Omvårdnad vid förstoppning hos dementa personer : undersköterskors och vårdbiträdens reflektioner

Constipation is a common problem for people with dementia and it may result in discomfort, suffering and lower quality of life. Nurses in municipal nursing homes have difficult to observe and prevent these problems because they do not participate in the daily caring work. The aim of this study was to illustrate the nurse assistants’ reflections about the care they gave people with dementia and constipation. Main questions vas how they became aware of such problems and what they did when someone had problem with constipation. It also asked about their methods to prevent constipation and if they thought anything could be done better in the future. The method used was a qualitative interview study. The study included eight nurse assistants who worked in municipal nursing homes for people with dementia. The interviews where tape recorded, then written and analysed with a phenomenological method. The result illustrate how the nurse assistants used their sense for observing and their personal feelings to share the experience with the person. This gave trust and renders possibility to get knowledge and also gave opportunity to prevent problems and give help, in a way that not reduced dignity for the person. Bowel control, fluid, food and the possibility to get out for a walk was important. It was also important to have enough time for sharing reflections. Small units gave possibility to personal knowledge.

Passive crosslaminated timber buildings : Final report Cerbof-project no. 76

In this project, Stora Enso’s newly developed building system has been further developed to allow building to the Swedish passive house standard for the Swedish climate. The building system is based on a building framework of CLT (Cross laminated timber) boards. The concept has been tested on a small test building. The experience gained from this test building has also been used for planning a larger building (two storeys with the option of a third storey) with passive house standard with this building system. The main conclusions from the project are:  It is possible to build airtight buildings with this technique without using traditional vapour barriers. Initial measurements show that this can be done without reaching critical humidity levels in the walls and roof, at least where wood fibre insulation is used, as this has a greater capacity for storing and evening out the moisture than mineral wool. However, the test building has so far not been exposed to internal generation of moisture (added moisture from showers, food preparation etc.). This needs to be investigated and this will be done during the winter 2013-14.  A new fixing method for doors and windows has been tested without traditional fibre filling between them and the CLT panel. The door or window is pressed directly on to the CLT panel instead, with an expandable sealing strip between them. This has been proved to be successful.  The air tightness between the CLT panels is achieved with expandable sealing strips between the panels. The position of the sealing strips is important, both for the air tightness itself and to allow rational assembly.  Recurrent air tightness measurements show that the air tightness decreased somewhat during the first six months, but not to such an extent that the passive house criteria were not fulfilled. The reason for the decreased air tightness is not clear, but can be due to small movements in the CLT construction and also to the sealing strips being affected by changing outdoor temperatures.  Long term measurements (at least two years) have to be carried out before more reliable conclusions can be drawn regarding the long term effect of the construction on air tightness and humidity in the walls.  An economic analysis comparing using a concrete frame or the studied CLT frame for a three storey building shows that it is probably more expensive to build with CLT. For buildings higher than three floors, the CLT frame has economic advantages, mainly because of the shorter building time compared to using concrete for the frame. In this analysis, no considerations have been taken to differences in the influence on the environment or the global climate between the two construction methods.

Integrated Product Development in Truck Industry - A Case Study on Product Development Processes

This paper presents the result from a case study at Scania on product development processes. The objective with the case study was to gather information on Scania’s product development process (PDP) including the use of CAD and simulation tools, and project work. The objective was also to find any deviations or different interpretations among the employees on the PDP. To gather the information, semi-structured tape-recorded interviews have been used to ensure that individual interpretations from the interviewees could be gathered. Scania uses a defined and structured PDP which facilitates concurrent and cross-functional work. The PDP is implemented and followed to various degrees. The newly employed personnel may have difficulties with communication, both to find and to give information. Although, newly graduated personnel may find it easier to adapt to changes, and also to use a structured process which they have studied at universities. It was also known during the case study that the PDP is a major support for the newly employed personnel, which in turn decreases the time to get into the same working process as the more experienced personnel. Employees with decades of experience know the right sources from which to both give and gather information. Also, the terminology and definitions in the product development process may not be used as intended. This makes it difficult for other project members or teams who need to interpret the information received. At the same time, the routines among the more experienced personnel, which have been set-up throughout the years, make them more inflexible in adapting changes. The findings in the case study as well as challenges with implementing the PDP are known to Scania and are a part of the continuing work with improvement.

Fear causes tears – perineal injuries in home birth settings : a Swedish interview study

Background: Perineal injury is a serious complication of vaginal delivery that has a severe impact on the quality of life of healthy women. The prevalence of perineal injuries among women who give birth in hospital has increased over the last decade, while it is lower among women who give birth at home. The aim of this study was to describe the practice of midwives in home birth settings with the focus on the occurrence of perineal injuries. Methods: Twenty midwives who had assisted home births for between one and 29 years were interviewed using an interview guide. The midwives also had experience of working in a hospital delivery ward. All the interviews were tape-recorded and transcribed. Content analysis was used. Results: The overall theme was "No rushing and tearing about", describing the midwives' focus on the natural process taking its time. The subcategories 1) preparing for the birth; 2) going along with the physiological process; 3) creating a sense of security; 4) the critical moment and 5) midwifery skills illuminate the management of labor as experienced by the midwives when assisting births at home. Conclusions: Midwives who assist women who give birth at home take many things into account in order to minimize the risk of complications during birth. Protection of the woman's perineum is an act of awareness that is not limited to the actual moment of the pushing phase but starts earlier, along with the communication between the midwife and the woman.