Personalens förväntningar inför sammanslagning av förlossnings-, BB- och neonatalavdelningen och att samtidigt införa samvård : Kvalitativ studie med fokusgruppsintervjuer

Bakgrund: Anknytningen underlättas mellan barn och föräldrar om de kan vara tillsammans redan från förlossningen. Teamarbete förbättrar kvalitén och bidrar till helhetsperspektiv i vården. En god arbetsmiljö och ett gott samarbete mellan personal är viktigt för effektiviteten av samvård. Att undersöka personalens förväntningar inför ett nytt arbetssätt är betydelsefullt eftersom det kan avspegla sig i den vård som senare ges.Syftet med studien var att belysa personalens förväntningar inför sammanslagning av olika vårdavdelningar och att samtidigt införa samvård.Metoden var en kvalitativ metod med totalt 14 deltagare i tre fokusgruppsintervjuer. Datainsamlingen analyserades med en kvalitativ innehållsanalys.Resultatet sammanfattades med temat ”Tryggt och välkänt eller nytt och osäkert – förändringsarbetets balansgång” som beskrev personalens känslor inför sammanslagningen. Kategorierna ”Att få en bra miljö för föräldrar och personal”, ”Att samarbeta med familjen i fokus”, ”Att förena två kliniker och kulturer” och ”Att genomgå en arbetsplatsförändring” beskrev de förväntningar och farhågor personalen uttryckte.Slutsatser: Resultatet visade på förväntningar av att vård- och arbetsmiljö skulle förbättras samt att samarbetet mellan klinikerna skulle bli mer effektivt. Det framkom att det var av betydelse att ha fungerande informationsflöden, uppleva delaktighet samt ha en tydlig ledning i en genomgripande organisationsförändring.

Microstructural, Mechanical and Tribological Characterisation of CVD and PVD Coatings for Metal Cutting Applications

The present thesis focuses on characterisation of microstructure and the resulting mechanical and tribological properties of CVD and PVD coatings used in metal cutting applications. These thin and hard coatings are designed to improve the tribological performance of cutting tools which in metal cutting operations may result in improved cutting performance, lower energy consumption, lower production costs and lower impact on the environment.  In order to increase the understanding of the tribological behaviour of the coating systems a number of friction and wear tests have been performed and evaluated by post-test microscopy and surface analysis. Much of the work has focused on coating cohesive and adhesive strength, surface fatigue resistance, abrasive wear resistance and friction and wear behaviour under sliding contact and metal cutting conditions. The results show that the CVD deposition of accurate crystallographic phases, e.g. α-Al2O3 rather than κ-Al2O3, textures and multilayer structures can increase the wear resistance of Al2O3. However, the characteristics of the interfaces, e.g. topography as well as interfacial porosity, have a strong impact on coating adhesion and consequently on the resulting properties.  Through the deposition of well designed bonding and template layer structures the above problems may be eliminated. Also, the presence of macro-particles in PVD coatings may have a significant impact on the interfacial adhesive strength, increasing the tendency to coating spalling and lowering the surface fatigue resistance, as well as increasing the friction in sliding contacts. Finally, the CVD-Al2O3 coating topography influences the contact conditions in sliding as well as in metal cutting. In summary, the work illuminates the importance of understanding the relationships between deposition process parameters, composition and microstructure, resulting properties and tribological performance of CVD and PVD coatings and how this knowledge can be used to develop the coating materials of tomorrow.

Parent’s experiences of feeding their preterm infant in Neonatal Units in Sweden. : Ethnographic design

Introduction: Studies have shown that having a preterm infant may cause stress and powerlessness for parents. It is important to support parents around the feeding situation, and that the Neonatal Intensive Care Unit (NICU) has appropriate space and place to help the family to bond to each other. For the healthcare professionals it is important to promote skin-to-skin contact and breastfeeding; particularly for preterm infants. There are many studies on parent’s experiences of NICUs and a few studies on parent’s experiences of feeding their infant in the NICU. Objective: The objective of this study was to explore parents experiences of feeding their infant in the NICU. Design: The study was conducted using an ethnographic design. Results: A global theme of ‘The journey in feeding’ was developed from four organising themes: ‘Ways of infant feeding’; ‘Environmental influences’; ‘Relationships’ and ‘Emotional factors’. These themes illustrate the challenges mothers reported with different methods of feeding. The environment had a big impact on parent’s experiences of infant feeding. Some mothers felt that breastfeeding seemed unnatural because their infant was so tiny but breastfeeding and skin-to-skin contact helped them to bond to their infant. The mothers thought it was difficult to keep up with the milk production by only pumping. Routines were not inviting parents to find their own rhythm. They also felt stressed about the weighing. Healthcare professionals had positive and negative influences on the parents. Conclusions: This study demonstrates that while all parents expressed the wish to breastfeed, their ‘journey in feeding’ was highly influenced by method of feeding, environmental, relational and emotional factors. The general focus upon routines and assessing milk intake generated anxiety and reduced relationality. Midwives and neonatal nurses need to ensure that they emphasise and support the relational aspects of parenting and avoid over-emphasising milk intake and associated progress of the infant