Syftet med denna studie är att undersöka vilken uppfattning elever i årskurs nio har om hälsa. Ämnet Idrott och hälsa bedrivs på olika sätt och syftet med studien är även att få en klarare bild över hur eleverna upplever att de arbetar med hälsa i undervisningen. Genom intervjuer vill vi höra elevernas tankar och erfarenheter om hälsa och vad de skulle vilja lära sig mer om. Vi vill även veta vad de tycker är viktigt för att kunna påverka sin framtida hälsa.

Bakgrund: Anestesisjuksköterskan arbetar i en komplex vårdmiljö med självständigt ansvar för patientens anestesi under operation och förväntas bedöma och hantera komplexa vårdsituationer. Lärande till yrkesprofession sker delvis under utbildningen till specialistsjuksköterska inom anestesi och delvis inom ramen för det yrkeskollektiv som anestesisjuksköterskan arbetar. För att uppnå kompetens som anestesisjuksköterska krävs vissa komponenter i lärandet till yrkesprofession.

Syfte: Att beskriva anestesisjuksköterskors uppfattningar av lärandet till yrkesprofession.

Metod: Studien har en kvalitativ design med fenomenografisk forskningsansats.  Anestesisjuksköterskor från en operationsavdelning i sydöstra Sverige har intervjuats kring temat lärande till yrkesprofession. Intervjumaterialet har analyserats enligt fenomenografisk metod.

Resultat: Fyra beskrivningskategorier som handlade om lärande till yrkesprofession identifierades. Att lära sig utföra anestesisjukvård, att lära sig tänka och agera som anestesisjuksköterska, att lära sig bemöta patienter och att lära sig samarbeta.

Slutsats: Resultatet visar att för att lära sig vårda en patient i en anestesikontext krävs vissa komponenter. Det är viktigt att vara medveten om dessa komponenter när studenter eller nyanställda skall lära sig yrkesprofessionen. Genom klinisk träning och teoretisk förankring kan anestesisjuksköterskan lära sig vårda komplexa sjukdomstillstånd där patientens säkerhet och integritet bibehålls.

Background As global aging accelerates, routinely assessing the functional status and morbidity burden of older patients becomes paramount. The aim of this study is to assess the validity of the comprehensive clinical and functional Health Assessment Tool (HAT) based on four cohorts of older adults (60 + years) from the Swedish National study on Aging and Care (SNAC) spanning urban, suburban, and rural areas.Methods The HAT integrates five health indicators (gait speed, global cognition, number of chronic diseases, and basic and instrumental activities of daily living), providing an individual-level score between 0 and 10. The tool was constructed using nominal response models, first separately for each cohort and then in a harmonized dataset. Outcomes included all-cause mortality over a maximum follow-up of 16 years and unplanned hospital admissions over a maximum of 3 years of follow-up. The predictive capacity was assessed through the area under the curve (AUC) using logistic regressions. For time to death, Cox regressions were performed, and Harrell's C-indices were reported. Results from the four cohorts were pooled using individual participant data meta-analysis and compared with those from the harmonized dataset.Results The HAT demonstrated high predictive capacity across all cohorts as well as in the harmonized dataset. In the harmonized dataset, the AUC was 0.84 (95% CI 0.81-0.87) for 1-year mortality, 0.81 (95% CI 0.80-0.83) for 3-year mortality, 0.80 (95% CI 0.79-0.82) for 5-year mortality, 0.69 (95% CI 0.67-0.70) for 1-year unplanned admissions, and 0.69 (95% CI 0.68-0.70) for 3-year unplanned admissions. The Harrell's C for time-to-death throughout 16 years of follow-up was 0.75 (95% CI 0.74-0.75).Conclusions The HAT is a highly predictive, clinically intuitive, and externally valid instrument with potential for better addressing older adults' health needs and optimizing risk stratification at the population level.

Aim: This study aimed at exploring the experiences of primary health-care providers of their encounters with patients with type 2 diabetes, and their preferences and suggestions for future improvement of diabetes care. Background: Barriers to good diabetes care could be related to problems from health-care providers' side, patients' side or the healthcare system of the country. Treatment of patients with type 2 diabetes has become a huge challenge in Oman, where the prevalence has increased to high levels. Method: Semi-structured interviews were conducted with 26 health-care professionals, 19 doctors and seven nurses, who worked in primary health care in Oman. Qualitative content analysis was applied. Findings: Organizational barriers and barriers related to patients and healthcare providers were identified. These included workload and lack of teamwork approach. Poor patients' management adherence and influence of culture on their attitudes towards illness were identified. From the providers' side, language barriers, providers' frustration and aggressive attitudes towards the patients were reflected. Decreasing the workload, availability of competent teams with diabetes specialist nurses and continuity of care were suggested. Furthermore, changing professional behaviours towards a more patient-centred approach and need for health education to the patients, especially on self-management, were addressed. Appropriate training for health-care providers in communication skills with emphasis on self-care education and individualization of care according to each patient's needs are important for improvement of diabetes care in Oman.

Bakgrund: Föräldrar till barn med medfött hjärtfel hamnar ofta i en utmanande livssituation där de lever med stress, ovetskap om hur de ska vårda sitt barn och undrar om barnet kommer överleva. Samtidigt saknas en sammanställning som mer exakt visar vilka upplevelser föräldrarna har och hur sjuksköterskor ska kunna anpassa sin vård till föräldrarnas speciella livssituation.

Syftet med denna studie var att beskriva föräldrars erfarenheter av att vårda barn med medfött hjärtfel.

Metoden genomfördes genom en litteraturstudie som baserades på nio artiklar med kvalitativ ansats och analyserades genom tematisering.

Resultatet presenteras genom temana plötslig chock och stress, omställningar i vardagslivet och behov av samvaro och kommunikation. Föräldrarna upplevde plötslig chock och stress efter diagnos, där de kände sig osäkra över barnets möjligheter att överleva. Föräldrarna upplevde omställningar i vardagslivet eftersom de fick en ny föräldraroll och behövde hitta nya rutiner för att besöka sjukhus och vårda barnet i hemmet. Föräldrarnas behov av samvaro och kommunikation förändrades, där de behövde hitta ömsesidig förståelse med sjukvårdspersonal och andra familjer i samma livssituation. 

Slutsats(er): En slutsats blev att sjuksköterskor behöver förstå den chock och stress som föräldrarna kan uppleva. Genom att sjuksköterskor skapar rutiner för chock- och stresshantering direkt efter diagnos kan föräldrarnas känsla av trygghet och förståelse för sin nya livssituation öka.

Aim

To practise emergency care situations during the education can be stressful. The aim of this study is to identify factors that cause stress in simulated emergency care.

Design

A descriptive observational study.

Methods

Video recordings (N = 26) subjected to observation with written field notes in turn subjected to interpretive qualitative content analysis.

Results

To assess the patient's condition and decide what measures to take trigger stress reactions. If the students failed to connect the correct and relevant information in the conversation with the physician, the students showed signs of stress. Also, to calculate medication dosages stress the students.

Background: Estimating the actual number of COVID-19 infections is crucial for steering through the COVID-19 pandemic crisis. It is, however, notoriously difficult, as many cases have no or only mild symptoms. Surveillance data for in-household secondary infections offers unbiased samples for COVID-19 prevalence estimation.

Methods: We analyse 16 115 Polish surveillance records to obtain key figures of the COVID-19 pandemic. We propose conservative upper and lower bound estimators for the number of SARS-CoV-2 infections. Further, we estimate age-dependent bounds on the severe case rate, death rate, and the in-household attack rate.

Results: By maximum likelihood estimates, the total number of COVID-19 cases in Poland as of July 22nd, 2020, is at most around 13 times larger and at least 1.6 times larger than the recorded number. The lower bound on the severeness rate ranges between 0.2% for the 0–39 year-old to 5.7% for older than 80, while the upper bound is between 2.6% and 34.1%. The lower bound on the death rate is between 0.04% for the age group 40–59 to 1.34% for the oldest. Overall, the severeness and death rates grow exponentially with age. The in-household attack ratio is 8.18% for the youngest group and 16.88% for the oldest.

Conclusions: The proposed approach derives highly relevant figures on the COVID-19 pandemic from routine surveillance data, under assumption that household members of detected infected are tested and all severe cases are diagnosed.

Background: Neighborhood environment studies of physical activity (PA) have been mainly single-country focused. The International Prevalence Study (IPS) presented a rare opportunity to examine neighborhood features across countries. The purpose of this analysis was to: 1) detect international neighborhood typologies based on participants' response patterns to an environment survey and 2) to estimate associations between neighborhood environment patterns and PA. Methods: A Latent Class Analysis (LCA) was conducted on pooled IPS adults (N=11,541) aged 18 to 64 years old (mean=37.5 +/- 12.8 yrs; 55.6% women) from 11 countries including Belgium, Brazil, Canada, Colombia, Hong Kong, Japan, Lithuania, New Zealand, Norway, Sweden, and the U. S. This subset used the Physical Activity Neighborhood Environment Survey (PANES) that briefly assessed 7 attributes within 10-15 minutes walk of participants' residences, including residential density, access to shops/services, recreational facilities, public transit facilities, presence of sidewalks and bike paths, and personal safety. LCA derived meaningful subgroups from participants' response patterns to PANES items, and participants were assigned to neighborhood types. The validated short-form International Physical Activity Questionnaire (IPAQ) measured likelihood of meeting the 150 minutes/week PA guideline. To validate derived classes, meeting the guideline either by walking or total PA was regressed on neighborhood types using a weighted generalized linear regression model, adjusting for gender, age and country. Results: A 5-subgroup solution fitted the dataset and was interpretable. Neighborhood types were labeled, "Overall Activity Supportive (52% of sample)", "High Walkable and Unsafe with Few Recreation Facilities (16%)", "Safe with Active Transport Facilities (12%)", "Transit and Shops Dense with Few Amenities (15%)", and "Safe but Activity Unsupportive (5%)". Country representation differed by type (e. g., U. S. disproportionally represented "Safe but Activity Unsupportive"). Compared to the Safe but Activity Unsupportive, two types showed greater odds of meeting PA guideline for walking outcome (High Walkable and Unsafe with Few Recreation Facilities, OR=2.26 (95% CI 1.18-4.31); Overall Activity Supportive, OR=1.90 (95% CI 1.13-3.21). Significant but smaller odds ratios were also found for total PA. Conclusions: Meaningful neighborhood patterns generalized across countries and explained practical differences in PA. These observational results support WHO/UN recommendations for programs and policies targeted to improve features of the neighborhood environment for PA.

Background: Populations in many high-income countries are ageing, with an ever-increasing proportion of the population aged 65 years or older. Despite increasingly better health in older people, susceptibility to chronic illness increase with age. As life expectancy increases, the length of time people can live with chronic illness increases correspondingly, mainly due to improved medication treatments. Decreased number of hospital beds per capita and length of stay in hospital has gained primary care an increasing role in the healthcare system, with higher demands on patients and their knowledge and abilities to manage medications and self-management.

Aim: The overarching aim of this thesis was to explore how medication regimens are communicated in primary care consultations and in written discharge letters.

Methods: In Study I, passive participant observations of primary care consultations were audio-recorded, transcribed and analysed using content analysis. Study II had a convergent mixed methods design. An assessment matrix, constructed based on previous research, was used to assess and quantify discharge letter content. The quantified discharge letter content, questionnaires and register data were used to calculate correlations between discharge letter content and readmission rate as well as self-rated quality of care transition. Finally, associations between discharge letter content and time to readmission were calculated both univariable and multivariable. In addition to discharge letter content, several other potential independent variables were included in the multivariable analysis.

Results: Both studies show that physicians were prone to give information about medications and blood-samples or other examinations performed in advance to the consultation (Study I) or during the hospital admission (Study II). The physicians were, however, less prone to inform patients about self-management and lifestyle changes, symptoms to be aware of, and what to do in case they would appear. Communication was occasionally hindered by misunderstandings, e.g., when vague expressions or words with ambiguous meaning was used. Ambiguities e.g., arose due to dialectal disparity. Although physicians mainly communicated in plain language with patients, medication names imposed a significant problem for patients and in communication about medications. Discharge letter content was not associated to readmissions, the only significant predictor variables for time to readmission were previous admission the past 180 days and birth outside the Nordic countries. Discharge letters with more content were, on the other hand, correlated to worse self-estimated quality of care transition from hospital to home (Study II).

Conclusions: Physicians informed patients about tests and examinations performed in the past time, and comprehensive information was provided about medications, both during consultations and in discharge letters. However, information about symptoms to be aware of and measures to take in case they would appear was scarce in consultations and discharge letters. In conversations where lifestyle changes were raised, the topic was quickly dropped without recommendations or offering support if the patient showed unconcern. Lifestyle changes in relation to chronic illness and medications were rarely discussed. Improved lifestyle as a means of reducing the need for medications was not discussed or informed about in discharge letters. Discharge letter content did not have any impact on readmissions.

Background

Care transitions are high-risk processes, especially for people with complex or chronic illness. Discharge letters are an opportunity to provide written information to improve patients' self-management after discharge. The aim of this study is to determine the impact of discharge letter content on unplanned hospital readmissions and self-rated quality of care transitions among patients 60 years of age or older with chronic illness.

Methods

The study had a convergent mixed methods design. Patients with chronic obstructive pulmonary disease or congestive heart failure were recruited from two hospitals in Region Stockholm if they were living at home and Swedish-speaking. Patients with dementia or cognitive impairment, or a "do not resuscitate" statement in their medical record were excluded. Discharge letters from 136 patients recruited to a randomised controlled trial were coded using an assessment matrix and deductive content analysis. The assessment matrix was based on a literature review performed to identify key elements in discharge letters that facilitate a safe care transition to home. The coded key elements were transformed into a quantitative variable of "SAFE-D score". Bivariate correlations between SAFE-D score and quality of care transition as well as unplanned readmissions within 30 and 90 days were calculated. Lastly, a multivariable Cox proportional hazards model was used to investigate associations between SAFE-D score and time to readmission.

Results

All discharge letters contained at least five of eleven key elements. In less than two per cent of the discharge letters, all eleven key elements were present. Neither SAFE-D score, nor single key elements correlated with 30-day or 90-day readmission rate. SAFE-D score was not associated with time to readmission when adjusted for a range of patient characteristics and self-rated quality of care transitions.

Conclusions

While written summaries play a role, they may not be sufficient on their own to ensure safe care transitions and effective self-care management post-discharge.

Trial registration

Clinical Trials. giv, NCT02823795, 01/09/2016.

Aim: To determine the impact of discharge letter content on unplanned hospital readmissions within 30 and 90 days, and to identify correlations between discharge letter content and quality of care transitions among patients with chronic illness.

Design: A convergent mixed methods design.

Methods: Discharge letters from 154 patients recruited to a randomised controlled trial were coded using an assessment matrix and deductive content analysis. The assessment matrix was based on a literature review performed to identify key elements in discharge letters that facilitate a safe care transition to home. The coded key elements were transformed into a quantitative variable of 'discharge letter score'. Bivariate correlations between discharge letter score and quality of care transition as well as unplanned readmissions within 30 and 90 days were calculated. Lastly, a multivariable Cox proportional hazards model was used to investigate associations between discharge letter score and time to readmission.

Results: All discharge letters contained at least five of eleven key elements. In less than four percent, all eleven key elements were present. Neither discharge letter score nor single key elements correlated with 30-day or 90-day readmission rate. Discharge letter score was not associated with time to readmission when adjusted for a range of patient characteristics and self-rated quality of care transitions.

Conclusion: Discharge letter score is not correlated with either 30-day or 90-day readmission rate or with time to readmission at 90 days, when patient characteristics are adjusted for.

Implications for the profession and patient care: Written discharge summaries are not enough to facilitate safe care transitions and self-management after discharge. A person-centred approach, providing written and verbal information to patients, encouraging patient involvement soon after discharge, may be needed to avoid readmission.

Objective To explore communication about medication management during annual consultations in primary care. Design: passive participant observations of primary care consultations.

Setting Two primary care centres in southern Sweden.

Participants Consultations between 18 patients (over the age of 60 years) with chronic diseases and 10 general practitioners (GPs) were observed, audio-recorded, transcribed and analysed using content analysis.

Results Four categories emerged: communication barriers, striving for a shared understanding of medication management, evaluation of the current medication treatment and the plan ahead and behavioural changes in relation to medication management. Misunderstandings in communication, failure to report changes in the medication treatment and use of generic substitutes complicated mutual understanding and agreement on continued treatment. The need for behavioural changes to reduce the need for medication treatment was recognised but should be explored further.

Conclusion Several pitfalls, including miscommunication and inaccurate medication lists, for safe medication management were identified. The purpose of annual consultations should be clarified, individual treatment plans could be used more actively during primary care consultations and efforts are needed to improve verbal communication and information continuity.No data are available.

Abstrakt

Bakgrund: Patienter som vårdas i samband med operation lider ofta av någon grad av preoperativ oro. Att uppleva oro beskrivs vara ett obehagligt och känslomässigt tillstånd som avger en negativ ansträngning och stress på kroppen. Oron påverkar patienterna både psykiskt och fysiskt. Det finns ett värde för operationssjuksköterskan att få en fördjupad förståelse för patientens upplevelse av preoperativ oro. Operationssjuksköterskan har en utmaning i sitt möte med patienten att skapa en säker vårdmiljö både gällande den tekniska säkerheten och den icke-tekniska för att förebygga vårdskador samtidigt som patienten behöver vårdas med värdighet. Syfte: Beskriva patienters upplevelse av preoperativ oro i samband med en operation. Metod: Studien är utförd som en strukturerad litteraturstudie med kvalitativ ansats enligt Bettany-Saltikov och McSherry (2016). Resultat: Studien resulterade i två teman med två kategorier till respektive tema under sig. Temat begränsad tillgång till livet efter operation har kategorierna negativa händelser i samband med operation och det förändrade livet efter operationen under sig. Temat maktlöshet inför det främmande har kategorierna att inte kunna påverka och att vara patient i en okänd miljö under sig. Slutsats: Patienternas upplevelse av oro visar sig olika beroende på deras individuella specifika livssituation. Deras oro har ofta kopplingar till erfarenheter som livet erbjudit. Sambandet mellan oro och relationerna till vårdpersonal i den preoperativa perioden visar vilken betydelse bemötandet har i relation till patienternas upplevelse. Operationssjuksköterskan, och övrig vårdpersonal, kan påverka patientens möjlighet till trygghet och minskning av lidande genom ett personcentrerat förhållningssätt i sina möten.

Background: Palliative care is performed throughout the continuum of care, from home care to specialized care in an institution. Palliative care is buildt on a holistic approach that is secured through patient-centered care where the patient's participation is central.

Objective: Highlighting adult patients' experiences of participation when they are cared for in late stage palliative care.

Method: The study is a systematic literature review mainly based on the methodology described by Forsberg and Wengström (2013).

Results: The theme opportunities and obstacles in the experience of their participation emerged, with four categories below: the management of their disease situation, overwhelming new living situations, be seen as an individual and not to be seen as an                                    individual. It was discovered that patients in the late stage palliative phase found opportunities to participate in their care by gathering knowledge about their disease and their future. This knowledge created understanding, giving them the tools to manage and participate in their care. An obstacle to patients’ participation appeared to be when the patients experienced neglect by health professionals.

Conclusion: Adult patients' experiences of participation when they are cared for in late stage palliative care cannot be described as a single phenomenon, but needs to be described by an integrated approach of the patient. The unique patient forms a dynamic whole, and needs to be treated as the unique individual he/she is.

Bakgrund: Endometrios är en sjukdom som drabbar var tionde kvinna i fertil ålder, vilket gör sjukdomen till en av de vanligaste gynekologiska sjukdomarna som drabbar kvinnor världen över. Trots detta är forskningen kring sjukdomen bristfällig och begränsad, vilket föranleder fördröjd diagnostisering och bristande behandlingsmetoder. Detta utgör ett problem då endometrios är en sjukdom som i de flesta fall föranleder svåra symtom samt följdproblem som infertilitet och depression. Syfte: Att beskriva kvinnors upplevelse av att leva med sjukdomen endometrios. Metod: Kvalitativ litteraturöversikt med en induktiv ansats. Resultat: Studiens resultat mynnade ut i tre huvudteman; Livet i smärtans skugga, Striden för erkännande och gehör samt Min kvinnliga identitet är försvagad och åtta subteman; Smärtans fysiska avtryck, Smärtans psykiska avtryck, Smärtan styr kalendern, Kamp mellan smärta och plikt, Kamp för rätt diagnos, Kamp för förståelse från omgivningen, Hinder för reproduktiv hälsa och slutligen Förändrad självbild - att tappa sig själv. Alla dessa framkom efter en sammanställning av kvinnors upplevelser av att leva med sjukdomen endometrios. Slutsats: Hela kvinnornas liv påverkades negativt till följd av sjukdomen och dess följdproblem. För att detta ska kunna förändras krävs det utökad kunskap inom såväl hälso- och sjukvården som i samhället som ytterligare forskning.

Operationssjuksköterskor utför en mängd olika uppgifter för att resultatet av patientens operation eller behandling ska bli så bra som möjligt. Trots detta fortsätter patienterna att lida skada av vården och hela 10 procent av alla patienter som opereras beräknas vara drabbade. Den vanligaste vårdskadan är vårdrelaterade infektioner och inkluderar postoperativa sårinfektioner, som också är den vanligaste komplikationen efter ett kirurgiskt ingrepp. Sjukvårdsskador leder till stort lidande för patienten och höga kostnader för sjukvården och samhället.

Bakgrund: Att vårda en döende människa är komplicerat och sjuksköterskan bör ha ett professionellt förhållningssätt samt ett holistiskt synsätt. Att vårda palliativa patienter kan vara både den svåraste och den mest privilegierade uppgiften som en sjuksköterska kan genomföra. Syfte: Att beskriva sjuksköterskans erfarenheter av att vårda palliativa patienter i hemsjukvården. Metod: Litteraturstudie baserat på 11 vetenskapliga artiklar med kvalitativ design. Artiklarna hämtades från databaserna Cinahl och PubMed. Resultat: Fem huvudkategorier; Vårdrelationen mellan sjuksköterska, patient och anhöriga, Teamarbete, Vårdmiljö, Emotionella utmaningar, Etiska utmaningar. Slutsats: För att en sjuksköterska ska utvecklas i sitt arbete är det viktigt att reflektera över de egna värderingarna och medvetandegöra dessa. Sjuksköterskan bör ge patienten och anhöriga stöd genom att samtala och vara närvarande. Resultaten visade att det var av stor betydelse att samarbetet från kollegor fungerade, då teamarbetet är en central del i det palliativa vårdandet. 

Bakgrund: 60% av världens kvinnor utsätts någon gång under sitt liv för könsbaserat våld. Den stora utbredningen av våld resulterar i att våldsutsatta kvinnor får ett minskat välbefinnande och påverkas negativt psykiskt, fysiskt och socialt. För att sjuksköterskan ska kunna förmedla god rådgivning och stöd i mötet med våldsutsatta kvinnor är det sjuksköterskans ansvar att beakta dessa kvinnors upplevelser. 

Syfte: Syftet var att beskriva sjuksköterskans erfarenheter av att vårda kvinnor utsatta för våld i nära relationer.

Metod: Studien genomfördes som litteraturstudie med 7 kvalitativa respektive 1 kvantitativ vetenskaplig artikel från databaserna CINAHL och Psycinfo. Integrativ analys genomfördes utifrån artiklarnas resultat.

Resultat: Resultatet presenteras i två huvudkategorier: Identifiera våld och Utbildning respektive fem underkategorier våldets innebörd, våga fråga, hindrande faktorer, brist på utbildning och behov av kunskap.

Slutsats: Anledningen till att frågan om våldsutsatthet i nära relationer inte ställs av sjuksköterskan, beror till stor del på brist i utbildningen och att sjuksköterskan inte vet hur man ska gå tillväga med svaret. Faktorer som tidsbrist och att inte våga fråga om våldsutsatthet påverkade också identifieringen av våldsutsatta kvinnor. 

Syftet med studien var att undersöka de professionellas uppfattningar om: a) de strategier och verktyg som deltagarna i ett tolvstegsprogram använder sig av och b) tolvstegsprogrammets effekter relaterat till målsättningen att deltagarna i behandlings-formen bibehåller ett nyktert och drogfritt liv. Den metodologiska utgångspunkten som användes i studien var fenomenologi med kvalitativa semistrukturerade intervjuer (Bryman, 2018 och Johansson, 2012). Vi höll intervjuer med sju olika informanter. Informanterna beskrev olika strategier och verktyg som deltagarna använder sig av under tolvstegsprogrammet samt vilka effekter dessa strategier och verktyg ger. De beskrev även vilka olika svårigheter som deltagarna stöter på under tolvstegs-programmet samt vilka framgångar som tolvstegsprogrammet ger. Informanterna beskrev att de använder sig av gruppsessioner, uppgifter samt undervisning som en del av behandlingen inom tolvstegsprogrammet. De beskrev även att tolvstegsprogrammet ger goda effekter som till exempel att deltagarna lär sig att bryta dåliga mönster och etablera en sundare livsstil. Det framkom att det religiösa i programmet är en svårighet som många deltagare upplever samt att en framgång som medföljer för de som arbetar i stegen är gemenskap och delaktighet, både i samhället och i gruppen. Vid analysen har vi använt oss av Jarvis (2010) teori om det livslånga lärandet, där faktorer som människan som social varelse, hur människors lärande sker via imitation samt omgivningens betydelse för människans utveckling har varit centrala i analysen. Studiens slutsats var att de socialpedagogiska begreppen gemenskap, delaktighet och meningsfullhet är viktiga komponenter både för att strategierna och verktygen ska ha önskad effekt och för att bibehålla och fortsätta arbeta på sin nykterhet och den förändring man gjort under tolvstegsprogrammet (Berglund och Cederlund, 2017). Det framkom även att det socialpedagogiska arbetssättets hörnstenar relation, struktur och förändring är av avgörande betydelse för tolvstegsprogrammets resultat av behandlingen (Storö, 2013).

Bakgrund: I Sverige drabbas ungefär 20 kvinnor av bröstcancer varje dag och nästan hälften har genomgått en mastektomi. En av sjuksköterskans uppgifter är att ge stöd för att förbättra kvinnans livskvalitet, då kvinnan ska uppleva ett gott liv med harmoni i sig själv och sin omgivning.Studien förankrades i Katie Erikssons lidandeteori.

Syfte: Syftet var att beskriva hur en mastektomi till följd av bröstcancer kan påverka kvinnors livskvalitet.

Metod: En systematisk litteraturstudie med induktiv ansats har använts. Datainsamlingen resulterade i 17 artiklar som sedan kvalitetsgranskades. Totalt ingick 14 artiklar. En manifest innehållsanalys genomfördes.

Resultat: Resultatet utgörs av fyra huvudkategorier: Operationens fysiska och psykiska konsekvenser, Förändrade relationer, Inverkan av det kosmetiska resultatet med tre tillhörande underkategorier samt Acceptansens betydelse. En mastektomi leder till både fysiska och psykiska påfrestningar som påverkar livskvaliteten. Förmågan att skapa relationer försämrades. Många kvinnor upplevde bröstförlusten som påfrestande genom att kroppsuppfattningen, kvinnligheten och sexualiteten påverkades negativt. Äldre kvinnor accepterade förlusten lättare.

Slutsats: Kvinnor som genomgått en mastektomi upplevde sämre livskvalitet där förlorandet av bröstet spelar stor roll. De drabbas emotionellt och förlusten har betydelse för livskvaliteten. Resultatet kan ge en ökad förståelse för sjuksköterskor som i sin tur kan vara ett stöd för att lindra lidande.

Background: The childhood vaccination program is the most successful medical response to public health. Despite this, there have always been negative voices about vaccination. Information about childhood vaccinations is spread quickly and easily through media and information channels, such as Facebook and YouTube. This information is not always critically reviewed and suspected sideeffects may then be overestimated. Evidence shows that there is a variety of reasons why some parents have doubt about childhood vaccination. Child Health nurse's task is to meet all parents with respect and give correct information so the parents have a decision basis for vaccination.

A lack of communication between the Child Health nurse and the parents can contribute to increased concern, which may lead to the parents choosing to abstain from vaccination.

Aim: The aim was to describe Child Health nurse's experiences of communicating with parents before childhood vaccinations.

Method: Semi-structured interviews with nine Child Health nurses. The study has been analyzed using a qualitative content analysis.

Results: The result showed that all participants in the study felt that most parents had a positive attitude towards childhood vaccination. The study showed that the Child Health nurses felt that they provided a good and distinct information to the parents. At the same time, participants believed that the dissemination of information could be improved. It showed that there are differences in when Child Health nurses present information to the parents. The participants in the study felt safe in the meeting with parents and about communication of information prior to vaccination.

Conclusion: The study showed that Child Health nurses felt secure about communication, both with information before vaccination and in meeting hesitent parents. Child Health nurses described that they had good and distinct information within the organization.

Background: Sweden has one of the highest proportions of older people in the world. More people live longer with chronic diseases, which increases the demand for care. The proportion of people with heart failure is increasing. Digital technology can become an important link between patient, relative and healthcare. Increased use of digital technology in healthcare can help patients with chronic illness and lead to a better quality of life. Self-monitoring in the home provides a quick indication of deterioration and leads to less emergency visits and admissions as well as reduced healthcare costs.

Aim: The aim was to describe the experience of self-monitoring in the home based on the elderly patient with heart failure and the relative's perspective.

Method: A qualitative study with inductive design was chosen to answer the study's purpose and problem area. Data was obtained through semi-structured interviews, and analysed using qualitative analysis according to Malterud's systematic text condensation.

Results: Seven elderly patients with heart failure and six relatives participated in the study.  Participants self-monitored in the home using a mobile device. The analysis resulted in three categories. Aspects of security and insecurity related to self-monitoring, self-monitoring provides support for self-care and self-monitoring a support to become a partner in care but also a responsibility.

Conclusion: Health care is facing major challenges with an increasing ageing population where more people live longer with chronic diseases. The patient needs to become more involved and need to take greater responsibility for their own care. The results of the study indicate that elderly patients with heart failure and their relatives through self-monitoring in the home experience security, are described to gain an increased knowledge of their disease and treatment and take greater responsibility for their health by performing advanced self-care at home.

Bakgrund: Fysisk aktivitet är all kroppsrörelse som resulterar i ökad energiförbrukning. Genom att vara fysisk aktiv så minskar risken att drabbas av flera sjukdomar. Balans och muskelstyrka förbättras och risk för benskörhet minskar. Fysisk aktivitet kan användas både i förebyggande syfte och som behandling av sjukdom. Sedan 2001 har fysisk aktivitet kunnat förskrivas på recept (FaR®). FaR® innebär att en läkare, sjuksköterska, sjukgymnast eller annan legitimerad vårdpersonal kan ordinera fysisk aktivitet på ett liknande sätt som läkemedel.

Syfte: Syftet med studien var att kartlägga inställning till och användande av fysisk aktivitet på recept (FaR®) hos sjuksköterskor i primärsjukvården inom Växjö kommun.

Metod: Metoden som användes var en kvantitativ enkätundersökning som genomfördes på sjuksköterskor på elva vårdcentraler inom Växjö kommun. Svarsfrekvensen var 73 %.

Resultat: De flesta sjuksköterskorna i studien diskuterade ofta fysisk aktivitet med sina patienter. Inställningen till FaR® var övervägande positiv, en knapp fjärdedel hade förskrivit FaR®.

Slutsatser: Sjuksköterskor är mycket eller ganska positiva till att ordinera FaR® i förebyggande syfte och merparten av dem är positiva till att ordinera FaR® i behandlande syfte. En trolig slutsats är att FaR® kommer att användas i större utsträckning i framtiden under förutsättning att tillräcklig utbildning och uppföljning görs.

Aims 

Previous research on racial/ethnic disparities in relation to cardiac arrest has mainly focused on black vs. white disparities in the USA. The great majority of these studies concerns out-of-hospital cardiac arrest (OHCA). The current nationwide registry study aims to explore whether there are ethnic differences in treatment and survival following in-hospital cardiac arrest (IHCA), examining possible disparities towards Middle Eastern and African minorities in a European context.

Methods and results

In this retrospective registry study, 24 217 patients from the IHCA part of the Swedish Registry of Cardiopulmonary Resuscitation were included. Data on patient ethnicity were obtained from Statistics Sweden. Regression analysis was performed to assess the impact of ethnicity on cardiopulmonary resuscitation (CPR) delay, CPR duration, survival immediately after CPR, and the medical team’s reported satisfaction with the treatment. Middle Eastern and African patients were not treated significantly different compared to Nordic patients when controlling for hospital, year, age, sex, socioeconomic status, comorbidity, aetiology, and initial heart rhythm. Interestingly, we find that Middle Eastern patients were more likely to survive than Nordic patients (odds ratio = 1.52).

Conclusion

Overall, hospital staff do not appear to treat IHCA patients differently based on their ethnicity. Nevertheless, Middle Eastern patients are more likely to survive IHCA.

If we have to document our professional action, will we then only perform the actions that we are supposed to document? This question reflects the content of this chapter. The chapter includes a frame of reference for studying control of professionals in organizations and illustration on different types of professional controls.

Medicinen kommer inte så mycket längre när det gäller att minska dödligheten i hjärt–kärlsjukdomar. Framtidens utmaning ligger i att förhindra att människor alls insjuknar i hjärtinfarkt. Författarna efterlyser politiska åtgärder som gör de hälsosamma valen billiga och attraktiva.

Abstrakt (Sammanfattning)

Bakgrund: Fibromyalgi är ett smärtsyndrom som karaktäriseras av generaliserad smärta. Det drabbar flest kvinnor och orsaken till sjukdomen är fortfarande inte känd. Det påverkar kvinnors livsvärld samt hälsa betydlig då det tar flera år att diagnostiseras, de blir oftast symtombehandlade. Kvinnor med fibromyalgi blir misstrodda av vårdpersonal, vilket leder till ett ytterligare lidande, eftersom sjukdomen fibromyalgi varken är synlig eller känd. Syfte: Är att beskriva kvinnors upplevelser av att leva med sjukdomen fibromyalgi Metod: Kvalitativ litteraturöversikt med induktiv ansats. Resultat: I studiens resultat framställdes 3 huvudkategorier Att livet begränsas, Att inte bli tagen på allvar samt Att återfå kraft. Slutsats: Resultatet visade att kvinnor var otroligt utsatta och begränsade. De upplevde lidande och ohälsa på grund av misstroende från sin omgivning samt vårdpersonal. Däremot återkom kraften när kvinnor upplevde stöd och bekräftelse. Nyckelord: Fibromyalgia, women, experiences & qualitative research.

Bakgrund: Hjärtstopp utgör ett stort hälsoproblem och förknippas med en hög dödlighet. Idag överlever allt fler hjärtstopp då kunskapen om behandling har ökat. Behandlingen utgörs av hjärt-lungräddning, och om det inte ges uppkommer skador på hjärnan och hjärtat som kan leda till döden. Hjärtstopp påverkar sannolikt patientens livssituation och livsvärld, vilket den grundutbildade sjuksköterskan kan behöva möta med en personcentrerad vård.Syfte: Att undersöka patienters erfarenheter av att överleva ett hjärtstopp.Metod: En litteraturöversikt över både kvalitativ- och kvantitativ forskning.  Resultat: Fyra kategorier identifierades: Livsvärld, Mental hälsa, En förändrad kropp och Trygghet, med tolv identifierade underkategorier: En förändrad livsvärld, Förlora självständigheten, Tillbaka till livet innan hjärtstoppet, Kognitiva förändringar, Ångest, Minnesbild, Otillräcklighet och frustration, Kroppsliga begränsningar, Smärta, Information, Gemenskap och Tacksamhet.Slutsats: Ett hjärtstopp är omtumlande både för kroppen och själen. Livets förutsättningar ändras vilket medför ett stort behov av stöd från både närstående och sjukvården. Detta gör att hälso-och sjukvården behöver en större och bättre kunskap om patienters erfarenheter av att överleva ett hjärtstopp. 

Bakgrund: Negativ arbetsrelaterad stress är ett ständigt problem i flera samhällssektorer, även så i stor utsträckning inom vårdsektorn. Forskning visar att arbetsrelaterad stress inom vården kan utlösas av flera olika faktorer, bland annat en för hög arbetsbelastning. Långvarig negativ stress kan orsaka utmattningssymtom och utbrändhet.

Syfte: Syftet med studien var att undersöka stress relaterad till arbetsbelastningen hos allmänsjuksköterskor som arbetar på sjukhusavdelningar.

Metod: En kvantitativ enkätstudie utfördes på fyra sjukhusavdelningar på ett sjukhus i Södra Sverige. Instrumentet Maslach Burnout Inventory- HSS användes för att mäta respondenternas stress. Resultatet redovisades och analyserades med deskriptiv statistik, regressionsanalys och Spearmans rangkorrelationskoefficient.

Resultat: Resultatet visar att det hos allmänsjuksköterskor finns ett samband mellan arbetsbelastning och stress. Samband uppmättes mellan antal övertidstimmar och utbrändhetsfaktorn ”Otillräcklighet” (p < 0,05), samt mellan känslan av att vara överarbetad och utbrändhetsfaktorn ”Emotionell utmattning” (p < 0,01).  Resultatet visar också att bakgrundsfaktorer som kan kopplas  till privatlivet spelar en mindre roll för sjuksköterskornas upplevda arbetsstress och att det huvudsakligen är arbetsrelaterade faktorer som påverkar upplevelsen av stress.

Slutsats: Den undersökta populationen lider av stressfaktorer kopplade till arbetsbelastning och låg arbetstillfredsställelse och majoriteten av den undersökta populationen löper en risk att drabbas av utbrändhet. För att bibehålla god vårdkvalité, eller förbättra den ytterligare, bör åtgärder för att sänka arbetsbelastningen och öka arbetstillfredställelsen ses över.

Aim. To develop and validate a new instrument measuring patient anxiety during Magnetic Resonance Imaging examinations, Magnetic Resonance Imaging-Anxiety Questionnaire. Background. Questionnaires measuring patients' anxiety during Magnetic Resonance Imaging examinations have been the same as used in a wide range of conditions. To learn about patients' experience during examination and to evaluate interventions, a specific questionnaire measuring patient anxiety during Magnetic Resonance Imaging is needed. Design. Psychometric cross-sectional study with test-retest design. Methods. A new questionnaire, Magnetic Resonance Imaging-Anxiety Questionnaire, was designed from patient expressions of anxiety in Magnetic Resonance Imaging-scanners. The sample was recruited between October 2012-October 2014. Factor structure was evaluated with exploratory factor analysis and internal consistency with Cronbach's alpha. Criterion-related validity, known-group validity and test-retest was calculated. Results. Patients referred for Magnetic Resonance Imaging of either the spine or the heart, were invited to participate. The development and validation of Magnetic Resonance Imaging-Anxiety Questionnaire resulted in 15 items consisting of two factors. Cronbach's alpha was found to be high. Magnetic Resonance Imaging-Anxiety Questionnaire correlated higher with instruments measuring anxiety than with depression scales. Known-group validity demonstrated a higher level of anxiety for patients undergoing Magnetic Resonance Imaging scan of the heart than for those examining the spine. Test-retest reliability demonstrated acceptable level for the scale. Conclusion. Magnetic Resonance Imaging-Anxiety Questionnaire bridges a gap among existing questionnaires, making it a simple and useful tool for measuring patient anxiety during Magnetic Resonance Imaging examinations.

BackgroundA fast-track system was introduced do topeople suffer from low-energy trauma with a suspected hip fracture.Thispathway up comewas to minimize the suffering a was introduced to bypass the emergency department to win time and minimizes the numbers of movement and getsthe patient faster on to the operating table.MethodsThe aim ofthis study was toexplore howthe pathway have any positiveeffects for the patient through analyzing made studies on the subject. Twelve studies wereused toanswer the aim of this study.All twelve were analyzedtrough SBU:s model for analysis.Both studies with qualitative and quantitative design wereused to answer the aim and to give it a deeper understanding. ResultsThere was an advantage for the patient in the pathway with the fewer new faces in anoften confused and painfulmomentwhich gives the patient a calmer and quicker recovery. The compassion and knowledge of the patient was bigger if the same person took care of the patient through the process. The gain in time was only a fact up untilthe x-ray after that the waitingtimebecame the same with orwithout pathway. ConclusionThe studies show an advantage for the patient with the pathway up to a point after that point there still is room for more research and change in the pathway to optimize for the patient and caregiver.

Bakgrund:  Fibromyalgi är en kronisk sjukdom vars huvudsakliga symtom är generell smärta i kroppen. En diagnos tar lång tid att ställa och kräver otaliga besök hos olika specialister på grund av dess komplexa sjukdomsbild. Sjukdomens prevalens ligger mellan två-fyra procent av befolkningen. 

Syfte: Att beskriva hur patienter med fibromyalgi upplever mötet med vården.  

Metod: Kvalitativ litteraturstudie med en induktiv ansats, inklusionskriterier för studien var artiklar skrivna på engelska, “peer reviewed”, publicerade mellan år 2012–2020, innefattade etiskt godkännande. Studiens resultat bygger på Lundman och Hällgren Graneheims, innehållsanalys genomförd på tio vetenskapliga artiklar som myntade på två kategorier och sex underkategorier.

Resultat: I innehållsanalysen av artiklarna framkom huvudkategorierna ”En omtvistad diagnos” och ”Vårdrelationens betydelse”. Att möta vården med fibromyalgi hade både negativa och positiva aspekter. Negativa upplevelser i vården och brist på stöd, bidrog till ett vårdlidande som i längden kan leda till ohälsa. De positiva upplevelserna visade på att patienter som får stöd och blir bekräftade hade större möjlighet att hantera sin sjukdom.

Slutsats: Vården behöver öka sina kunskaper kring sjukdomen och skapa tydligare kriterier för att ställa diagnos. En vårdrelation som ger patienter bekräftelse och stöd är en grogrund för patienters välbefinnande.  

Background: Each year, more than 700 000 people around the world die because of suicide, and the biggest risk factor for committing suicide is previous suicide attempts. Research shows that people who commit suicide often visit the emergency department one, up to several times before taking their own lives. Emergency departments are therefore an important place for preventing suicide. Research shows that suicide attempts and self-harming behavior are becoming more common, and that selfharming behavior is an important risk factor for suicide. In emergency departments, nurses often meet patients with self-harming behaviors, patients who have attempted suicide and patients with suicidal ideation. Aim: The aim was to describe the emergency nurses’ experiences of caring for patients who have been admitted to emergency rooms because of self-harming behaviors and suicide attempts, and to describe emergency nurses' attitudes towards these patients Method: A systematic literature review with integrative design. Systematic searches have been conducted in three medical databases using the PEO model. Ten included scientific articles of qualitative, quantitative, and mixed method designs have been reviewed and analyzed. Results: The results highlight five main themes: I. Nurses’ attitudes; II. Nurses’ treatment of physical over mental health; III. Work experience in the emergency department; IV. Barriers in the context of the emergency department; and V. Nurses’ perceived competencies and skills. Conclusions: As the result show that many emergency nurses' report insecurity in the care of patients with self-harming behavior and patients who have attempted suicide, more training should be offered in emergency departments around these conditions. Emergency departments should also try to retain and recruit competent and experienced nurses, to provide more sustainable and patient-safe care.

Being cared for in an intensive care unit affects both the patient being cared for and the family in various ways. The family is of great importance for the recovery of the former intensive-care patient. The aim is to explore family functioning and family hardiness in families of former intensive care patients. A cross-sectional study using two self-reported questionnaires. Former adult intensive care patients and their family were recruited to participate between December 2017 and June 2019. The data were coded and entered the Statistical Package for the Social Sciences version 25, for analysis. To explore questionnaire data, descriptive and inferential statistical analyses were performed. Scale values were calculated on, both family wise and between the patients and the family members. STROBE checklist was used. Data was collected from 60 families (60 former intensive cared patients and 85 family members) and showed that 50 families scored healthy family functioning and 52 high strengths in hardiness. The data showed small variations between and within families for family functioning and family hardiness, there were only two families scoring low for both family functioning and hardiness. The variation was higher within the families, but there was no significance level.The conclusions were that family functioning and hardiness was, to a large extent, assessed as good by the families. Nevertheless, it is important to help the family obtain information and support. So, the family need to continue to communicate, finding coping abilities and strengths in adopting new strategies to protect the family unit. The family are very important for members' mental and physical recovery as the health of one family member affects the family as a unit.

Introduction: When a family member has been critically ill and cared for at an intensive care unit the individual family member as well as the family system are affected and in need of support. The aim of this study was to compare and contrast the responses from 2 different types of follow-up interventions for families of critically ill persons, focusing on individual hopes, health-related quality of life, family functioning and ability to cope with challenges.

Method: Adult family members from 3 hospitals attended 1 of 2 interventions 2 months after intensive care. The family health conversation included the family. The support group conversation included just family members and not the patient who had experienced intensive care. Data were collected via self-reported questionnaires and follow-up interviews with family members. Quantitative and qualitative data were first analyzed separately, and the results were then integrated through mixed methods analysis.

Results: A total of 38 family members took part in the interventions. Family members in the 2 intervention groups talked about how they had more hope for the future, and about how talking within the family and the group had helped them justify their feelings, which empowered them in the transition toward a healthier quality of life. Comparisons of the interventions show a higher significance of family function and hope in the family health conversation.

Discussion: The article illustrates a disparity between how family members function and the needs they have for follow-up. We discuss what kind of follow-up these persons need.

Aim: We aimed to investigate symptoms of low energy availability (LEA) among athletes and recreational active people, and the associations with EDs, excessive exercise, and motivation for training and dietary behavioural changes. 

Methods: Swedish female national team athletes (n=150) from 26 sports, and recreational active women (n=108), 18-39 years were recruited via sport organizations and social media. Participants filled out an anonymous on-line survey comprising the LEA in Females Questionnaire (LEAF-Q), the Eating Disorder Examination Questionnaire (EDE-Q), the Major Depression Index (MDI), the Exercise Addiction Inventory (EAI), and  the Motivation to Change Questionnaire (MCQ). LEAF-Q total score >8 and EDE-Q Global score >2.3  were used to classify participants as having symptoms of LEA and eating disorders (EDs), respectively.

Results: Of all participants, 47% had symptoms of LEA with no difference between elite athletes (47%) and controls (48%). Participants with LEA had lower body mass and BMI compared to those with no symptoms, while no differences were found in age or training load. Most of the participants with LEA (69%) did not have symptoms of EDs. However, when excluding all participants with ED symptoms (n=65), participants with LEA had higher EDE-Q sub scale scores, MDI and EAI scores, and they reported poorer health status and reduced ability to increase energy intake and to lower the training load compared to participants with no LEA symptoms. 

Conclusion: Our findings confirm earlier indications that symptoms of LEA is frequent among elite athletes as well as sedentary people, and that most LEA cases do not have EDs. However, our findings suggest that symptoms of LEA may still be associated with poor well-being, restricted eating and excessive training behaviour and negative focus on body shape and weight. Reversing LEA by increased energy intake and/or reduced training load is the only treatment to prevent REDs health and performance implications. Our findings therefore emphasize the need for multidisciplinary prevention strategies to ensure necessary dietary and training behavioural changes.

Background: The demography of the world is changing as the population is ageing. Because of this change to a higher proportion of older people, the WHO has called for improved palliative care for older persons. A large number of all deaths in the industrialised world occur while older people are living in nursing homes and therefore a key question becomes how the principles of palliative care can be implemented in that context. The aims of this study are: a) to describe a model of an educational intervention with the goal of implementing knowledge-based palliative care in nursing homes, and b) to describe the design of the evaluation of the effectiveness regarding the implementation of knowledge-based palliative care. Methods/design: A complex intervention is evaluated by means of a cross-over design. An educational intervention concerning palliative care consisting of five seminars during 6 months for staff and managers has been developed and conducted in 20 nursing homes in two counties. Before the intervention started, the feasibility was tested in a pilot study conducted in nursing homes not included in the main study. The intervention is evaluated through a non-randomized experimental design with intervention and control groups and pre- and post-assessments. The evaluation includes older persons living in nursing homes, next-of-kin, staff and managers. Data collection consists of quantitative methods such as questionnaires and register data and qualitative methods in the form of individual interviews, focus-group interviews and participant observations. Discussion: The research will contribute to new knowledge about how to implement knowledge-based palliative care in a nursing home setting. A strength of this project is that the Medical Research Council framework of complex intervention is applied. The four recommended stages, Development, Feasibility and piloting, Evaluation and Implementation, are combined for the educational intervention, which functions as a strategy to achieve knowledge-based palliative care in the nursing homes. Implementation is always a question of change and a good theoretical understanding is needed for drawing valid conclusions about the causal mechanisms of change. The topic is highly relevant considering the world's ageing population. The data collection is completed and the analysis is ongoing.

Bakgrund: Som patient i den prehospitala sjukvården kan känslan av utsatthet vara stor, oro ur flera perspektiv. Sjuksköterskan har ansvar för att skapa en relation med patienten, vilket är en del av omvårdnad. Vidare måste relationen skapas utifrån patientens förutsättningar. Sjuksköterskan inom ambulanssjukvården har ansvar för att ett vårdande möte skapas och för det krävs att förtroende kan skapas mellan patient och sjuksköterska. Tidigare forskning pekar på att förtroende är en viktig faktor för att samspelet ska vara fungerande.

Syfte: Syftet är att belysa vilka faktorer som bidrar till ett förtroendeskapande möte mellan patient och ambulanssjuksköterska, sett ur ett patientperspektiv.

Metod: Fem systematiska artikelsökningar genomfördes som resulterade i 14 artiklar som användes i resultatet. Som resultat i litteraturstudien användes artiklar av kvalitativ design. En niostegsmodell, framtagen för kvalitativa litteraturstudier, användes. Meningsbärande teman skapades och öppen kodning användes, och datan grupperades utefter teman som sedan utgjorde resultatet.

Resultat: Ett förtroendeskapande möte skapades enligt patienter genom icke verbal och verbal kommunikation. Andra avgörande faktorer var att ambulanssjuksköterskan hade ett professionellt förhållningssätt och vården var personcentrerad. Resultatet presenteras enligt följande tema: Kommunikation; med subtema icke-verbal kommunikation, verbal kommunikation och informationsöverföring som faktorer som är viktiga för det förtroendeskapande mötet. Personcentrerad vård; med subteman att bli bekräftad, säkerhet och delaktighet som ansågs av patienter bidra till att det förtroendeskapande mötet kan äga rum. Professionalism; där subteman professionellt bemötande och empati beskrev förtroendeskapande faktorer.

Slutsats: Att etablera ett förtroendefullt möte mellan patient och sjuksköterska är av betydelse för hur patienten upplever prehospitalt omhändertagande. Litteraturstudien bidrar med kunskap om hur ett förtroendefullt möte kan skapas.

Bakgrund: Tidigare studier visar att mellan 5-10% av alla barn och 3-10% av dagens vuxna har ADHD ( Attention-Deficit/Hyperactivity Disorder). Bakomliggande orsaker till ADHD är idag inte helt klarlagt. Individer med ADHD har symtom som koncentrationsproblem, hyperaktivitet och impulsivitet vilket påverkar deras dagliga liv. 

Syfte: Syftet med studien var att belysa vuxnas upplevelser av att leva med ADHD.

Metod: En litteraturstudie utfördes på fem självbiografier som kvalitetsgranskades och analyserades med hjälp av Lundmans & Hällgren Granheims (2012) kvalitativa manifesta innehållsanalys.

Resultat: Att leva med ADHD innebär många svårigheter. Det framkom samstämmiga uppgifter som beskrev känslan av att vara annorlunda, utanförskap, dålig självkänsla. För att klara vardagen krävdes ett ökat behov av strategier och rutiner samt stöd från familjen. 

Slutsats: Individer med ADHD, upplever svårigheter i vardagen som medför både mentalt och socialt lidande. Det kan finnas ett behov av att sjuksköterskan får en fördjupad förståelse för hur det är att leva med ADHD, likaså på vilket sätt sjuksköterskan kan hjälpa och vägleda dessa individer vid kontakt med sjukvården.

The present study proposed a new instrument for the assessment of the current faculty development programs at Iranian medical universities. Although the literature concerning the subject of faculty development activities has already identified strengths and weakness of such programs, it is still questionable whether these activities can be assessed using a pedagogical and managerial comprehensive approach. Therefore, it was determined to develop an instrument to examine faculty development activities that address all components of programs from planning and implementing to evaluating phases, with the possibility of utilizing this instrument as a tool to assess faculty development activities.

Introduction

Natural environments are known to promote health and may also provide extraordinary conditions for post exercise recovery (Kuo 2015). In the project Health Effects of Recreation Outdoors (HERO) we explore the hypothesis that post exercise recovery in natural environments may be reflected in white blood cell counts (WBC). In our study 50 seniors (age >65 years) performed moderate physical activity (20 min) followed by passive recovery (2h) in three different environments (indoors, simulated outdoors and “true” outdoors).

Method

The experimental setup was a randomized cross-over design, thus all test persons did all treatments in a randomized order. We sampled white blood cells (WBC-diff), which were used to detect and quantify inflammatory response.

Results

Our early findings provide some support for the hypothesis that environment may impose differences in recovery effectiveness. White blood cell count (WBC-diff) appears to differ between the treatments and there is a significant interaction between sampling time and recovery environment in the monocytes, suggesting that the monocyte numbers differ, not only between sampling times but also between environments. In addition, WBC also show that some of the test persons develop leukocytosis during exercise and that white blood cell levels decrease rapidly immediately post exercise to levels significantly lower than base line values.

Discussion

Our results suggest that moderate physical activity in senior citizens may result in acute leukocytosis (see e.g. Sand et. al. 2013) and that recovery effectiveness (e.g in monocyte response) may be dependent upon environmental factors. The clinical importance of our results are not fully understood but there has been suggested an “open window” immediately post exercise in which infection risk may be elevated (Pedersen & Toft 2000) and it is possible that recovery out of doors may reduce this risk.

References

Sand, K., L, Flatebo, K., Andersen, M., B., Maghazachi, A., A. (2013) World J Exp Med 20; 3(1): 11-20

Pedersen, B., K. & Toft, A., D. (2000) Br J Sports Med 34:246–251

Kuo, M. (2015) Frontiers in Psychology 6:1-8

INTRODUCTION: IntroductionPhysical exercise has been proven beneficial for health in all ages. In elderly, physical exercise, may contribute to prolonged life with maintained high quality and less costs associated with health care for society. In this study we explore if exercise out of doors may provide extra benefits as compared to exercise indoors and we measure power output, lactate levels and perceived effort in 49 senior citizens performing 20 minutes of moderate physical activity.METHODS:MethodThe HERO project is a randomized cross-over experiment with three different treatments <indoors, simulated="" outdoors="" and="">. The study sample consisted of 49 healthy senior citizens. They performed 20 minutes moderate intensity physical activity on an ergometer bike in all three conditions. Before immediately after and at minutes 10, 20, 30, 60 and 120 we sampled blood lactate. Power output was computed at 7 occasions during the 20 minutes of cycling, as was the rating of perceived exertion . Data was analyzed using mixed linear models. RESULTS:ResultsOur findings show that there were no differences between the two indoor treatments in any of the measured variables. In the outdoor treatment, however, there were significant effects on blood lactate levels and power output but not in perceived exertion, suggesting that exercise out of doors makes the test person more efficient although the experience of effort stay unaffected.CONCLUSION:Discussion/conclusionsOur results support the notion that the outdoors may provide extraordinary conditions for exercise, not only because it appear to results in more exercise/effort, the outdoors is also an “arena” with high availability and most often totally for free. Previous results from the HERO project also suggests that white blood cell counts are affected by the outdoor treatment, something that may be related to the observed increased power output herein

Outdoor activities may be intuitively associated with interest for nature and environmental concern. However, most scientific studies suggest that no such correlation exists. In this quantitative study we have used a questionnaire and explored the hypothesis that a one day educational intervention may be a successful tool in increasing environmental awareness, interest for nature and interest for recreational fishing. We present evidence suggesting that educational interventions in which young people are exposed to natural environments in a recreational fishing context have positive effects on interest for nature and recreational fishing, knowledge about nature and environmental awareness. Our findings also reveal that frequency of nature visits does not correlate with self estimated interest for nature.  We also show that the observed effects of the educational intervention “Klassdraget” appear to be larger for the girls which are, by tradition, less interested in recreational fishing as compared to boys.

Purpose: The purpose of this study was to test the hypothesis that the ”outdoors” has an added health effect on top of that of physical activity. This hypothesis is based on the fairly extensive volume of evidens suggesting that the outdoor environment is beneficial for overall health. We, however, consider most previous studies insufficiently designed in order to draw causal relationship between spending time outdoors and examined health parameters. In this study we state that our experimental design allows us to do just that. 

Methods:

In this randomized cross-over experimental design, 49 healthy subjects (+65 years, 27 female) performed a standardized submaximal bike ergometer test in three different environments (indoors, simulated outdoors and outdoors). The test consisted of 20 minutes cycling and subjects were instructed to stay between 11-13 at the Borg RPE scale (i.e. moderate intensity). Each test was followed by two hours of passive recovery. We measured power output, heart rate, lactate and counts of five fractions (lymphocytes, monocytes, neutrophiles, basophiles and eosinophiles) of white blood cells (leukocytes) in circulation.

Results:

Our results revealed that the outdoor treatment resulted in higher levels of lactate, higher heart rate and higher power output despite that there were no differences in Borg RPE-rating between the treatments. The white blood cell analysis showed an increase of circulating leukocytes in almost all fractions immediately post exercise in all treatments. Numbers decreased rapidly post exercise and the lymphocyte numbers stayed well under baseline for more than one hour during recovery. This is referred to as an “open window” where the immune function is temporarily suppressed and there is an elevated risk of infection of primarily URTI.

Conclusions:

Our results not only suggest that exercise is more efficient out of doors such that more exercise/effort is obtained but also that recovery outdoors may be a way to decrease the risk of infections due to exercise induced immune suppression. The risk of getting an infection is known to be generally lower out of doors. Taken together, our results support the notion that exercising and spending time outdoors indeed is beneficial for health in senior citizens.

BackgroundA growing body of evidence suggests that exposure to nature is beneficial for human health. However, the observed health effect of nature may be mediated by physical activity and that humans are physically active at a higher intensity outdoors compared to when they are physical active indoors.ObjectiveThis study examines the variation of heart rate and power output for a fixed rating of perceived exertion in a group of healthy older adults in three different environments representing three levels of exposure to nature.MethodsTo this randomized, 3-by-3 crossover design study, healthy older adults (≥65 years) were recruited from local gyms. All participants participated in three experimental conditions; indoors, simulated outdoors and outdoor environments, in a randomized order. The participants exercised for 20 minutes at an intensity equivalent to a rating of 11–13 on the Borg scale for perceived exertion (RPE). Measurements of heart rate, power output (Watt) and ratings of perceived exertion were taken at minutes 1 to 6 and at minute 20. To examine the effect of the environment on heart rate and power, linear mixed models were used.ResultsIn all, 48 participants (56% females) were included in the analysis. No significant main effects on the outcomes were observed for power output (p = 0.073, η2 = 0.04) or heart rate (p = 0.067, η2 = 0.04)ConclusionNo significant effect on the outcomes was observed. However, borderline significant outcomes for power output or heart rate outdoors in nature, along with previous studies in the field, indicates that such an effect cannot be completely ruled out, but any effect is likely to be small. Future research examining health benefits of the independent exposure to nature are encouraged to adjust for the dose of physical activity.