärtbehandlingsmetoder: forskningsöversikt2012Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 163.
    Asplin, Nina
    Sophiahemmet University.
    Women's experiences and reactions when a fetal malformation is detected by ultrasound examination2013Doctoral thesis, comprehensive summary (Other academic)
    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.

  • 164.
    Asplin, Nina
    et al.
    Sophiahemmet University.
    Dellgren, Annika
    Conner, Peter
    Education in obstetrical ultrasound - an important factor for increasing the prenatal detection of congenital heart disease2013In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 92, no 7, 804-808 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To evaluate the effects of postgraduate education in obstetrical ultrasound on the prenatal detection rate of congenital heart disease. SETTING: Tertiary care center. POPULATION: Experienced and less experienced midwives performing ultrasound scans. METHODS: Number of fetuses and live born children with severe congenital heart malformations were extracted from patient records. The detection rates of experienced and less experienced midwives were compared following a postgraduate training program in obstetrical ultrasound. MAIN OUTCOME MEASURES: The prenatal detection rate of complex congenital heart malformations. RESULTS: The prenatal detection rate for the entire unit increased significantly during the study period (32 vs. 69%, p<0.05). Following education, we observed a significant increase in detection rates (21 vs. 67%, p<0.01) among experienced midwives. In the group of less experienced midwives, we found a positive effect of training with considerably higher detection rates compared to results achieved by their more experienced colleagues prior to the program (40 vs. 21%). CONCLUSION: There is a clear improvement in the prenatal detection rates of complex heart malformations following a postgraduate education in obstetrical ultrasound. Similar training should be offered to both midwives and doctors performing routine scans to increase the standards of antenatal screening for congenital heart disease. © 2013 The Authors Acta Obstetricia et Gynecologica Scandinavica © 2013 Nordic Federation of Societies of Obstetrics and Gynecology.

  • 165. Asplin, Nina
    et al.
    Wessel, Hans
    Marions, Lena
    Georgsson Öhman, Susanne
    Sophiahemmet University.
    Maternal emotional wellbeing over time and attachment to the fetus when a malformation is detected2015In: Sexual & Reproductive Healthcare, ISSN 1877-5756, Vol. 6, no 3, 191-195 p.Article in journal (Refereed)
  • 166.
    Asplin, Nina
    et al.
    Sophiahemmet University.
    Wessel, Hans
    Marions, Lena
    Georgsson Öhman, Susanne
    Sophiahemmet University.
    Pregnancy termination due to fetal anomaly: women's reactions, satisfaction and experiences of care2014In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 30, no 6, 620-627 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    to explore what women who have had a pregnancy terminated due to a detected fetal malformation perceived as having been important in their encounters with caregivers for promoting their healthy adjustment and well-being.

    METHOD:

    an exploratory descriptive design was used. Semi-structured interviews were audiotaped, and the information pathway described. The text was processed through qualitative content analysis in six steps.

    SETTING:

    four fetal care referral centres in Stockholm, Sweden.

    PARTICIPANTS:

    11 women opting for pregnancy termination due to fetal malformation.

    FINDINGS:

    in-depth understanding and compassion are important factors in providing the feeling of support people need so they are able to adapt to crisis. The women emphasised that the caregivers have to communicate a sense of responsibility, hope and respect and provide on-going care for them to feel assured of receiving good medical care and treatment. Aside from existing psychological conditions, the women identified as having emotional distress directly after termination and for at least the following three months. Most women experienced a range of negative emotions after pregnancy termination, including sadness, meaninglessness, loneliness, tiredness, grief, anger and frustration. Still some of this group had positive reactions because they experienced empathy and well-organised care.

    CONCLUSION AND IMPLICATIONS FOR PRACTICE:

    The most important factors associated with satisfaction regarding pregnancy termination due to a fetal malformation are the human aspects of care, namely state-dependent communication and in-depth understanding and compassion. The changes in care most often asked for were improvements in the level of standards and provision of adequate support through state-dependent communication, in-depth understanding and compassion, and complete follow-up routines and increased resources. Targeted education for the caregivers may be suited to ensuring that they properly meet needs of their patients.

  • 167.
    Asplin, Nina
    et al.
    Sophiahemmet University.
    Wessel, Hans
    Marions, Lena
    Georgsson Öhman, Susanne
    Sophiahemmet University.
    Pregnant women's experiences, needs, and preferences regarding information about malformations detected by ultrasound scan2012In: Sexual & reproductive healthcare : official journal of the Swedish Association of Midwives, ISSN 1877-5764, Vol. 3, no 2, 73-8 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The aim of the study was to explore pregnant women's experiences of received information in relation to fetal malformation detected on ultrasound.

    METHOD: An exploratory descriptive design was used. Semi-structured interviews with women who continued their pregnancy and women who chose to terminate were audiotaped, the information pathway described, and the text subjected to qualitative content analysis.

    RESULTS: Most of the women who expected a baby with an abnormality experienced the information given as insufficient, often misleading, conflicting, or incoherent, and sometimes negative. Important factors for interaction between women and caregivers were timing, duration, and manner of the initial dialog and ongoing support. Positive interactions improved the women's ability to understand the information, fostered feelings of trust and safety which reduced their anxiety.

    CONCLUSION: Women expressed dissatisfaction both regarding the care-givers' methods of giving information and apply for information from different specialists and continuity. The study highlights important factors which may be helpful to the professionals for improving the information to this vulnerable group of women.

  • 168.
    Asplin, Nina
    et al.
    Sophiahemmet University.
    Wessel, Hans
    Marions, Lena
    Georgsson Öhman, Susanne
    Sophiahemmet University.
    Pregnant women's perspectives on decision-making when a fetal malformation is detected by ultrasound examination2013In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 4, no 2, 79-84 p.Article in journal (Refereed)
    Abstract [en]

    Objectives

    The aims of the study were to explore factors influencing the decision to continue or terminate pregnancy due to detection of fetal malformation following ultrasound examination, to elucidate the need for more information or other routines to facilitate the decision-making process and to assess satisfaction with the decision made.

    Design

    Descriptive study.

    Setting

    Four fetal care referral centres in Stockholm, Sweden.

    Population

    Pregnant women with a detected fetal malformation.

    Methods

    Data was collected by questionnaires. 134 women participated, 99 completing the questionnaire. Descriptive statistical analysis was performed.

    Results

    Both women who continued and those who terminated pregnancy based their decision on the severity of the malformation. Other reasons for terminating the pregnancy were aspects including socioeconomic considerations. None stated religious factors. The doctor at the fetal care unit also had an influence on the decision-making. The timeframe receiving information was regarded as long enough in duration but not the number of occasions. In both groups the women made the decision by themselves or together with their partners. The majority experienced that they had made the right decision. Women who terminated their pregnancy had a significant higher rate (51.2%) (p⩽ 0.004) of previous abortions than those in the continuing group (23.2%).

    Conclusion

    The decision to continue or terminate the pregnancy was to a great extent based on the severity of the malformation. Religious aspects did not seem to influence the decision. Many women expressed a need for additional occasion of information. The vast majority of women were satisfied with their decision.

  • 169.
    Asplund, Sandra
    Sophiahemmet University.
    Sjuksköterskors upplevelse av anhörignärvaro vid hjärt- och lungräddning: en kvalitativ intervjustudie2016Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Årligen drabbas cirka 10 000 personer av plötsligt hjärtstopp i Sverige och det påbörjas återupplivningsförsök på cirka 4000 personer. Att erbjuda anhöriga att närvara vid hjärt- lungräddning har varit ett ämne som varit omdiskuterat sedan det först fördes på tal 1987. Flertalet studier har genomförts, med fokus på att belysa personalens attityd gällande anhörignärvaro vid HLR och hur anhörignärvaro vid HLR påverkar de anhöriga. Studier har visat att det kan vara gynnsamt för anhöriga att närvara, samtidigt som andra studier visar att det är relativt ovanligt att de närvarar. Syftet med denna studie var att beskriva sjuksköterskors upplevelser av anhörignärvaro vid hjärt-lungräddning inom akutsjukvård. Metoden som användes var en kvalitativ intervjustudie med semi-strukturerade intervjuer. Sju sjuksköterskor som arbetade på en akutmottagning i norra Sverige inkluderades till studien. Intervjuerna genomfördes under perioden december 2015 till januari 2016. Intervjuerna transkriberades och texten analyserades med kvalitativ innehållsanalys. Analysen resulterade i två teman med fyra underliggande kategorier. Resultatet visade att det fanns både positiva och negativa upplevelser kring anhörignärvaro. Några negativa aspekter som belystes var ökad stress för sjuksköterskan och att anhöriga ibland kunde upplevas som störande och därmed distraherade i situationen. En fördel som sjuksköterskorna i studien beskrev var att de upplevde att anhörignärvaro var värdefullt för de anhöriga, att de fick ett bättre omhändertagande samt att det upplevdes som värdefullt för anhöriga att se att personalen gjort allt de kunnat för patienten. Vidare beskrev sjuksköterskorna att anhörignärvaro i samband med HLR bidrog till en bättre och lugnare stämning inne på akutrummet vilket upplevdes som positivt. Studiens resultat tyder på att sjuksköterskor hade en positiv inställning till anhörignärvaro vid HLR, trots vissa utmaningar och negativa erfarenheter. Sjuksköterskorna ansåg att anhöriga hade rätt att närvara. Informanterna berättade att de sällan bjuder in anhöriga att närvara vid HLR men det framkom en önskan om ändring på det så att fler anhöriga får möjlighet att se vad som görs inne på akutrummet.

  • 170.
    Asplund, Tina
    Sophiahemmet University.
    Övergången från barnklinik till vuxenklinik för unga personer med diabetes typ 1: en litteraturöversikt2015Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 171.
    Assine, Nicole
    et al.
    Sophiahemmet University College.
    Gustafsson, Jaqueline
    Sophiahemmet University College.
    Se mig som en individ- inte som en diagnos: en litteraturstudie om personers upplevelser av bemötande från vårdpersonalen2012Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 172.
    Astros, Josefin
    et al.
    Sophiahemmet University College.
    Eriksson, Matilda
    Sophiahemmet University College.
    Alkoholberoendes och alkoholmissbrukares upplevelser av bemötande i den svenska sjukvården2012Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund

    Överkonsumtion av alkohol är ett vanligt problem i Sverige och ett beroende eller missbruk av alkohol kan orsaka både kroppslig och själslig skada hos individen. Därför påträffas personer som överkonsumerar alkohol ofta inom den svenska sjukvården. Tidigare forskning har visat att vårdpersonal har fördomar gentemot dessa personer och att personalens attityder och fördomar kan påverka bemötandet. Samtidigt har alla rätt till vård på lika villkor, oavsett vad de har för problem.

    Syfte

    Studiens syfte var att beskriva hur personer med alkoholberoende eller alkoholmissbruk upplever sig bli bemötta inom svensk sjukvård.

    Metod

    För att besvara studiens syfte valdes en kvalitativ metod. Nio personer med nuvarande eller tidigare alkoholberoende eller alkoholmissbruk intervjuades. Intervjumaterialet sammanställdes och analyserades med hjälp av en kvalitativ innehållsanalys.

    Resultat

    Alla deltagare i denna studie hade både bra och dåliga upplevelser av bemötande inom den svenska sjukvården. Under intervjuerna framkom att ett personcentrerat bemötande och noggrannhet från personalens sida fick informanterna att känna sig sedda och uppleva bemötandet som bra. Då personalen sett bortom alkoholproblemen och behandlat informanterna på samma villkor som andra patienter har vårdmötet blivit tryggt och ömsesidig respekt har uppstått.

    Misstänksamhet och nonchalans upplevdes som dåligt bemötande, men kunde i vissa fall enligt informanterna själva ha berott på deras eget beteende. Dåligt bemötande och brist på respekt, oavsett från vilken sida, har lett till negativa upplevelser och att en del personer senare undvikit att söka vård.

    Slutsats

    Slutsatsen är att alkoholberoendes och alkoholmissbrukares upplevelser av bemötande varierar från individ till individ, och att det beror på vad personen själv klassar som bra eller dåligt bemötande. Det mest centrala för att bemötandet ska ses som bra är att det är personcentrerat, och att inte alkoholproblemen tar all fokus. Alkoholberoendes och alkoholmissbrukares eget agerande och förhållningssätt gentemot vårdpersonalen påverkar också bemötandet.

  • 173.
    Augustsson Hedman, Kaj
    et al.
    Sophiahemmet University.
    Nkobo, Laura
    Sophiahemmet University.
    Hälsorelaterad livskvalitet hos personer med diabetes typ-1: en litteraturöversikt2014Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund Diabetes typ 1 är en vanlig sjukdom. Sjukdomen kan medföra komplikationer som kan påverkar livskvalitet hos de drabbade. Denna typ av sjukdom kräver livsstilsförändringar som påverkar till exempel kost och motion. Dessa förändringar är viktiga för både individen och behandlingseffekten. En av de viktigaste delarna i behandlingen av sjukdomen, är att ha kontroll över sin blodsockernivå för att på så sätt ha ett relativt bra liv.

    Syfte Syftet var att beskriva den hälsorelaterade livskvaliteten hos patienter med diabetes typ 1.

    Metod Metoden var en beskrivande litteraturöversikt där författarna har använt 15 vetenskapliga artiklar. Artiklarna identifierades genom sökning i databaserna Cinahl och PubMed.

    Resultat Resultatet visar att depression var en av de mest förekommande symtomen som påverkade livskvalitet hos patienter med diabetes typ1. Resultatet visade att komplikationer påverkade den hälsorelaterade livskvaliteten. Vidare framkom att beroende på formen av komplikation, kunde själva behandlingen antigen förbättra eller försämra individens livskvalitet.

    Slutsats Diabetes typ 1 är en växande sjukdom som drabbar individer över hela världen. Sjukvårdens arbete behöver inrikta sig på att förebygga redan i ett tidigt stadium, allt för att kunna undvika mentala, somatiska och psykosociala komplikationer.

  • 174. Avelin, Pernilla
    et al.
    Erlandsson, Kerstin
    Hildingsson, Ingegerd
    Rådestad, Ingela
    Sophiahemmet University.
    Swedish parents' experiences of parenthood and the need for support to siblings when a baby is stillborn2011In: Birth, ISSN 0730-7659, E-ISSN 1523-536X, Vol. 38, no 2, 150-8 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: It has been argued that having a stillborn baby in the family affects older siblings more than parents realize. The aim of this study was to describe parenthood and the needs of siblings after stillbirth from the parents' perspective.

    METHODS: Six focus groups were held with 27 parents who had experienced a stillbirth and who had had children before the loss. The discussion concerned parents' support to the siblings, and the sibling's meeting, farewell, and memories of their little sister or brother. Data were analyzed using qualitative content analysis.

    RESULTS: The overall theme of the findings was parenthood in a balance between grief and everyday life. In the analysis, three categories emerged that described the construction of the theme: support in an acute situation, sharing the experiences within the family, and adjusting to the situation.

    CONCLUSIONS: The siblings' situation is characterized by having a parent who tries to maintain a balance between grief and everyday life. Parents are present and engaged in joint activities around the stillbirth together with the siblings of the stillborn baby. Although parents are aware of the sibling's situation, they feel that they are left somewhat alone in their parenthood after stillbirth and therefore need support and guidance from others.

  • 175. Avelin, Pernilla
    et al.
    Gyllenswärd, Göran
    Erlandsson, Kerstin
    Rådestad, Ingela
    Sophiahemmet University.
    Adolescents' experiences of having a stillborn half-sibling2014In: Death Studies, ISSN 0748-1187, E-ISSN 1091-7683, Vol. 38, no 9, 557-562 p.Article in journal (Refereed)
    Abstract [en]

    Although there is an increasing interest in siblings' experiences of loss and grief there is limited knowledge of adolescent's own perspectives, especially in a unique situation as after stillbirth in a reconstituted family. The authors interviewed 13 bereaved adolescents. They were sad that their family was not the same and expressed feelings of being inside family grief, yet outside, because they did not have full access in their reconstituted family. An implication of present findings is that it is important to include all the members of the family in the grieving process, even half-siblings of the deceased child.

  • 176. Avelin, Pernilla
    et al.
    Hildingsson, Ingegerd
    Davidsson-Bremborg, Anna
    Rådestad, Ingela
    Sophiahemmet University.
    Make the stillborn baby and the loss real for the siblings: parents' advice on how the siblings of a stillborn baby can be supported2012In: Journal of Perinatal Education, ISSN 1058-1243, EISSN 1548-8519, Vol. 21, no 2, 90-98 p.Article in journal (Refereed)
    Abstract [en]

    This study aimed to investigate parents' advice to other parents on the basis of their own experiences of siblings' taking leave of a stillborn sister or brother. The study was a Web questionnaire study of 411 parents. The thematic content analysis resulted in two categories: "Make the stillborn baby and the loss real for the siblings" and "Take the siblings' resources and prerequisites into account." Parents' advised that siblings should see and hold the stillborn baby and, thus, be invited and included into the leave-taking process with respect to the siblings' feelings, resources, and prerequisites. Based on these findings, professional caregivers can usefully be proactive in their approach to facilitate and encourage the involvement of siblings.

  • 177. Avelin, Pernilla
    et al.
    Rådestad, Ingela
    Sophiahemmet University.
    Säflund, Karin
    Wredling, Regina
    Erlandsson, Kerstin
    Parental grief and relationships after the loss of a stillborn baby2013In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 29, no 6, 668-673 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: to describe the grief of mothers and fathers and its influence on their relationships after the loss of a stillborn baby. DESIGN: a postal questionnaire at three months, one year and two years after stillbirth. SETTING: a study of mothers and fathers of babies stillborn during a one-year period in the Stockholm region of Sweden. PARTICIPANTS: 55 parents, 33 mothers and 22 fathers. FINDINGS: mothers and fathers stated that they became closer after the loss, and that the feeling deepened over the course of the following year. The parents said that they began grieving immediately as a gradual process, both as individuals, and together as a couple. During this grieving process their expectations, expressions and personal and joint needs might have threatened their relationship as a couple, in that they individually felt alone at this time of withdrawal. While some mothers and fathers had similar grieving styles, the intensity and expression of grief varied, and the effects were profound and unique for each individual. KEY CONCLUSIONS: experiences following a loss are complex, with each partner attempting to come to terms with the loss and the resultant effect on the relationship with their partner. IMPLICATIONS FOR PRACTICE: anticipating and being able to acknowledge the different aspects of grief will enable professionals to implement more effective intervention in helping couples grieve both individually and together.

  • 178.
    Axell, Karin
    Sophiahemmet University College.
    Gravida kvinnor och typ 1-diabetes: stress, oro och välbefinnande under graviditetens trimestrar2012Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
  • 179.
    Axelsson, Christina
    et al.
    Sophiahemmet University College.
    Sondell, Pernilla
    Sophiahemmet University College.
    Vård på lika villkor: en genusfråga vid hjärtinfarkt?2009Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 180.
    Axelsson, Lena
    Sophiahemmet University.
    Living with haemodialysis close to death - patients' and close relatives' experiences2013Doctoral thesis, comprehensive summary (Other academic)
    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.

  • 181.
    Axelsson, Lena
    et al.
    Sophiahemmet University.
    Alvariza, Anette
    Lindberg, Jenny
    Öhlén, Joakim
    Håkanson, Cecilia
    Sophiahemmet University.
    Reimertz, Helene
    Fürst, Carl Johan
    Årestedt, Kristofer
    Unmet palliative care needs among patients with end-stage kidney disease: A national registry study about the last week of life2017Conference paper (Other academic)
  • 182.
    Axelsson, Lena
    et al.
    Sophiahemmet University.
    Alvariza, Anette
    Lindberg, Jenny
    Öhlén, Joakim
    Håkanson, Cecilia
    Sophiahemmet University.
    Reimertz, Helene
    Fürst, Carl-Johan
    Årestedt, Kristofer
    Unmet palliative care needs among patients with end-stage kidney disease: a national registry study about the last week of life2017In: Journal of Pain and Symptom Management, ISSN 0885-3924, E-ISSN 1873-6513, S0885-3924(17)30494-3Article in journal (Refereed)
    Abstract [en]

    CONTEXT: End-stage kidney disease (ESKD) is characterized by high physical and psychological burden and therefore, more knowledge about the palliative care provided close to death is needed.

    OBJECTIVES: To describe symptom prevalence, relief and management during the last week of life, as well as end-of-life communication, in patients with ESKD.

    METHODS: This study was based on data from the Swedish Register of Palliative Care. Patients aged 18 or older who died from a chronic kidney disease, with or without dialysis treatment (ICD-10-SE; N18.5 or N18.9), during 2011 and 2012 were selected.

    RESULTS: 472 patients were included. Of six predefined symptoms, pain was the most prevalent (69%), followed by respiratory secretion (46%), anxiety (41%), confusion (30%), shortness of breath (22%), and nausea (17%). Of patients with pain and/or anxiety, 32% and 44% respectively were only partly relieved or not relieved at all. Of patients with the other symptoms, a majority (55%-84%) were partly relieved or not relieved at all. End-of-life discussions were reported in 41% of patients and 71% of families. A minority died in specialized palliative care: 8% in hospice/in-patient palliative care and 5% in palliative home care. Of all patients, 19% died alone. Bereavement support was offered to 38% of families.

    CONCLUSION: Even if death is expected, the majority of patients dying with ESKD had unmet palliative care needs regarding symptom management, advance care planning, and bereavement support.

  • 183.
    Axelsson, Lena
    et al.
    Sophiahemmet University.
    Benzein, Eva
    Persson, Carina
    Complexities of the processes towards palliative care for patients with end-stage kidney disease: Physicians' and nurses' perspectives2017Conference paper (Other academic)
  • 184.
    Axelsson, Lena
    et al.
    Sophiahemmet University.
    Björvell, Catrin
    Mattiasson, Anne-Cathrine
    Sophiahemmet University.
    Randers, Ingrid
    Sophiahemmet University.
    Swedish Registered Nurses' incentives to use nursing diagnoses in clinical practice2006In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 15, no 8, 936-45 p.Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES: The purpose of this study was to describe Registered Nurses' incentives to use nursing diagnoses in clinical practice. BACKGROUND: The use of nursing diagnoses is scarce in Swedish patient records. However, there are hospital wards were all nurses formulate and use nursing diagnoses in their daily work. This leads to the question of what motivates these nurses who do use nursing diagnoses in clinical practice. DESIGN: A qualitative descriptive design. METHODS: A purposeful sampling of 12 Registered Nurses was used. Qualitative interviews to collect data and a content analysis were performed. RESULTS: Five categories were identified: identification of the patient as an individual and as a whole, a working tool for facilitating nursing care, increasing awareness within nursing, support from the management and influence on the professional role. The principle findings of this study were: (i) that the Registered Nurses perceived that nursing diagnoses clarified the patient's individual needs and thereby enabled them to decide on more specific nursing interventions, (ii) that nursing diagnoses were found to facilitate communication between colleagues concerning patient care and thus promoted continuity of care and saved time and (iii) that nursing diagnoses were perceived to increase the Registered Nurses' reflective thinking leading to a continuous development of professional knowledge. CONCLUSIONS: The present findings suggest that the incentives to use nursing diagnoses originate from effects generated from performing a deeper analysis of the patient's nursing needs. Further research is needed to test and validate the usability and consequences of using nursing diagnoses in clinical practice. Motivating factors found in this study may be valuable to Registered Nurses for the use and development of nursing diagnoses in clinical care. Moreover, these factors may be of relevance in other countries that are in a similar situation as Sweden concerning application of nursing diagnoses.

  • 185.
    Axelsson, Lena
    et al.
    Sophiahemmet University.
    Klang, Birgitta
    Lundh Hagelin, Carina
    Sophiahemmet University.
    Jacobson, Stefan H
    Andreassen Gleissman, Sissel
    Sophiahemmet University.
    End of life of patients treated with haemodialysis as narrated by their close relatives2015In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 29, no 4, 776-784 p.Article in journal (Refereed)
    Abstract [en]

    AIM: The study aimed to describe end of life for patients treated with maintenance haemodialysis as narrated by their close relatives.

    INTRODUCTION: Many patients undergoing haemodialysis are older, have several comorbidities and underestimated symptoms and are in their last year of life. To improve care, we need to know more about their end-of-life situation.

    DESIGN: Qualitative and descriptive.

    METHODS: Qualitative retrospective interviews were conducted with 14 close relatives of deceased haemodialysis patients (3-13 months after death). Data were analysed using qualitative content analysis. The study is ethically approved.

    FINDINGS: In the last months, a gradual deterioration in health with acute episodes necessitating hospital admissions was described. This involved diminishing living space and expressions of dejection, but also of joy. Three patterns emerged in the last weeks: uncertain anticipation of death as life fades away; awaiting death after haemodialysis withdrawal; and sudden but not unexpected death following intensive care. Findings show complexities of decisions on haemodialysis withdrawal.

    CONCLUSIONS: Different end-of-life patterns all involved increasingly complex care needs and existential issues. Findings show a need for earlier care planning. The identification of organisational factors to facilitate continuity and whole person care to meet these patients' specific care needs with their complex symptom burdens and comorbidities is needed. Findings indicate the need for integration of a palliative care approach in the treatment of patients in haemodialysis care.

  • 186.
    Axelsson, Lena
    et al.
    Sophiahemmet University.
    Klang, Birgitta
    Lundh Hagelin, Carina
    Sophiahemmet University.
    Jacobson, Stefan H
    Andreassen Gleissman, Sissel
    Sophiahemmet University.
    Meanings of being a close relative of a family member treated with haemodialysis2015In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 24, no 3/4, 447-456 p.Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES:

    To describe and elucidate the meanings of being a close relative of a severely ill family member treated with maintenance haemodialysis approaching the end of life.

    BACKGROUND:

    End-stage renal disease together with comorbidities, haemodialysis treatment and high mortality rates also affects the lives of close relatives, who report burdens and impaired quality of life. To improve care, more understanding is needed of close relatives' experiences during these patients' end of life.

    DESIGN:

    This study has a qualitative interpretative design.

    METHODS:

    Fourteen retrospective qualitative interviews were conducted with close relatives (aged 48-93 years) of deceased patients who had been treated with haemodialysis. The interview text was interpreted using a phenomenological hermeneutical method in three phases.

    RESULTS:

    The findings of the structural analysis were formulated as six themes: Striving to be supportive and helpful without doing harm to the ill person's self; Needing increasing strength and support; Balancing the will to help with one's own ongoing life; Increasing responsibility involving dilemmas; Striving for a good life together in the present and Living with awareness of death.

    CONCLUSIONS:

    Close relatives strive for balance and well-being accompanying their ill family member through the end of life. They are facing moral dilemmas and growing demands as their responsibility increases with the deterioration of their family member. Support from and interaction with the healthcare professionals is then of significance.

    RELEVANCE TO CLINICAL PRACTICE:

    Findings challenge healthcare professionals in haemodialysis settings to identify close relatives' individual resources and needs towards the patients' end of life. Healthcare professionals in haemodialysis settings need to offer close relatives opportunities to talk about the future and what may be expected at end of life, with or without haemodialysis. They should also contact the closest relative after the death as they may need confirmation and closure.

  • 187.
    Axelsson, Lena
    et al.
    Sophiahemmet University.
    Randers, Ingrid
    Sophiahemmet University.
    Jacobson, Stefan H
    Klang, Birgitta
    Living with haemodialysis when nearing end of life2012In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 26, no 1, 45-52 p.Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES: The aim of this study was to describe and to elucidate the meanings of being severely ill living with haemodialysis when nearing end of life.

    INTRODUCTION: To have end stage renal disease and to be treated with maintenance haemodialysis implies being dependent on lifelong treatment. Several studies have reported that these patients suffer a high symptom burden and an impaired quality of life due to both disease and treatment. In the dialysis unit, where the focus is on handling technology and maintaining life, end of life care may be neglected or overlooked. Nevertheless, mortality rates show that about one-fourth of patients in haemodialysis care are in their last year of life.

    DESIGN: A qualitative interpretative design was used.

    METHODS: Serial qualitative interviews over a period of 12 months were conducted with eight patients (aged 66-87). Altogether text of 31 interviews was interpreted using a phenomenological hermeneutical method in three phases. The study is ethically approved.

    FINDINGS: The structural analysis resulted in 11 subthemes and thereafter the following three themes were formulated; being subordinate to the deteriorating body, changing outlook on life and striving for upheld dignity. The comprehensive interpretation revealed that being severely ill living with haemodialysis near the end of life means living with suffering simultaneously with reconciliation and well-being. Further, the meanings are understood as intertwined with being old.

    CONCLUSIONS: Findings contribute to an increased awareness of the complexities of these patients' life worlds and their meanings, and thus of the importance to listen to their experiences and their understandings. Findings suggest that to integrate the philosophy of palliative care in haemodialysis units may improve care for patients who are living with haemodialysis and approaching the end of their lives.

  • 188.
    Axelsson, Lena
    et al.
    Sophiahemmet University.
    Randers, Ingrid
    Sophiahemmet University.
    Lundh Hagelin, Carina
    Sophiahemmet University.
    Jacobson, Stefan H
    Klang, Birgitta
    Thoughts on death and dying when living with haemodialysis approaching end of life2012In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 21, no 15-16, 2149-59 p.Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES: To describe inner thoughts and feelings relating to death and dying when living with haemodialysis approaching end of life.

    BACKGROUND: Patients who undergo maintenance haemodialysis suffer a significant symptom burden and an impaired quality of life. The high mortality rate in these patients indicates that about one-fourth of them are in their last year of life, suggesting the presence of death and dying in the haemodialysis unit.

    DESIGN: A qualitative descriptive design was used. Methods.  A total of 31 qualitative interviews were conducted with eight patients (aged 66-87) over a period of 12 months. Qualitative content analysis was used to analyse data.

    RESULTS: The analysis revealed 10 subthemes that were sorted into three main themes. Being aware that death may be near comprises being reminded of death and dying by the deteriorating body, by the worsening conditions and deaths of fellow patients, and by knowing haemodialysis treatment as a border to death. Adapting to approaching death comprises looking upon death as natural, preparing to face death, hoping for a quick death and repressing thoughts of death and dying. Being alone with existential thoughts comprises a wish to avoid burdening family, lack of communication with healthcare professionals and reflections on haemodialysis withdrawal as an hypothetic option.

    CONCLUSIONS: Living with haemodialysis approaching, the end of life involves significant and complex existential issues and suffering, and patients are often alone with their existential thoughts.

    RELEVANCE TO CLINICAL PRACTICE: Nurses and other healthcare professionals in haemodialysis settings need to combine technical and medical abilities with committed listening and communication skills and be open to talking about death and dying, with sensitivity to individual and changeable needs.

  • 189.
    Axelsson, Martina
    Sophiahemmet University College.
    Sjuksköterskors bekräftelse av patienters känsla av sammanhang inom vård och omsorg av äldre2009Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
  • 190.
    Axelsson, Åsa
    Sophiahemmet University.
    Patientens självskattade perioperativa smärta vid lokalbedövningsmetoden wide awake och traditionell lokalbedövningsmetod vid handkirurgiska ingrepp: en jämförande pilotstudie2016Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Handen har en mycket central roll för människans funktion och benämns ofta som hjärnans förlängning mot världen. Huvudsyftet inom handkirurgi är att vid skador, återskapa handens funktion för att förbättra människans livskvalité. De flesta operationer inom handkirurgi sker i någon form av lokalanestesi och majoriteten kräver blodtomhet i operationsområdet. Dagens former av lokalanestesi medför vissa begränsningar av operationstiden då trycket av blodtomhetsmanschetten orsakar smärta och obehag för patienten. Då det vid vissa handkirurgiska operationer är av stor fördel för operationsresultatet att patienten är vaken och vid uppmaning aktivt kan medverka vid operationen är det bra med vaken patient och därför bra om generell anestesi kan undvikas. Genom att bedöva patienten med en buffrad lokalbedövningsblandning med adrenalin kan patienten bli bedövad samtidigt som blodtomhet uppnås i operationsområdet, patienten behåller sin rörelseförmåga och kan på så sätt medverka vid operationen. Denna metod kallas Wide Awake.

    Syftet: Syftet med denna studie var att jämföra patientens smärtskattning vid Wide Awake lokalbedövningsmetod och den nuvarande lokalbedövningsmetoden som används vid handkirurgiska kliniken, samt beskriva patientens smärtupplevelse vid båda metoderna.

    Metod: Studien utfördes som en pilotstudie med både kvalitativ och kvantitativ ansats, en så kallad mixad metod. Tjugo forskningspatienter följdes under operationsprocessen med numeriskt kvantitativt protokoll där smärtskattningsdata samlades in och analyserades enligt Mann-Whitney U test. Ett uppföljande samtal dagen efter operation gjordes och sammanställdes med en manifest innehållsanalys enligt Graneheim och Lundman.

    Resultat: Studien visar på en skillnad i smärtupplevelse där patienter som opereras i Wide Awake lokalbedövningsmetod upplever mindre smärta och obehag än patienter som opereras i nuvarande lokalbedövningsmetod.

    Slutsats: Slutsatsen av denna studie visar på att Wide Awake är en bedövningsform som är lindrigare ur smärtsynpunkt för patienten vid mindre handkirurgiska ingrepp än den nuvarande traditionella lokalbedövning som används idag på handkirurgiska kliniken.

  • 191.
    Axner, Anna
    et al.
    Sophiahemmet University College.
    Wekesa, Brunhilda
    Sophiahemmet University College.
    Kvinnors upplevelser vid missfall : en forskningsöversikt2007Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 192.
    Azodi Ghajar, Sahar
    Sophiahemmet University.
    Smärtbedömning av patienter med demenssjukdom inom akutsjukvård: en litteraturöversikt2016Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    När en individ drabbas av en demenssjukdom och kognitiv svikt kan det leda till oförmågan att uttrycka smärta, på ett sätt som omgivningen kan förstå. Personer med demenssjukdom är ofta äldre och vårdas inom akutsjukvård på grund akut sjukdomstillstånd eller fall i hemmet som kräver omedelbar smärtbedömning och smärtlindring. Smärtbedömning samt smärtlindring för patienter med demenssjukdom är komplext och en utmaning för sjuksköterskor inom akutsjukvården. Syftet med studien var att belysa smärtbedömning av patienter med demenssjukdom inom akutsjukvård. En litteraturöversikt valdes som metod för att identifiera och lyfta fram aktuell forskning inom området. Mellan december 2015 och januari och februari 2016 gjordes sökningar i databaserna CINAHL, PubMed och PsykINFO. Totalt inkluderades 15 vetenskapliga artiklar, publicerade mellan 2004-2015. Artiklarna kvalitetsgranskades och analyserade utifrån syftet med studien och kring likheter och skillnader. Resultatet kom att beskriva tre huvudteman: kroppsspråk och beteendeförändringar; smärtskattninginstrument och sjuksköterskans erfarenhet. Slutsatsen från studien är att smärta orsakar lidande, vidare att smärtbedömning av patienter med demenssjukdom inom akutsjukvård är komplicerad. Flera smärtbedömningsinstrument identifierades som kan vara till hjälp vid smärtbedömning av patienter med demenssjukdom. Vårdrelation, personcentrerat förhållningssätt samt användning av flera strategier kan säkerställa en korrekt smärtbedömning av patient med demenssjukdom vid vård inom akutsjukvården. Fortsatt forskning behövs för att utvärdera olika smärtbedömningsinstrument inom svensk sjukvård.

  • 193.
    Backlund, Emilie
    et al.
    Sophiahemmet University.
    Ludvigsen, Jannich
    Sophiahemmet University.
    Egenvård vid hjärtsvikt: egenvårdens påverkan på livssituationen2016Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Många patienter formar deras liv utifrån deras hjärtsvikt och här hjälper sjuksköterskan genom att öka egenvårdsförmågan. Dorothea Orem har skapat en omvårdnadsteori som bygger på tillämpningen av egenvård också kallad self-care. Hon betonar att patienten ska göra så mycket egenvård som möjligt och att sjuksköterskan ska uppmana till detta. Enligt svensk lag har patienten rätt till att medverka i sin egen vård. Vi vill undersöka hur egenvården påverkar livssituationen hos personer med hjärtsvikt.

  • 194.
    Backlund, Johanna
    et al.
    Sophiahemmet University College.
    Johansson, Anna
    Sophiahemmet University College.
    Åtgärder för att minska suicidrisken hos tonåringar2007Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 195.
    Backman, Elin
    et al.
    Sophiahemmet University.
    Kainu, Jenny
    Sophiahemmet University.
    Föräldrars upplevelse och behov av vårdpersonalens stöd och omsorg - när deras barn insjuknat i cancer: en litteraturöversikt2015Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    SAMMANFATTNING

    Bakgrund

    I Sverige drabbas årligen ungefär 250 – 300 barn mellan 0 – 18 år av cancer. När barn får cancer kan det innebära en påverkan på barnets föräldrar. I sjuksköterskans roll ingår både att ta hand om barnet och dess närstående. Medan barnet diagnostiseras och behandlas går föräldrarna igenom olika känslor och tankar som de kan behöva hjälp med att hantera.

    Syfte

    Att belysa föräldrars upplevelse och behov av vårdpersonalens stöd och omsorg när deras barn insjuknat i cancer.

    Metod

    En litteraturöversikt valdes som metod. Sökningar efter relevanta artiklar gjordes i olika databaser samt via manuell sökning. Femton artiklar identifierades som besvarade föreliggande studies syfte.

    Resultat

    Kommunikation, information, socialt och emotionellt stöd samt omsorg är de fyra teman som presenteras i resultatet. Kommunikation ansågs vara viktig då den kunde ha en lugnande effekt hos föräldrar. Information var ett verktyg som kunde ge föräldrarna större inblick i barnets sjukdom vilket i sin tur leder till ökad möjlighet att kunna hantera situationen. Socialt och emotionellt stöd behövdes och kunde hjälpa föräldrarna att hantera sina känslor. Omsorg i form av att vårdpersonalen visade empati samt brydde sig om barnen var betydelsefullt.

    Slutsats

    Föräldrar till barn med en cancersjukdom går igenom en svår tid medan deras barn vårdas. Sjuksköterskan behöver ha kunskap om föräldrarnas behov för att kunna erbjuda dem den hjälp och det stöd de behöver. En bra vårdrelation kan leda till att föräldrarna känner sig lugna och trygga med den omvårdnad som deras barn får.

  • 196.
    Backman, Josefin
    et al.
    Sophiahemmet University.
    Drakander, Andrea
    Sophiahemmet University.
    Hur sjuksköterskan kan hantera arbetsrelaterad stress: metoder, modeller och dess effekter2015Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    SAMMANFATTNING

    Bakgrund

    Sjuksköterskeyrket har visat sig vara ett stressfyllt yrke med många olika stressfaktorer såsom hot och våld, bristande kunskap, oregelbundna arbetstider samt den fysiska och psykiska arbetsmiljön. Långvarig stress kan leda till allvarliga konsekvenser, både för sjuksköterskan som individ och även för den vård sjuksköterskan utför, vilket i sin tur kan påverka patientsäkerheten. Därför är det av största vikt att finna effektiva metoder att hantera stress för sjuksköterskor.

    Syfte

    Att beskriva hur sjuksköterskan med hjälp av coping och mindfulness kan hantera arbetsrelaterad stress inom den sjukvård som bedrivs på akutsjukhus samt effekten av dessa.

    Metod

    Metoden som valdes för denna studie var litteraturöversikt. Databassökningar gjordes i CINAHL, PubMed och PsycINFO. Arton artiklar inkluderades och granskades i studien.

    Resultat

    Tre teman framkom efter granskning: coping, mindfulness och socialt stöd. Val av använd metod att hantera stress visade sig vara individuell och effektiviteten av stresshanteringen varierade mellan individer och mellan de olika metoderna. Problemfokuserad coping visade sig vara mer effektiv gentemot stress än emotionsfokuserad coping. Mindfulness i form av mindfulnessbaserad stressreduktion och socialt stöd visade sig effektivt vid stresshantering, inte bara för individen utan även för arbetsgruppen.

    Slutsats

    En god stresshantering hos sjuksköterskan i form av problemfokuserad coping, mindfulnessbaserad stressreduktion och socialt stöd kan med fördel leda till förbättrad fysisk och psykisk hälsa hos sjuksköterskan samt främja omvårdnadsarbetet.

  • 197. Backman, Sara
    et al.
    Björling, Gunilla
    Sophiahemmet University.
    Johansson, Unn-Britt
    Sophiahemmet University.
    Lysdahl, Michael
    Markström, Agneta
    Schedin, Ulla
    Aune, Ragnhild E
    Frostell, Claes
    Karlsson, Sigbritt
    Material wear of polymeric tracheostomy tubes: a six-month study2009In: The Laryngoscope, ISSN 1531-4995, Vol. 119, no 4, 657-64 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The objectives were to study long-term material wear of tracheostomy tubes made of silicone (Si), polyvinyl chloride (PVC), and polyurethane (PU) after 3 and 6 months of clinical use. STUDY DESIGN: The study has a prospective and comparative design. METHODS: Nineteen patients with long-term tracheostomy, attending the National Respiratory Center in Sweden, were included, n = 6 with Si tubes, n = 8 with PVC tubes, and n = 5 with PU tubes. The tubes were exposed to the local environment in the trachea for 3 and 6 months and analyzed by scanning electron microscopy, attenuated total reflectance Fourier transform infrared spectroscopy, and differential scanning calorimetry. RESULTS: All tubes revealed severe surface changes. No significant differences were established after 3 or 6 months of exposure between the various materials. The changes had progressed significantly after this period, compared to previously reported changes after 30 days of exposure. The results from all analyzing techniques correlated well. CONCLUSIONS: All tubes, exposed in the trachea for 3-6 months, revealed major degradation and changes in the surface of the material. Polymeric tracheostomy tubes should be changed before the end of 3 months of clinical use.

  • 198.
    Bagger, Tina
    Sophiahemmet University College.
    Copingstrategier hos individer med långvarig icke-malign smärta2004Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 199.
    Bahramy, Zahra
    et al.
    Sophiahemmet University College.
    Wennergren, Inga
    Sophiahemmet University College.
    Kvinnors upplevelse av ett dagligt liv efter hjärtinfarkt2013Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 200.
    Bakhtiari, Miranda
    et al.
    Sophiahemmet University.
    Segerman, Dannielle
    Sophiahemmet University.
    Människors upplevelser av yoga vid långvarig nack- och ryggsmärta2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Att leva med långvarig smärta i rygg och nacke under en längre tid innebär en fysisk och psykisk påfrestning. Funktionsnedsättning, sjukskrivning, dagar med inställda aktiviteter och depression är endast några av smärtans följder. Det kan vara svårt att hitta en effektiv behandling, och i majoriteten av fallen har de drabbade människorna redan provat de flesta metoderna. Yoga är en behandlingsmetod som inte har fått en lika stor utbredning inom vården som exempelvis fysioterapi. Trots detta har yogan både fysiska och psykiska positiva effekter.

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