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  • 2301.
    Ulfsdottir, Hanna
    Sophiahemmet University.
    To give birth in water2019Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The aim of this thesis was to study waterbirth in a Swedish context and to bring focus on clinical outcomes and women’s experiences associated with waterbirth. The literature describes advantages for women giving birth in water like relaxation and a positive birth experience. Still, waterbirth is controversial in Sweden and has not been offered at hospitals until recently.

    Study I compared birth characteristics and outcomes of waterbirths with conventional uncomplicated births at the two clinics in Sweden providing waterbirth, from March 2014 to November 2015 (n=306+306). We found an association with fewer perineal tears of second degree among women giving birth in water and that these women were exposed to significantly less interventions such as amniotomy and oxytocin infusion intrapartum. There were no differences in Apgar scores or admissions to the neonatal intensive care unit, but three cases of umbilical cord rupture occurred among the waterbirths. Women having a waterbirth ranked their experience of childbirth higher in a numeric rating scale indicating a more positive birth experience.

    Study II was a qualitative study based on 20 in-depth interviews describing women’s experience of giving birth in water. The interviews, which took place 3-5 months postpartum were analyzed with qualitative content analysis. The overall theme emerging from the analysis was “Like an empowering microhome” describing the effect of being strengthened, enabled and authorized in the birth process. The limited space of a bathtub was described to give a relaxed and homelike feeling of privacy. Three categories were identified: “Synergy between body and mind”, “Privacy and discretion” and “Natural and pleasant”.

    In Study III we explored the experience, knowledge and attitudes regarding waterbirth among midwives, obstetricians/gynecologists and neonatologists in a cross-sectional study. Using a web- via The Swedish Association of Midwives and the Heads of department of all Swedish maternity wards between April and June 2016, yieleded 1609 responses. The questionnaire contained a Likert Scale and open-ended questions which were analyzed with descriptive statistics and quantitative content analysis. We found that midwives had amore positive attitude to waterbirth as well as towards providing and implementing waterbirth, compared to physicians. Strong opinions wereheld about waterbirth, which to some extent were based on subjective attitudes secondary to knowledge, experience and evidence.

    In Study IV we compared childbirth experience between women having a waterbirth (n=111) and women having an uncomplicated conventional birth (n=104) using the validated Childbirth Experience Questionnaire (CEQ). The 22-item questionnaire assessed four domains: Own capacity, Professional support, Perceived safety and Participation. Further, supplementary questions about the second stage of labour were added to the web-questionnaire. The total CEQ score did not differ between the groups, while women having a waterbirth scored significantly higher in the domain, “Own capacity” and lower in the domain, “Professional support”. Women having a waterbirth rated significantly less pain and higher scores of being in control in the second stage of labour.

  • 2302.
    Ulfsdottir, Hanna
    Sophiahemmet University.
    Waterbirths in Sweden2016Conference paper (Other academic)
  • 2303.
    Ulfsdottir, Hanna
    et al.
    Sophiahemmet University.
    Saltvedt, Sissel
    Ekborn, Marie
    Georgsson, Susanne
    Sophiahemmet University.
    Like an empowering micro-home: A qualitative study of women's experience of giving birth in water2019Conference paper (Other academic)
  • 2304.
    Ulfsdottir, Hanna
    et al.
    Sophiahemmet University.
    Saltvedt, Sissel
    Ekborn, Marie
    Georgsson, Susanne
    Sophiahemmet University.
    Like an empowering micro-home: A qualitative study of women's experience of giving birth in water2018In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 67, p. 26-31, article id S0266-6138(18)30277-8Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To describe women´s experiences and perceptions of giving birth in water.

    DESIGN: A qualitative study with in-depth interviews three to five months after the birth. A content analysis of the interviews was made.

    SETTING: One city-located hospital in Stockholm, offering waterbirth to low risk women.

    PARTICIPANTS: 20 women, 12 primiparas and 8 multiparas, aged 27-39.

    MEASUREMENTS AND FINDINGS: The overall theme emerging from the analysis was, "Like an empowering micro-home", which describes the effect of being strengthened, enabled and authorized in the birth process. Three categories were found: "Synergy between body and mind", "Privacy and discretion", and "Natural and pleasant".

    KEY CONCLUSIONS: The immersion in warm water provided the women with conditions that helped them to cope and feel confident during labour and birth. The homelike and limited space of a bathtub helped give a relaxed feeling of privacy, safety, control and focus for the women.

    IMPLICATIONS FOR PRACTICE: This study contributes to a deeper understanding of what waterbirth offers to women. For some women, waterbirth may be a way to accomplish an empowering and positive birth experience, and could work as a tool that preserves the normality of, and increases self-efficacy in, childbirth.

  • 2305.
    Ulfsdottir, Hanna
    et al.
    Sophiahemmet University.
    Saltvedt, Sissel
    Georgsson, Susanne
    Sophiahemmet University.
    Testing the waters: A cross-sectional survey of views about waterbirth among Swedish health professionals2019In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, article id S1871-5192(18)31645-7Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: For women with low risk births, waterbirth is an alternative that is requested and provided in approximately a hundred countries. However, in some countries, including Sweden, waterbirth is not generally available.

    AIM: To explore the experiences, knowledge and attitudes regarding waterbirth among midwives, obstetricians/gynaecologists and neonatologists.

    METHODS: A cross-sectional study was conducted in Sweden, using a web-based survey distributed via The Swedish Association of Midwives and the Heads of department of all Swedish maternity wards between April and June 2016. The respondents (n = 1609) answered a combination of Likert-scale and open-ended questions. The responses were analysed with descriptive statistics and quantitative content analyses.

    FINDINGS: Both midwives and physicians stated a lack of experience, knowledge and clinical guidelines related to attending and assisting waterbirths. Overall, midwives had more positive attitudes to waterbirth (38.8% vs 4.5%) as well as towards providing and implementing waterbirth, compared to physicians (71.0% vs 14.9%). Midwives stated significantly more benefits and fewer risks for women and babies, compared to physicians who requested more evidence.

    CONCLUSIONS: Opinions regarding waterbirth are to some extent based on attitudes rather than actual experience and knowledge. There are diverse interpretations of the strength of evidence and a lack of updating in the research field of waterbirth. As waterbirth is requested by women, health professionals need to update their knowledge in this topic in order to give coherent and evidence-based information and care to prospective parents.

  • 2306.
    Ulfsdottir, Hanna
    et al.
    Sophiahemmet University.
    Saltvedt, Sissel
    Georgsson, Susanne
    Sophiahemmet University.
    Waterbirth in Sweden - a comparative study2018In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 97, no 3, p. 341-348Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: The literature describes advantages for mothers giving birth in water, but waterbirth is controversial in Sweden and has not been offered at hospitals until recently. This study aimed to describe and compare the characteristics and outcome of waterbirths with spontaneous vaginal births at the same clinics.

    MATERIAL AND METHODS: A retrospective cohort study was conducted on all waterbirths at two maternity units in Sweden from March 2014 to November 2015 (n=306), and a consecutively selected comparison group of 306 women having conventional spontaneous vaginal births. Logistic regression was used to analyze the primary outcome; second-degree perineal tears.

    RESULTS: Women giving birth in water had a lower risk of second-degree perineal tears (adj. OR 0.6 [95% CI 0.4-0.9]). Their labor was shorter (6:03 hrs. vs 7:52 hrs.) and there were significantly less interventions than in the comparison group; amniotomy (13.7% vs. 35.3%), internal cardiotocography (11.1% vs.56.8%), and augmentation with oxytocin (5.2% vs.31.3%). There were no differences in Apgar scores or admissions to neonatal intensive care unit. The experience of childbirth, measured with a numeric rating scale, was higher in the waterbirth group indicating a more positive birth experience. Three newborns born in water had an umbilical cord avulsion.

    CONCLUSIONS: In this low-risk population, waterbirth is associated with positive effects on perineal tears, the frequency of interventions, the duration of labor and women's birth experience. Midwives handling waterbirth should be aware of the risk of umbilical cord avulsion. This article is protected by copyright. All rights reserved.

  • 2307.
    Ulfsdottir, Hanna
    et al.
    Sophiahemmet University.
    Saltvedt, Sissel
    Georgsson, Susanne
    Sophiahemmet University.
    Women's experiences of waterbirth and conventional uncomplicated birthsManuscript (preprint) (Other academic)
  • 2308.
    Ullgren, Helena
    Sophiahemmet University College.
    Per oral cancerbehandling: patientens följsamhet till ordination2011Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Användningen av per oral cancerbehandling har ökat de senaste åren. Per oral cancerbehandling är inte automatiskt förknippat med samma strikta riktlinjer som vid intravenös behandling, däremot så är biverkningsprofilen med allvarliga och ibland livshotande tillstånd i stort sett densamma. Forskning har visat att följsamheten till den per orala cancerbehandlingen varierar, ibland är låg och inte är bättre än andra kroniskt sjuka gruppers följsamhet. Patienten sköter till stor del behandlingen själv. Konsekvenserna av detta kan vara ett försämrat behandlingsresultat, risk för över resp. underdosering och oförutsägbara biverkningar. Mätning av följsamhet är komplext och det finns ingen standardiserad metod.                             

    Syftet med denna studie var att belysa faktorer som påverkar patienters följsamhet till läkemedelsordinationer med per oral cancerbehandling.

    Metoden var en en forskningsöversikt. Sökorden som användes var; oral administration, antineoplastic agents, patient compliance, nursing care, medication adherence, treatment compliance och drug administration methods. De databaser som söktes igenom var PubMed, Cinahl och PsykInfo (Ovid). Totalt så inkluderades 15 artiklar i resultatet.

    Resultatet visade att förekomst av biverkningar och svårighet att hantera dessa kunde hindra följsamhet. Ett samband mellan följsamhet och chansen till att behandlingen var verksam hittades. Andra faktorer som framkom var att yngre patienter kunde löpa högre risk för att inte följa ordinationen, följsamheten var till viss del lägre bland yngre patienter. Enstaka studier fann ett samband mellan var behandlingen gavs (universitetssjukhus eller andra vårdinrättningar) och socioekonomisk status. Utbildning kunde öka följsamheten enligt en studie. En studie visade att psykologisk hälsa hos patienten kunde påverka följsamheten.

    Slutsatsen var att följsamhet till per oral cancerbehandling beror på flera olika faktorer. Förekomst av biverkningar, patientens uppfattning om prognos och ålder kan påverka följsamheten. Socioekonomisk status, var behandlingen ges och psykologisk hälsa är faktorer som kan påverka följsamheten och behöver studeras vidare. Informationen måste vara individuell och samtal kring följsamhet kan vara av betydelse. Hantering av biverkningar och information kring konsekvenserna av en låg följsamhet behöver utvecklas. Vårdpersonalen behöver utbildas i vad som kan påverka följsamhet och vara lyhörda för eventuella missuppfattningar kring behandlingens effekt. Vikten av följsamhet bör tas upp av både läkare och sjuksköterskor och gärna tillsammans med anhöriga.

     

     

  • 2309. Unbeck, Maria
    et al.
    Sterner, Eila
    Sophiahemmet University.
    Elg, Mattias
    Fossum, Bjöörn
    Sophiahemmet University.
    Thor, Johan
    Pukk Härenstam, Karin
    Design, application and impact of quality improvement 'theme months' in orthopaedic nursing: a mixed method case study on pressure ulcer prevention2013In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 50, no 4, p. 527-35Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: While there is growing awareness of quality problems in healthcare systems, it remains uncertain how best to accomplish and sustain improvement over time.

    OBJECTIVE: To report on the design and application of quality improvement theme months in orthopaedic nursing, and evaluate the impact on pressure ulcer as an example.

    DESIGN: Retrospective mixed method case study with time series diagrams.

    SETTING: An orthopaedic department at a Swedish university hospital.

    METHOD: The interventions were led by nursing teams and focused on one improvement theme at a time in two-month cycles, hence the term 'improvement theme months'. These included defined objectives, easy-to-use follow-up measurement, education, changes to daily routines, "reminder months" and data feedback. The study draws on retrospective record data regarding one of the theme topics, pressure ulcer risk assessment and prevalence, in 2281 orthopaedic admissions during January 2007-October 2010 through point prevalence measurement one-day per month. Data were analysed in time series diagrams and through comparison to annual point prevalence data from mandatory county council-wide measurements prior to, during and after interventions from 2003 to 2010. By using document analysis we reviewed concurrent initiatives at different levels in the healthcare organisation and related them to the improvement theme months and their impact.

    RESULTS: The 46 monthly point prevalence samples ranged from 28 to 66 admissions. Substantial improvements were found in risk assessment rates for pressure ulcers both in the longitudinal follow-up (p<0.001) and in the annual county council-wide measurements. A reduction in pressure ulcer rate was observed in the annual county council-wide measurements. In the longitudinal data, wider variation in the pressure ulcer rate was seen (p<0.067); however, there was a significant decrease in pressure ulcer rates during the final ten-month period in 2010, compared to the baseline period in 2007 (p=0.004). Improvements were moderate the first years and needed reinforcement to be maintained.

    CONCLUSIONS: The theme month design and the way it was applied in this case showed potential, contributing to reduced pressure ulcer prevalence, as a way to conduct quality improvement initiatives in nursing. For sustainable improvement, multi component interventions are needed with regular monitoring and reminder efforts.

  • 2310. Unbeck, Maria
    et al.
    Sterner, Eila
    Sophiahemmet University.
    Elg, Mattias
    Fossum, Bjöörn
    Sophiahemmet University.
    Thor, Johan
    Pukk Härenstam, Karin
    'The value of Statistical Process Control in quality improvement contexts: Commentary on Unbeck et al. (2013)': Authors' response2014In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 51, no 2, p. 348-349Article in journal (Other academic)
  • 2311. Unbeck, Maria
    et al.
    Sterner, Eila
    Elg, Mattias
    Fossum, Bjöörn
    Sophiahemmet University.
    Thor, Johan
    PukkHärenstam, Karin
    Authors' response (Unbeck and colleagues)2015In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 52, no 1, p. 484-5; discussion 485Article in journal (Other academic)
  • 2312.
    Valdez Linder, Analyn
    Sophiahemmet University.
    Egenvårdshantering och informationsbehov hos personer med typ 2 diabetes: en litteraturöversikt2015Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    SAMMANFATTNING

    Diabetes är en global folksjukdom som kräver stora insatser från både personer med diabetes

    och vårdgivaren. Det krävs att personer med diabetes kan hantera sin egenvård för att ta

    kontroll över sjukdomen. De behöver också en uppdaterad kunskap gällande hur

    egenvårdshantering ska fungera för att uppnå välbefinnande. Likaväl krävs att vårdgivaren har

    kunskap för att hjälpa patienten på bästa möjliga sätt. Informationen individualiseras och

    anpassas till personens kunskap och förmåga.

    Syftet med litteraturöversikten var att beskriva faktorer som kan påverka egenvårdshantering

    samt informationsbehov hos personer med typ 2 diabetes.

    Litteraturöversikt användes som metod i den här studien och resultatet baserades på 15

    vetenskapliga original artiklar med kvantitativ och kvalitativ design. De 15 artiklarna söktes

    fram i databaserna PubMed och Cinahl.

    Sammanställning av resultatet från de 15 artiklarna visade olika faktorer som påverkade

    egenvård hos personer med typ 2 diabetes. De faktorerna är följande: kunskap, socialt stöd,

    psykologiska aspekter, socioekonomiska förhållanden, kommunikation, religion och kultur

    och vårdsystem. Informationen som patienten fick från vårdgivare upplevdes ofta att den var

    alltför generell. Patienter uttryckte sig i studierna att individuellt anpassad information behövs

    för att förbättra hantering av egenvård.

    Studien visade att individuellt anpassad information är viktig för personer med typ 2 diabetes.

    Det fanns flera faktorer, såsom kunskap, socialt stöd, psykologiska aspekter, socioekonomiska

    förhållanden, kommunikation, religion/kultur, kön och vårdsystem, som påverkade hantering

    av egenvård för personer med typ 2 diabetes. För att kunna få bra resultat av egenvård hos

    personer med typ 2 diabetes krävs att vårdsystemet fungerar väl och är lättillgängligt. Det är

    också viktigt att vårdgivare har ett holistiskt synsätt för att hjälpa dessa patienter.

  • 2313.
    Valijani, Vanessa
    Sophiahemmet University.
    Att undervisa och ge stöd till patienter med stomi: en litteraturöversikt2014Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund

    Vid inflammatorisk tarmsjukdom, ulcerös kolit, Crohns sjukdom och kolorektal cancer kan det bli aktuellt att patienten får en stomi. För den drabbade individen kan ofta en stomioperation leda till förändrad kroppsuppfattning och negativ inställning till sitt utseende. Både det psykiska och det fysiska välbefinnandet påverkas av att ha stomi. Sjuksköterskan har en viktig roll i arbetet med att göra patienten trygg och ge en bra vårdkvalitet.

     Syfte

     Syftet var att beskriva hur undervisning och stöd bäst kan ges av sjuksköterskan till patienter i samband med stomioperation utifrån patientens perspektiv.

     Metod

     För att besvara syftet valdes en litteraturstudie. Artikelsökningar gjordes via databaserna CINAHL, PsycINFO och PubMed, både kvantitativa och kvalitativa artiklar inkluderades i studien.

     Resultat

     Resultatet från artiklarna sammanställdes och presenterades i tre teman: Patientens upplevelse av stöd vid stomioperation, patientutbildningar vid stomioperation samt Sjuksköterskans roll i stomiutbildning. Studien visade att de flesta stomipatienter är nöjda med den vård de får i samband med operationen men mindre nöjda med den pre- och postoperativa informationen. En kombination av sjuksköterskans kunskaper och färdigheter är nödvändigt för att ge lämplig information och stöd till patienterna.

     Slutsats

     Utförlig information, stöd och rådgivning är viktiga faktorer som påverkar patientens välmående i samband med stomioperation. I denna litteraturstudie har det framkommit att stomipatienter är i behov av praktisk information för att själva hantera stomin. Sjuksköterskans ansvar är att hjälpa patienterna att förstå sin nya livssituation och kunna hantera sin egenvård på ett bra sätt. Sjuksköterskan bör inte koncentera sig enbart på fysiska symptom, utan måste också se patientens tillvaro som en helhet. Utförlig information, stöd och rådgivning är viktiga faktorer som påverkar patienternas välmående vid en stomioperation.

  • 2314.
    Valter, Ann-Sofie
    et al.
    Sophiahemmet University College.
    Wall, Erica
    Sophiahemmet University College.
    Kvinnors kroppsuppfattning och sexualitet efter en mastektomi2009Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 2315. Vasconcellos-Silva, Paulo Roberto
    et al.
    Sormunen, Taina
    Sophiahemmet University.
    Gransjön Craftman, Åsa
    Sophiahemmet University.
    Evolution of accesses to information on breast cancer and screeing on the Brazilian National Cancer Institute website: An exploratory study2018In: Ciência & Saúde Coletiva, ISSN 1413-8123, E-ISSN 1678-4561, Vol. 23, no 4, p. 1303-1312Article in journal (Refereed)
    Abstract [en]

    Delays in diagnosis due to low Breast Cancer awareness are widespread in Brazil maybe owing to ineffective strategies to raise attention on early diagnosis. As a proxy of collective interest in BC screanning (BCS) we studied the monthly accesses to BC and BCS webpages in INCA’s website along 48 months. A log analyzer built a time serie (2006-2009) of BC and BCS monthly means, which oscilations were studied by analysis of variance (ANOVA). We found significant increasing accesses to BC and transient "attention peaks". Enlargement in BC/BCS differences along all period were caused by increasing accesses to BC and decreasing/minor/stable oscillations to SBC pages. These results are consistent with previous reports on increasing interest to BC contrasting with indifference on BCS. In the context of an exploratory study, we discussed some aspects: weakness of a "prevention culture"; lack of confidence in health system and screening programs; "celebrity effect" in the context of media framing; collective perception of risks heightened by perception of social vulnerability. Findings suggest that culture-tailored communication strategies would be necessary to inform Brazilian people about BCS. Future research is needed to study social perceptions and constructions on BC topics.

  • 2316.
    Vernersdotter, Nina
    et al.
    Sophiahemmet University.
    Kukkola, Heli
    Sophiahemmet University.
    ”Att ha ett varm hjärta och hur du använder det”: omvårdnadspersonalens erfarenheter av omvårdnad i en palliativ kontext på en korttidsavdelning2016Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    SAMMANFATTNING

    Palliativ vård omfattar idag även andra sammanhang än hospicevård och vård för människor med cancersjukdom. Hospicevård har länge varit synonymt med vård i livets slut- palliativ vård och idag gör den palliativa vårdfilsofin sig gällande även för äldre människor inom kommunal omsorg. På en korttidsavdelning har patienterna många olika behov av omvårdnad och åtgärder relaterat till diagnos. När det finns avsedda platser för vård i livets slut, innebär det att omvårdnadspersonalen även ska arbeta utifrån en palliativ värdegrund. Omvårdnadspersonalen arbetar således i ett sammanhang med mångskiftande omvårdnadsåtgärder och behov.

    Studiens syfte varatt beskriva omvårdnadspersonalens erfarenheter av att vårda patienter i livets slutskede på en korttidsavdelning.

    En empirisk studie med kvalitativ ansats, vilken genomfördes med semistruktureradintervju i fokusgrupp. I studien deltog sex omvårdnadspersonalvilkaarbetade på en korttidsavdelning på ett vård-och omsorgsboende. Korttidsavdelningen deltog i ett projektmed platser för svårt sjuka äldre, med syfteatt vårda i livets slutskede.Analysen genomfördes med kvalitativ innehållsanalys och resulterade i en huvudkategori, två kategorier och fem underkategorier.

    Resultatetvisade att ett blandat patientklientelpå samma avdelning skapade en komplex arbetsmiljö för omvårdnadspersonalen. Ständiga växlingar av förhållningssätt, mellan patienter som vårdades i livets slutskede och patienter som vårdades på korttidsplats påverkade arbetsmiljön. Vidare framkomomvårdnadspersonalens synsätt, känslor och strategier i samband med vård av patienter ilivets slutskede.

    Studien visade omvårdnadspersonalens erfarenheter av att vårda svårt sjuka äldre i livets slutskede på en korttidsavdelning, samtidigt med andra patientklientel på avdelningen. Erfarenheterna visadeattständiga prioriteringar mellan olika patientklientel medförde att omvårdnadspersonalen upplevde känslor av otillräcklighet. Känslor av otillräcklighet var även ett skäl till att de inte ansåg sig uppfylla god vård i livets slutskede. Trots detta,visade det sig att studiens deltagare trivdes med sitt arbete på korttidsavdelningen. De fann det utmanande och intressant och att byta avdelning var inte ett alternativ för någon av deltagarna.Studiens resultat visar att det finns behov av att förbättra förutsättningarna för att kunna erbjuda platser för svårt sjuka äldre i livets slutskede i äldreomsorg.Detta är en viktig aspekt, utifrån möjligheten att kunna tillgodose god palliativ vård utifrån gällandenationella riktlinjer. Dock är intentionen med att kunna erbjuda platser för svårt sjuka äldre i livets slutskede, värd att begrunda.

  • 2317.
    Vikström, Anna
    Sophiahemmet University College.
    Faktorer som påverkar barns upplevelser av vårdmiljö2011Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Barn skrivs in på sjukhus när deras behandling och omvårdnad inte längre kan tillgodoses i hemmet. För barn innebär sjukhusvistelse stora förändringar i deras fysiska och emotionella liv. Barns begränsade förmåga till kognitivt tänkande kan göra förändringarna svåra att hantera. När barn har svårt att förstå och tolka vad som sker under en sjukhusvistelse kan det leda till lidande som kvarstår lång tid efter upplevelsen. En vårdmiljö som ser till barnets behov kan minska lidande under och efter en sjukhusvistelse. En bra planerad vårdmiljö tar hänsyn till barns utvecklingsmässiga, fysiska, sociala, psykiska och emotionella behov.

    Syftet var att belysa faktorer som påverkar barns upplevelser av vårdmiljö under en sjukhusvistelse.

    En litteraturbaserad studie valdes för att besvara föreliggande studies syfte. Artikelsökning genomfördes i databaserna PubMed och Cinahl. Totalt ingår 17 vetenskapliga artiklar i föreliggande studie.

    I resultatet framkom fyra huvudteman som påverkar barns upplevelse av vårdmiljö; miljö, omvårdnad, separation och begränsningar. Faktorer i miljön som påverkade barns upplevelser utgick från den fysiska och sociala miljön. Den fysiska miljön inkluderade maten, sängarna, ljus, ljud, lukter, temperatur, och rummens utformning. Faktorerna hade betydelse för barns känsla av bekvämlighet, välbefinnande, trygghet och säkerhet. Barn visade behov av social kontakt med andra barn och vuxna i en miljö som var anpassad för lek och aktivitet. Möjligheten till aktivitet gjorde att barn fick en känsla av trygghet och säkerhet under sjukhusvistelsen. Barn hade behov av att känna tillförlitlighet i omvårdnadsmötet och viktiga egenskaper hos sjuksköterskan var bland annat professionell kompetens och kommunikativa färdigheter. Tillförlitligheten gjorde att barn blev tryggare under sjukhusvistelsen. Sjukhusvistelsen orsakade separation från familj, vänner och skola och störde vardagliga rutiner. Barn hade behov av att vara nära sin familj under sjukhusvistelse eftersom de hade en viktig roll i att tillhandhålla en känsla av trygghet. Under sjukhusvistelse upplevde barn en förlust av självbestämmande. De beskrev förlorad kontroll över bland annat personliga behov och rutiner.

    Sammanfattningsvis framkom att betydande faktorer för barns upplevelse av vårdmiljö var miljö, sjuksköterskan, separation och förlust av självbestämmande. Faktorerna förorsakade både negativa och positiva upplevelser under sjukhusvistelsen. Att tillgodose barns behov av aktivitet, information, delaktighet, tillit, närhet och integritet kunde urskiljas som betydande aspekter för upplevelsen av vårdmiljö.

  • 2318.
    Vilson Fritz, Nathalie
    et al.
    Sophiahemmet University.
    Wöllner, Ki
    Sophiahemmet University.
    Det där brukar vi hoppa över...: sjuksköterskans samtal med patienten om sexuell hälsa, vad hindrar och vad främjar?2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 2319.
    Voghoui, Mehran
    et al.
    Sophiahemmet University.
    Voghoui, Minna
    Sophiahemmet University.
    Motiverande samtal som ett verktyg för sjuksköterskan inom den psykiatriska vården och inom beroendevården: en litteraturstudie2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Forskning har visat att Motiverande samtal, Motivational interviewing (MI), främjar delaktighet, följsamhet till ordinerad läkemedelsbehandling och positiva livsstilsförändringar hos patienter. Inom den psykiatriska sluten–och öppenvården samt beroendevården möter sjuksköterskor patienter med allvarliga psykiatriska sjukdomar samt beroendesjukdomar såsom alkoholberoende.

    Forskning visar att följsamheten till ordinerad behandling är generellt låg vilket ofta leder till en försämring och återinläggning inom slutenvården. Gemensamt för många av dessa personer är att de är i behov av positiva livsstilsförändringar och bland annat i behov av att sjuksköterskor motiverar patienterna att följa ordinerad läkemedelsbehandling.

    Syftet var att undersöka betydelsen av MI vid psykisk sjukdom samt vid drogberoende för att möjliggöra en positiv livsstilsförändring.

    En litteraturstudie valdes som metod för att sammanställa befintlig forskning kring det valda problemområdet. Vetenskapliga artiklar söktes via databaserna Cinahl och PsycINFO. Sexton vetenskapliga artiklar inkluderades i resultatet.

    Resultatet visade att MI hade betydelse i att förbättra följsamheten till behandling och förhöjde motivationen bland patienterna till att göra positiva livsstilsförändringar inom beroendevården samt inom psykiatrin. MI hade positiv effekt vid rökavvänjning, missbruksproblematik och vid följsamhet till ordinerad läkemedelsbehandling.

    Slutsatsen var att MI enskilt eller kombinerad med andra behandlingsmetoder kan användas av sjuksköterskor inom den psykiatriska- och beroendesjukvården för att möjliggöra en positiv livsstilsförändring bland patienterna.

  • 2320.
    von Gohren Antequera, José
    et al.
    Sophiahemmet University.
    Willis, Lydia
    Sophiahemmet University.
    Föräldrars erfarenhet av stöd då deras barn vårdas på sjukhus: en litteraturöversikt2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund

    Det finns barn över hela världen som behöver vårdas på sjukhus, enbart i Sverige rör det sig om 95 000 barn varje år. När barn vårdas på sjukhus medför det stora konsekvenser som drabbar såväl barnet som familj och närstående. Sjuksköterskan behöver därför erhålla kunskap för att kunna ge stöd och omvårdnad till både barnet och föräldrar i en svår situation.

    Syfte

    Att beskriva föräldrars erfarenheter av sjuksköterskans stöd då deras barn vårdas på sjukhus.

    Metod

    Det här arbetet använde sig av metoden litteraturöversikt. Till detta användes 15 artiklar och sökningarna gjordes i databaserna Cinahl och PubMed.

    Resultat

    Resultatet visade på att föräldrar var i behov av sjuksköterskans stöd under barnets vårdtid. Sjuksköterskans stöd gavs i form av information, att föräldrarna fick vara delaktiga och att deras behov respekterades. Med hjälp av detta kunde en tillitsfull relation uppstå mellan parterna, vilket ledde till att sjuksköterskan även kunde ge stöd på en mer emotionell nivå. Det fanns dock föräldrar som inte fick utförlig information, exkluderades från att medverka i vården och som inte kände sig sedda av vårdpersonalen.

    Slutsats

    Föräldrar till barn som vårdas på sjukhus har olika behov av stöd. Till stor del handlar dessa behov om att få korrekt och utförlig information om vad som kommer att ske samt en kontinuerlig uppdatering av barnets sjukdomstillstånd. De flesta föräldrar uppskattar även en öppen och ärlig kommunikation samt att få vara med och påverka vården av barnet.

  • 2321.
    Väisänen, Katarina
    et al.
    Sophiahemmet University College.
    Westberg, Suzanne
    Sophiahemmet University College.
    Sjuksköterskans arbete enligt omvårdnadsprocessen på sjuksköterskebaserad hjärtsviktsmottagning: ett omvårdnadsteoretiskt pespektiv utifrån Imogene King´s teori om måluppfyllelse2002Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 2322.
    Västerbo, Liselotte
    Sophiahemmet University College.
    Smärta och palpationssmärta hos patienter med inneliggande perifer venkateter2010Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
  • 2323.
    Wadman, Emma
    et al.
    Sophiahemmet University College.
    Westin, Emma
    Sophiahemmet University College.
    Att ge asylsökande vård2007Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 2324.
    Wahlberg, Camilla
    Sophiahemmet University College.
    Sambandet mellan patienternas inställning/attityd till läkemedel/läkemedelsbehandling och följsamhet studie: en kvantitativ intervjubaserad studie2004Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 2325.
    Wahlbäck, Jennny
    Sophiahemmet University College.
    Akupunkturens effekter på välbefinnande / livskvalitet vid smärta och sjukdom2003Independent thesis Basic level (degree of Bachelor), 5 credits / 7,5 HE creditsStudent thesis
  • 2326.
    Wahlström, Maria
    Sophiahemmet University.
    Effects of MediYoga among patients with paroxysmal atrial fibrillation2019Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Introduction

    Patients with paroxysmal atrial fibrillation often experience impaired health-related quality of life. Standard treatment is not always sufficient and changes in life-style habits are suggested as a complement. Also, studies have suggested differences in gender where women have extended side effects of rhythm medications, more symptoms and estimate lower health-related quality of life than men. Yoga has been shown to increase health-related quality of life and decrease blood pressure, heart rate and cardiac biomarkers. The overall aim of this thesis was to study the effects of MediYoga among patients with paroxysmal atrial fibrillation. In addition, to evaluate perceptions and experiences of MediYoga as well as gender differences.

    Methods and results

    Paper I: This is a randomized, controlled pilot study in which 80 patients were randomized to MediYoga, n=40, or a control group, n=40 at an University Hospital, in Stockholm, Sweden. The yoga groups had been performing MediYoga for one hour/week over a 12 weeks period. Assessments as health-related quality of life questionnaires (i.e. SF-36, EQ-5D Visual Analogue Scale), blood pressure and heart rate were collected at baseline and at the end of study. The results showed an improvement of health-related quality of life in the yoga group. Blood pressure and heart rate also decreased in the yoga group.

    Paper II: In this prospective randomized study at an University Hospital, Stockholm, Sweden, with stratification in gender, 132 patients, with symptomatic PAF, were randomized to yoga (n=44), relaxation (n=44) and a control group (n=44). The yoga groups had been performing MediYoga for one hour/week over a 12 weeks period. Assessments as health-related quality of life questionnaires (i.e. SF-36, ASTA), blood pressure, heart rate as well as NT-proBNP were collected at baseline and at the end of the study. The results showed no differences in the ASTA and SF-36 between the groups. However, improvements were seen in health-related quality of life, SF-36, with-in the MediYoga group. Both systolic and diastolic blood pressure decreased in the MediYoga group compared to the control group but there was no difference compared to the relaxation group. There were no differences in heart rate and NT-proBNP between or with-in the groups after 12 weeks.

    Paper III: A study with a qualitative design was conducted using individual semistructured interviews. The study included 12 participants (7 men and 5 women) who had participated in the yoga group in Paper II. The data were analysed using qualitative content analysis with an inductive method and a manifest approach. Three categories were found in the analysis; “A time for a sense of existence and presence”, “A way of gaining well-being and increased consciousness” and “Access to a tool to gain willpower and relieve symptoms”.

    Paper IV: A comparative design examining gender differences among those who had performed MediYoga (women n=37, men n=34). The yoga groups had been performing MediYoga for one hour/week over a 12 weeks period. Data (i.e healthrelated quality of life [SF-36], blood pressure and heart rate) were collected at baseline and the end of the study. There were no differences between the women or men group in SF-36 at end of study, however, there was improvement with-in the women group in the subscales vitality, social function, mental health and the domain mental component summary score. In the male group, there were improvement within the subscales role-physical, bodily pain, general health, vitality, social function, role-emotion and the domain mental component summary score (SF-36). There were no differences between the groups in systolic and diastolic blood pressure as well as heart rate at the end of the study. With-in the women group differences were observed in systolic and diastolic blood pressure, however, no difference was seen in heart rate. With-in the men group improvement were seen in diastolic blood pressure but no differences were seen in systolic blood pressure or heart rate.

    Conclusions

    MediYoga improves health-related quality of life as well as blood pressure among patients with PAF. Also, both genders report benefits, and patients describe MediYoga as an accessible tool with which to handle emotions and symptoms. MediYoga may be a part of a self-management program, as a complementary treatment, among patients with PAF.

  • 2327.
    Wahlström, Maria
    et al.
    Sophiahemmet University.
    Medin, Jörgen
    Sophiahemmet University.
    Rydell Karlsson, Monica
    Differences in gender in health-related quality of life, blood pressure and heart rate among patients with paroxysmal atrial fibrillation after performning MediYogaManuscript (preprint) (Other academic)
  • 2328.
    Wahlström, Maria
    et al.
    Sophiahemmet University.
    Rosenqvist, Mårten
    Medin, Jörgen
    Walfridsson, Ulla
    Rydell Karlsson, Monica
    MediYoga as a part of self-management program among patients with Paroxysmal Atrial FibrillationManuscript (preprint) (Other academic)
  • 2329.
    Wahlström, Maria
    et al.
    Sophiahemmet University.
    Rosenqvist, Mårten
    Medin, Jörgen
    Walfridsson, Ulla
    Rydell-Karlsson, Monica
    MediYoga as a part of a self-management programme among patients with paroxysmal atrial fibrillation - a randomised study2019In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, article id 1474515119871796Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Paroxysmal atrial fibrillation is associated with impaired health-related quality of life. Yoga has been suggested to improve health-related quality of life among patients with heart failure and hypertension.

    AIM: The aim of the study was to evaluate the effects of MediYoga, in respect of health-related quality of life, blood pressure, heart rate, as well as N-terminal pro b-type natriuretic peptide, among patients with symptomatic paroxysmal atrial fibrillation, compared with standard therapy or relaxation.

    METHODS: Patients with symptomatic paroxysmal atrial fibrillation, n=132, were stratified for gender and randomised to MediYoga, a relaxation group or a control group, 44 patients per group with a 12-week follow-up. Health-related quality of life, blood pressure, heart rate and N-terminal pro b-type natriuretic peptide were assessed.

    RESULTS: After 12 weeks, there were no differences in health-related quality of life between the groups. There were improvements in Short-Form Health Survey bodily pain, general health, social function, mental health and mental component summary scores within the MediYoga group (p=0.014, p=0.037, p=0.029, p=0.030, p=0.019, respectively). No change was seen in the relaxation and control groups. Systolic blood pressure decreased in the MediYoga group (134±18 to 127±13) compared with the control group (126±17 to 127±15, p=0.041); no difference compared with the relaxation group (131±17 to 125±12). Diastolic blood pressure decreased in the MediYoga group (79±9 to 74 ±9) compared with the control group (76±9 to 79±8, p=0.005); no difference compared with the relaxation group (76±9 to 77±8). There were no differences in heart rate and N-terminal pro b-type natriuretic peptide between the groups after 12 weeks.

    CONCLUSIONS: MediYoga improves health-related quality of life and decreases blood pressure in patients with paroxysmal atrial fibrillation. MediYoga may be used as a part of a self-management programme among patients with paroxysmal atrial fibrillation.

  • 2330.
    Wahlström, Maria
    et al.
    Sophiahemmet University.
    Rydell Karlsson, Monica
    Medin, Jörgen
    Sophiahemmet University.
    Perceptions and experiences of MediYoga among patients with paroxysmal atrial fibrillation: An interview study2018In: Complementary Therapies in Medicine, ISSN 0965-2299, E-ISSN 1873-6963, Vol. 41, p. 29-34, article id S0965-2299(18)30040-2Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: We investigated the perceptions and experiences of a therapeutic yoga form, MediYoga, which is evolved from Kundaliniyoga among patients with symptomatic paroxysmal atrial fibrillation (PAF).

    DESIGN AND SETTING: an inductive exploratory design was chosen with individual semi-structured interviews. The study was conducted with 12 participants (7 men and 5 women, average age 63.5) at a university hospital, Sweden. Informed consent was obtained from all participants. The data were analyzed using a qualitative content analysis with an inductive method and a manifest approach.

    RESULTS: Three categories were found in the analysis. In the category "A time for a sense of existence and presence", the patients described an increased thoughtfulness and experiences of gaining access to an inner self. The category "A way of gaining well-being and increased consciousness" describes patients` feelings of relaxation and feeling of comfort, with components of mental and physical well-being. Furthermore, "Access to a tool to gain willpower and relieve symptoms" describes the perceptions from patients to obtained access to a tool for handling the emotions, such as fear and anxiety, as well as symptoms that they could struggling with between, and during, their episodes of atrial fibrillation. No adverse events were reported by the yoga group, during the study.

    CONCLUSIONS: Patients with PAF described MediYoga as an accessible tool to manage emotions and symptoms related to episodes of AF. MediYoga may also assist in enhancing body awareness, whereby physical, mental and spiritual components are integrated. MediYoga may strengthen self-management among patients with PAF.

  • 2331.
    Wahlström, Maria
    et al.
    Sophiahemmet University.
    Rydell Karlsson, Monica
    Sophiahemmet University.
    Medin, Jörgen
    Sophiahemmet University.
    Frykman, Viveka
    Effects of yoga in patients with paroxysmal atrial fibrillation - a randomized controlled study.2016In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, no 1, p. 57-63Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Patients with atrial fibrillation often have an impaired quality of life (QoL). Practising yoga may decrease stress and have positive effects on mental and physical health. The aim of this study was to investigate whether yoga can improve QoL and decrease blood pressure and heart rate in patients with paroxysmal atrial fibrillation (PAF).

    METHODS: In this pilot study, 80 patients diagnosed with PAF were randomized to standard treatment (control group, n=40) or standard treatment in combination with yoga (yoga group, n=40) during a 12-week period. QoL, blood pressure and heart rate were evaluated at baseline and at the end of the study (12 (+2) weeks). EuroQoL-5D (EQ-5D) Visual Analogue Scale (VAS) and the two dimensions in Short-Form Health Survey (SF-36) were used to evaluate QoL.

    RESULTS: At baseline there was a significant difference in QoL between the groups in EQ-5D VAS- scale (p=0.02) and SF-36 mental health score (p<0.001) in which the control group had higher scores. At the end of the study, the yoga group averaged higher SF-36 mental health scores. There was a significant difference between the two groups (p=0.016), but no differences in EQ-5D VAS- scale and physiological health score was seen between the two groups. At the end of the study, the yoga group had significantly lower heart rate (p=0.024) and systolic (p=0.033) and diastolic blood pressure (p<0.001) compared to the control group.

    CONCLUSIONS: Yoga with light movements and deep breathing may lead to improved QoL, lower blood pressure and lower heart rate in patients with PAF compared to a control group. Yoga could be a complementary treatment method to standard therapy.

  • 2332. Walker, Jenelle R
    et al.
    Soroush, Ali
    Ainsworth, Barbara E
    Belyea, Michael
    Swan, Pamela D
    Yngve, Agneta
    Sophiahemmet University.
    U.S. Cohort Differences in Body Composition Outcomes of a 6-Month Pedometer-Based Physical Activity Intervention: The ASUKI Step Study2014In: Asian journal of Sports Medicine, ISSN 2008-000X, E-ISSN 2008-7209, Vol. 5, no 4, p. e25748-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Regular physical activity (PA) enhances health and is an important factor in disease prevention and longevity. The 2008 U.S. Physical Activity Guidelines recommends that all healthy adults attain at least 150 minutes per week of moderate intensity aerobic PA (e.g., brisk walking) to maintain and promote PA.

    OBJECTIVES: This study determined the effects of a 6-month pedometer-based worksite walking intervention with participants focusing on a goal of achieving 10,000 steps per day, on body composition in adults with a wide range of body mass index (BMI) values and compares the changes with outcomes of similar studies.

    MATERIALS AND METHODS: The design was a single group, quasi-experimental study. All participants received a pedometer and were asked to register the daily number of steps. Men and women (n = 142; age = 41 ± 11.5 years; BMI = 27.2 ± 7.25 kg.m(-2)) received body composition measures at 1, 3, and 6 months. A multilevel growth modeling approach was used to explore change over time and to predict change by steps, age, gender, and fat category categorized as normal and overweight/obese.

    RESULTS: Significant individual differences in linear slopes and change over time were observed for waist circumference (WC) (-3.0 cm) only in unconditional model (t = -0.67, P = 0.02).

    CONCLUSIONS: A 3.0 cm loss in WC shows that a 10,000 step per day walking program has the potential to influence changes in body composition measures that are correlated with adverse health outcomes. While significant changes did occur there are some limitations. The analysis did not consider the data regarding completing of 10,000 steps per day and other potential factors that could influence the results. Compliance to the walking dose and initial physical activity and body composition levels are important to consider when studying body composition changes in such programs.

  • 2333.
    Wallberg, Maria
    Sophiahemmet University.
    Faktorer som kan påverka den nyutbildade sjuksköterskans utveckling i sin professionella roll: en litteraturöversikt2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Sammanfattning

    Hälso- och sjukvården ska bedrivas så att kraven på en god vård uppfylls. Det krävs därmed ett tydligt ledarskap på alla nivåer. Sjuksköterskan ska planera och organisera omvårdnaden för patienterna vilket innebär att kunna bedöma patientens behov, prioritera och samordna patientens vård och behandling, leda teamet och vara ett stöd till övrig personal. Vården ska bedrivas med goda kontakter mellan patient och personal.

    Syftet var att belysa faktorer som kan stödja eller hindra nyutbildade sjuksköterskor att utveckla sin professionella roll inom slutenvården.

    Litteraturöversikt valdes som metod. Sökning av artiklarna gjordes i PubMed, CINAHL samt manuell sökning. Artiklarna var publicerad mellan 2007 – januari 2018. Fjorton artiklar valdes utifrån inklusions- och exklusionskriterier. Artiklarna bedömdes, analyserades, sammanställdes och presenterades i en artikelmatris.

    Resultatet visade att de nyutbildade sjuksköterskorna behövde en god introduktion, mycket stöd och uppmuntran från chefsjuksköterska och kollegor samt att arbetsmiljön var bra, så att de nyutbildade sjuksköterskorna vågade fråga. Den nyutbildade sjuksköterskans förmåga att leda upplevdes som en ständig pågående process. För att klara av ledarskapsrollen behövde den nyutbildade sjuksköterskan ha överblick, känna patienterna, känna medarbetarna och kunna delegera.

    Slutsatsen var att det är ett stort steg från studentrollen till arbetet som nyutbildad sjuksköterska med mycket ansvar och krav. De nyutbildade sjuksköterskorna hade inte all kunskap för de olika situationer som uppkom på en vårdavdelning. Men ju mer erfarenhet och kunskap som de nyutbildade sjuksköterskorna utvecklar över tiden desto säkrare blev de i sin professionella roll vilket även ledde till en ökad förmåga att kunna leda teamet i omvårdnadsarbetet. För att kunna leda teamet behövde de nyutbildade sjuksköterskorna få en överblick över situationen, kunna patienterna, känna medarbetarna samt delegera.En stödjande arbetsmiljön hade betydelse för de nyutbildade sjuksköterskorna såsom att kollegorna visade respekt, tolerans och omtänksamhet mot de nyutbildade sjuksköterskorna. Den stödjande arbetsmiljön medförde även att de nyutbildade sjuksköterskorna vågade fråga sina kollegor vid problem samt att de nyutbildade sjuksköterskornas självförtroende ökadeViktigt att chefsjuksköterskan är positiv till de nyutbildade sjuksköterskor och att chefsjuksköterskan har korta avstämningsmöten under introduktionen för att fånga upp om något inte är bra såsom handledning, kollegor eller arbetsmiljö samt att de nyutbildade sjuksköterskorna får återkoppling till sitt arbete.

    Nyckelord: ledarskap, nyutbildad sjuksköterska, omvårdnad, teamarbete

  • 2334.
    Wallin Lundell, Inger
    Sophiahemmet University.
    Induced Abortions and Posttraumatic Stress - Is there any relation?: A Swedish multi-centre study2014Doctoral thesis, comprehensive summary (Other academic)
    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

  • 2335. Wallin Lundell, Inger
    et al.
    Frans, Örjan
    Helström, Lotti
    Högberg, Ulf
    Moby, L
    Nyberg, S
    Sundström Poromaa, Inger
    Sydsjö, Gunilla
    Georgsson Öhman, Susanne
    Sophiahemmet University.
    Östlund, I
    Skoog Svanberg, Agneta
    Post-traumatic stress disorder among women requesting induced termination of pregnancy: a Swedish multi-centre study2012In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 119, no S2, p. 2-2Article in journal (Other academic)
  • 2336.
    Wallin Lundell, Inger
    et al.
    Sophiahemmet University.
    Georgsson, Susanne
    Sophiahemmet University.
    Sundström Poromaa, Inger
    Högberg, Ulf
    Sydsjö, Gunilla
    Skoog Svanberg, Agneta
    How women perceive abortion care: A study focusing on healthy women and those with mental and posttraumatic stress.2016Conference paper (Other academic)
  • 2337.
    Wallin Lundell, Inger
    et al.
    Sophiahemmet University.
    Georgsson, Susanne
    Sophiahemmet University.
    Sundström Poromaa, Inger
    Högberg, Ulf
    Sydsjö, Gunilla
    Skoog Svanberg, Agneta
    How women perceive abortion care: A study focusing on healthy women and those with mental and posttraumatic stress.2016Conference paper (Other academic)
  • 2338.
    Wallin Lundell, Inger
    et al.
    Sophiahemmet University.
    Georgsson, Susanne
    Sophiahemmet University.
    Sundström Poromaa, Inger
    Högberg, Ulf
    Sydsjö, Gunilla
    Skoog Svanberg, Agneta
    How women perceive abortion care: A study focusing on healthy women and those with mental and posttraumatic stress2016Conference paper (Other academic)
  • 2339.
    Wallin Lundell, Inger
    et al.
    Sophiahemmet University.
    Georgsson Öhman, Susanne
    Sophiahemmet University.
    Frans, Örjan
    Helström, Lotti
    Högberg, Ulf
    Nyberg, Sigrid
    Sundström Poromaa, Inger
    Sydsjö, Gunilla
    Östlund, Ingrid
    Skoog Svanberg, Agneta
    Posttraumatic stress among women after induced abortion: a Swedish multi-centre cohort study2013In: BMC women's health, ISSN 1472-6874, Vol. 13, p. 52-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Induced abortion is a common medical intervention. Whether psychological sequelae might follow induced abortion has long been a subject of concern among researchers and little is known about the relationship between posttraumatic stress disorder (PTSD) and induced abortion. Thus, the aim of the study was to assess the prevalence of PTSD and posttraumatic stress symptoms (PTSS) before and at three and six months after induced abortion, and to describe the characteristics of the women who developed PTSD or PTSS after the abortion.

    METHODS: This multi-centre cohort study included six departments of Obstetrics and Gynaecology in Sweden. The study included 1457 women who requested an induced abortion, among whom 742 women responded at the three-month follow-up and 641 women at the six-month follow-up. The Screen Questionnaire-Posttraumatic Stress Disorder (SQ-PTSD) was used for research diagnoses of PTSD and PTSS, and anxiety and depressive symptoms were evaluated by the Hospital Anxiety and Depression Scale (HADS). Measurements were made at the first visit and at three and six months after the abortion. The 95% confidence intervals for the prevalence of lifetime or ongoing PTSD and PTSS were calculated using the normal approximation. The chi-square test and the Student's t-test were used to compare data between groups.

    RESULTS: The prevalence of ongoing PTSD and PTSS before the abortion was 4.3% and 23.5%, respectively, concomitant with high levels of anxiety and depression. At three months the corresponding rates were 2.0% and 4.6%, at six months 1.9% and 6.1%, respectively. Dropouts had higher rates of PTSD and PTSS. Fifty-one women developed PTSD or PTSS during the observation period. They were young, less well educated, needed counselling, and had high levels of anxiety and depressive symptoms. During the observation period 57 women had trauma experiences, among whom 11 developed PTSD or PTSS and reported a traumatic experience in relation to the abortion.

    CONCLUSION: Few women developed PTSD or PTSS after the abortion. The majority did so because of trauma experiences unrelated to the induced abortion. Concomitant symptoms of depression and anxiety call for clinical alertness and support.

  • 2340.
    Wallin Lundell, Inger
    et al.
    Sophiahemmet University.
    Georgsson Öhman, Susanne
    Sophiahemmet University.
    Sundström Poromaa, Inger
    Högberg, Ulf
    Sydsjö, Gunilla
    Skoog Svanberg, Agneta
    How women perceive abortion care: A study focusing on healthy women and those with mental and posttraumatic stress2015In: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 20, no 3, p. 211-222Article in journal (Refereed)
    Abstract [en]

    Objectives To identify perceived deficiencies in the quality of abortion care among healthy women and those with mental stress. Methods This multi-centre cohort study included six obstetrics and gynaecology departments in Sweden. Posttraumatic stress (PTSD/PTSS) was assessed using the Screen Questionnaire-Posttraumatic Stress Disorder; anxiety and depressive symptoms, using the Hospital Anxiety Depression Scale; and abortion quality perceptions, using a modified version of the Quality from the Patient's Perspective questionnaire. Pain during medical abortion was assessed in a subsample using a visual analogue scale. Results Overall, 16% of the participants assessed the abortion care as being deficient, and 22% experienced intense pain during medical abortion. Women with PTSD/PTSS more often perceived the abortion care as deficient overall and differed from healthy women in reports of deficiencies in support, respectful treatment, opportunities for privacy and rest, and availability of support from a significant person during the procedure. There was a marginally significant difference between PTSD/PTSS and the comparison group for insufficient pain alleviation. Conclusions Women with PTSD/PTSS perceived abortion care to be deficient more often than did healthy women. These women do require extra support, relatively simple efforts to provide adequate pain alleviation, support and privacy during abortion may improve abortion care.

  • 2341.
    Wallin Lundell, Inger
    et al.
    Sophiahemmet University.
    Sundström Poromaa, Inger
    Ekselius, Lisa
    Georgsson, Susanne
    Sophiahemmet University.
    Frans, Örjan
    Helström, Lotti
    Högberg, Ulf
    Skoog Svanberg, Agneta
    Neuroticism-related personality traits are associated with posttraumatic stress after abortion: findings from a Swedish multi-center cohort study2017In: BMC Women's Health, ISSN 1472-6874, E-ISSN 1472-6874, Vol. 17, no 1, article id 96Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Most women who choose to terminate a pregnancy cope well following an abortion, although some women experience severe psychological distress. The general interpretation in the field is that the most consistent predictor of mental disorders after induced abortion is the mental health issues that women present with prior to the abortion. We have previously demonstrated that few women develop posttraumatic stress disorder (PTSD) or posttraumatic stress symptoms (PTSS) after induced abortion. Neuroticism is one predictor of importance for PTSD, and may thus be relevant as a risk factor for the development of PTSD or PTSS after abortion. We therefore compared Neuroticism-related personality trait scores of women who developed PTSD or PTSS after abortion to those of women with no evidence of PTSD or PTSS before or after the abortion.

    METHODS: A Swedish multi-center cohort study including six Obstetrics and Gynecology Departments, where 1294 abortion-seeking women were included. The Screen Questionnaire-Posttraumatic Stress Disorder (SQ-PTSD) was used to evaluate PTSD and PTSS. Measurements were made at the first visit and at three and six month after the abortion. The Swedish universities Scales of Personality (SSP) was used for assessment of Neuroticism-related personality traits. Multiple logistic regression analyses were performed to investigate the risk factors for development of PTSD or PTSS post abortion.

    RESULTS: Women who developed PTSD or PTSS after the abortion had higher scores than the comparison group on several of the personality traits associated with Neuroticism, specifically Somatic Trait Anxiety, Psychic Trait Anxiety, Stress Susceptibility and Embitterment. Women who reported high, or very high, scores on Neuroticism had adjusted odds ratios for PTSD/PTSS development of 2.6 (CI 95% 1.2-5.6) and 2.9 (CI 95% 1.3-6.6), respectively.

    CONCLUSION: High scores on Neuroticism-related personality traits influence the risk of PTSD or PTSS post abortion. This finding supports the argument that the most consistent predictor of mental disorders after abortion is pre-existing mental health status.

  • 2342.
    Wallin Lundell, Inger
    et al.
    Sophiahemmet University.
    Sundström Poromaa, Inger
    Ekselius, Lisa
    Georgsson Öhman, Susanne
    Sophiahemmet University.
    Frans, Örjan
    Helström, Lotti
    Högberg, Ulf
    Sydsjö, Gunilla
    Skoog Svanberg, Agneta
    Neuroticism-related personality traits are associated with post-abortion posttraumatic stress2014In: Archives of Women's Mental Health, ISSN 1434-1816, E-ISSN 1435-1102Article in journal (Refereed)
  • 2343.
    Wallin Lundell, Inger
    et al.
    Sophiahemmet University.
    Sundström Poromaa, Inger
    Frans, Örjan
    Helström, Lotti
    Högberg, Ulf
    Moby, Lena
    Nyberg, Sigrid
    Sydsjö, Gunilla
    Georgsson Öhman, Susanne
    Sophiahemmet University.
    Östlund, Ingrid
    Skoog Svanberg, Agneta
    The prevalence of posttraumatic stress among women requesting induced abortion2013In: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 18, no 6, p. 480-8Article in journal (Refereed)
    Abstract [en]

    Objectives To describe the prevalence and pattern of traumatic experiences, to assess the prevalence of posttraumatic stress disorder (PTSD) and posttraumatic stress symptoms (PTSS), to identify risk factors for PTSD and PTSS, and to analyse the association of PTSD and PTSS with concomitant anxiety and depressive symptoms in women requesting induced abortion. Methods A Swedish multi-centre study of women requesting an induced abortion. The Screen Questionnaire - Posttraumatic Stress Disorder was used for research diagnoses of PTSD and PTSS. Anxiety and depressive symptoms were evaluated by the Hospital Anxiety and Depression Scale (HADS). Results Of the 1514 respondents, almost half reported traumatic experiences. Lifetime- and point prevalence of PTSD were 7% (95% confidence interval [CI]: 5.8-8.5) and 4% (95% CI: 3.1-5.2), respectively. The prevalence of PTSS was 23% (95% CI: 21.1-25.4). Women who reported symptoms of anxiety or depression when requesting abortion were more likely to have ongoing PTSD or PTSS. Also single-living women and smokers displayed higher rates of ongoing PTSD. Conclusions Although PTSD is rare among women who request an induced abortion, a relatively high proportion suffers from PTSS. Abortion seeking women with trauma experiences and existing or preexisting mental disorders need more consideration and alertness when counselled for termination.

  • 2344.
    Wallin, Mette
    et al.
    Sophiahemmet University College.
    Ekwurtzel Johansson, Anna
    Sophiahemmet University College.
    Att delta i en klinisk studie eller inte: Faktorer som påverkar beslutet att delta i en klinisk studie för patienter med cancersjukdom2012Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Under 2010 diagnostiserades 55342 personer i Sverige med cancer. Cancersjukdom behandlas med kirurgi, strålbehandling, cytostatika, immunterapi, hormonbehandling och målsökande behandlingar. För att säkerställa att nya behandlingsmetoder är bättre än nuvarande metoder provas de i kliniska studier. Forskning på människor är omgärdat av flera etiska principer, riktlinjer och lagar. I kliniska studier anses inklusionen av deltagare vara en av de mest krävande delarna. Inte alla patienter kan inkluderas i kliniska studier på grund av strikta inklusions- och exklusionskriterier, men även bland de som kan inkluderas väljer vissa att inte delta.

    Syftet var att belysa faktorer som kan påverka beslut att delta i kliniska studier hos personer med cancersjukdom.

    Som metod till arbetet valdes forskningsöversikt. Vetenskapliga artiklar söktes i databaserna PubMed och Cinahl. Sexton artiklar inkluderades i resultatet.

    Resultatet visade att de vanligaste faktorerna som påverkade beslutet att delta i en klinisk studie var altruism, personliga medicinska fördelar och nackdelar, information, relation till vårdpersonal samt anhöriga. En enskild faktor var sällan avgörande utan en kombination av flera faktorer tillsammans ledde fram till beslutet om deltagande i klinisk studie eller inte.

    Slutsatsen var att många olika faktorer har betydelse för om en patient med cancersjukdom väljer att delta i en klinisk studie eller inte. Det gick inte att hitta ett övergripande skäl till att patienterna väljer att delta i en klinisk studie eller inte.

  • 2345.
    Wallin, Ulrika
    Sophiahemmet University.
    Färg eller siffror vid symtomskattning inom palliativ vård: en kvalitativ studie2014Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
  • 2346.
    Wallingstam, Carina
    et al.
    Sophiahemmet University.
    Westerholm, Camilla
    Sophiahemmet University.
    Specialistsjuksköterskors upplevelser av medicinsk simulering: en intervjustudie2019Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Fel och misstag relaterade till bristande kommunikation och brister i teamarbete sker inom

    sjukvården, vilket medför ett hot mot patientsäkerheten, framför allt i akuta situationer där

    snabba beslut måste tas och där liv står på spel. Forskningen visar att det är den mänskliga

    faktorn som är en bidragande orsak till dessa fel och misstag. Standardiserade arbetssätt,

    effektivt teamarbete och tydlig kommunikation i teamet krävs för att säkerställa

    patientsäkerheten.

    Syfte med föreliggande studie var att beskriva specialistsjuksköterskans upplevelser av

    interprofessionell teamträning samt hur det påverkar kommunikation och teamarbetet i det

    kliniska arbetet.

    Metoden utgjordes av semistrukturerade intervjuer som genomfördes med åtta

    specialistsjuksköterskor som genomgått interprofessionell medicinsk simulering. Materialet

    analyserades med hjälp av kvalitativ innehållsanalys med induktiv ansats.

    Resultatet utmynnade i två teman utifrån studiens tvådelade syfte. Det första temat var

    upplevelser av simuleringsövningen där följande tre kategorier framkom: lärandemiljö,

    samverkan i team samt kommunikation. Det andra temat var effekter i det kliniska arbetet där

    följande tre kategorier framträdde: samverkan i team, kommunikation samt patientsäkerhet.

    Resultatet visar att specialistsjuksköterskans upplevelser den interprofessionella

    teamträningen som mycket positiv. Nyttan av att träna och att använda sig av

    loopkommunikation tillsammans med de andra i teamet belystes. Likaså belystes betydelsen

    av att ha en tydlig ledare i teamet i det akuta omhändertagande, vilket skapar känslan av

    delaktighet. Teamledarens uppgift är att skapa en tydlig struktur och ett bra teamarbete runt

    patienten, vilket ökar patientsäkerheten.

    Slutsatsen av studien visar att interprofessionell medicinsk simuleringsövning ger en ökad

    medvetenhet kring vikten av ett välfungerande team med en effektiv kommunikation i det

    akuta omhändertagandet. Vidare visade det sig att alla specialistsjuksköterskor fått flera

    verktyg som var användbara i det kliniska arbetet.

  • 2347.
    Wallén, Linnéa
    et al.
    Sophiahemmet University.
    Wramsby, Anna
    Sophiahemmet University.
    Midwives experiences of working with post abortion family planning: a Minor Field Study in Zambia2019Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    The prevalence of post abortion contraception in Zambia is lower than in many other African countries, with unmet family planning needs. Midwives play an important professional role in family planning. In conjunction with an abortion the midwife is provided with an opportunity to inform, discuss, prescribe and initiate family planning with the woman concerned. It is shown that women receiving information and knowledge about post abortion contraception are more likely to use it.

     

    The aim of the study was to describe midwives experiences of working with post abortion family planning in Zambia.

     

    A qualitative interview study with semi-structured questions was used. To conduct the study and find participants with the right inclusion criteria a strategic sampling was used. Ten midwives working with post abortion family planning in Zambia were interviewed. Qualitative content analysis was performed to analyze the collected data from the interviews.

     

    During the data-analysis two categories and eight subcategories were identified. The midwives had experiences of several challenges within post abortion family planning. These included lack of knowledge, supplies and health care staff as well as problem with stigma around family planning and lack of compliance. The midwives also described other factors influencing the work with post abortion family planning. These factors included changes in attitudes, the midwife's knowledge and the importance of information provided by the midwives.

     

    The midwives experienced that there were several factors influencing their work with post abortion family planning. Several challenges within post abortion family planning were identified in this study. Areas of improvement involve education, more midwives working and a better availability to post abortion family planning equipment and services.

  • 2348.
    Wandin, Cecilia
    et al.
    Sophiahemmet University College.
    Westin Sjöberg, Susann
    Sophiahemmet University College.
    Motivation: hur sjuksköterskan kan stödja patienter med fetma för att motivera till viktnedgång2002Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 2349.
    Warfvinge, Frida
    et al.
    Sophiahemmet University College.
    Wedin, Ellinor
    Sophiahemmet University College.
    Icke-farmakologiska metoder för att minska procedursmärta hos barn: en intervjustudie med barn- och distriktssköterskor2007Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 2350. Warne, Tony
    et al.
    Johansson, Unn-Britt
    Sophiahemmet University.
    Papastavrou, Evridiki
    Tichelaar, Erna
    Tomietto, Marco
    Van den Bossche, Koen
    Moreno, Maria Flores Vizcaya
    Saarikoski, Mikko
    An exploration of the clinical learning experience of nursing students in nine European countries2010In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 30, p. 809-815Article in journal (Refereed)
    Abstract [en]

    The overall aim of the study was to develop a composite and comparative view of what factors enhance the learning experiences of student nurses whilst they are in clinical practice. The study involved students undertaking general nurse training programmes in nine Western European countries. The study focused on: (1) student nurse experiences of clinical learning environments, (2) the supervision provided by qualified nurses in clinical placements, and (3) the level of interaction between student and nurse teachers. The study utilised a validated theoretical model: the Clinical Learning Environment, Supervision and Nurse Teacher (CLES + T) evaluation scale. The evaluation scale has a number of sub-dimensions: Pedagogical atmosphere on the ward; Supervisory Relationships; the Leadership Style of Ward Managers; Premises of Nursing; and the Role of the Nurse Teacher. Data (N = 1903) was collected from Cyprus, Belgium, England, Finland, Ireland, Italy, Netherlands, Spain and Sweden using web-based questionnaire 2007–2008. The findings revealed that respondents were generally satisfied with their clinical placements. There was clear support for the mentorship approach; 57% of respondents had a successful mentorship experience although some 18% of respondents experienced unsuccessful supervision. The most satisfied students studied at a university college, and had at least a seven week clinical placement supported by individualised mentorship relationships. Learning to become a nurse is a multidimensional process that requires both significant time being spent working with patients and a supportive supervisory relationship.

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