Trycksår : preventiva omvårdnadsåtgärder och bedömningsinstrumentens effektivitet : en systematisk litteraturstudie

Syftet med denna litteraturstudie var att beskriva vilka omvårdnadsåtgärder som kan förebygga uppkomsten av trycksår samt vilken förmåga att identifiera patienter som riskerar att utveckla trycksår sjuksköterskan har med de bedömningsinstrument som finns. De vetenskapliga artiklarna (n = 20) som ingick i studien söktes via Högskolan Dalarnas databaser Blackwell Synergy, PubMed och ELIN@Dalarna. Sökorden som användes i olika kombinationer var pressure sore, pressure ulcers, nursing, routines, treatment, knowledge, methods, management, measures, risk assessment, scales, risk patients och prevention/preventing. Inklusionskriterierna var att de skulle vara empiriska, skrivna på svenska eller engelska samt vara publicerade efter 1997. Resultatet visade att det finns många olika förebyggande åtgärder som vidtas. I preventivt syfte var evidensbaserade bedömningsinstrument ett bra och användbart verktyg. Även tryckreducerande underlag som luft- eller trögskumsmadrasser, fårskinn eller vattenfyllda handskar användes som trycksårspreventiva åtgärder. Lägesändringar med hjälp av vändscheman samt tidig mobilisering var också förebyggande åtgärder som vidtogs. Patienternas näringsstatus har stor betydelse i det preventiva arbetet. Resultat visade att det förekommer näringstillägg som en förebyggande strategi. Kontinuerlig inspektion av hud samt noggrann hygien var även något som utfördes i preventivt syfte. Det finns en mängd olika bedömningsinstrument och resultatet av litteraturstudien visar att resultaten vad gällde skalornas förmåga att förutse trycksår varierade mellan olika studier. Uppsatsförfattarna anser att trycksårsprevention är viktigt då trycksår orsakar lidande för patienten och är kostsamma för samhället. Preventiva rutinmässiga åtgärder borde utföras inom de flesta patientgrupper och då är bedömningsinstrumenten en viktig del i det arbetet.

Individuell utprovning av inkontinenshjälpmedel i kommunala särskilda boenden

The purpose of this study was to examine the extent to which incontinence aids, used in local authority/municipal nursing homes, were adapted to the resident’s urine-leakage volume and to find out how nurses perceived the current situation concerning individual testing of incontinence aids in municipal nursing homes. The study method was a quantitative empirical study and was carried out in two phases. The first phase was a weighing test, carried out in three nursing homes, whereby the incontinence aids used by 25 residents during a 48 hour period were weighed. The second phase was the completion of a questionnaire by the municipal nurses working in the same local authority. The questionnaire covered: the division of responsibilities; routines for testing incontinence aids, and the level of knowledge concerning individual incontinence aid testing. Only 22 % of the pads used during the observation were properly adapted to the patients’ urinary leakage volume, while 76 % of incontinence aids were larger than necessary in relation to the real volume of urinary leakage. The municipal nurses, who have a key role and formal responsibility for individual incontinence aid testing, considered that there was insufficient knowledge within the organisation concerning individual incontinence aid testing, and that the division of responsibilities in this area was unclear. There were great variations relating to the extent of the nurses’ involvement in individual incontinence aid testing, and the nurses stated that increased involvement in individual incontinence aid testing was dependent on more time being made available for this task. Only a minority of the nurses thought that the requisitioning of incontinence aids was preceded by individual testing of the incontinence pads within the organisation. The majority of nurses considered that this was not the case or were unsure of the situation.

Förstudie kring ledningssystem vid reklambyrån Confetti

The aim of the project is to develop a tool for a management system at the advertising agency ofConfetti. The company has during a longer period of time felt a need of introducing a quality and environmentalsystem but have a lack in resources of knowledge, time and money. Their goal is to have aconcrete documentation which describes their quality policy and the function of the activity.The work has been performed by mapping and analyzing the processes of the company according tothe process model with focus on one pilot process. New routines have been developed and documentedin a management system.Confetti would like their management system to fulfil the ISO-standard so that they eventually inthe future can be certified. Therefore a literature study has been done according to management systemsand standards. The project has been directed to fulfil the ISO-standards demands for a qualitymanagement system. It has resulted in the creation of a comprehensible and userfriendly managementsystem which includes a routine model and new routines for the pilot process of PDF-handling. A oneyear-plan has been created to facilitate for the continuos development of the quality management systemat Confetti. The new quality implementations demands investment, why a budget has been calculatedshowing profitability.Confetti has to continue the development of the management system very soon. They ought to createan analyzis of the companys current situation and choose the processes that they themeselves considermost important or easiest to improve. A management system will not operate by it self, it needsmaintenance and development.

Granskning av kvalitetssäkringsarbetet vid en ICC-profilbaserad trycksaksproduktion

To make your company change from a conventional workflow to an ICC-based workflow you need tomake investments in time and money. On the other hand you get your reward in terms of a stable andquality safe production. To choose this way of adjusting your company to new routines requires accuracyas well as a great deal of commitment. It is not only about having the right equipment. There area lot of factors that affect the quality of production.Our ambition with this report is to bring out the importance of general thinking when it comes toICC-profiling and to discuss on which basis printing profiles should be created. Quality parameters asfor example roughness and whiteness of paper are also discussed. To be able to investigate these mattersin detail we have taken a closer look at two companies, which have chosen to commit themselvesto achive better quality through color management but still feel that they have some problems withtheir workflow.One of the conclusions that are made in this report is that both companies should extend their investmentsin education of employees to become less independent of consultants, but also to increase theinterest in changes within the company. It is also stressed that an ICC-profile only can be efficient if acompany commits itself to accuracy regarding routines, control and calibration.

Delivery care in Quang Ninh province, Northern Vietnam : resources and access to safe care.

Every mother and child has the right to survive childbirth which requires skilled birth attendants together with referral and available emergency obstetric care (EmOC). The objective of the study was to describe delivery care routines at different levels in the health care system in Quang Ninh province, Northern Vietnam. The design was cross sectional using a structured questionnaire. Two districts in Quang Ninh province with 40 Community Health Centres (CHC), three district hospitals and one region hospital was included in the study, in total 138 (CHC n=105 and hospitals n=33) health care providers participated. In our study 20% (CHC) of the health care providers assisting deliveries at CHC were midwives and health care provider’s in our study further report to have assisted at less then 10 deliveries/year (81% of respondents at CHC). Findings show that the health care provider’s routines and care for women during labour and delivery vary and that there is a need for re-training and that women in labour should be cared for by health care providers with adequate training like midwifery. In our study CHC had poor resources to provide basic or comprehensive EmOC. Our findings indicate that there is a need for re-training in delivery care among health care providers and since the number of deliveries at CHC is few they should be handled by someone who is a skilled birth attendant. Our findings also show a variation in care routines during labour and delivery among health care providers at CHC and hospital levels and this also show the need for re-training and support from proper authorities in order to improve maternal and newborn health.

Sjuksköterskestudenters upplevelse av den kliniska färdighetsträningen på Kompetenscenter : Fokusgruppsintervjuer med sjuksköterskestuderande

Syfte: Syfte med denna studie var att belysa hur sjuksköterskestudenter upplevde den kliniska färdighetsträningen på Kompetenscenter. Metod: Den genomfördes som en empirisk studie med kvalitativ ansats där två fokusgruppsintervjuer med fem sjuksköterskestuderande i vardera utfördes. Deltagarna var mellan 22 och 30 år. Materialet analyserades med hjälp av kvalitativ innehållsanalys. Resultat: I analysen framkom ett tema, tre kategorier och tio subkategorier. Studenternas upplevelser speglade ett behov av att lärandemiljön, lärarna och undervisningen bör ha en verklighetsanknytning. Studenterna upplevde den fysiska miljön som autentiskt vilket var viktigt för dem. De framhöll även att läromaterialet bör vara verklighetstroget, vara av god kvalitet och finnas i tillräckligt antal. Studenterna uttryckte behov av trygghet och framhöll vikten av en god relation med läraren. De uttryckte även behov av samstämmiga lärare och poängterade behov att metoder och rutiner som lärs ut skulle vara enhetliga och baseras på aktuell evidens. För att läraren skulle uppfattas trovärdig framhöll de att vederbörande bör ha en verklighetsanknytning. De underströk vikten av att övningarna skulle upplevas verkliga och vara relevanta för det kommande yrket. Studenterna önskade interprofessionellt lärande då de trodde det kunde öka känslan av sammanhang och verklighet. Konklusion: Studenternas upplevelser av den kliniska färdighetsträningen på KC gav uttryck för en verklighetsförankrad lärandemiljö. Studenterna uttryckte behov av att övningarna skulle var evidensbaserade och upplevas verkliga då det ökade deras förmåga att tillägna sig kunskaper i den kliniska färdighetsträningen. 

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.

Klassrumsinteraktion i de tidiga skolåren : flerspråkiga elever i skolans språkliga vardag

Classroom interaction is particularly important for those students who learn school knowledge in a second language. In this article two episodes of whole class teaching in pre-school and standard one are analyzed. The analysis shows the importance of making teachers aware of interactional patterns in classrooms. Although knowledge was presented clearly and concretely and teachers used routines that made norms explicit, inconsistencies in interactional patterns made the role of the teacher stand out as unclear. Whole class teaching of this type does not provide students with such linguistic and intellectual demands that are necessary for their language development.

Nuets förnöjsamhet : en grundad teori om livsval och överlevnadsstrategier

Contentment in the moment ”Contentment in the moment” is a classic grounded theory exploring safety and contentment within a small community in northern Norway. The purpose of the study was to explore the village’s everyday life from a participant’s perspective and to develop an understanding of their living conditions. We found different survival strategies, which have their roots in the village’s history of poverty, isolation and harsh climate. Today these strategies have changed from a matter of life and death to a modern psychosocial foundation of contentment. The study is based on four and a half years of observations, in-depth interviews and informal but focused conversations with people living in Polarfjorden. The data was analysed using the constant comparative method of classic grounded theory. In this article we further relate our work to more general sociological theory, more specifically to Charles Tilly’s work on reason and routines.

Multi-agent simulation of sawmill yard operations

This paper reports the findings of using multi-agent based simulation model to evaluate the sawmill yard operations within a large privately owned sawmill in Sweden, Bergkvist Insjön AB in the current case. Conventional working routines within sawmill yard threaten the overall efficiency and thereby limit the profit margin of sawmill. Deploying dynamic work routines within the sawmill yard is not readily feasible in real time, so discrete event simulation model has been investigated to be able to report optimal work order depending on the situations. Preliminary investigations indicate that the results achieved by simulation model are promising. It is expected that the results achieved in the current case will support Bergkvist-Insjön AB in making optimal decisions by deploying efficient work order in sawmill yard.

Image processing technique to count the number of logs in a timber truck

This paper summarises the results of using image processing technique to get information about the load of timber trucks before their arrival using digital images or geo tagged images. Once the images are captured and sent to sawmill by drivers from forest, we can predict their arrival time using geo tagged coordinates, count the number of (timber) logs piled up in a truck, identify their type and calculate their diameter. With this information we can schedule and prioritise the inflow and unloading of trucks in the light of production schedules and raw material stocks available at the sawmill yard. It is important to keep all the actors in a supply chain integrated coordinated, so that optimal working routines can be reached in the sawmill yard.   

A user guide to simple monitoring and sustainable operation of PV-diesel hybrid systems : Handbook for system users and operators

This report contains a suggestion for a simple monitoring and evaluation guideline for PV-diesel hybrid systems. It offers system users a way to better understand if their system is operated in a way that will make it last for a long time. It also gives suggestions on how to act if there are signs of unfavourable use or failure. The application of the guide requires little technical equipment, but daily manual measurements. For the most part, it can be managed by pen and paper, by people with no earlier experience of power systems.The guide is structured and expressed in a way that targets PV-diesel hybrid system users with no, or limited, earlier experience of power engineering. It is less detailed in terms of motivations for certain choices and limitations, but rich in details concerning calculations, evaluation procedures and maintenance routines. A more scientific description of the guide can be found in a related journal article.

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

Monitoring vegetation on railway embankments : supporting maintenance decisions

The national railway administrations in Scandinavia, Germany, and Austria mainly resort to manual inspections to control vegetation growth along railway embankments. Manually inspecting railways is slow and time consuming. A more worrying aspect concerns the fact that human observers are often unable to estimate the true cover of vegetation on railway embankments. Further human observers often tend to disagree with each other when more than one observer is engaged for inspection. Lack of proper techniques to identify the true cover of vegetation even result in the excess usage of herbicides; seriously harming the environment and threating the ecology. Hence work in this study has investigated aspects relevant to human variationand agreement to be able to report better inspection routines. This was studied by mainly carrying out two separate yet relevant investigations.First, thirteen observers were separately asked to estimate the vegetation cover in nine imagesacquired (in nadir view) over the railway tracks. All such estimates were compared relatively and an analysis of variance resulted in a significant difference on the observers’ cover estimates (p<0.05). Bearing in difference between the observers, a second follow-up field-study on the railway tracks was initiated and properly investigated. Two railway segments (strata) representingdifferent levels of vegetationwere carefully selected. Five sample plots (each covering an area of one-by-one meter) were randomizedfrom each stratumalong the rails from the aforementioned segments and ten images were acquired in nadir view. Further three observers (with knowledge in the railway maintenance domain) were separately asked to estimate the plant cover by visually examining theplots. Again an analysis of variance resulted in a significant difference on the observers’ cover estimates (p<0.05) confirming the result from the first investigation.The differences in observations are compared against a computer vision algorithm which detects the "true" cover of vegetation in a given image. The true cover is defined as the amount of greenish pixels in each image as detected by the computer vision algorithm. Results achieved through comparison strongly indicate that inconsistency is prevalent among the estimates reported by the observers. Hence, an automated approach reporting the use of computer vision is suggested, thus transferring the manual inspections into objective monitored inspections

Facilitation of learning in specialist nursing training in the PICU : the supervisors´ concerns in the learning situation

With the aim to unfold nurses’ concerns of the supervision of the student in the clinical caring situation of the vulnerable child, clinical nurses situated supervision of postgraduate nursing students in the Pediatric Intensive Care Unit (PICU) are explored. A qualitative approach, interpretive phenomenology, with participant observations and narrative interviews, was used. Two qualitative variations of patterns of meaning for the nurses’ clinical facilitation were disclosed in this study. Learning by doing theme supports the students learning by doing through performing skills and embracing routines. The reflecting theme supports thinking and awareness of the situation. As the supervisor often serves as a role model for the student this might have an immediate impact on how the student applies nursing care in the beginning of his or her career. If the clinical supervisor narrows the perspective and hinders room for learning the student will bring less knowledge from the clinical education than expected, which might result in reduced nursing quality.