Patienters oro inför anestesi : En litteraturöversikt

Syftet med studien var att beskriva förekomst och typ av patienters eventuella oro inför anestesi. Litteraturöversikten har baserats på vetenskapliga artiklar av både kvantitativ och kvalitativ art. Trettioen artiklar granskades och 21 av dessa valdes ut till resultatet.De flesta studier som behandlade oro inför anestesi var av kvantitativ art. Oro i form av olika slags olustkänslor definierades av flera författare utförligt och på flera sätt. Resultatet påvisade att oro var ett vanligt förekommande fenomen och kunde objektivt mätas med hjälp av självskattningsskalor, där de vanligast förekommande är Visuel Analog Skala (VAS) och State Trait Anxiety Inventory (STAI). Dagkirurgin har ökat och tiden att träffa patienten för mental förberedelse har minskat, vilket var till nackdel för både patient och personal. Vi har genom den här studien och kliniska erfarenheter uppmärksammat riskfaktorer för oro, till exempel kvinnor och yngre patienter. En studie påvisade även att patienter med sen placering på operationslistan hade en signifikant högre nivå av oro. För att ge känslomässigt stöd till patienter som har behov av ökad uppmärksamhet, krävs en bred insats som omfattar bemötande, information, patientutbildning och kommunikation. Trots all kunskap som finns presenterad i resultatet av studierna förstår vi det som att den psykologiska omvårdnaden är otillräcklig och måste prioriteras.

Tandvårdsrädsla och attityder till tandhygienist bland patienter med kronisk parodontit- en kvantitativ studie

Syftet med studien var att beskriva och jämföra tandvårdsrädsla och attityder till tandhygienist vid studiens start samt 3 månader efter icke kirurgisk parodontalbehandling hos patienter med kronisk parodontit samt att beskriva hur olika bakgrundsfaktorer påverkar tandvårdsrädsla och attityder till tandhygienist. Ett ytterligare syfte var att studera sambandet mellan attityder till tandhygienist och tandvårdsrädsla. Studien var en jämförande studie med kvantitativ ansats och en del i en större experimentell studie med två aktiva interventioner för att påverka munhygienbeteende. Studien innefattade 109 studiedeltagare, 57 kvinnor och 52 män i åldrarna 25-65 år som var remitterade till specialistklinik för parodontologi. Frågeformuläret som användes gällande tandvårdsrädsla var Dental Anxiety Scale (DAS) med 4 påståenden avseende upplevelser för att besöka tandhygienist. För att fastställa attityder till tandhygienist användes Dental Hygiene Belief Survey (DHBS) som innehöll 8 påståenden rörande kommunikation. Resultatet visade att studiedeltagarna 3 månader efter behandling hade en lägre grad av tandvårdsrädsla samt en mer positiv attityd till tandhygienist jämfört med vid studiens start. Ingen skillnad mellan interventionerna kunde ses med avseende på tandvårdsrädsla samt attityder till tandhygienist. Samband mellan ålder, kön och tandvårdsrädsla kunde endast ses vid studiens start. Konklusionen visar att icke-kirurgisk parodontalbehandling utförd av tandhygienist minskar graden av tandvårdrädsla och att attityder till tandhygienist förbättras efter denna behandling.

The facial affective scale as a predictor for pain unpleasantness when children undergo immunizations.

Needle fear is a common problem in children undergoing immunization. To ensure that the individual child's needs are met during a painful procedure it would be beneficial to be able to predict whether there is a need for extra support. The self-reporting instrument facial affective scale (FAS) could have potential for this purpose. The aim of this study was to evaluate whether the FAS can predict pain unpleasantness in girls undergoing immunization. Girls, aged 11-12 years, reported their expected pain unpleasantness on the FAS at least two weeks before and then experienced pain unpleasantness immediately before each vaccination. The experienced pain unpleasantness during the vaccination was also reported immediately after each immunization. The level of anxiety was similarly assessed during each vaccination and supplemented with stress measures in relation to the procedure in order to assess and evaluate concurrent validity. The results show that the FAS is valid to predict pain unpleasantness in 11-12-year-old girls who undergo immunizations and that it has the potential to be a feasible instrument to identify children who are in need of extra support to cope with immunization. In conclusion, the FAS measurement can facilitate caring interventions.

Small-Scale Farmers Land Use and Socioeconomic Situation in the Mount Elgon District in Northwestern Kenya : A Minor Field Study - Combined Field Mapping and Interview

This Minor Field Study was carried out during November and December in 2011 in the Mount Elgon District in Western Kenya. The objective was to examine nine small-scale farming household´s land use and socioeconomic situation when they have joined a non-governmental organization (NGO) project, which specifically targets small-scale farming households to improve land use system and socioeconomic situation by the extension of soil and water conservation measures. The survey has worked along three integral examinations methods which are mapping and processing data using GIS, semi structured interviews and literature studies.   This study has adopted a theoretical approach referred to as political ecology, in which landesque capital is a central concept. The result shows that all farmers, except one, have issues with land degradation. However, the extent of the problem and also implemented sustainable soil and water conservation measures were diverse among the farmers. The main causes of this can both be linked to how the farmers themselves utilized their farmland and how impacts from the climate change have modified the terms of the farmers working conditions. These factors have consequently resulted in impacts on the informants’ socioeconomic conditions. Furthermore it was also registered that social and economic elements, in some cases, were the causes of how the farmers manage their farmland. The farmer who had no significant problem with soil erosion had invested in trees and opportunities to irrigate the farmland. In addition, it was also recorded that certain farmers had invested in particular soil and water conservation measures without any significant result. This was probably due to the time span these land measures cover before they start to generate revenue.  The outcome of this study has traced how global, national and local elements exist in a context when it comes to the conditions of the farmers´ land use and their socioeconomic situation. The farmers atMt.Elgon are thereby a component of a wider context when they are both contributory to their socioeconomic situation, mainly due to their land management, and also exposed to core-periphery relationships on which the farmers themselves have no influence.

'They would never receive you without a husband' : Paradoxical barriers to antenatal care scale-up in Rwanda

OBJECTIVE: to explore perspectives and experiences of antenatal care and partner involvement among women who nearly died during pregnancy ('near-miss'). DESIGN: a study guided by naturalistic inquiry was conducted, and included extended in-community participant observation, semi-structured interviews, and focus group discussions. Qualitative data were collected between March 2013 and April 2014 in Kigali, Rwanda. FINDINGS: all informants were aware of the recommendations of male involvement for HIV-testing at the first antenatal care visit. However, this recommendation was seen as a clear link in the chain of delays and led to severe consequences, especially for women without engaged partners. The overall quality of antenatal services was experienced as suboptimal, potentially missing the opportunity to provide preventive measures and essential health education intended for both parents. This seemed to contribute to women's disincentive to complete all four recommended visits and men's interest in attending to ensure their partners' reception of care. However, the participants experienced a restriction of men's access during subsequent antenatal visits, which made men feel denied to their increased involvement during pregnancy. CONCLUSIONS: 'near-miss' women and their partners face paradoxical barriers to actualise the recommended antenatal care visits. The well-intended initiative of male partner involvement counterproductively causes delays or excludes women whereas supportive men are turned away from further health consultations. Currently, the suboptimal quality of antenatal care misses the opportunity to provide health education for the expectant couple or to identify and address early signs of complications IMPLICATIONS FOR PRACTICE: these findings suggest a need for increased flexibility in the antenatal care recommendations to encourage women to attend care with or without their partner, and to create open health communication about women's and men's real needs within the context of their social situations. Supportive partners should not be denied involvement at any stage of pregnancy, but should be received only upon consent of the expectant mother.

The Facial Affective Scale (FAS) as a predictor for pain unpleasantness when children undergo immunizations

Needle fear is a common problem in children undergoing immunization. To ensure that the individual child’s needs are met during a painful procedure it would be beneficial to be able to predict whether there is a need for extra support. The self-reporting instrument facial affective scale (FAS) could have potential for this purpose. The aim of this study was to evaluate whether the FAS can predict pain unpleasantness in girls undergoing immunization. Girls, aged 11-12 years, reported their expected pain unpleasantness on the FAS at least two weeks before and then experienced pain unpleasantness immediately before each vaccination. The experienced pain unpleasantness during the vaccination was also reported immediately after each immunization. The level of anxiety was similarly assessed during each vaccination and supplemented with stress measures in relation to the procedure in order to assess and evaluate concurrent validity. The results show that the FAS is valid to predict pain unpleasantness in 11-12-year-old girls who undergo immunizations and that it has the potential to be a feasible instrument to identify children who are in need of extra support to cope with immunization. In conclusion, the FAS measurement can facilitate caring interventions.