Nutritionens betydelse för patienter med KOL - Kronisk Obstruktiv Lungsjukdom : Metoder för sjuksköterskans bedömning av nutritionsstatus

Syftet med denna studie var att belysa hur viktig nutritionen är för patienter med diagnosen KOL (Kronisk Obstruktiv Lungsjukdom). Författarna ville även visa på enkla metoder för sjuksköterskan att bedöma nutritionsstatus för att förebygga malnutrition hos dessa patienter. Denna studie är en systematisk litteraturstudie där författarna använt sig av databaserna ELIN@Dalarna, CINAHL, Blackwell Synergy och SWEMED+ för att söka vetenskapliga artiklar. Sökorden som användes i olika kombinationer var: COPD, nutrition, malnutrition, undernutritioned, nutritionalstatus, nutritional supplement, BMI, energy expenditure, caring och nursing. Resultatet visade att nutritionen är av central betydelse i behandlingen av KOL patienter där sjuksköterskan har en viktig roll i samarbetet med andra yrkeskategorier såsom läkare, dietist, sjukgymnast, arbetsterapeut, kurator och psykolog. Bedömningen av patientens nutritionsstatus är en väsentlig del av sjuksköterskans omvårdnad av KOL patienter då det påverkar prognosen. Patienternas försämrade nutritionsstatus ökar risken för exacerbationer och därmed också risken för dödlighet.Sjuksköterskan kan använda sig av enkla mätmetoder för att upptäcka malnutrition, till exempel BMI (Body Mass Index) och MNA (Mini Nutritional Assessment). Ett steg i att förebygga malnutrition är regelbundna viktkontroller och att varje patient har en individuell åtgärdsplan då patientens behov alltid ska komma i första hand. Det är också viktigt att se till psykosociala aspekter runt måltiderna för dessa patienter. En noggrann planering krävs runt deras måltider som patienten kan behöva hjälp med då sjukdomen utgör ett hinder.För en ökad livskvalitet är det angeläget med information om nutritionens betydelse både till patienten och hans anhöriga.

Bildens godkännandeprocessi katalogproduktion : The image approval processin a catalog production

The objective of this thesis has been to investigate the approval process for an image. This investigation has been carriedout at four catalog-producing companies and three companies working with repro or printing. The information wasgathered through interviews and surveys and later used for evaluation. The result of the evaluation has shown that allbusinesses are very good at technical aspects but also that the biggest problem they have is with the communication. Theconclusion is that businesses need a clear construction for the image process. This will minimize the communicationproblems and make the process effective.

Den fysiska och psykosociala arbetsmiljön samt arbetstillfredsställelse hos egenföretagande tandhygienister i Sverige : en deskriptiv tvärsnittstudie

Syftet med denna studie var att beskriva svenska egenföretagande tandhygienisters (EfTH) arbetsförhållanden för att studera om där fanns samband mellan fysisk och psykosocial arbetsmiljö och arbetstillfredsställelse i gruppen. Samliga tandhygienister i Sveriges tandhygienistförenings sektion för egna företagare (n = 179) inbjöds att deltaga i studien vilken gjordes med hjälp av ett frågeformulär grundat på en förkortad version av the General Nordic Questionnaire for Psychological and Social Factors at Work, QPSNordic 34+. Sextiofem procent (n=108) svarade på enkäten. Resultaten visade att äldre tandhygienister och de som hade fler än 19 yrkesår upplevde högre grad av arbetsskicklighet, var säkrare i sin yrkesroll och kände sig mindre stressade än yngre. Stress var relaterat till fler än trettio arbetstimmar per vecka. Alla frågor i skalorna om arbetstillfredsställelse, arbetsglädje och arbetsstolthet skattades högt och allra högst frågan om arbetsstolthet. Frågor i skalorna om kontroll i arbetet visade på hög kontroll av arbetstakt, pauser och påverkan av beslut i det egna arbetet. Ett statistiskt signifikant samband kunde påvisas mellan kontroll av arbetstakt, påverkansmöjligheter, positiv feedback från patienter och arbetstillfredsställelse. Det fanns också statistiskt signifikanta samband mellan kontroll av arbetstakt, positiv feedback från tandläkare för arbetsresultat, positiv feedback från patienter samt att få tillhöra en (arbets)grupp och arbetsglädje. En slutsats från denna studie är att det förefaller finnas ett samband mellan EfTH:s arbetsförhållanden och hög arbetstillfredsställelse.

The core characteristics and nursing care activities in psychiatric intensive care units in Sweden

Internationally, research on psychiatric intensive care units (PICUs) commonly reportsresults from demographic studies such as criteria for admission, need for involuntary treatment, andthe occurrence of violent behaviour. A few international studies describe the caring aspect of thePICUs based specifically on caregivers’ experiences. The concept of PICU in Sweden is not clearlydefined. The aim of this study is to describe the core characteristics of a PICU in Sweden and todescribe the care activities provided for patients admitted to the PICUs. Critical incident techniquewas used as the research method. Eighteen caregivers at a PICU participated in the study bycompleting a semistructured questionnaire. In-depth interviews with three nurses and two assistantnurses also constitute the data. An analysis of the content identified four categories that characterizethe core of PICU: the dramatic admission, protests and refusal of treatment, escalating behaviours, andtemporarily coercive measure. Care activities for PICUs were also analysed and identified as controlling– establishing boundaries, protecting – warding off, supporting – giving intensive assistance, andstructuring the environment. Finally, the discussion put focus on determining the intensive aspect ofpsychiatric care which has not been done in a Swedish perspective before. PICUs were interpreted asa level of care as it is composed by limited structures and closeness in care.

Psychometric properties of the Swedish version of the Fear of Complications Questionnaire

Objectives: To translate and evaluate the psychometric properties of the Swedish version of the Fear of Complications Questionnaire. Design: Cross-sectional study design and scale development. Settings: Totally, 469 adults (response rate 63.5%) with Type 1 diabetes completed the questionnaires. Participants were recruited from two university hospitals in Sweden. Participants: Eligible patients were those who met the following inclusion criteria: diagnosed with Type 1 diabetes, diabetes duration of at least 1 year and aged at least 18 years. Methods: The Fear of Complications Questionnaire was translated using the forward-backward translation method. Factor analyses of the questionnaire were performed in two steps using both exploratory and confirmatory factor analysis. Convergent validity was examined using the Hospital Anxiety and Depression Scale and the Fear of Hypoglycaemia Fear Survey. Internal consistency was estimated using Cronbach’s alpha.Results: Exploratory factor analysis supported a two-factor solution. One factor contained three items having to do with fear of kidney-related complications and one factor included the rest of items concerning fear of other diabetes-related complications, as well as fear of complications in general. Internal consistency was high Cronbach’s alpha 0.96. The findings also gave support for convergent validity, with significant positive correlations between measures (r = 0.51 to 0.54). Conclusion: The clinical relevance of the identified two-factor model with a structure of one dominant subdomain may be considered. We suggest, however a one-factor model covering all the items as a relevant basis to assess fear of complications among people with Type 1 diabetes.

Effects of computer reminders on complications of peripheral venous catheters and nurses' adherence to a guideline in paediatric care : a cluster randomised study

BACKGROUND: Reminder systems in electronic patient records (EPR) have proven to affect both health care professionals' behaviour and patient outcomes. The aim of this cluster randomised trial was to investigate the effects of implementing a clinical practice guideline (CPG) for peripheral venous catheters (PVCs) in paediatric care in the format of reminders integrated in the EPRs, on PVC-related complications, and on registered nurses' (RNs') self-reported adherence to the guideline. An additional aim was to study the relationship between contextual factors and the outcomes of the intervention. METHODS: The study involved 12 inpatient units at a paediatric university hospital. The reminders included choice of PVC, hygiene, maintenance, and daily inspection of PVC site. Primary outcome was documented signs and symptoms of PVC-related complications at removal, retrieved from the EPR. Secondary outcome was RNs' adherence to a PVC guideline, collected through a questionnaire that also included RNs' perceived work context, as measured by the Alberta Context Tool. Units were allocated into two strata, based on occurrence of PVCs. A blinded simple draw of lots from each stratum randomised six units to the control and intervention groups, respectively. Units were not blinded. The intervention group included 626 PVCs at baseline and 618 post-intervention and the control group 724 PVCs at baseline and 674 post-intervention. RNs included at baseline were 212 (65.4 %) and 208 (71.5 %) post-intervention. RESULTS: No significant effect was found for the computer reminders on PVC-related complications nor on RNs' adherence to the guideline recommendations. The complication rate at baseline and post-intervention was 40.6 % (95 % confidence interval (CI) 36.7-44.5) and 41.9 % (95 % CI 38.0-45.8), for the intervention group and 40.3 % (95 % CI 36.8-44.0) and 46.9 % (95 % CI 43.1-50.7) for the control. In general, RNs' self-rated work context varied from moderately low to moderately high, indicating that conditions for a successful implementation to occur were less optimal. CONCLUSIONS: The reminders might have benefitted from being accompanied by a tailored intervention that targeted specific barriers, such as the low frequency of recorded reasons for removal, the low adherence to daily inspection of PVC sites, and the lack of regular feedback to the RNs. TRIAL REGISTRATION: Current Controlled Trials ISRCTN44819426.

What is important for you? A qualitative interview study of living with diabetes and experiences of diabetes care to establish a basis for a tailored Patient-Reported Outcome Measure for the Swedish National Diabetes Register

OBJECTIVES: There is a growing emphasis on the perspective of individuals living with diabetes and the need for a more person-centred diabetes care. At present, the Swedish National Diabetes Register (NDR) lacks patient-reported outcome measures (PROMs) based on the perspective of the patient. As a basis for a new PROM, the aim of this study was to describe important aspects in life for adult individuals with diabetes. DESIGN: Semistructured qualitative interviews analysed using content analysis. SETTING: Hospital-based outpatient clinics and primary healthcare clinics in Sweden. PARTICIPANTS: 29 adults with type 1 diabetes mellitus (DM) (n=15) and type 2 DM (n=14). INCLUSION CRITERIA: Swedish adults (≥18 years) living with type 1 DM or type 2 DM (duration ≥5 years) able to describe their situation in Swedish. Purposive sampling generated heterogeneous characteristics. RESULTS: To live a good life with diabetes is demanding for the individual, but experienced barriers can be eased by support from others in the personal sphere, and by professional support from diabetes care. Diabetes care was a crucial resource to nurture the individual's ability and knowledge to manage diabetes, and to facilitate life with diabetes by supplying support, guidance, medical treatment and technical devices tailored to individual needs. The analysis resulted in the overarching theme 'To live a good life with diabetes' constituting the two main categories 'How I feel and how things are going with my diabetes' and 'Support from diabetes care in managing diabetes' including five different categories. CONCLUSIONS: Common aspects were identified including the experience of living with diabetes and support from diabetes care. These will be used to establish a basis for a tailored PROM for the NDR.

A therapy dog's impact on daytime activity and night-time sleep for older persons with Alzheimer's disease : a case study

Background: Animal-Assisted Therapy using dogs have been described as having a calming effect, decrease sundowning and blood-pressure in persons with Alzheimer’s disease. The aim was to investigate how continuous and scheduled visits by a prescribed therapy dog affected daytime and night-time sleep for persons with Alzheimer’s disease. Methods: In this case study, registration of activity and sleep curves was conducted from five persons with moderate to severe Alzheimer’s disease living at a nursing home, over a period of 16 weeks using an Actiwatch. Data was analysed with descriptive statistics. Result: The study shows no clear pattern of effect on individual persons daytime activity and sleep when encounter with a therapy dog, but instead points to a great variety of possible different effects that brings an increased activity at different time points, for example during night-time sleep. Conclusions: Effects from the use of a Animal-Assisted Therapy with a dog in the care of persons with Alzheimer’s disease needs to be further investigated and analysed from a personcentred view including both daytime and nightime activities.

Can therapy dogs evoke awareness of one's past and present life in persons with Alzheimer's disease?

BACKGROUND: Persons with Alzheimer's disease (AD) sometimes express themselves through behaviours that are difficult to manage for themselves and their caregivers, and to minimise these symptoms alternative methods are recommended. For some time now, animals have been introduced in different ways into the environment of persons with dementia. Animal-Assisted Therapy (AAT) includes prescribed therapy dogs visiting the person with dementia for a specific purpose. AIM: This study aims to illuminate the meaning of the lived experience of encounters with a therapy dog for persons with Alzheimer's disease. METHOD: Video recorded sessions were conducted for each visit of the dog and its handler to a person with AD (10 times/person). The observations have a life-world approach and were transcribed and analysed using a phenomenological hermeneutical approach. RESULTS: The result shows a main theme 'Being aware of one's past and present existence', meaning to connect with one's senses and memories and to reflect upon these with the dog. The time spent with the dog shows the person recounting memories and feelings, and enables an opportunity to reach the person on a cognitive level. CONCLUSIONS: The present study may contribute to health care research and provide knowledge about the use of trained therapy dogs in the care of older persons with AD in a way that might increase quality of life and well-being in persons with dementia. IMPLICATIONS FOR PRACTICE: The study might be useful for caregivers and dog handlers in the care of older persons with dementia.