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  • 51.
    Engström, Ingemar
    Örebro universitet, Hälsovetenskapliga institutionen.
    Tvingad till hjälp: ett forskningsprojekt om tvång i svensk barn- och ungdomspsykiatri2007Konferensbidrag (Refereegranskat)
  • 52.
    Engström, Ingemar
    Örebro universitet, Hälsovetenskapliga institutionen.
    Vad har vi lärt oss av de apatiska flyktingbarnen?2007Konferensbidrag (Refereegranskat)
  • 53.
    Eriksson, Annika
    et al.
    Örebro universitet, Hälsovetenskapliga institutionen.
    Ramberg, Anna
    Örebro universitet, Hälsovetenskapliga institutionen.
    Burkarens tillfredställelse med sitt hjälpmedel och service: En jämförelse mellan tre olika län2006Självständigt arbete på grundnivå (kandidatexamen), 10 poäng / 15 hpStudentuppsats
    Abstract [sv]

    Hjälpmedel är ofta en förutsättning för att personer med funktionshinder ska klara av sina

    olika dagliga aktiviteter.Syftet med uppsatsen är att genomföra en jämförelse mellan Örebro län, Västmanland och Södermanland hur tillfredsställda brukarna är med sitt hjälpmedel och service.Resultatet visar

    att majoriteten av brukare i de tre olika länen är tillfredställda med sitt hjälpmedel och service.

    Det högsta medelvärdet visar att brukare i Örebro län var mest tillfredställda med variabeln

    effektivitet och varaktighet, brukare i Västmanland var även de mest tillfredställda med

    varaktighet. I Södermanland visade sig att brukare var mest tillfredsställda med variabeln

    användbarhet.

  • 54.
    Eriksson, Charli
    et al.
    Örebro universitet, Hälsovetenskapliga institutionen.
    Elander, Ingemar
    Örebro universitet, Institutionen för samhällsvetenskap.
    Fröding, Karin
    Johansson, Björn
    Örebro universitet, Institutionen för beteende-, social- och rättsvetenskap.
    Healthy cities, social inclusion and urban governance: a research program2004Konferensbidrag (Övrigt vetenskapligt)
  • 55.
    Eriksson, Karin
    et al.
    Örebro universitet, Hälsovetenskapliga institutionen.
    Hagerman, Annica
    Örebro universitet, Hälsovetenskapliga institutionen.
    Kännedom om hörsel och hörselrelaterade angelägenheter bland undersköterskor inom äldreomsorgen i Örebro kommun: -en enkätstudie-2006Självständigt arbete på grundnivå (kandidatexamen), 10 poäng / 15 hpStudentuppsats
    Abstract [sv]

    Antalet äldre personer med hörselnedsättning som lever inom äldreomsorgen i Sverige är stort. Av den anledningen är det viktigt att personalen inom äldreomsorgen innehar kunskap om hörsel och hörselrelaterade angelägenheter. Syftet med föreliggande studie var att undersöka vilken kännedom undersköterskor på vårdbostäder inom Örebro kommun har om hörsel och hörselnedsättning hos äldre samt deras kännedom om hörhjälpmedel och kommunikation med äldre personer som har hörselnedsättning. Studien avgränsades till att endast inkludera yrkesgruppen undersköterskor. Materialet i undersökningen bestod av en enkät som delades ut till 60 undersköterskor på sex olika vårdbostäder i kommunen. Studiens resultat visade att undersköterskorna hade viss bristande kännedom inom undersökningens tre huvudområden. Störst kännedom hade undersköterskorna om kommunikation, minst kännedom hade de om hörsel och hörselnedsättning. Trots att viss kännedom fanns bland undersköterskorna uppgav en betydande majoritet att de skulle ha nytta av ett skriftligt material som belyser de tre huvudområdena.

  • 56.
    Florin, Jan
    Örebro universitet, Hälsovetenskapliga institutionen.
    Patient participation in clinical decision making in nursing: a collaborative effort between patients and nurses2007Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [sv]

    Patientens delaktighet i kliniskt beslutsfattande i omvårdnad – ett gemensamt ansvar för patienter och sjuksköterskor

    Bakgrund

    Patienten har, med bas i lagstiftning och förordningar, en stark ställning inom svensk hälso- och sjukvård. Det grundas delvis på en samhällelig uppfattning om betydelsen av patientens delaktighet i såväl planering som genomförande av sin egen vård. I ett etiskt perspektiv har delaktigheten ett värde i sig själv, som en förutsättning för individens autonomi och integritet. Sjuksköterskan identifierar patientens behov och problem i syfte att kunna ge en individuellt anpassad omvårdnad. Sjuksköterskan har ofta djupgående professionell kunskap om patientens omvårdnadsproblem, medan patienten har preferenser och värderingar om vårdens genomförande. Om planeringen av omvårdnaden inte utgår från patientens preferenser så finns det stor risk att patientens perspektiv inte kommer med som bedömningsgrund. En samsyn mellan patient och sjuksköterska om patientens behov av omvårdnad och roll i beslutsfattandet kan öka möjligheten att optimera omvårdnadsinsatserna och främja en hög kvalitet på omvårdnaden. Kunskapen om kliniskt beslutsfattande inom omvårdnad är bristfällig, framförallt med fokus på patientens delaktighet och graden av samsyn mellan patienternas och sjuksköterskornas subjektiva perspektiv.

    Syfte

    Avhandlingens övergripande syfte var att undersöka kliniskt beslutsfattande inom omvårdnad med speciellt fokus på omvårdnadsdiagnosers kvalitet, patientens delaktighet i beslutsprocessen och överensstämmelsen mellan patienters och sjuksköterskors uppfattningar om behov och problem inom omvårdnad.

    Specifika syften för respektive delarbeten var att I) undersöka effekten av utbildning i omvårdnadsdiagnostik riktad till sjuksköterskor och utveckling av journaldokument på omvårdnadsdiagnosers kvalitet; II) beskriva överensstämmelse i patienters och sjuksköterskors bedömningar av förekomst, svårighetsgrad och betydelse av problem inom omvårdnaden; III) beskriva samstämmighet mellan patienters och sjuksköterskors uppfattning om patientens preferenser för delaktighet i kliniskt beslutsfattande i omvårdnaden, samt samstämmighet mellan patienters preferenser och faktiska erfarenhet av delaktighet; och IV) identifiera prediktorer för patienters preferenser att delta i kliniskt beslutsfattande om den egna omvårdnaden.

    Material och metod

    Studier har genomförts med beskrivande, jämförande och kvasi-experimentell design på avdelningar inom somatisk sjukhusvård. Urvalet består av 140 patientjournaler (studie I), 80 patient-sjuksköterskepar (studie II och III), samt 428 patienter som nyligen blivit utskrivna från somatisk sjukhusvård (studie IV). Data har insamlats genom granskning av innehåll i patientjournaler samt genom enkäter till patienter och sjuksköterskor. Instrumenten CAT-CH-ING och Control Preference Scale har använts tillsammans med frågeformulär som utvecklats specifikt för studien.

    Resultat

    Delarbete I

    Kvaliteten på omvårdnadsdiagnoserna förbättrades signifikant efter att sjuksköterskorna på experimentavdelningen genomgått en utbildning och nya journaldokument hade introducerats. Störst kvarvarande svårigheter var förknippade med hur etiologin i omvårdnadsdiagnosen formulerades. Omvårdnadsdiagnosernas kvalitet förbättrades inte på motsvarande sätt på kontrollavdelningarna.

    Delarbete II

    Sjuksköterskorna identifierade de omvårdnadsbehov och problem som patienterna uppfattade sig ha med en sensitivitet på 0.53 och ett prediktivt värde på 0.50. Det innebär att patienterna delvis identifierade andra problem än sjuksköterskorna, framför allt var det vanligt inom områdena nutrition, sömn, smärta och känslor/andlighet. Sjuksköterskorna underskattade problemens svårighetsgrad för 47 % av de behov och problem som hade identifierats gemensamt av patienter och sjuksköterskor. En gemensam uppfattning om betydelsen av att få stöd och hjälp med att lösa omvårdnadsproblemet fanns i knappt hälften av fallen.

    Delarbete III

    En majoritet av sjuksköterskorna uppfattade att patienterna föredrog att vara mer aktiva i det kliniska beslutsfattandet om omvårdnad än vad patienterna själv uppgav. Sammanlagt 61 % av patienterna föredrog en passiv roll i beslutsfattandet medan sjuksköterskorna angav att 24 % ville vara passiva. Preferenser om en aktiv roll i beslutsfattande angavs av 9 % av patienterna medan sjuksköterskorna hade uppfattat att 45 % av patienterna föredrog en aktiv roll. Totalt 71 % av patienterna upplevde att de inte hade varit delaktiga i den utsträckning de själva hade föredragit, 37 % hade varit mer passiva och 34 % mer aktiva. Patienterna uppgav att de intagit en mer passiv roll än vad de hade önskat i samband med behov och problem inom områdena kommunikation, andning och smärta, medan en mer aktiv roll än önskat förekom i samband med behov och problem inom områdena aktivitet och känslor/roller.

    Delarbete IV

    En majoritet av patienterna i sluten somatisk vård föredrog att inledningsvis under vårdperioden inta en passiv roll i kliniskt beslutsfattande om omvårdnad. Sammanlagt 22 % av patienterna föredrog en aktiv roll. Faktorer som predicerade preferenser för att inta en aktiv roll var kön (Odds ratio [OR] = 1.8), utbildning (OR = 2.2), levnadsförhållanden (OR = 1.8) och sysselsättning, d.v.s. om personen var yrkesarbetande eller pensionär (OR = 2.0). Sannolikheten var 53 % att en pensionerad högutbildad kvinna som levde ensam föredrog att vara aktiv i beslutsfattandet om sin egen omvårdnad. Sannolikheten för att en yrkesarbetande lågutbildad man som levde tillsammans med någon annan föredrog att vara aktiv var 8 %.

    Slutsats

    Kvaliteten på de omvårdnadsdiagnoser som sjuksköterskan ställer kan förbättras genom utbildning men orsakerna till omvårdnadsproblemet behöver identifieras på ett tydligare sätt. Det fanns en skillnad i hur patienter och sjuksköterskor uppfattade vad som utgjorde ett omvårdnadsbehov eller problem samt problemets svårighetsgrad och betydelse. Sjuksköterskan identifierade 53 % av de omvårdnadsproblem som patienten själv identifierade, samtidigt som sjuksköterskan identifierade andra omvårdnadsproblem som inte patienten uppfattade. Uppfattningarna skiljde sig också åt om vilken roll patienten föredrog att ha i det kliniska beslutsfattande om omvårdnad. Faktorer som kunde predicera patientens preferenser att ha en aktiv roll i kliniskt beslutsfattande var kön, utbildningsnivå, boendesituation och om personen yrkesarbetade eller var pensionär.

    En slutsats av den påvisade diskrepansen i uppfattningar är att sjuksköterskor i högre grad behöver involvera patienterna i en diskussion om hälsotillståndet, behovet av omvårdnad och patientens önskan att delta i beslut om sin omvårdnad. Det är nödvändigt för att så långt det är möjligt kunna uppnå en samsyn som grund för planering och genomförande av omvårdnaden. Om sjuksköterskan validerar sina egna bedömningar om behovet av omvårdnad med patienten kan kvaliteten på bedömningarna förbättras. Patientens perspektiv blir en explicit del av beslutsunderlaget vid planering av omvårdnad vilket sannolikt också påverkar omvårdnadens innehåll och därmed även omvårdnadens kvalitet. Det bästa sättet att identifiera det individuella perspektivet är genom en systematisk bedömning i dialog mellan sjuksköterskan och den enskilde patienten. Mötet och dialogen mellan patienten och sjuksköterskan är en förutsättning för en god omvårdnad men är också en central del av själva omvårdnaden.

    Delarbeten
    1. Quality of nursing diagnoses: evaluation of an educational intervention
    Öppna denna publikation i ny flik eller fönster >>Quality of nursing diagnoses: evaluation of an educational intervention
    2005 (Engelska)Ingår i: International Journal of Nursing Terminologies and Classifications, ISSN 1541-5147, Vol. 16, nr 2, s. 33-43Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    PURPOSE:

    To evaluate the impact of the quality of nursing diagnoses, interventions, and outcomes in an acute care hospital following the implementation of an educational program.

    METHOD:

    In a pretest-posttest experimental design study, nurses from 12 wards of a Swiss hospital received an educational intervention--an introductory class and consecutive classes, using a case discussion method--to implement nursing diagnoses, interventions, and outcomes. Two sets of 36 randomly selected nursing records were evaluated before and after implementation. The quality of documented nursing diagnoses, interventions, and nursing-sensitive patient outcomes was assessed by 29 Likert-type items with a 0-4 scale instrument, called Quality of Nursing Diagnoses, Interventions, and Outcomes (Q-DIO) and tested using t-tests.

    FINDINGS:

    Significant enhancements in the quality of documented nursing diagnoses, interventions, and outcomes were found following the implementation of a planned educational program.

    CONCLUSIONS:

    The implementation of NANDA, NIC, and NOC (NNN) nursing diagnoses, interventions, and outcomes led to higher quality of nursing diagnosis documentation, etiology-specific nursing interventions, and nursing-sensitive patient outcomes.

    IMPLICATIONS FOR NURSING PRACTICE:

    Educational measures support nurses to improve documentation of diagnoses, interventions, and outcomes. The Q-DIO is a useful audit tool.

    Nationell ämneskategori
    Omvårdnad
    Forskningsämne
    Vårdvetenskap
    Identifikatorer
    urn:nbn:se:oru:diva-3212 (URN)10.1111/j.1744-618X.2005.00008.x (DOI)
    Tillgänglig från: 2007-01-26 Skapad: 2007-01-26 Senast uppdaterad: 2017-10-18Bibliografiskt granskad
    2. Patients' and nurses' perceptions of nursing problems in an acute care setting
    Öppna denna publikation i ny flik eller fönster >>Patients' and nurses' perceptions of nursing problems in an acute care setting
    2005 (Engelska)Ingår i: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 51, nr 2, s. 140-149Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    AIM:

    This paper reports a study to determine the degree of agreement or disagreement between nurses and patients in their perceptions of the presence, severity, and importance of nursing problems.

    BACKGROUND:

    Patient experiences, values and preferences are increasingly acknowledged as important factors underpinning healthcare decision-making. The ability to identify patient problems accurately is an important prerequisite for planning and implementing individualized high quality care.

    METHODS:

    A convenience sample of patients (n = 80) and Registered Nurses (n = 30) in an acute care setting responded to a 43-item questionnaire. Findings. Nurses identified patients' problems with a sensitivity of 0.53 and a positive predictive value of 0.50. Patients identified several severe problems that were not identified by nurses, particularly problems with nutrition, sleep, pain, and emotions/spirituality. Nurses underestimated the severity in 47% of mutually-identified problems. An overall level of agreement of 44% was found on the importance of patient problems. Low levels of agreement on severity and importance were related more to individual differences than to systematic differences.

    CONCLUSIONS:

    Nurses need to be more aware that patients and nurses often hold disparate views of the priorities in nursing care. To plan individualized nursing care effectively, nurses need to elicit and use individual patients' preferences more systematically in care planning.

    Nationell ämneskategori
    Omvårdnad
    Forskningsämne
    Vårdvetenskap
    Identifikatorer
    urn:nbn:se:oru:diva-3213 (URN)10.1111/j.1365-2648.2005.03477.x (DOI)
    Tillgänglig från: 2007-01-26 Skapad: 2007-01-26 Senast uppdaterad: 2017-12-14Bibliografiskt granskad
    3. Patient participation in clinical decision making in nursing: a comparative study of nurses' and patients' perceptions
    Öppna denna publikation i ny flik eller fönster >>Patient participation in clinical decision making in nursing: a comparative study of nurses' and patients' perceptions
    2006 (Engelska)Ingår i: Journal of Clinical Nursing, ISSN 0962-1067, Vol. 15, nr 12, s. 1498-1508Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    AIM AND OBJECTIVES:

    The aim of this study was to compare the degree of concordance between patients and Registered Nurses' perceptions of the patients' preferences for participation in clinical decision-making in nursing care. A further aim was to compare patients' experienced participation with their preferred participatory role.

    BACKGROUND:

    Patient participation in clinical decision-making is valuable and has an effect on quality of care. However, there is limited knowledge about patient preferences for participation and how nurses perceive their patients' preferences.

    METHODS:

    A comparative design was adopted with a convenient sample of 80 nurse-patient dyads. A modified version of the Control Preference Scale was used in conjunction with a questionnaire developed to elicit the experienced participation of the patient.

    RESULTS:

    A majority of the Registered Nurses perceived that their patients preferred a higher degree of participation in decision-making than did the patients. Differences in patient preferences were found in relation to age and social status but not to gender. Patients often experienced having a different role than what was initially preferred, e.g. a more passive role concerning needs related to communication, breathing and pain and a more active role related to activity and emotions/roles.

    CONCLUSIONS:

    Registered Nurses are not always aware of their patients' perspective and tend to overestimate patients' willingness to assume an active role. Registered Nurses do not successfully involve patients in clinical decision-making in nursing care according to their own perceptions and not even to the patients' more moderate preferences of participation.

    RELEVANCE TO CLINICAL PRACTICE:

    A thorough assessment of the individual's preferences for participation in decision-making seems to be the most appropriate approach to ascertain patient's involvement to the preferred level of participation. The categorization of patients as preferring a passive role, collaborative role or active role is seen as valuable information for Registered Nurses to tailor nursing care.

    Nationell ämneskategori
    Tvärvetenskapliga studier inom samhällsvetenskap Omvårdnad
    Forskningsämne
    Vårdvetenskap
    Identifikatorer
    urn:nbn:se:oru:diva-3214 (URN)10.1111/j.1365-2702.2005.01464.x (DOI)
    Tillgänglig från: 2007-01-26 Skapad: 2007-01-26 Senast uppdaterad: 2018-01-13Bibliografiskt granskad
    4. Predictors of patient participation in clinical decision making in nursing care
    Öppna denna publikation i ny flik eller fönster >>Predictors of patient participation in clinical decision making in nursing care
    (Engelska)Manuskript (Övrigt vetenskapligt)
    Nationell ämneskategori
    Omvårdnad
    Forskningsämne
    Vårdvetenskap
    Identifikatorer
    urn:nbn:se:oru:diva-3215 (URN)
    Tillgänglig från: 2007-01-26 Skapad: 2007-01-26 Senast uppdaterad: 2017-10-18Bibliografiskt granskad
  • 57.
    Florin, Jan
    et al.
    Örebro universitet, Hälsovetenskapliga institutionen.
    Ehnfors, Margareta
    Örebro universitet, Hälsovetenskapliga institutionen.
    Ehrenberg, Anna
    Predictors of patient participation in clinical decision making in nursing careManuskript (Övrigt vetenskapligt)
  • 58.
    Florin, Jan
    et al.
    Örebro universitet, Hälsovetenskapliga institutionen.
    Ehrenberg, Anna
    Ehnfors, Margareta
    Örebro universitet, Institutionen för vårdvetenskap och omsorg.
    Patient participation in clinical decision making in nursing: a comparative study of nurses' and patients' perceptions2006Ingår i: Journal of Clinical Nursing, ISSN 0962-1067, Vol. 15, nr 12, s. 1498-1508Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM AND OBJECTIVES:

    The aim of this study was to compare the degree of concordance between patients and Registered Nurses' perceptions of the patients' preferences for participation in clinical decision-making in nursing care. A further aim was to compare patients' experienced participation with their preferred participatory role.

    BACKGROUND:

    Patient participation in clinical decision-making is valuable and has an effect on quality of care. However, there is limited knowledge about patient preferences for participation and how nurses perceive their patients' preferences.

    METHODS:

    A comparative design was adopted with a convenient sample of 80 nurse-patient dyads. A modified version of the Control Preference Scale was used in conjunction with a questionnaire developed to elicit the experienced participation of the patient.

    RESULTS:

    A majority of the Registered Nurses perceived that their patients preferred a higher degree of participation in decision-making than did the patients. Differences in patient preferences were found in relation to age and social status but not to gender. Patients often experienced having a different role than what was initially preferred, e.g. a more passive role concerning needs related to communication, breathing and pain and a more active role related to activity and emotions/roles.

    CONCLUSIONS:

    Registered Nurses are not always aware of their patients' perspective and tend to overestimate patients' willingness to assume an active role. Registered Nurses do not successfully involve patients in clinical decision-making in nursing care according to their own perceptions and not even to the patients' more moderate preferences of participation.

    RELEVANCE TO CLINICAL PRACTICE:

    A thorough assessment of the individual's preferences for participation in decision-making seems to be the most appropriate approach to ascertain patient's involvement to the preferred level of participation. The categorization of patients as preferring a passive role, collaborative role or active role is seen as valuable information for Registered Nurses to tailor nursing care.

  • 59.
    Florin, Jan
    et al.
    Örebro universitet, Hälsovetenskapliga institutionen.
    Ehrenberg, Anna
    Ehnfors, Margareta
    Örebro universitet, Institutionen för vårdvetenskap och omsorg.
    Patients' and nurses' perceptions of nursing problems in an acute care setting2005Ingår i: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 51, nr 2, s. 140-149Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM:

    This paper reports a study to determine the degree of agreement or disagreement between nurses and patients in their perceptions of the presence, severity, and importance of nursing problems.

    BACKGROUND:

    Patient experiences, values and preferences are increasingly acknowledged as important factors underpinning healthcare decision-making. The ability to identify patient problems accurately is an important prerequisite for planning and implementing individualized high quality care.

    METHODS:

    A convenience sample of patients (n = 80) and Registered Nurses (n = 30) in an acute care setting responded to a 43-item questionnaire. Findings. Nurses identified patients' problems with a sensitivity of 0.53 and a positive predictive value of 0.50. Patients identified several severe problems that were not identified by nurses, particularly problems with nutrition, sleep, pain, and emotions/spirituality. Nurses underestimated the severity in 47% of mutually-identified problems. An overall level of agreement of 44% was found on the importance of patient problems. Low levels of agreement on severity and importance were related more to individual differences than to systematic differences.

    CONCLUSIONS:

    Nurses need to be more aware that patients and nurses often hold disparate views of the priorities in nursing care. To plan individualized nursing care effectively, nurses need to elicit and use individual patients' preferences more systematically in care planning.

  • 60.
    Florin, Jan
    et al.
    Örebro universitet, Hälsovetenskapliga institutionen.
    Ehrenberg, Anna
    Ehnfors, Margareta
    Quality of nursing diagnoses: evaluation of an educational intervention2005Ingår i: International Journal of Nursing Terminologies and Classifications, ISSN 1541-5147, Vol. 16, nr 2, s. 33-43Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE:

    To evaluate the impact of the quality of nursing diagnoses, interventions, and outcomes in an acute care hospital following the implementation of an educational program.

    METHOD:

    In a pretest-posttest experimental design study, nurses from 12 wards of a Swiss hospital received an educational intervention--an introductory class and consecutive classes, using a case discussion method--to implement nursing diagnoses, interventions, and outcomes. Two sets of 36 randomly selected nursing records were evaluated before and after implementation. The quality of documented nursing diagnoses, interventions, and nursing-sensitive patient outcomes was assessed by 29 Likert-type items with a 0-4 scale instrument, called Quality of Nursing Diagnoses, Interventions, and Outcomes (Q-DIO) and tested using t-tests.

    FINDINGS:

    Significant enhancements in the quality of documented nursing diagnoses, interventions, and outcomes were found following the implementation of a planned educational program.

    CONCLUSIONS:

    The implementation of NANDA, NIC, and NOC (NNN) nursing diagnoses, interventions, and outcomes led to higher quality of nursing diagnosis documentation, etiology-specific nursing interventions, and nursing-sensitive patient outcomes.

    IMPLICATIONS FOR NURSING PRACTICE:

    Educational measures support nurses to improve documentation of diagnoses, interventions, and outcomes. The Q-DIO is a useful audit tool.

  • 61.
    Forslund, Kerstin
    Örebro universitet, Hälsovetenskapliga institutionen.
    Challenges in prehospital emergency care: patient, spouse and personnel perspectives2007Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Prehospital emergency care (PEC) with the emergency call to the Emergency Medical Dispatch (EMD) centre is an essential part of the health-care system. It is important to obtain knowledge about the links in the PEC chain from the perspectives of those providing the service and those receiving it. The overall aim of this thesis was to describe the challenges surrounding PEC based on the experiences of patients, spouses and personnel. A qualitative descriptive design was used in the five papers included. The data analysis methods were phenomenological-hermeneutics (I–III), qualitative content analysis (IV–V) and descriptive statistics (V).

    Interviews with thirteen patients who had called the EMD-centre due to acute chest pain (I) revealed a general satisfaction with PEC. They were aware of the number to call in an emergency but were uncertain when to call. The potentially life threatening emergency situation was marked by vulnerability and dependency and was fraught with pain, fear and a sense of aloneness.

    An overall theme of aloneness emerged from the interviews with nineteen spouses who had placed an emergency call for their husband or wife that was experiencing acute chest pain (II). The challenges in being a spouse to a person in need of PEC were associated with: “Being responsible and trying to preserve life” and “Being able to manage the uneasiness and feel trust in an uncertain situation”. The spouses were in an escalating spiral of aloneness, worry, uncertainty, stress, fear of loss and desperation.

    Interviews with sixteen emergency operators dealt with situations they considered difficult to deal with and their reflections on how they managed such situations (III). Uncertainty, communication difficulties and insufficient resources characterized those situations. Skills, knowledge, experience, as well as personal qualities such as sensitivity, self-insight, empathy and intuition were regarded as important when handling them.

    Interviews with four nurses and fifteen emergency operators related to their experiences of working together for two years at an EMD-centre were conducted after the nurses were added to the EMD-centre to increase medical and nursing competence (IV). Initial frustration and scepticism changed to positive experiences with improved cooperation and service. The nurses voiced difficulties dealing with the more medically urgent calls and the emergency operators with the more complicated and diffuse medical cases.

    A total of 336 questionnaires related to alarms involving acute chest pain and given the highest priority by the emergency operator were collected in a study aimed at describing the ambulance personnel’s perceptions of the quality of the information received from the EMD-centre (V). The ambulance personnel perceived most of the information such as patient assessment, condition, history, preparedness and in particular pain status to be of high quality.

    In summary: In PEC there is many interdependent complexities that present demands and challenges to the actors involved (I–V). In general those who received emergency assistance from PEC were satisfied, but the margins between success and failure are small. Risks for errors exist throughout the PEC chain and time poses a challenge. Understanding is crucial for all involved, and the same situation can be experienced differently. Challenges inherent in PEC are the communication problems, unpredictability and uniqueness along with daring to be in the acute situation and dealing with a sense of aloneness, uncertainty and dependency. The personnel that do not have the ability to see the person they are helping are even more challenged. Important attributes for PEC personnel are caring attitudes, personal skills, experiences and professional knowledge. PEC personnel have the authority and power to act and make decisions, in which responsibility, sensitivity, and human dignity must be addressed. Lives are saved with PEC despite all the challenges and possibilities for error, such as those that exist between the different actors. It is vital that the PEC chain is as strong as possible.

    Delarbeten
    1. Patients with acute chest pain: experiences of emergency calls and pre-hospital care
    Öppna denna publikation i ny flik eller fönster >>Patients with acute chest pain: experiences of emergency calls and pre-hospital care
    2005 (Engelska)Ingår i: Journal of Telemedicine and Telecare, ISSN 1357-633X, E-ISSN 1758-1109, Vol. 11, nr 7, s. 361-367Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Acute chest pain is a common reason why people call an emergency medical dispatch (EMD) centre. We examined how patients with acute chest pain experience the emergency call and their pre-hospital care. A qualitative design was used with a phenomenological-hermeneutic approach. Thirteen patients were interviewed, three women and 10 men. The patients were grateful that their lives had been saved and in general were satisfied with their pre-hospital contact. Sometimes they felt that it took too long for the emergency operators to answer and to understand the urgency. They were in a life-threatening situation and their feeling of vulnerability and dependency was great. Time seemed to stand still while they were waiting for help during their traumatic experience. The situation was fraught with pain, fear and an experience of loneliness. A sense of individualized care is important to strengthen trust and confidence between the patient and the pre-hospital personnel. Patients were aware of what number to call to reach the EMD centre, but were uncertain about when to call. More lives can be saved if people do not hesitate to call for help.

    Nationell ämneskategori
    Omvårdnad
    Forskningsämne
    Vårdvetenskap
    Identifikatorer
    urn:nbn:se:oru:diva-5941 (URN)16238838 (PubMedID)
    Tillgänglig från: 2009-03-06 Skapad: 2009-03-06 Senast uppdaterad: 2017-12-13Bibliografiskt granskad
    2. Acute chest pain: spouses' experiences of the alarm situation, emergency call and prehospital care
    Öppna denna publikation i ny flik eller fönster >>Acute chest pain: spouses' experiences of the alarm situation, emergency call and prehospital care
    (Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
    Nationell ämneskategori
    Omvårdnad
    Forskningsämne
    Vårdvetenskap
    Identifikatorer
    urn:nbn:se:oru:diva-15655 (URN)
    Tillgänglig från: 2011-05-23 Skapad: 2011-05-23 Senast uppdaterad: 2017-10-17Bibliografiskt granskad
    3. Operators' experiences of emergency calls
    Öppna denna publikation i ny flik eller fönster >>Operators' experiences of emergency calls
    2004 (Engelska)Ingår i: Journal of Telemedicine and Telecare, ISSN 1357-633X, E-ISSN 1758-1109, Vol. 10, nr 5, s. 290-297Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    In Sweden, the operators at emergency dispatch centres are responsible for allocating resources (e.g. ambulances, fire brigade, police) in response to calls. We analysed situations that the emergency operators experienced as difficult and their reflections on how they managed them. Interviews were conducted with all 16 emergency operators at a centre that serves a population of 275,000 and receives about 700,000 emergency calls annually. A phenomenological-hermeneutic approach was used for the analysis. Situations that operators experienced as difficult were characterized by uncertainty, communication difficulties and insufficient resources. Skills, knowledge and experience were regarded as important in the management of these situations, as were personal qualities such as sensitivity, insight, empathy and intuition. The emergency operators stated that they needed more guidance, feedback and education in their work. This would lead to an increased sense of certainty, which would lead to decreased stress and a better outcome for those in need.

    Nationell ämneskategori
    Omvårdnad
    Forskningsämne
    Vårdvetenskap
    Identifikatorer
    urn:nbn:se:oru:diva-5939 (URN)10.1258/1357633042026323 (DOI)
    Tillgänglig från: 2009-03-06 Skapad: 2009-03-06 Senast uppdaterad: 2017-12-13Bibliografiskt granskad
    4. Experiences of adding nurses to increase medical competence at an emergency medical dispatch centre
    Öppna denna publikation i ny flik eller fönster >>Experiences of adding nurses to increase medical competence at an emergency medical dispatch centre
    2006 (Engelska)Ingår i: Accident and Emergency Nursing, ISSN 0965-2302, E-ISSN 1532-9267, Vol. 14, nr 4, s. 230-236Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    INTRODUCTION: Prehospital care begins when the call is placed to the emergency medical dispatch (EMD) centre and ends when the patient is cared for at the emergency department. The highly technical and specialized character demands advanced medical competence. Communication problems, serious and unpredictable situations can often occur during the emergency calls. A two-year intervention study involved the addition of registered nurses to an EMD-centre team to increase medical competence. AIM: To describe registered nurses' and emergency-operators' experiences of working together at an EMD-centre after adding registered nurses to increase medical competence. METHODS: Qualitative content analysis was used to analyse the text from interviews with four registered nurses and 15 emergency-operators involved in the intervention. RESULTS: Initial frustration and scepticism changed to more positive experiences that resulted in improved cooperation and service. The registered nurses had difficulties dealing with the more urgently acute calls, while the emergency-operators had difficulties with the more complicated, somewhat diffuse cases. The two professions complemented each other. CONCLUSION: Combining the registered nurses' and emergency-operators' knowledge and experience at an EMD-centre can perhaps improve the prehospital care for those requiring emergency medical care.

    Nationell ämneskategori
    Tvärvetenskapliga studier inom samhällsvetenskap Omvårdnad
    Forskningsämne
    Vårdvetenskap
    Identifikatorer
    urn:nbn:se:oru:diva-5943 (URN)10.1016/j.aaen.2006.06.006 (DOI)
    Tillgänglig från: 2009-03-06 Skapad: 2009-03-06 Senast uppdaterad: 2018-01-13Bibliografiskt granskad
    5. Acute chest pain alarms: ambulance personnel's perceptions of the quality of the information received from the EMD-centre
    Öppna denna publikation i ny flik eller fönster >>Acute chest pain alarms: ambulance personnel's perceptions of the quality of the information received from the EMD-centre
    (Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
    Nationell ämneskategori
    Omvårdnad
    Forskningsämne
    Vårdvetenskap
    Identifikatorer
    urn:nbn:se:oru:diva-15654 (URN)
    Tillgänglig från: 2011-05-23 Skapad: 2011-05-23 Senast uppdaterad: 2017-10-17Bibliografiskt granskad
  • 62.
    Forslund, Kerstin
    et al.
    Örebro universitet, Hälsovetenskapliga institutionen.
    Gustafsson, Margareta
    Örebro universitet, Hälsovetenskapliga institutionen.
    Sörlie, Venke
    Acute chest pain alarms: ambulance personnel's perceptions of the quality of the information received from the EMD-centreManuskript (preprint) (Övrigt vetenskapligt)
  • 63.
    Forslund, Kerstin
    et al.
    Örebro universitet, Hälsovetenskapliga institutionen.
    Kihlgren, Mona
    Centrum för omvårdnadsvetenskap, Universitetssjukhuset, Örebro.
    Sorlie, Venke
    Bodö högskola, Bodö, Norge.
    Theory and practice in nursing education: Five Aspects Meal Model (FAMM) : a tool for nursing practice and education?2006Ingår i: Theory and practice in nursing education: proceedings 2005 / [ed] Kirsten Beedholm, Niels Buus, Susanne Malchau, Inger Moos, Ulli Zeitler, Århus, Danmark: The Center for Innovation in Nursing Education , 2006, s. 141--150Konferensbidrag (Övrigt vetenskapligt)
  • 64.
    Forslund, Kerstin
    et al.
    Örebro universitet, Hälsovetenskapliga institutionen.
    Kihlgren, Mona
    Centrum för omvårdnadsvetenskap, Universitetssjukhuset, Örebro.
    Sørlie, Venke
    Bodö högskola, Bodö, Norge.
    Experiences of adding nurses to increase medical competence at an emergency medical dispatch centre2006Ingår i: Accident and Emergency Nursing, ISSN 0965-2302, E-ISSN 1532-9267, Vol. 14, nr 4, s. 230-236Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    INTRODUCTION: Prehospital care begins when the call is placed to the emergency medical dispatch (EMD) centre and ends when the patient is cared for at the emergency department. The highly technical and specialized character demands advanced medical competence. Communication problems, serious and unpredictable situations can often occur during the emergency calls. A two-year intervention study involved the addition of registered nurses to an EMD-centre team to increase medical competence. AIM: To describe registered nurses' and emergency-operators' experiences of working together at an EMD-centre after adding registered nurses to increase medical competence. METHODS: Qualitative content analysis was used to analyse the text from interviews with four registered nurses and 15 emergency-operators involved in the intervention. RESULTS: Initial frustration and scepticism changed to more positive experiences that resulted in improved cooperation and service. The registered nurses had difficulties dealing with the more urgently acute calls, while the emergency-operators had difficulties with the more complicated, somewhat diffuse cases. The two professions complemented each other. CONCLUSION: Combining the registered nurses' and emergency-operators' knowledge and experience at an EMD-centre can perhaps improve the prehospital care for those requiring emergency medical care.

  • 65.
    Forslund, Kerstin
    et al.
    Örebro universitet, Hälsovetenskapliga institutionen.
    Kihlgren, Mona
    Centrum för omvårdnadsvetenskap, Universitetssjukhuset, Örebro.
    Östman, Ingela
    Centrum för omvårdnadsvetenskap, Universitetssjukhuset, Örebro.
    Venke, Sørlie
    Bodö högskola, Bodö, Norge.
    Patients with acute chest pain: experiences of emergency calls and pre-hospital care2005Ingår i: Journal of Telemedicine and Telecare, ISSN 1357-633X, E-ISSN 1758-1109, Vol. 11, nr 7, s. 361-367Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Acute chest pain is a common reason why people call an emergency medical dispatch (EMD) centre. We examined how patients with acute chest pain experience the emergency call and their pre-hospital care. A qualitative design was used with a phenomenological-hermeneutic approach. Thirteen patients were interviewed, three women and 10 men. The patients were grateful that their lives had been saved and in general were satisfied with their pre-hospital contact. Sometimes they felt that it took too long for the emergency operators to answer and to understand the urgency. They were in a life-threatening situation and their feeling of vulnerability and dependency was great. Time seemed to stand still while they were waiting for help during their traumatic experience. The situation was fraught with pain, fear and an experience of loneliness. A sense of individualized care is important to strengthen trust and confidence between the patient and the pre-hospital personnel. Patients were aware of what number to call to reach the EMD centre, but were uncertain about when to call. More lives can be saved if people do not hesitate to call for help.

  • 66.
    Forslund, Kerstin
    et al.
    Örebro universitet, Hälsovetenskapliga institutionen.
    Quell, Robin
    Sörlie, Venke
    Acute chest pain: spouses' experiences of the alarm situation, emergency call and prehospital careManuskript (preprint) (Övrigt vetenskapligt)
  • 67. Franke Stenport, V
    et al.
    Johansson, Carina B
    Örebro universitet, Hälsovetenskapliga institutionen.
    Evaluations of Bone Tissue Integration to Pure and Alloyed Titanium Implants2008Ingår i: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, E-ISSN 1708-8208, Vol. 10, nr 3, s. 191-199Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: This study was performed for comparisons of tissue integration to commercially pure (CP) and titanium-6-aluminum-4 vanadium (Ti-6-Al-4V) implants using various existing three-dimensional biomechanical and two-dimensional histomorphometrical techniques, and to monitor the loosening torque during in vivo removal torque (RTQ) test with a novel unit not used before in a pilot study in rabbits.

    Materials and Methods: The implants were topographically characterized and inserted in femurs and tibiae of five rabbits (in total 40 implants, 20 per group). After 16 weeks, the implant integration was biomechanically evaluated by: (1) resonance frequency test, and (2) peak RTQ test and the graph from the monitoring curve. Biopsies of the implants in situ were processed to undecalcified cut and ground sections followed by light microscopical quantifications. Shear strength calculations were performed.

    Results: Significantly higher mean value of RTQ (p = .01) and shear strength tests (p = .03) were observed for the CP titanium implants compared to Ti-6-Al-4V implants. The monitoring curve from the RTQ test demonstrated no differences in the shape or form that could provide further information about the differences in the implant-to-bone attachment.

    Conclusions: The CP titanium implants showed increased RTQ and shear strength values compared to the Ti-6-Al-4V implants. The new tool of monitoring the RTQ curve could not demonstrate differences between the two materials. The exact influence of the implant materials on the surrounding tissues needs to be further investigated.

  • 68. Franke Stenport, Victoria
    et al.
    Johansson, Carina B.
    Örebro universitet, Hälsovetenskapliga institutionen. Örebro universitet, Institutionen för klinisk medicin.
    Sawase, Takashi
    Yamasaki, Yasuharu
    Oida, Shinichiro
    FGF-4 and titanium implants: a pilot study in rabbit bone2003Ingår i: Clinical Oral Implants Research, ISSN 0905-7161, E-ISSN 1600-0501, Vol. 14, nr 3, s. 363-368Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: To evaluate the effect of a local single injection of amino-terminally truncated recombinant human fibroblast growth factor-4 (rhFGF-4s) on titanium implant incorporation in a rabbit bone.

    Material and methods: Thirty-six threaded titanium implants were inserted into the femur and tibia of six rabbits. Three weeks prior to implant insertion 10 μg of FGF-4 in an altelocollagen carrier or the carrier alone was injected into the intended implant sites.

    Biomechanical evaluation by (i) resonance frequency analysis and (ii) peak removal torque measurements was performed after 6 weeks. The implants with surrounding tissue were processed to undecalcified ground sections followed by light-microscopic quantifications of the bone in threaded area and the apical parts of the implants.

    Results: A general trend, however not statistically significant, with higher mean values obtained in the above-mentioned tests was found. The FGF-4-treated implants revealed a significantly increased bone area in the apical part of the implants compared to the corresponding control implants.

    Conclusion: A local single injection of rhFGF-4 may stimulate bone formation around titanium implants in bone. However, further research is required to confirm these results, understand the mechanisms of FGF, and establish optimal dose and delivery methods.

  • 69. Franke-Stenport, Victoria
    et al.
    Johansson, Carina B.
    Örebro universitet, Hälsovetenskapliga institutionen. Örebro universitet, Institutionen för klinisk medicin.
    Joo Heo, S.
    Aspenberg, P.
    Albrektsson, T.
    Titanium implants and BMP-7 in bone: an experimental model in the rabbit2003Ingår i: Journal of materials science. Materials in medicine, ISSN 0957-4530, E-ISSN 1573-4838, Vol. 14, nr 3, s. 247-254Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This study evaluates the effect of rhBMP-7/OP-1 on the osseointegration of commercially pure titanium implants in an experimental implant model in rabbits. Threaded titanium implants with two transverse parallel canals were inserted in the femur and tibia of rabbits. The canals were filled with, 10 microg of BMP-7/collagen carrier, pure collagen carrier or were left empty as a control. The stiffness of the implant fixation was evaluated by Resonance Frequency Analysis (RFA) at baseline and four weeks postoperatively. Percentage of bone ingrowth in the canals was measured on microradiographs. Histomorphometry along the threaded part of the implants was performed on 15 microm thin sections. The results from the RFA demonstrated a higher mean value for the BMP-7 treated implants in the tibia than the carrier treated implants but not compared to the control implants. The control implants in the tibia demonstrated more bone ingrowth in the upper canal than to the carrier or the BMP-7 treated implants. Apart from these differences there were no significant effects of BMP. In this study BMP-7 did not contribute to any substantially improved bone anchorage of titanium implants.

  • 70.
    Frisk, Margot
    et al.
    Örebro universitet, Hälsovetenskapliga institutionen.
    Arvidsson, Helena
    Arbets- och miljömed. kliniken, USÖ.
    Kiviloog, Jaak
    Lungkliniken, USÖ.
    Ivarsson, Ann-Britt
    Örebro universitet, Hälsovetenskapliga institutionen.
    Kamwendo, Kitty
    Örebro universitet, Hälsovetenskapliga institutionen.
    Stridh, Göran
    Örebro universitet, Institutionen för teknik.
    An investigation of the housing environment for persons with asthma and persons without asthma2006Ingår i: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 13, nr 1, s. 4-12Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Asthma is a chronic disease affected by environmental factors that may increase symptoms that impact on a persons' well-being. An important issue in occupational therapy is to improve the relationship between a person's functional capacity and the physical environment. The aim of the study was to compare the housing environment of persons with asthma (cases, n=49) and persons without asthma (controls, n=48), with regard to building construction and condition, physical, chemical and biological factors, and cleaning routines. A secondary aim was to compare different types of accommodation within cases and controls. A specialist team, including a construction engineer, a biological scientist, and an occupational therapist, conducted the study. Data were collected using protocols, as well as a number of established technical methods from the field of occupational and environmentsl medicine. The primary results showed no major differences in the housing environment between the two groups. However, in individual homes environmental factors at levels that could increase symptoms were identified. When single-familyhouses were compared with multi-family houses, significant differences were found indicating that preventive interventions may be needed in some single-family houses. Further studies are needed to clarify the person-environment relationship for persons with asthma, focusing on their ability to perform daily activities.

  • 71.
    Frisk, Margot
    et al.
    Örebro universitet, Hälsovetenskapliga institutionen.
    Blomqvist, Anna
    Stridh, Göran
    Sjödén, Per-Olow
    Kiviloog, Jaak
    Occupational therapy adaptation of the home environment in Sweden for people with asthma2002Ingår i: Occupational Therapy International, ISSN 0966-7903, Vol. 9, nr 4, s. 294-311Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The purpose of this study was to evaluate changes of lung function, respiratory symptoms and indoor air quality after reducing allergens and indoor pollutants in the home environment of people with asthma (n = 21). A quasi-experimental pre-/post-test design with one group of participants was implemented. The interventions included removal of wall-to-wall carpets (n = 14) or improvement of indoor air exchange (n = 7). Participants' lung function, symptoms, medication and type-1 allergy were recorded before and after the intervention. The indoor environment was monitored at house calls by an occupational therapist using conventional physical, biological and chemical methods. There was an improvement of lung function evidenced by an increased mean Forced Expiratory Volume (FEV(1) %) and a reduction of airway obstruction (reversibility, % of baseline value), which indicate an improved asthmatic condition. Lung function assessed by vital capacity, bronchial hyper-responsiveness, mean of Peak Expiratory Flow, symptom score and medicine consumption did not change significantly. There was a tendency that the amount of airborne dust (p=0.06) was reduced in the indoor environment. Relative humidity, carbon dioxide, formaldehyde and house dust mite levels had decreased after the intervention, but not significantly. Asthma symptoms related to the home environment are probably caused by several factors. When people with asthma suffer from increased symptoms in the home, house calls should be performed routinely. Dust samples from beds and carpets for analysis of allergens give information about exposure, and environmental assessments should be performed before interventions. Occupational therapists can make a valuable contribution in evaluating the home environment and suggesting ergonomic adaptations for individuals with asthma.

  • 72.
    Frisk, Margot L. A.
    Örebro universitet, Hälsovetenskapliga institutionen.
    Asthma and respiratory symptoms related to the housing environment2007Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    The overall aim of this dissertation was to study the housing environment with a focus on indoor climate factors which may maintain or worsen respiratory symptoms among persons with asthma.

    Quasi-experimental and cross-sectional designs and a case-control approach were used. In Study I data was collected from a consecutive series of patients with asthma (n=21) and in the three other studies from a randomly selected sample, representative of the general population (n=6732). This sample was classified into subgroups (Study II): persons with asthma (n=261), healthy persons (n=5266) and persons with symptoms (n=1205). In Study III persons with asthma (n=49) were compared to persons without asthma (n=48), and the same group, persons with asthma (n=49) was also included in Study IV. Data were gathered using subjective information from diaries and questionnaires as well as objective measurements of medical and environmental factors.

    Lung function was improved and there was a tendency for the indoor climate to improve after the removal of textile wall-to-wall carpets or the increase of air exchange rate. No statistically significant differences were found in the housing environment when persons with and without asthma were compared. However in some individual homes, environmental factors at levels that could increase symptoms were identified. In single-family houses higher levels of humidity, insufficient ventilation and the occurrence of house dust mites indicated a less favorable indoor climate compared to multi-family houses. Respiratory symptoms attributed to specific environmental exposures increased in both healthy and unhealthy persons when they reported occurrence of indoor climate risk indicators. No statistically significant associations were found between separate risk indicators, identified by a ‘Housing Environmental-index’, or the frequency of indicators and clinical tests. The lack of significant associations may show that the chosen cut-off levels in the index were too high in reference to persons with asthma and further research is needed to establish relevant cut-off levels.

    In some of the investigated houses there was a need for secondary preventive interventions to improve the indoor climate in order to decrease the exposure of allergens and airway irritants. In this dissertation one aspect of the complex relationship between the person and the environment, i.e. accessibility, has been studied. Further research is needed to address the aspect of usability, i.e. the person’s own evaluation of the degree to which they can be in and use the environment.

    Delarbeten
    1. Occupational therapy adaptation of the home environment in Sweden for people with asthma
    Öppna denna publikation i ny flik eller fönster >>Occupational therapy adaptation of the home environment in Sweden for people with asthma
    Visa övriga...
    2002 (Engelska)Ingår i: Occupational Therapy International, ISSN 0966-7903, Vol. 9, nr 4, s. 294-311Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    The purpose of this study was to evaluate changes of lung function, respiratory symptoms and indoor air quality after reducing allergens and indoor pollutants in the home environment of people with asthma (n = 21). A quasi-experimental pre-/post-test design with one group of participants was implemented. The interventions included removal of wall-to-wall carpets (n = 14) or improvement of indoor air exchange (n = 7). Participants' lung function, symptoms, medication and type-1 allergy were recorded before and after the intervention. The indoor environment was monitored at house calls by an occupational therapist using conventional physical, biological and chemical methods. There was an improvement of lung function evidenced by an increased mean Forced Expiratory Volume (FEV(1) %) and a reduction of airway obstruction (reversibility, % of baseline value), which indicate an improved asthmatic condition. Lung function assessed by vital capacity, bronchial hyper-responsiveness, mean of Peak Expiratory Flow, symptom score and medicine consumption did not change significantly. There was a tendency that the amount of airborne dust (p=0.06) was reduced in the indoor environment. Relative humidity, carbon dioxide, formaldehyde and house dust mite levels had decreased after the intervention, but not significantly. Asthma symptoms related to the home environment are probably caused by several factors. When people with asthma suffer from increased symptoms in the home, house calls should be performed routinely. Dust samples from beds and carpets for analysis of allergens give information about exposure, and environmental assessments should be performed before interventions. Occupational therapists can make a valuable contribution in evaluating the home environment and suggesting ergonomic adaptations for individuals with asthma.

    Nationell ämneskategori
    Omvårdnad
    Forskningsämne
    Vårdvetenskap med inriktning arbetsterapi
    Identifikatorer
    urn:nbn:se:oru:diva-2831 (URN)10.1002/oti.170 (DOI)
    Tillgänglig från: 2007-05-03 Skapad: 2007-05-03 Senast uppdaterad: 2017-10-18Bibliografiskt granskad
    2. Increased occurrence of respiratory symptoms is associated with indoor climate risk indicators: a cross-sectional study in a Swedish population
    Öppna denna publikation i ny flik eller fönster >>Increased occurrence of respiratory symptoms is associated with indoor climate risk indicators: a cross-sectional study in a Swedish population
    Visa övriga...
    2007 (Engelska)Ingår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 101, nr 9, s. 2031-2035Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    A basic assumption was that exposure to the indoor environment would increase the manifestation of respiratory symptoms in predisposed individuals. The aim was to investigate the proportion of perceived respiratory symptoms attributed to specific environmental exposures, and associations related to indoor climate risk indicators, i.e. occurrence of damp or mould, insufficient ventilation and condensation on windows.

    Method

    A questionnaire was mailed to a random sample of 8008 individuals, stratified for gender and age. The response rate was 84% (n=6732). Established criteria for current asthma were used to classify subjects into three subgroups: asthmatics, healthy and symptomatics (but without current asthma).

    Results

    The proportion of symptoms attributed to specific environmental exposures increased in the total sample and in the three subgroups when indoor climate risk indicators, particularly damp or mould, were reported. Generally, the lowest proportions were found for healthy and the highest for asthmatics. Univariate analyses presented as relative risks (RR) (95% CI) showed significantly increased risks for perceived overall influence on airways for all groups, with RR ranging from 4.3 to 6.8. Although respiratory symptoms attributed to dust, environmental tobacco smoke (ETS) and strong scents increased when risk indicators were reported, RR were generally lower in all groups.

    Conclusion

    The high frequency of respiratory symptoms among asthmatics increased when occurrences of risk indicators were reported. Similarly, increased symptoms were found for healthy indicating that indoor climate risk indicators may affect both healthy and unhealthy individuals.

    Nyckelord
    asthma, airway symptoms, housing environment, risk indicators
    Nationell ämneskategori
    Omvårdnad Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
    Forskningsämne
    Vårdvetenskap med inriktning arbetsterapi
    Identifikatorer
    urn:nbn:se:oru:diva-2832 (URN)10.1016/j.rmed.2007.05.002 (DOI)
    Tillgänglig från: 2007-05-03 Skapad: 2007-05-03 Senast uppdaterad: 2017-12-14Bibliografiskt granskad
    3. An investigation of the housing environment for persons with asthma and persons without asthma
    Öppna denna publikation i ny flik eller fönster >>An investigation of the housing environment for persons with asthma and persons without asthma
    Visa övriga...
    2006 (Engelska)Ingår i: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 13, nr 1, s. 4-12Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Asthma is a chronic disease affected by environmental factors that may increase symptoms that impact on a persons' well-being. An important issue in occupational therapy is to improve the relationship between a person's functional capacity and the physical environment. The aim of the study was to compare the housing environment of persons with asthma (cases, n=49) and persons without asthma (controls, n=48), with regard to building construction and condition, physical, chemical and biological factors, and cleaning routines. A secondary aim was to compare different types of accommodation within cases and controls. A specialist team, including a construction engineer, a biological scientist, and an occupational therapist, conducted the study. Data were collected using protocols, as well as a number of established technical methods from the field of occupational and environmentsl medicine. The primary results showed no major differences in the housing environment between the two groups. However, in individual homes environmental factors at levels that could increase symptoms were identified. When single-familyhouses were compared with multi-family houses, significant differences were found indicating that preventive interventions may be needed in some single-family houses. Further studies are needed to clarify the person-environment relationship for persons with asthma, focusing on their ability to perform daily activities.

    Nyckelord
    environmental factors, housing, occupational therapy, respiratory symptoms
    Nationell ämneskategori
    Tvärvetenskapliga studier inom samhällsvetenskap Omvårdnad Arbetsterapi
    Forskningsämne
    Vårdvetenskap med inriktning arbetsterapi
    Identifikatorer
    urn:nbn:se:oru:diva-2833 (URN)10.1080/11038120510031824 (DOI)
    Projekt
    FinEsS-studies
    Tillgänglig från: 2007-05-03 Skapad: 2007-05-03 Senast uppdaterad: 2018-01-13Bibliografiskt granskad
    4. Are there associations between indoor climate risk indicators, identified by a Housing Environmental index (HE-index), and clinical tests of lung function, allergy and bronchial hyper-responsiveness in persons with asthma?
    Öppna denna publikation i ny flik eller fönster >>Are there associations between indoor climate risk indicators, identified by a Housing Environmental index (HE-index), and clinical tests of lung function, allergy and bronchial hyper-responsiveness in persons with asthma?
    Visa övriga...
    (Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
    Nationell ämneskategori
    Omvårdnad Arbetsterapi
    Forskningsämne
    Vårdvetenskap med inriktning arbetsterapi
    Identifikatorer
    urn:nbn:se:oru:diva-2834 (URN)
    Tillgänglig från: 2007-05-03 Skapad: 2007-05-03 Senast uppdaterad: 2017-10-18Bibliografiskt granskad
  • 73.
    Frisk, Margot L. A.
    et al.
    Örebro universitet, Hälsovetenskapliga institutionen.
    Magnuson, Anders
    Statistical and Epidemiological Unit, Center for Clinical Research, Örebro University Hospital.
    Kiviloog, Jaak
    Department of Respiratory Medicine, Örebro University Hospital.
    Ivarsson, Ann-Britt
    Örebro universitet, Hälsovetenskapliga institutionen.
    Kamwendo, Kitty
    Örebro universitet, Hälsovetenskapliga institutionen.
    Increased occurrence of respiratory symptoms is associated with indoor climate risk indicators: a cross-sectional study in a Swedish population2007Ingår i: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 101, nr 9, s. 2031-2035Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    A basic assumption was that exposure to the indoor environment would increase the manifestation of respiratory symptoms in predisposed individuals. The aim was to investigate the proportion of perceived respiratory symptoms attributed to specific environmental exposures, and associations related to indoor climate risk indicators, i.e. occurrence of damp or mould, insufficient ventilation and condensation on windows.

    Method

    A questionnaire was mailed to a random sample of 8008 individuals, stratified for gender and age. The response rate was 84% (n=6732). Established criteria for current asthma were used to classify subjects into three subgroups: asthmatics, healthy and symptomatics (but without current asthma).

    Results

    The proportion of symptoms attributed to specific environmental exposures increased in the total sample and in the three subgroups when indoor climate risk indicators, particularly damp or mould, were reported. Generally, the lowest proportions were found for healthy and the highest for asthmatics. Univariate analyses presented as relative risks (RR) (95% CI) showed significantly increased risks for perceived overall influence on airways for all groups, with RR ranging from 4.3 to 6.8. Although respiratory symptoms attributed to dust, environmental tobacco smoke (ETS) and strong scents increased when risk indicators were reported, RR were generally lower in all groups.

    Conclusion

    The high frequency of respiratory symptoms among asthmatics increased when occurrences of risk indicators were reported. Similarly, increased symptoms were found for healthy indicating that indoor climate risk indicators may affect both healthy and unhealthy individuals.

  • 74.
    Frisk, Margot
    et al.
    Örebro universitet, Hälsovetenskapliga institutionen.
    Stridh, Göran
    Magnuson, Anders
    Ivarsson, Ann-Britt
    Kamwendo, Kitty
    Are there associations between indoor climate risk indicators, identified by a Housing Environmental index (HE-index), and clinical tests of lung function, allergy and bronchial hyper-responsiveness in persons with asthma?Manuskript (preprint) (Övrigt vetenskapligt)
  • 75.
    Gatu, Kerstin
    Örebro universitet, Hälsovetenskapliga institutionen.
    Tillgång till information och självbestämmande: om delaktighet för personer med utvecklingsstörning2007Självständigt arbete på grundnivå (kandidatexamen), 10 poäng / 15 hpStudentuppsats
    Abstract [sv]

    Det kognitiva funktionshindret medför att personer med utvecklingsstörning har svårt att skaffa information och uttrycka behov. Den forskning som hittills genomförts baserar sig till stor del på hur andra beskriver deras delaktighet. Syftet med studien var att undersöka hur delaktighet upplevs av den funktionshindrade och dennes nätverk dels då det gäller möjlighet för den funktionshindrade att själv kunna skaffa information och dels möjlighet för den funktionshindrade att bestämma om olika aktiviteter. En bildsatt intervjuguide ”delaktighetsintervjun” baserad på ICIDH 2s livsområden som utvecklades i projektet ”Enkla bärbara datorer för personer med utvecklingsstörning” användes. Resultatet sammanställdes kvantitativt och illustrerades med kvalitativa kommentarer. Resultatet sammanställdes kvantitativt. Studiens resultat visade att det fanns stora skillnader dels mellan hur olika försökspersoner skattade delaktighet och dels hur försöksperson och respektive stödperson skattade delaktighet. Skillnader återfanns även mellan de olika livsområdena. Studiens resultat pekar på att delaktighet är ett komplext fenomen för personer med utvecklingsstörning samt att ytterligare forskning behövs.

  • 76.
    Gatu, Kerstin
    Örebro universitet, Hälsovetenskapliga institutionen.
    Tillgång till information och självbestämmande: om delaktighet för personer med utvecklingsstörning2007Självständigt arbete på grundnivå (kandidatexamen), 10 poäng / 15 hpStudentuppsats
    Abstract [sv]

    Det kognitiva funktionshindret medför att personer med utvecklingsstörning har svårt att skaffa information och uttrycka behov. Den forskning som hittills genomförts baserar sig till stor del på hur andra beskriver deras delaktighet. Syftet med studien var att undersöka hur delaktighet upplevs av den funktionshindrade och dennes nätverk dels då det gäller möjlighet för den funktionshindrade att själv kunna skaffa information och dels möjlighet för den funktionshindrade att bestämma om olika aktiviteter. En bildsatt intervjuguide ”delaktighetsintervjun” baserad på ICIDH 2s livsområden som utvecklades i projektet ”Enkla bärbara datorer för personer med utvecklingsstörning” användes. Resultatet sammanställdes kvantitativt och illustrerades med kvalitativa kommentarer. Resultatet sammanställdes kvantitativt. Studiens resultat visade att det fanns stora skillnader dels mellan hur olika försökspersoner skattade delaktighet och dels hur försöksperson och respektive stödperson skattade delaktighet. Skillnader återfanns även mellan de olika livsområdena. Studiens resultat pekar på att delaktighet är ett komplext fenomen för personer med utvecklingsstörning samt att ytterligare forskning behövs.

  • 77.
    Germer, Sofia
    et al.
    Örebro universitet, Hälsovetenskapliga institutionen.
    Astin, Malin
    Örebro universitet, Hälsovetenskapliga institutionen.
    Frakturdrabbade personers upplevelser av hemrehabilitering2006Självständigt arbete på grundnivå (kandidatexamen), 10 poäng / 15 hpStudentuppsats
    Abstract [sv]

    En kvalitativ intervjustudie med syftet att beskriva hur personer med fraktur upplever rehabilitering i sitt eget hem. Intervjuerna ägde rum i sex personers hemmiljö med hjälp av bandspelare och en egenhändigt framarbetad intervjuguide. Deltagarna upplevde bland annat att det sociala nätverket och motivation hade stor betydelse samt att personalens goda bemötande, tillgång till hjälpmedel och den välkända hemmiljön bidrog till en upplevelse av trygghet under hemrerhabiliteringen.

    Slutsatsen är att deltagarna uppskattade möjligheten att få vara i sitt hem under rehabiliteringen.

  • 78.
    Greulich, Robert
    Örebro universitet, Hälsovetenskapliga institutionen.
    Livsstilsförändringar i kardiell sekundärprevention - en litteraturstudie2006Självständigt arbete på grundnivå (kandidatexamen), 10 poäng / 15 hpStudentuppsats
    Abstract [sv]

    Kranskärlssjukdomar är på grund av deras utbredning en stor utmaning för sjukvården. Klienter med kranskärlssjukdom erbjuds sekundärpreventiva program som planeras och genomförs av sjuksköterskor. Livsstilsförändring är en del i sekundärpreventionen. Syftet med föreliggande arbete är att beskriva mål för klienten och påverkande faktorer i dennes förändringsprocess. Arbetet är en systematisk litteraturstudie. Nio vetenskapliga artiklar analyserades. Målen för livsstilsförändringar beskrivs som individuella eller överensstämmande med sjukvårdens rekommendationer. Målen är relaterade till fysisk aktivitet, kosthållning, rökning, stresshantering och medicinering. Påverkande faktorer kan delas in i somatiska, kognitiva och emotionella samt sociala och praktiska faktorer. Föreliggande arbete anses vara relevant för den praktiska verksamheten. Vetenskapliga studier om betydelsen av individuella målbeskrivningar efterlyses. Vikten av kontinuitet i uppföljningen betonas.

  • 79. Gunningberg, L.
    et al.
    Fogelberg Dahm, M.
    Ehrenberg, Anna
    Örebro universitet, Hälsovetenskapliga institutionen.
    Accuracy in the recording of pressure ulcers and prevention after implementing an electronic health record in hospital care2008Ingår i: Quality and Safety in Healthcare, ISSN 1475-3898, E-ISSN 1470-7934, Vol. 17, nr 4, s. 281-285Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To compare the accuracy in recording of pressure-ulcer prevalence and prevention before and after implementing an electronic health record (EHR) with templates for pressure-ulcer assessment. Methods: All inpatients at the departments of surgery, medicine and geriatrics were inspected for the presence of pressure ulcers, according to the European Pressure Ulcer Advisory Panel -methodology, during 1 day in 2002 (n= 357) and repeated in 2006 (n= 343). The corresponding patient records were audited retrospectively for the presence of documentation on pressure ulcers. Results: In 2002, the prevalence of pressure ulcers obtained by auditing paper-based patient records (n= 413) was 14.3%, compared with 33.3% in physical inspection (n= 357). The largest difference was seen in the geriatric department, where records revealed 22.9% pressure ulcers and skin inspection 59.3%. Four years later, after the implementation of the EHR, there were 20.7% recorded pressure ulcers and 30.0% found by physical examination of patients. The accuracy of the prevalence data had improved most in the geriatric department, where the EHR showed 48.1% and physical examination 43.2% pressure ulcers. Corresponding figures in the surgical department were 22.2% and 14.1%, and in the medical department 29.9% and 10.2%, respectively. The patients received pressure-reducing equipment to a higher degree (51.6%) than documented in the patient record (7.9%) in 2006. Conclusions: The accuracy in pressure-ulcer recording improved in the EHR compared with the paper-based health record. However, there were still deficiencies, which mean that patient records did not serve as a valid source of information on pressure-ulcer prevalence and prevention.

  • 80.
    Gustafsson, Margareta
    et al.
    Örebro universitet, Hälsovetenskapliga institutionen.
    Ahlström, Gerd
    Centre for Nursing Research, Örebro University Hospital, Box 1324, Örebro, Sweden.
    Emotional distress and coping in the early stage of recovery following acute traumatic hand injury: a questionnaire survey2006Ingår i: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 43, nr 5, s. 557-565Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Emotional distress is frequent in patients with acute traumatic hand injury during the first weeks after the accident. Knowledge of coping in relation to emotional distress could help to identify those who need support.

    Objectives: To describe the different kinds of coping used by patients in the early stage of recovery following an acute traumatic hand injury and to investigate differences in coping patterns in patients with and without symptoms of emotional distress.

    Design: Questionnaire survey with a descriptive and comparative design. Setting/participants: A total of 112 patients with acute traumatic hand injury requiring inpatient treatment at the hand surgical clinic. Those with injuries caused by a suicide attempt or with known drug abuse were excluded. Method/main outcome measures: The patients answered a postal questionnaire at home 1-2 weeks after the accident. Emotional distress was assessed with the Hospital Anxiety and Depression scale. Coping was measured with the Jalowiec Coping Scale-40.

    Results: Coping by "trying to keep the situation under control" and "trying to look at the problems objectively and see all sides" were most frequent. These strategies are typical for the confrontive coping style, which dominated in the actual illness-situation. Symptoms of emotional distress occurred in 32% of the patients. These patients used significantly more kinds of coping strategies and used confrontive and emotive coping strategies more often than the others. Coping by "hoping for improvement", "working tension off with physical activity", "trying to put the problem out of one's mind", "worrying", "getting nervous or angry" and "taking off by one self" were associated with emotional distress. Coping by "accepting the situation as it is" and "thinking that it is nothing to worry about" were more frequent in patients without emotional distress.

    Conclusions: Observations of the coping strategies associated with emotional distress in this study could help to identify patients in clinical practice that need nursing support. Coping associated with less emotional distress should be encouraged.

  • 81.
    Gustafsson, Margareta
    et al.
    Centre for Assessment of Medical Technology in Örebro, KFC, Örebro University Hospital, Örebro, Sweden.
    Edvardsson, Tanja
    Ahlström, Gerd
    Örebro universitet, Hälsovetenskapliga institutionen.
    The relationship between function, quality of life and coping in patients with low-grade gliomas2006Ingår i: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 14, nr 12, s. 1205-1212Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: The principal aim of the study was to describe function, quality of life and coping with illness-related problems in patients with low-grade gliomas (LGG), to evaluate the need of support. A second aim was to investigate how function, quality of life and coping were related.

    MATERIALS AND METHODS: Thirty-nine patients with a diagnosis of LGG answered the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC-QLQ-C30) and the Ways of Coping Questionnaire (WCQ). The patients' level of function was assessed in accordance with the WHO performance status scale.

    RESULTS AND DISCUSSION: Nearly all patients were capable of self-care, but less than half were able to carry out normal activities without restriction. Problems with fatigue, sleep disturbances and pain were most frequent. Most difficulties were reported in the domains, Role, Cognitive and Emotional functioning. Seventeen patients (45%) had scores indicating low overall quality of life. Ratings of overall quality of life and fatigue had the strongest relationship. The trend in the results suggested that mental problems have a stronger impact on quality of life than physical ones. Emotion-focused coping dominated. There was a significant relationship between coping by escape-avoidance and lower level of emotional functioning.

    CONCLUSIONS: The results of this study indicate that a multidisciplinary team is needed for assessment and treatment of the different problems in patients with LGG. Furthermore, special attention should be paid to patients who use coping by escape-avoidance, as this is associated with emotional distress.

  • 82.
    Göransson, Katarina
    Örebro universitet, Hälsovetenskapliga institutionen.
    Registered nurse-led emergency department triage: organisation, allocation of acuity ratings and triage decision making2006Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Successful triage is the basis for sound emergency department (ED) care, whereas unsuccessful triage could result in adverse outcomes. ED triage is a rather unexplored area in the Swedish health care system. This thesis contributes to our understanding of this complex nursing task. The main focus of this study has been on the organisation, performance, and decision making in Swedish ED triage. Specific aims were to describe the Swedish ED triage context, describe and compare registered nurses’ (RNs) allocation of acuity ratings, use of thinking strategies and the way they structure the ED triage process.

    In this descriptive, comparative, and correlative research project quantitative and qualitative data were collected using telephone interviews, patient scenarios and think aloud method. Both convenience and purposeful sampling were used when identifying the participating 69 nurse managers and 423 RNs from various types of hospital-based EDs throughout the country.

    The results showed national variation, both in the way triage was organised and in the way it was conducted. From an organisational perspective, the variation emerged in several areas: the use of various triageurs, designated triage nurses, and triage scales. Variation was also noted in the accuracy and concordance of allocated acuity ratings. Statistical methods provided limited explanations for these variations, suggesting that RNs’ clinical experience might have some affect on the RNs’ triage accuracy. The project identified several thinking strategies used by the RNs, indicating that the RNs, amongst other things, searched for additional information, generated hypotheses about the fictitious patients and provided explanations for the interventions chosen. The RNs formed relationships between their interventions and the fictitious patients’ symptoms. The RNs structured the triage process in several ways, beginning the process by searching for information, generating hypotheses, or allocating acuity ratings. Comparison of RNs’ use of thinking strategies and the structure of the triage process based on triage accuracy revealed only slight differences.

    The findings in this dissertation indicate that the way a patient is triaged, and by whom, depends upon the particular organisation of the ED. Moreover, the large variation in RNs triage accuracy and the inter-rater agreement and concordance of the allocated acuity ratings suggest that the acuity rating allocated to a patient may vary considerably, depending on who does the allocation. That neither clinical experience nor the RNs’ decision-making processes alone can explain the variations in the RNs triage accuracy indicates that accuracy might be influenced by individual and contextual factors. Future studies investigating triage accuracy are recommended to be carried out in natural settings.

    In conclusion, Swedish ED triage is permeated by diversity, both in its organisation and in its performance. The reasons for these variations are not well understood.

    Delarbeten
    1. Triage in emergency departments: national survey
    Öppna denna publikation i ny flik eller fönster >>Triage in emergency departments: national survey
    2005 (Engelska)Ingår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 14, nr 9, s. 1067-1074Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    AIM:

    This paper reports a study the aim of which was to describe how triage-related work was organized and performed in Swedish emergency departments.

    BACKGROUND:

    Hospitals in many developed countries use some kind of system to prioritize the patients attending emergency departments. Triage is a commonly used term to refer to the process of sorting and prioritizing patients for care. How the triage procedure is organized and which personnel perform this type of work vary considerably throughout the world. In Sweden, few studies have explored this important issue.

    METHOD:

    A national survey was conducted using telephone interviews, with nurse managers at each of the emergency departments. The sample represented 87% of emergency departments in Sweden.

    RESULTS:

    The findings clearly illustrate the organization of emergency department triage, focusing on personnel who perform triage, as well as the facilities, resources and procedures available for triage. However, the results indicate that work associated with such triage in Sweden is not organized in any consistent matter. In 81% of the emergency departments a clerk, Licensed Practical Nurse or Registered Nurse were assigned to assess patients not arriving by ambulance. There was also diversity in other areas, including requirements for staff to have particular qualifications and clinical experience for being allocated to triage work, as well as facilities for triage personnel assessing and prioritizing patients. The use of triage scales and acuity ratings also lacked uniformity and disparities were observed in both the design and use of triage scales. A little less than half (46%) of the emergency departments did not use any kind of triage scale to document patient acuity ratings.

    CONCLUSION:

    In contrast to several other countries, this study shows that Swedish emergency departments do not adhere well to established standards and guidelines about triage in emergency care. Research on emergency department triage, especially in the areas of personnel performing triage, triage scales and standards and guidelines are recommended.

    RELEVANCE TO CLINICAL PRACTICE:

    The diversity among several aspects of nursing triage (e.g. use of less qualified personnel performing triage, the use of different triage scales) presented in the study points to a safety risk for the patients. It also shows the need of further education for the personnel in clinical practice as well as further research on triage in order to gain national consensus about this nursing task.

    Nationell ämneskategori
    Omvårdnad
    Forskningsämne
    Vårdvetenskap
    Identifikatorer
    urn:nbn:se:oru:diva-3165 (URN)10.1111/j.1365-2702.2005.01191.x (DOI)
    Tillgänglig från: 2006-11-03 Skapad: 2006-11-03 Senast uppdaterad: 2020-01-28Bibliografiskt granskad
    2. Accuracy and concordance of nurses in emergency department triage
    Öppna denna publikation i ny flik eller fönster >>Accuracy and concordance of nurses in emergency department triage
    2005 (Engelska)Ingår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 19, nr 4, s. 432-438Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    In the emergency department (ED) Registered Nurses (RNs) often perform triage, i.e. the sorting and prioritizing of patients. The allocation of acuity ratings is commonly based on a triage scale. To date, three reliable 5-level triage scales exist, of which the Canadian Triage and Acuity Scale (CTAS) is one. In Sweden, few studies on ED triage have been conducted and the organization of triage has been found to vary considerably with no common triage scale. The aim of this study was to investigate the accuracy and concordance of emergency nurses acuity ratings of patient scenarios in the ED setting. Totally, 423 RNs from 48 (62%) Swedish EDs each triaged 18 patient scenarios using the CTAS. Of the 7,550 triage ratings, 57.6% were triaged in concordance with the expected outcome and no scenario was triaged into the same triage level by all RNs. Inter-rater agreement for all RNs was kappa = 0.46 (unweighted) and kappa = 0.71 (weighted). The fact that the kappa-values are only moderate to good and the low concordance between the RNs call for further studies, especially from a patient safety perspective.

    Nationell ämneskategori
    Omvårdnad
    Forskningsämne
    Vårdvetenskap
    Identifikatorer
    urn:nbn:se:oru:diva-3166 (URN)10.1111/j.1471-6712.2005.00372.x (DOI)
    Tillgänglig från: 2006-11-03 Skapad: 2006-11-03 Senast uppdaterad: 2020-01-28Bibliografiskt granskad
    3. Emergency department triage: is there a link between nurses’ personal characteristics and accuracy in triage decisions?
    Öppna denna publikation i ny flik eller fönster >>Emergency department triage: is there a link between nurses’ personal characteristics and accuracy in triage decisions?
    2006 (Engelska)Ingår i: Accident and Emergency Nursing, ISSN 0965-2302, E-ISSN 1532-9267, Vol. 14, nr 2, s. 83-88Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Introduction

    A common task of registered nurses is to perform emergency department triage, often using an especially designed triage scale in their assessment. However, little information is available about the factors that promote the quality of these decisions. This study investigated personal characteristics of registered nurses and the accuracy in their acuity ratings of patient scenarios.

    Methods

    Using the Canadian Triage and Acuity Scale (CTAS), 423 registered nurses from 48 (62%) Swedish emergency departments individually triaged 18 patient scenarios.

    Results

    The registered nurses’ percentage of accurate acuity ratings was 58%, with a range from 22% to 89% accurate acuity ratings per registered nurse. In total, 60.3% of the registered nurses accurately triaged the scenarios in 50–69% of the cases. No relationship was found between personal characteristics of the registered nurses and their ability to triage.

    Discussion

    The lack of a relationship between personal characteristics of registered nurses and their ability to triage suggests that there might be intrapersonal characteristics, particularly the decision-making strategies used which can partly explain this dispersion. Future research that focuses on decision-making is likely to contribute in identifying and describing essential nursing characteristics for successful emergency department triage.

    Nationell ämneskategori
    Tvärvetenskapliga studier inom samhällsvetenskap Omvårdnad
    Forskningsämne
    Vårdvetenskap
    Identifikatorer
    urn:nbn:se:oru:diva-3167 (URN)10.1016/j.aaen.2005.12.001 (DOI)
    Tillgänglig från: 2006-11-03 Skapad: 2006-11-03 Senast uppdaterad: 2020-01-28Bibliografiskt granskad
    4. Thinking strategies nurses use in emergency department triage
    Öppna denna publikation i ny flik eller fönster >>Thinking strategies nurses use in emergency department triage
    (Engelska)Manuskript (Övrigt vetenskapligt)
    Nationell ämneskategori
    Omvårdnad
    Forskningsämne
    Vårdvetenskap
    Identifikatorer
    urn:nbn:se:oru:diva-3168 (URN)
    Tillgänglig från: 2006-11-03 Skapad: 2006-11-03 Senast uppdaterad: 2020-01-28Bibliografiskt granskad
  • 83.
    Göransson, Katarina E.
    et al.
    Örebro universitet, Hälsovetenskapliga institutionen.
    Ehnfors, Margareta
    Örebro universitet, Hälsovetenskapliga institutionen.
    Fonteyn, Marsha E.
    Ehrenberg, Anna
    Örebro universitet, Hälsovetenskapliga institutionen.
    Thinking strategies nurses use in emergency department triageManuskript (Övrigt vetenskapligt)
  • 84.
    Göransson, Katarina E.
    et al.
    Örebro universitet, Hälsovetenskapliga institutionen.
    Ehrenberg, Anna
    Örebro universitet, Hälsovetenskapliga institutionen.
    Ehnfors, Margareta
    Örebro universitet, Hälsovetenskapliga institutionen.
    Triage in emergency departments: national survey2005Ingår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 14, nr 9, s. 1067-1074Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM:

    This paper reports a study the aim of which was to describe how triage-related work was organized and performed in Swedish emergency departments.

    BACKGROUND:

    Hospitals in many developed countries use some kind of system to prioritize the patients attending emergency departments. Triage is a commonly used term to refer to the process of sorting and prioritizing patients for care. How the triage procedure is organized and which personnel perform this type of work vary considerably throughout the world. In Sweden, few studies have explored this important issue.

    METHOD:

    A national survey was conducted using telephone interviews, with nurse managers at each of the emergency departments. The sample represented 87% of emergency departments in Sweden.

    RESULTS:

    The findings clearly illustrate the organization of emergency department triage, focusing on personnel who perform triage, as well as the facilities, resources and procedures available for triage. However, the results indicate that work associated with such triage in Sweden is not organized in any consistent matter. In 81% of the emergency departments a clerk, Licensed Practical Nurse or Registered Nurse were assigned to assess patients not arriving by ambulance. There was also diversity in other areas, including requirements for staff to have particular qualifications and clinical experience for being allocated to triage work, as well as facilities for triage personnel assessing and prioritizing patients. The use of triage scales and acuity ratings also lacked uniformity and disparities were observed in both the design and use of triage scales. A little less than half (46%) of the emergency departments did not use any kind of triage scale to document patient acuity ratings.

    CONCLUSION:

    In contrast to several other countries, this study shows that Swedish emergency departments do not adhere well to established standards and guidelines about triage in emergency care. Research on emergency department triage, especially in the areas of personnel performing triage, triage scales and standards and guidelines are recommended.

    RELEVANCE TO CLINICAL PRACTICE:

    The diversity among several aspects of nursing triage (e.g. use of less qualified personnel performing triage, the use of different triage scales) presented in the study points to a safety risk for the patients. It also shows the need of further education for the personnel in clinical practice as well as further research on triage in order to gain national consensus about this nursing task.

  • 85.
    Göransson, Katarina E.
    et al.
    Örebro universitet, Hälsovetenskapliga institutionen.
    Ehrenberg, Anna
    Örebro universitet, Hälsovetenskapliga institutionen.
    Marklund, Bertil
    Ehnfors, Margareta
    Örebro universitet, Hälsovetenskapliga institutionen.
    Emergency department triage: is there a link between nurses’ personal characteristics and accuracy in triage decisions?2006Ingår i: Accident and Emergency Nursing, ISSN 0965-2302, E-ISSN 1532-9267, Vol. 14, nr 2, s. 83-88Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction

    A common task of registered nurses is to perform emergency department triage, often using an especially designed triage scale in their assessment. However, little information is available about the factors that promote the quality of these decisions. This study investigated personal characteristics of registered nurses and the accuracy in their acuity ratings of patient scenarios.

    Methods

    Using the Canadian Triage and Acuity Scale (CTAS), 423 registered nurses from 48 (62%) Swedish emergency departments individually triaged 18 patient scenarios.

    Results

    The registered nurses’ percentage of accurate acuity ratings was 58%, with a range from 22% to 89% accurate acuity ratings per registered nurse. In total, 60.3% of the registered nurses accurately triaged the scenarios in 50–69% of the cases. No relationship was found between personal characteristics of the registered nurses and their ability to triage.

    Discussion

    The lack of a relationship between personal characteristics of registered nurses and their ability to triage suggests that there might be intrapersonal characteristics, particularly the decision-making strategies used which can partly explain this dispersion. Future research that focuses on decision-making is likely to contribute in identifying and describing essential nursing characteristics for successful emergency department triage.

  • 86.
    Göransson, Katarina
    et al.
    Örebro universitet, Hälsovetenskapliga institutionen.
    Ehrenberg, Anna
    Örebro universitet, Hälsovetenskapliga institutionen.
    Marklund, Bertil
    Ehnfors, Margareta
    Örebro universitet, Hälsovetenskapliga institutionen.
    Accuracy and concordance of nurses in emergency department triage2005Ingår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 19, nr 4, s. 432-438Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In the emergency department (ED) Registered Nurses (RNs) often perform triage, i.e. the sorting and prioritizing of patients. The allocation of acuity ratings is commonly based on a triage scale. To date, three reliable 5-level triage scales exist, of which the Canadian Triage and Acuity Scale (CTAS) is one. In Sweden, few studies on ED triage have been conducted and the organization of triage has been found to vary considerably with no common triage scale. The aim of this study was to investigate the accuracy and concordance of emergency nurses acuity ratings of patient scenarios in the ED setting. Totally, 423 RNs from 48 (62%) Swedish EDs each triaged 18 patient scenarios using the CTAS. Of the 7,550 triage ratings, 57.6% were triaged in concordance with the expected outcome and no scenario was triaged into the same triage level by all RNs. Inter-rater agreement for all RNs was kappa = 0.46 (unweighted) and kappa = 0.71 (weighted). The fact that the kappa-values are only moderate to good and the low concordance between the RNs call for further studies, especially from a patient safety perspective.

  • 87. Hagquist, Curt
    et al.
    Sundh, Mona
    Eriksson, Charli
    Örebro universitet, Hälsovetenskapliga institutionen.
    Smoking habits before and after the introduction of a minimum-age law for tobacco purchase: analysis of data on adolescents from three regions of Sweden2007Ingår i: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 35, nr 4, s. 373-379Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aims: The purpose of this study was to analyse changes in smoking habits among adolescents in three regions of Sweden following the introduction in 1997 of a law prohibiting sales of tobacco to persons under 18 years: the minimum-age law. Methods: The analysis is based on data collected among adolescents in compulsory school years 7 and 9 (about 13-14 and 15-16 years respectively), in 1996, 2000, and 2005, in three regions of Sweden. The samples comprise 43,857 students who completed a self-administered questionnaire anonymously in the classroom. The data were subjected to contingency-table analysis and logistic regression analysis. Results: The rates of smoking among students in year 9 were significantly lower in 2005 than in 1996 in two regions and unchanged in one region. This pattern held even after control for sex, parents' smoking habits, and academic orientation. In year 7 there were no changes over time (boys) or any clear pattern (girls). Conclusions: Based on outcomes from test purchases of tobacco products that were carried out in parallel to the collection of the questionnaire data, it is reasonable to hypothesize that the regional differences described may at least in part be due to differences in the availability of cigarettes. In 2005 it was significantly easier for adolescents to purchase tobacco products at retailers in the city of Malmo than at those in the counties of Varmland and Vasternorrland.

  • 88.
    Hansson, Christine
    et al.
    Örebro universitet, Hälsovetenskapliga institutionen.
    Hammas, Josephine
    Örebro universitet, Hälsovetenskapliga institutionen.
    2007Självständigt arbete på grundnivå (kandidatexamen), 10 poäng / 15 hpStudentuppsats
  • 89.
    Hedberg, Sara Thulin
    et al.
    Örebro universitet, Hälsoakademin.
    Olcén, Per
    Fredlund, Hans
    Örebro universitet, Hälsoakademin.
    Unemo, Magnus
    Örebro universitet, Hälsovetenskapliga institutionen.
    Combined real-time PCR and pyrosequencing strategy for objective, sensitive, specific, and high throughput identification of reduced susceptibility to penicillins in Neisseria meningitidis2008Ingår i: Antimicrobial Agents and Chemotherapy, ISSN 0066-4804, E-ISSN 1098-6596, Vol. 52, nr 2, s. 753-756Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    A segment of penA in Neisseria meningitidis strains (n = 127), including two nucleotide sites closely associated to reduced susceptibility to penicillins, was amplified and pyrosequenced. All results were in concordance with Sanger sequencing, and a high correlation between alterations in the two Pen(i)-specific sites and reduced susceptibility to penicillins was identified.

  • 90.
    Heedman, Sophie
    et al.
    Örebro universitet, Hälsovetenskapliga institutionen.
    Jonasson, Christina
    Örebro universitet, Hälsovetenskapliga institutionen.
    Omvårdnadsdokumentation- faktorer som har betydelse för sjuksköterskans attityder: Nursing documentation- factors that have meanin to nurses´attitudes2007Självständigt arbete på grundnivå (kandidatexamen), 10 poäng / 15 hpStudentuppsats
    Abstract [sv]

    Enligt patientjournallagen har sjuksköterskan skyldigheter att föra journal om patienten. I Sverige finns elektronisk- och pappersbaserad journalföring i olika utsträckningar. Elektroniskt beslutstödsystem är en vägledning för sjuksköterskan i arbetet. Attityd kan beskrivas som inlärda inställningar antingen för eller emot något och hur situationer upplevs. Syftet var att beskriva faktorer som hade betydelse för sjuksköterskans attityder till omvårdnadsdokumentation. En litteraturstudie användes där elektroniska sökningar gjordes i databaserna Cinahl, Medline och PsycInfo. Även en manuell sökning gjordes. Huvudresultatet visade att sjuksköterskans attityder hade betydelse för sjuksköterskans ålder, utbildningsnivå, förhållningssätt till datorer och arbetssituation. Faktorer såsom arbetsledningens och professioners attityder hade också betydelse för sjuksköterskans attityder till omvårdnadsdokumentation vid implementering av dokumentationssystem. Sjuksköterskans attityder hade betydelse till den muntliga rapporteringen då den ansågs att den kunde tas bort och att organisatoriska förändringar behövdes då implementeringen skedde. Slutsatsen som kan dras av litteraturstudiens resultat, är att sjuksköterskans IT-kunskaper en generationsfråga, som måste förändras genom att ge sjuksköterskan olika förutsättningar såsom utbildning, stöd, motivation och organisationiska förändringar som kan göra så att sjuksköterskans arbetssituation underlättas vid ett införande av datoriserat dokumentationssystem. Attityder hos arbetsledningen och andra professioner måste förändras för att sjuksköterskan skall kunna få en mer positivare attityd.

  • 91.
    Hellsing, Anna-Lisa
    et al.
    Örebro universitet, Hälsovetenskapliga institutionen.
    Linton, Steven J.
    Andershed, Birgitta
    Örebro universitet, Hälsovetenskapliga institutionen.
    Bergman, Christina
    Liew, Margareta
    Ergonomic education for nursing students1993Ingår i: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 30, nr 6, s. 499-510Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    An educational package of common ergonomic training as well as behavioural training was implemented in nursing education. The teaching methods also had the aim of increasing students' awareness of the importance of total work environment for the prevention of back injuries. The experimental group was, on the whole, more pleased with their education than the control group. The experimental group judged their ability to analyse the work environment higher than the control group did. Observations in some practical work-tasks showed that students from the experimental group worked in physically more favourable positions with less strain on the body.

  • 92.
    Henriksson, Anette
    et al.
    Örebro universitet, Hälsoakademin.
    Andershed, Birgitta
    Örebro universitet, Hälsovetenskapliga institutionen.
    A support group programme for relatives during the late palliative phase2007Ingår i: International Journal of Palliative Nursing, ISSN 1357-6321, E-ISSN 2052-286X, Vol. 13, nr 4, s. 175-183Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This study describes an intervention where relatives were invited to take part in a support group programme during the late palliative phase of their family member. The purpose was to describe their experiences of the support group programme and the subsequent impact on their lives as relatives of a terminally ill person. Qualitative interviews were chosen as the data collection method. The analysis was inspired by the phenomenological method as described by Giorgi (1989). The relatives’ experiences were categorised into six key constituents: confirmation; insight into the gravity of the illness; sense of belonging created by similar experiences; participation in the care system; being able to rest; and strength to provide support for the patient. These six constituents resulted in a sense of safety in relation to the patient, the illness, the nursing staff and the care unit. The study’s findings show that interventions of this kind may be integral to the relatives’ ability to handle their situation when caring for a terminally ill family member.

  • 93.
    Hjalmarsson, Iréne
    et al.
    Örebro universitet, Hälsovetenskapliga institutionen.
    Enblom, Sara
    Örebro universitet, Hälsovetenskapliga institutionen.
    Kartläggning av arbetsterapeuters kognitiva bedömningar vid akut stroke2006Självständigt arbete på grundnivå (kandidatexamen), 10 poäng / 15 hpStudentuppsats
    Abstract [sv]

    Att drabbas av stroke innebär ofta kognitiva funktionsnedsättningar. Betydelsen av en snabb bedömning av strokepatienters kognitiva funktioner i det akuta skedet efter en stroke betonas i flera studier. Syftet med den här studien var att med hjälp av en enkätundersökning kartlägga de kognitiva bedömningar som genomförs av arbetsterapeuter på landets strokeenheter. Undersökningsgruppen utgjordes av arbetsterapeuter på 58 strokeenheter. Det insamlade materialet bearbetades med beskrivande statistik. Av resultatet framkom att de vanligast förekommande bedömningsinstrumenten/observationerna var MMT, RBMT, DBF samt AMPS. En kombination av bedömningar gjordes på de flesta strokeenheter, typvärdet var 4 bedömningar. Resultatet visade även att arbetsterapeuternas kunskap om bedömningarnas reliabilitet och validitet var god. Någon avgörande skillnad har inte observerats när det gäller valet av bedömning hos de olika strokeenheterna med hänsyn tagen till sjukhusets storlek eller antalet arbetsterapeuter som arbetar på strokeenheten. Vår slutsats är att strokepatienter som vårdas på de strokeenheter som ingår i den här undersökningen bedöms med bedömningsinstrument/observationer av arbetsterapeuter på ett likvärdigt sätt oavsett var i landet de vårdas.

  • 94.
    Hjulström, Patricia
    et al.
    Örebro universitet, Hälsovetenskapliga institutionen.
    Lindström, Rebecca
    Örebro universitet, Hälsovetenskapliga institutionen.
    EFFEKTER AV REHABILITERANDE ÅTGÄRDER FÖR PATIENTER MED UTMATTNINGSSYNDROM: Sett ur ett arbetsterapeutiskt perspektiv2006Självständigt arbete på grundnivå (kandidatexamen), 10 poäng / 15 hpStudentuppsats
    Abstract [sv]

    Utmattningssyndrom är ett snabbt växande problem i vårt land, studier

    inom området har visat att detta tillstånd ofta är stressrelaterat. Stress är en

    reaktion på obalans mellan de belastningar som människan utsätts för och

    de resurser som han/hon har för att hantera dessa belastningar. Att drabbas

    av utmattningssyndrom kan bl.a. innebära en minskad förmåga till

    rörlighet, vilket också innebär svårigheter att klara det dagliga livets

    aktiviteter. En av arbetsterapeutens uppgifter är att hjälpa patienter hitta en

    hälsosam balans mellan arbete, vila och fritid. Syftet med denna

    litteraturstudie var att kartlägga olika rehabiliterande åtgärder som är

    tillämpningsbara inom arbetsterapin och dess effekter för patienter med

    utmattningssyndrom. Metoden i uppsatsen är en systematisk

    litteraturstudie och sökningen gjordes i databaserna: Amed, Cinahl,

    Medline och PsycArticle. För att tydliggöra och få struktur i uppsatsen

    användes klassifikationssystemet ICF (International Classification of

    Functioning, Disability and Health), med komponenterna aktivitet,

    delaktighet, omgivning- och personliga faktorer. Resultatet visade att de

    rehabiliterande åtgärder som användes var kognitiv beteendeterapi (KBT),

    gradvis utökning av aktiviteter, copingstrategier och avslappningsterapi

    /meditation. Dessa åtgärder gav positiva effekter, främst i form av ökad

    aktivitets- och funktionsnivå hos patienterna. Mer forskning och

    framförallt fler randomised controlled trial (RCT) studier behövs i ämnet.

    Gärna på effekter av arbetsterapeutisk rehabilitering för dessa patienter, för

    att få bevis för att arbetsterapi kan göra nytta för patienter med

    utmattningssyndrom.

  • 95. Hjälm, Sören
    et al.
    Kenttä, Göran
    The Swedish School of Sport and Health Sciences, Sweden.
    Hassmén, Peter
    Stockholm University, Sweden University of Southern Queensland, Australia.
    Gustafsson, Henrik
    Örebro universitet, Hälsovetenskapliga institutionen.
    Burnout among elite soccer coaches2007Ingår i: Journal of Sport Behavior, ISSN 0162-7341, Vol. 30, nr 4, s. 415-427Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Burnout was investigated in a population of men coaching either men or women at the elite club level in Sweden. Out of 53 presently active top-level soccer coaches, 47 volunteered to participate. Results indicate that 71% of the coaches in the Premier league for women, compared to 23% of the coaches in the Premier league for men, experienced moderate to high levels of Emotional Exhaustion as measured by the Maslach Burnout Inventory. One possible explanation for this difference is that only 10% of the coaches responsible for teams in the Premier league for women had full time appointments, as compared to all coaches responsible for teams in the Premier league for men. The latter group also had more support staff, on average six people, whereas those coaching women only had four people available. In addition, leadership demands seem to vary between female and male teams, which together with less support and time-constraints place coaches in the Premier league for women at a relatively higher risk for burnout than coaches in the Premier league for men.

  • 96.
    Horttana, Britt Marie
    et al.
    Örebro universitet, Hälsovetenskapliga institutionen.
    Ahlström, Gerd
    Fahlström, Gunilla
    Patterns of and reasons for relocation in dementia care2007Ingår i: Geriatric Nursing, ISSN 0197-4572, E-ISSN 1528-3984, Vol. 28, nr 3, s. 193-200Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Because dementia is a progressive disease, the need for care in municipal shelter accommodations might-change over time, raising the crucial question whether to relocate an individual. The aim of the study was to investigate the number of relocations between municipal dementia housing units and to examine the patterns and reasons for relocation, together with the various municipal prerequisites for carrying out relocation. Thirty-three managers of 101 dementia care units in 12 municipalities in Sweden were interviewed, and records of persons who had moved into or out of the dementia care units during the year 2002 were reviewed retrospectively. The results showed that turnover occurred in 35% of the 865 rooms during the year. Of those relocations, 78 (9%) were persons who moved to another accommodation-either into (59), between (13), or out of (6) a dementia care unit. This finding indicates that there are situations in which remaining in place was considered less appropriate than relocating a single individual with dementia to other accommodations with or without dementia specialization. The most common reason for relocation within the municipal shelters was an increased need for care.

  • 97.
    Hägglund, Doris
    et al.
    Örebro universitet, Hälsovetenskapliga institutionen.
    Walker-Engström, Marie-Louise
    Larsson, Gregor
    Leppert, Jerzy
    Changes in urinary incontinence and quality of life after four years: a population-based study of women aged 22-50 years2004Ingår i: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 22, s. 112-117Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES:

    To investigate (a) the incidence and remission rates of female urinary incontinence (UI), (b) changes in type of UI and quality of life (QoL), and (c) whether professional help had been consulted regarding UI.

    DESIGN:

    A 4-year follow-up population-based cohort study.

    SETTING:

    Surahammar, Sweden, a community of 10,500 inhabitants.

    SUBJECTS:

    All 118 incontinent and 130 continent women aged between 22 and 50 years.

    MAIN OUTCOME MEASURES:

    Changes in type of UI were measured using the Detrusor Instability Score (DIS), which was used to distinguish between the stress incontinent and the urge incontinent women. Changes in QoL were measured using the SF-36 Health Survey.

    RESULTS:

    The mean annual incidence and remission rates of UI were the same (4%). The majority of women (83%) reported unchanged UI after 4 years and 77% of these women had stress incontinence. At follow-up, the changes in QoL scores were significantly greater in five out of eight dimensions in the persistently incontinent group compared with the persistently continent group. QoL scores did not change significantly from baseline to the 4-year follow-up within the incidence and remission groups. Three of four women with UI had not sought professional help.

    CONCLUSIONS:

    At 4-year follow-up the type of UI is fairly stable in women below 50 years of age. The QoL decreases in five dimensions, but the clinical relevance of this might be questioned. Most women with UI had not sought professional help.

  • 98.
    Hälleberg-Nyman, Maria
    et al.
    Örebro universitet, Hälsovetenskapliga institutionen.
    Johansson, Karin
    Örebro universitet, Hälsovetenskapliga institutionen.
    Kateterassocierad urinvägsinfektion - ur ett sjuksköterskeperspektiv: Catheter-associated urinary tract infection - in the nurses' perspective2006Självständigt arbete på grundnivå (kandidatexamen), 10 poäng / 15 hpStudentuppsats
    Abstract [sv]

    SAMMANFATTNING

    Sjukhusinfektioner förlänger vårdtiden och fördyrar vården samt innebär ett ökat lidande för patienten. Urinvägsinfektion (UVI) är den vanligaste vårdrelaterade infektionen. Behandling med kateter à démeur (KAD) är omfattande inom akutsjukvården. KAD anses vara den främsta orsaken till vårdrelaterad UVI.

    Syftet med litteraturstudien var att beskriva faktorer i sjuksköterskans arbete som påverkar incidensen för utvecklandet av kateterassocierad UVI.

    Underlaget för resultatet utgörs av 24 vetenskapliga artiklar som på manuell och systematisk väg söktes i databaser. Analysen av artiklarna resulterade i sju ämnesområden som utgör delarna i resultatet. De sju ämnesområdena var: metoder/tekniker vid insättande av KAD, tidsaspekten, dränagesystem, bemanningsfaktorer, utbildning, hygienaspekter hos personal, riskfaktorer för att utveckla UVI.

    Resultatet visar bland annat på att det inte finns belägg för att använda steril metod vid kateterisering, att kateteriseringstiden bör vara så kort som möjligt, handdesinfektion mellan arbetsmomenten minskar infektionsfrekvensen, hög ålder och kvinnligt kön i kombination med tid ökar risken för UVI samt att återkommande utbildning angående katetervård bör eftersträvas.

    Ytterligare forskning inom ämnet, framför allt ur ett omvårdnadsperspektiv, är önskvärt för ett fortsatt arbete för en evidensbaserad vård.

    Nyckelord: omvårdnad, prevention, urinkateter, urinvägsinfektion

  • 99. Högberg, Torbjörn
    et al.
    Magnusson, Annabella
    Ewertzon, Mats
    Örebro universitet, Hälsovetenskapliga institutionen.
    Lützén, Kim
    Attitudes towards mental illness in Sweden: adaptation and development of the Community Attitudes towards Mental Illness questionnaire2008Ingår i: International Journal of Mental Health Nursing, ISSN 1445-8330, E-ISSN 1447-0349, Vol. 17, nr 5, s. 302-310Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The main purpose for the expansion of supported community care for persons with serious mental illness in Sweden was to ensure the right for these persons to live as citizens in the community. However, earlier research shows that negative attitudes towards mental illness present an obstacle for social integration of persons with serious mental illness. The aim of this study, conducted in Sweden, was to evaluate an existing instrument's (Community Attitudes towards Mental Illness, CAMI), validity and reliability. An additional aim was to adapt and develop the questionnaire to Swedish circumstances. After translation and modification of the original CAMI, the Swedish version of the questionnaire (CAMI-S) was distributed to all student nurses at three different universities in Sweden. The overall Cronbach's alpha coefficient was 0.90 of the original CAMI-S. A corrected inter-item total correlation excluded 20 items because they showed loading <0.43. The overall Cronbach's alpha coefficient on the 20 items (new CAMI-S) that showed loading, >0.43, was 0.903. A factor analysis of these items revealed that the data could be extracted in three factors labelled as: open-minded and pro-integration, fear and avoidance and community mental health ideology. Finally, in order to reach reliable results in attitude research, it is important to measure the respondent's attitude towards the object in common as well as the respondent's attitude to interact with the object. Accordingly, it is important to add behavioural intention items to the 'new CAMI-S'. Statements exemplifying how something 'ought to be' in an impersonal way have a good degree of stability over time and place.

  • 100.
    Isaksson, Ann-Kristin
    Örebro universitet, Hälsovetenskapliga institutionen.
    Chronic sorrow and quality of life in patients with multiple sclerosis2007Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    The overall aim of this thesis was to increase our understanding and knowledge of patients’ experiences of living with multiple sclerosis (MS). A mixed-method design was used, including both qualitative and quantitative methods. Thirty-one immunologically treated MS patients were randomly selected and matched with patients without immunological treatment. Matching criteria were gender, impairment, time since diagnosis and age. One patient dropped out and therefore the final sample consisted of 61 patients. All 61 were interviewed (Studies I, III and IV) and completed the 36-item Short Form health survey questionnaire (SF-36), the Subjective estimation of Quality of Life questionnaire (SQoL), the Self-reported Impairment Check-list (SIC) (Study II) and the Montgomery–Asberg Depression Rating Scale questionnaire (MADRS) (Study III). The interviews were subjected to content analysis.

    Initial symptoms and being diagnosed with MS were described in terms of becoming vulnerable and remaining in that vulnerability long after the diagnosis. Eventually the patients were able to manage this emotional distress and acquired strength in their illness situation (Study I). In the matched analysis, 29 pairs of patients were included after internal drop-out. There were no statistically significant differences between the treatment and control groups. Concerning the total group of 61 patients, the self-reported impairment check-list showed that they had various problems of impairment, most evident in balance and walking. The score on health-related quality of life (SF-36) was reduced, disclosing a negative influence on vitality, physical role and function. However, subjective quality of life (SQoL) was not reduced, showing that the patients estimated their well-being to be quite unaffected (Study II). Thirty-eight of the 61 patients (62%) experienced chronic sorrow (Study III). The group were not depressed in general, only four having mild symptoms of depression, revealing that chronic sorrow is a particular form of emotional distress in MS. Chronic sorrow was experienced in terms of loss of hope, loss of control over the body and loss of integrity and dignity. When the patients could not adequately manage their sorrow and lacked support, they were struggling with their vulnerability. In the successful management of MS, losses and emotional distress are managed in such a way as to enhance personal growth, appreciation and trust in life. The theoretical model of chronic sorrow facilitated the sorting of the empirical data and the linking of these data to theory, showing the usefulness of the model (Study IV).

    Delarbeten
    1. From symptom to diagnosis: illness experiences of multiple sclerosis patients
    Öppna denna publikation i ny flik eller fönster >>From symptom to diagnosis: illness experiences of multiple sclerosis patients
    2006 (Engelska)Ingår i: Journal of Neuroscience Nursing, ISSN 1945-2810, Vol. 38, nr 4, s. 229-237Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    This interview study describes 61 multiple sclerosis (MS) patients' conceptions of the disease before they were diagnosed and their experiences of the initial symptoms and the diagnosis. Qualitative content analysis was applied. The patients' perception of MS was in most cases disablement and death, but some narrated a more nuanced image of MS. The experiences of the initial symptoms and the diagnosis were stressful. The patients became and remained vulnerable through diagnosis. They managed the situation in a variety of ways to acquire strength. Nurses who encounter MS patients require specialized knowledge to understand the vulnerability of these patients and to provide support.

    Nationell ämneskategori
    Omvårdnad
    Forskningsämne
    Vårdvetenskap
    Identifikatorer
    urn:nbn:se:oru:diva-11947 (URN)16924998 (PubMedID)
    Tillgänglig från: 2010-09-29 Skapad: 2010-09-29 Senast uppdaterad: 2017-10-17Bibliografiskt granskad
    2. Quality of life and impairment in patients with multiple sclerosis
    Öppna denna publikation i ny flik eller fönster >>Quality of life and impairment in patients with multiple sclerosis
    2005 (Engelska)Ingår i: Journal of Neurology, Neurosurgery and Psychiatry, ISSN 0022-3050, E-ISSN 1468-330X, Vol. 76, nr 1, s. 64-69Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Objectives: The aims of this study were to describe the quality of life in patients with multiple sclerosis (MS) given immunological treatment and in those not given immunological treatment and to investigate the relationship between impairment and quality of life.

    Methods: Twenty nine patients given immunological treatment were matched with the same number of patients not given such treatment. Matching variables were sex, Kurtzke’s Expanded Disability Status Scale (EDSS), years since diagnosis, and age (total n = 58). The patients were interviewed using the self-reported impairment checklist and they answered two questionnaires on quality of life, the 36-Item Short-Form Health Survey (SF-36) and the Subjective Estimation of Quality of Life (SQoL).

    Results: The self-reported impairment checklist captured a more differentiated picture of the patients’ symptoms of MS than the EDSS. Health related quality of life was markedly reduced, while the subjective quality of life was less affected. There was a stronger association between self-reported ratings of impairment and health related quality of life on the SF-36 than between impairment and global ratings of quality of life on the SQoL. Subjective quality of life on the SQoL was not directly dependent on impairment expressed in physical limitations. There were no statistically significant differences between the treated and untreated groups. A non-significant trend towards better health related quality of life was found in favour of the treated group with respect to emotional role, physical role, and social function on the SF-36.

    Conclusions: The self-reported impairment checklist and SF-36 proved to be valuable complements to the well established EDSS in describing the diverse symptoms of MS. Measuring both health related quality of life and subjective wellbeing provides valuable knowledge about the consequences of MS.

    Nationell ämneskategori
    Omvårdnad
    Forskningsämne
    Vårdvetenskap
    Identifikatorer
    urn:nbn:se:oru:diva-11946 (URN)10.1136/jnnp.2003.029660 (DOI)
    Tillgänglig från: 2010-09-29 Skapad: 2010-09-29 Senast uppdaterad: 2017-12-12Bibliografiskt granskad
    3. The presence and meaning of chronic sorrow in patients with multiple sclerosis
    Öppna denna publikation i ny flik eller fönster >>The presence and meaning of chronic sorrow in patients with multiple sclerosis
    2007 (Engelska)Ingår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 16, nr 11C, s. 315-324Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    AIM AND OBJECTIVES: The aim of this study was to explore the presence and meaning of chronic sorrow and the presence of depression in a fairly large group of persons with multiple sclerosis (MS). BACKGROUND: MS is a chronic and progressive neurological disease with a variety of symptoms. The patients have to live with losses of different kinds. A few earlier studies have used the concept of chronic sorrow to illustrate the emotional situation of such patients. METHOD: Sixty-one patients were interviewed about the occurrence of chronic sorrow and, thereafter, screened for depression. Thirty-eight (62%) of them fulfilled the criteria for chronic sorrow. The interviews were analysed with latent content analysis. RESULTS: Seven themes describe the losses that caused sorrow: loss of hope, loss of control over the body, loss of integrity and dignity, loss of a healthy identity, loss of faith that life is just, loss of social relations and loss of freedom. The sorrow was constantly present or periodically overwhelming. Only four of the 38 patients with chronic sorrow had symptoms of being mildly depressed. CONCLUSION: Chronic sorrow meant loss of hope, of control over the body, of integrity and of identity. The concept of chronic sorrow complements that of depression in providing important new knowledge relevant to understanding the consequences MS can have for the individual. RELEVANCE TO CLINICAL PRACTICE: Knowledge of the meaning of chronic sorrow can contribute to the nurse's ability to give psychological support and promote a sense of hope and control in the MS patient.

    Ort, förlag, år, upplaga, sidor
    Oxford: Blackwell, 2007
    Nationell ämneskategori
    Omvårdnad Omvårdnad
    Forskningsämne
    Vårdvetenskap
    Identifikatorer
    urn:nbn:se:oru:diva-11559 (URN)10.1111/j.1365-2702.2007.01995.x (DOI)17608632 (PubMedID)
    Tillgänglig från: 2010-08-12 Skapad: 2010-08-12 Senast uppdaterad: 2017-12-12Bibliografiskt granskad
    4. Managing chronic sorrow: experiences of patients with multiple sclerosis
    Öppna denna publikation i ny flik eller fönster >>Managing chronic sorrow: experiences of patients with multiple sclerosis
    2008 (Engelska)Ingår i: Journal of Neuroscience Nursing, ISSN 1945-2810, Vol. 40, nr 3, s. 180-191Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    The goals of this study were to describe the ways in which patients with multiple sclerosis (MS) manage chronic sorrow and to apply this information to the theoretical model of chronic sorrow. This descriptive study involved 38 participants with MS who were experiencing chronic sorrow. Using the theoretical model of chronic sorrow, we applied content analysis to participants' accounts of how they attempted to manage this sorrow. The findings showed that discomfort resulted from ineffective management of chronic sorrow, reflecting the vulnerability these patients experience and the lack of understanding of their needs and appropriate support from family, friends, and healthcare personnel. In some cases, however, the losses and emotional distress caused by MS were managed effectively, which led to increased comfort through personal growth and a greater appreciation of life, greater confidence, and hope for the future. The theoretical model was valuable in helping to describe participants' patterns of managing chronic sorrow. Healthcare personnel should acknowledge chronic sorrow as one aspect of psychological distress in MS. Knowledge of patients' experiences of chronic sorrow should be included in the education for neuroscience nurses. Furthermore, it is necessary to develop support interventions for patients with chronic sorrow and their families.

    Nationell ämneskategori
    Omvårdnad
    Forskningsämne
    Vårdvetenskap
    Identifikatorer
    urn:nbn:se:oru:diva-11948 (URN)18578277 (PubMedID)
    Tillgänglig från: 2010-09-29 Skapad: 2010-09-29 Senast uppdaterad: 2017-10-17Bibliografiskt granskad
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