Evidensbaserade omvårdnadsåtgärder vid trycksår : En systematisk litteraturstudie

I föreliggande systematiska litteraturstudie var syftet att samla information om och belysa sjuksköterskans evidensbaserade omvårdnadsåtgärder för att förebygga och bedöma trycksår. Artiklar söktes via Högskolan Dalarnas bibliotek och sökmotorn Electronic Library Information Navigator (ELIN). Sökorden pressure, ulcer och nurs* användes. De vetenskapliga artiklarna (n= 15) kvalitetsbedömdes enligt granskningsmallar som bestod av 28 kvalitetskriterier. Därefter evidensgraderades artiklarna. Resultatet i föreliggande studie visade att sjuksköterskan använde sig av tre evidensbaserade omvårdnadsåtgärder i omsorgen om patienter med risk för trycksår. Den första omvårdnadsåtgärden omfattade tryckavlastande omvårdnadsåtgärder, vilka insatser befanns vila på stark vetenskaplig grund. Den andra omvårdnadsåtgärden inbegrep användning av riskbedömningsinstrument och den tredje bestod av klinisk bedömning som båda befanns vila på måttlig vetenskapligt underlag. I resultatet framkom att riskbedömningsinstrument hjälpte sjuksköterskan att reducera uppkomsten av trycksår och därmed minskade ett onödigt lidande för patienten. Resultatet diskuterades utifrån Florence Nightingales omvårdnadsteori, där miljön var en av grundstenarna i omsorgen och att sjuksköterskan hade ansvaret för att anpassa miljön efter patientens behov. Medvetenheten om detta tillsammans med de evidensbaserade omvårdnadsåtgärderna som framkom i föreliggande studie kunde minska risken för trycksår hos patienter och i förlängningen reducera sjukvårds- kostnaderna.

Sjuksköterskans evidensbaserade hygienåtgärder som kan förebygga vårdrelaterade infektioner : En systematisk litteraturstudie

Föreliggande systematiska litteraturstudies syfte är att undersöka sjuksköterskans evidensbaserade hygienåtgärder som kan förebygga vårdrelaterade infektioner. Artiklarna söktes inom Högskolan Dalarnas bibliotek via databasen Electronic Library Information Navigator (ELIN). Använda sökord var Infect* and Prevent* and Nurs* and Hygien*. De artiklar vars titel och abstrakt motsvarade studiens syfte genomgick kvalitetsgranskning utifrån 28 stycken på förhand fastställda kriterier, sedan evidensgraderades artiklarna på basen av kvalitetsbedömningen med hjälp av en modifierad graderingsskala. Sammanlagt 15 artiklar uppnådde 60 % av kriterierna i granskningsmallen och användes i resultatet. Resultatet visade att det erhölls starkt vetenskapligt underlag för hygienåtgärd såsom hygienriktlinjer, handhygien, engångshandskar och desinfektion av händerna direkt efter avtagandet av engångshandskar. Studiens resultat visade att dessa fynd förebyggde vårdrelaterade infektioner, vilket var av betydelse då hygienåtgärder utgör grunden för all vård och främjar patientens hälsa, vilket i sin tur är kostnadseffektivt och gynnar den enskilda patienten. Resultatet i föreliggande studie diskuterades utifrån Nightingales omvårdnadsteori.

Vårdrelaterade infektioner : Nollvision-en utopi?

Vårdrelaterade infektioner [VRI] skapar onödigt lidande för patienter, förlänger vårdtider och kostar samhället enorma summor varje år. Det är därför viktigt att öka personalens kunskaper och följsamhet till gällande föreskrifter angående basala hygienrutiner. Syftet med denna studie var att belysa vårdpersonalens följsamhet, synliggöra mindre uppmärksammade smittkällor och redogöra för de åtgärder med vilka man kan minska spridningen av VRI. Artiklar samt litteratur till denna systematiska litteraturstudie söktes främst via sökmotorn ELIN, tillgänglig vid Högskolan Dalarnas bibliotek samt Mora Lasaretts bibliotek och Orsa- och Moras kommunbibliotek. Artiklar som inkluderades var publicerade 2000-2009, tillgängliga i fulltext, ej avgiftsbelagda eller skrivna på andra språk än engelska och svenska. Resultatet visar att följsamheten hos vårdpersonalen var låg och att införandet av åtgärdsprogram i de flesta fall endast gav temporär förbättring av följsamheten och att vårdpersonalen efter kort tid återgick till ett felaktigt beteende. När personalens bristande kunskap ledde till felaktigt användande av skyddsutrustning såsom handskar och plastförkläden kunde detta vara en källa till spridning av VRI. Vårdpersonalens arbetskläder visade sig bära på flertalet potenta mikroorganismer som kan orsaka VRI. Även patientnära- och medicinsk utrustning visade sig bära på smittförande mikroorganismer. Slutsatserna av litteraturstudien visar att punktprevalensmätningar är en preventiv åtgärd som på sikt kan minska spridningen av dessa VRI. För att även på lång sikt förbättra vårdpersonalens följsamhet behövs kontinuerlig uppföljning av åtgärdsprogram och studier.

Kvinnors upplevelse av planerad hemförlossning i Skandinavien : Women´s experience of planned home birth in the Scandinavian countries

Background: In Sweden and Norway planned home birth is not included in the health care system. In Denmark women with expected low risk birth have the right to choose home birth. Registrations of home births in the Nordic countries are not completed and women’s experiences of planned home birth in Scandinavian context are not earlier described.Objective: The aim of this study was to describe women’s experiences of planned home birth in the Scandinavian countries.Design: Inductive content analysis. Fifty-three Scandinavian women who have experienced planned home birth have replied an open question in a questionnaire. Findings: In the analysis five categories and twelve subcategories emerged. The categories were, to feel secure, experiences of support, being in control, harmony and insecurity. The women felt secure and calm in their own homes. They felt being in control, secure, support and trust in the midwife, relatives and the own body. What worried the women most in presence of the delivery was that the midwife should not be present. Keywords: Home birth, experiences, women.

The actual status of the development of a Danish/Swedish system concept of a solar combisystem

At the beginning of 2003 the four year long research project REBUS on education, research, development and demonstration of competitive solar combisystems was launched. Research groups in Norway, Denmark, Sweden and Latvia are working together with partners from industry on innovative solutions for solar heating in the Nordic countries. Existing system concepts have been analyzed and based on the results new system designs have been developed. The proposed solutions have to fulfill country specific technical, sociological and cost requirements. Due to the similar demands on the systems in Denmark and Sweden it has been decided to develop a common system concept for both countries, which increases the market potential for the manufacturer. The focus of the development is on systems for the large number of rather well insulated existing single family houses. In close collaboration with the industrial partners a system concept has been developed that is characterized by its high compactness and flexibility. It allows the use of different types of boilers, heating distribution systems and a variable store and collector size. Two prototypes have been built, one for the Danish market with a gas boiler, and one for the Swedish market with a pellet boiler as auxiliary heater. After intensive testing and eventual further improvements at least two systems will be installed and monitored in demonstration houses. The systems have been modeled in TRNSYS and the simulation results will be used to further improve the system and evaluate the system performance.

Load and Season Adapted Solar Collectors

In Sweden solar irradiation and space heating loads are unevenly distributed over the year. Domestic hot water loads may be nearly constant. Test results on solar collector performance are often reported as yearly output of a certain collector at fixed temperatures, e g 25, 50 and 75 C. These data are not suitable for dimensioning of solar systems, because the actual performance of the collector depends heavily on solar fraction and load distribution over the year.At higher latitudes it is difficult to attain high solar fractions for buildings, due to overheating in summer and small marginal output for added collector area. Solar collectors with internal reflectors offer possibilities to evade overheating problems and deliver more energy at seasons when the load is higher. There are methods for estimating the yearly angular irradiation distribution, but there is a lack of methods for describing the load and the storage in such a way as to enable optical design of season and load adapted collectors.This report describes two methods for estimation of solar system performance with relevance for season and load adaption. Results regarding attainable solar fractions as a function of collector features, load profiles, load levels and storage characteristics are reported. The first method uses monthly collector output data at fixed temperatures from the simulation program MINSUN for estimating solar fractions for different load profiles and load levels. The load level is defined as estimated yearly collector output at constant collector temperature divided be yearly load. This table may examplify the results:CollectorLoadLoadSolar Improvementtypeprofile levelfractionover flat plateFlat plateDHW 75 %59 %Load adaptedDHW 75 %66 %12 %Flat plateSpace heating 50 %22 %Load adaptedSpace heating 50 %28 %29 %The second method utilises simulations with one-hour timesteps for collectors connected to a simplified storage and a variable load. Collector output, optical and thermal losses, heat overproduction, load level and storage temperature are presented as functions of solar incidence angles. These data are suitable for optical design of load adapted solar collectors. Results for a Stockholm location indicate that a solar combisystem with a solar fraction around 30 % should have collectors that reduce heat production at solar heights above 30 degrees and have optimum efficiency for solar heights between 8 and 30 degrees.

Report on IEA Task-14 activities on solar collector systems conference in Rome, 25-29 Jan. 1993

The memebers of IEA (International Energy Agency) Task 14 (Advaced Active Solar Systems) met in Rome during January 1993. The latest developments in several countries were presented and discussed during this meeting. This report describes briefly the recent work carried out on small scale systems in the Domestic Hot Water (DHW) working group of Task 14, as reported by the representatives from Canada, Denmark, Germany, Holland and Switzerland. Klaus Lorenz, SERC, attended the meeting as observer and presented our work on small-tube heat exchangers. Several participants expressed their interest. A summary of his presentation is included in this report.

Competitive Solar Heating Systems for Residential Buildings (REBUS)

Research on solar combisystems for the Nordic and Baltic countries have been carriedout. The aim was to develop competitive solar combisystems which are attractive tobuyers and to educate experts in the solar heating field.The participants of the projects were the universities: Technical University of Denmark,Dalarna University, University of Oslo, Riga Technical University and Lund Institute ofTechnology, as well as the companies: Metro Therm A/S (Denmark), Velux A/S(Denmark), Solentek AB (Sweden), SolarNor (Norway) and SIA Grandeg (Latvia).The project included education, research, development and demonstration. Theactivities started in 2003 and were finished by the end of 2006. A number of Ph.D.studies in Denmark, Sweden and Latvia, and a post-doc. study in Norway were carriedout. Close cooperation between the researchers and the industry partners ensured thatthe results of the projects can be utilized. The industry partners will soon be able tobring the developed systems into the market.In Denmark and Norway the research and development focused on solarheating/natural gas systems, and in Sweden and Latvia the focus was on solarheating/pellet systems. Additionally, Lund Institute of Technology and University ofOslo studied solar collectors of various types being integrated into the building.

Solar thermal components adapted to common building standards (SCAS)

Pilot versions of a solar heating/natural gas burner system, of a solar heating/pellet burner system and of a façade/roof integrated polymeric collector have been installed in the summer of 2006 in a number of demonstration houses in Denmark, Sweden and Norway.These three new products have been evaluated by means of measurements of the thermal performance and energy savings of the pilot systems in practice and by means of a commercial evaluation.The conclusion of the evaluations is that the products are attractive for the industry partners METRO THERM A/S, Solentek and SOLARNOR. It is expected that the companies will bring the products into the market in 2007.Further, the results of the project have been presented atinternational and national congresses and seminars for the solar heating branch. The congresses and seminars attracted a lot of interested participants.Furthermore, the project results have been published in international congress papers as well as in national journals in the energy field.Consequently, the Nordic solar heating industry will benefit from the project.

Borlänge and Falun Brundtland cities

Development of an infrastructure for Brundtland Renewable Energy Network - BREN is a European Commission Alterner Project with Contract no XVII/4. 1030/Z96-032.The project has its origin in the UN-report “Our Common Future”, 1989. A change in and reduction of the use of energy was fundamental in order to reach the goals which the report proposed. Denmark decided on an action plan on how energy consumption could be reduced “Energi 2000 - Handlingsplan för en bäredygtig udvikling”. The ministries of energy in Denmark and Schleswig Holstein both agreed to start an energy saving project in a smaller town. The project was called “Brundtlandby” and the two first were Toftlund in South Jutland and Bredstedt in North Friesland. After a short period a further two German Cities, Rheinsberg and Viernheim, and Rajec in Slovakia joined the group. A network for the exchange of knowledge and experience between the cities was formed. The network, Brundtland City Project, inspired the participating cities in the continuing work with energy saving measures. The Brundtland City Project was presented at an international conference “Cities and Energy” in Trondheim, Norway,in December 1995. Great interest was shown in the project and it was decided that a network should be developed in northern European countries as a pilot project to be enlarged with other European countries later on. A steering committee was formed with representatives from the nordic countries.An application was sent to the European Commission, Alterner Program, and was approved in Juli 1996. The project was subdivided into nine activities. Activity 1, consisted of summarising the experiences of the Brundtland City Project in Toftlund, Denmark and the Brundtland Cities network in Slovakia, Germany and Denmark. The Scandinavian part started with Activity 2, to engage municipalities/cities in Finland, Norway and Sweden in the project. The Solar Energy Research Center, SERC, Högskolan Dalarna was appointed as co-ordinator for the Swedish part. The project was presented at a seminar on the 30th September for representatives from the municipalities of Borlänge and Falun. On the 10th of December 1996 the two municipalities accepted the invitation to join the Northern network. Pelle Helje, Borlänge Energi, has been informant for the municipality of Borlänge and Anders Goop, Department of Urban Planninginformant for the municipality of Falun with Jan Kaans, Estates department providing information to the basis for the Newsletter.Reports on the work in Borlänge and Falun municipalities have been made to Brundtland Center Denmark on three occasions; Activities 2-5, 16-12-1997, Activities 6-7, including parts of activities 8-9, 03-03-1998, and the basis for the Newsletter, 01-07-1998. The Nordic reports have been compiled at the Brundtland Center Denmark for submission to the European Commission. English has been the common language. After the report of activities 2 - 5 the participants wereinvited to a project meeting and a workshop at Brundtland Center the 23rd and 24th March 1998.This was the first occasion the participants in the project met and the network thus took a moreconcrete form. It also was decided that the next meeting should be in Borlänge in August 1998,with Borlänge Energi and Solar Energy Research Center SERC as organisers. As BrundtlandCentre Denmark was wound up for financial reasons, the project meeting in Borlänge wascancelled.Compilation of the Final Report was carried out by Esbensen Consultants in October 1998Future development of the networkIt is intended to continue the work with the Brundtland City Network as an “EU Thermie Bproject”and the network will be enlarged with the addition of four new Brundtland Cities from Austria, Germany, Italy and Great Britain. In addition the village of Putja in Estonia will join the network but this will be financed by the EU-Phare programme.

Improved Road Design for Future Maintenance - Analysis of Road Barrier Repair Costs

The cost of a road construction over its service life is a function of the design, quality of construction, maintenance strategies and maintenance operations. Unfortunately, designers often neglect a very important aspect which is the possibility to perform future maintenance activities. The focus is mainly on other aspects such as investment costs, traffic safety, aesthetic appearance, regional development and environmental effects. This licentiate thesis is a part of a Ph.D. project entitled “Road Design for lower maintenance costs” that aims to examine how the life-cycle costs can be optimized by selection of appropriate geometrical designs for the roads and their components. The result is expected to give a basis for a new method used in the road planning and design process using life-cycle cost analysis with particular emphasis on road maintenance. The project started with a review of literature with the intention to study conditions causing increased needs for road maintenance, the efforts made by the road authorities to satisfy those needs and the improvement potential by consideration of maintenance aspects during planning and design. An investigation was carried out to identify the problems which obstruct due consideration of maintenance aspects during the road planning and design process. This investigation focused mainly on the road planning and design process at the Swedish Road Administration. However, the road planning and design process in Denmark, Finland and Norway were also roughly evaluated to gain a broader knowledge about the research subject. The investigation was carried out in two phases: data collection and data analysis. Data was collected by semi-structured interviews with expert actors involved in planning, design and maintenance and by a review of design-related documents. Data analyses were carried out using a method called “Change Analysis”. This investigation revealed a complex combination of problems which result in inadequate consideration of maintenance aspects. Several urgent needs for changes to eliminate these problems were identified. Another study was carried out to develop a model for calculation of the repair costs for damages of different road barrier types and to analyse how factors such as road type, speed limits, barrier types, barrier placement, type of road section, alignment and seasonal effects affect the barrier damages and the associated repair costs. This study was carried out using a method called the “Case Study Research Method”. Data was collected from 1087 barrier repairs in two regional offices of the Swedish Road Administration, the Central Region and the Western Region. A table was established for both regions containing the repair cost per vehicle kilometre for different combinations of barrier types, road types and speed limits. This table can be used by the designers in the calculation of the life-cycle costs for different road barrier types.

Introduction

This special issue of Nordic Journal of English Studies is devoted to the research in Irish Studies being carried out in Scandinavia by a group of scholars based in Denmark, Norway and Sweden, as well as scholars associated—in one way or another—with Scandinavia. Denmark is represented by the University of Aalborg; Norway, by scholars affiliated to the Universities of Agder, the Artic University of Norway, Bergen, and Stavanger; and Sweden is represented by scholars from the universities of Dalarna, Göteborg, Stockholm, Södertörn and Umeå. Included also in this special issue is the work of two former students, who completed their Masters’ degree in Irish literature at DUCIS (Dalarna University Centre for Irish Studies), Sweden—from Norway and China respectively. The collection also contains an article by Dara Waldron, Limerick Institute of Technology, Ireland, whof recently presented his research at the Higher Seminar in Dalarna. Contributions by the Irish poet, Mary O’Donnell, who participated in the Nordic Irish Studies Network (NISN) conference, hosted by DUCIS in December 2012, are also included.

Nordic Journal of English Studies : Irish Studies in the Nordic Countries

This special issue of Nordic Journal of English Studies is devoted to the research in Irish Studies being carried out in Scandinavia by a group of scholars based in Denmark, Norway and Sweden, as well as scholars associated—in one way or another—with Scandinavia. Denmark is represented by the University of Aalborg; Norway, by scholars affiliated to the Universities of Agder, the Artic University of Norway, Bergen, and Stavanger; and Sweden is represented by scholars from the universities of Dalarna, Göteborg, Stockholm, Södertörn and Umeå. Included also in this special issue is the work of two former students, who completed their Masters’ degree in Irish literature at DUCIS (Dalarna University Centre for Irish Studies), Sweden—from Norway and China respectively. The collection also contains an article by Dara Waldron, Limerick Institute of Technology, Ireland, whof recently presented his research at the Higher Seminar in Dalarna. Contributions by the Irish poet, Mary O’Donnell, who participated in the Nordic Irish Studies Network (NISN) conference, hosted by DUCIS in December 2012, are also included.

Integration eller illusion : et deviance-perspektiv

Integration or illusion – a deviance perspective Denmark experienced one of its most successful periods of economic growth in 2004– 2008 with a tremendous reduction of unemployment, which in June 2008 was around. 1.5 percent, far below the expected level of structural unemployment. In the wake of this development the lack of utilization of migrants’ educations and skills became, once again, a core concern. The political, societal and academic debate followed to a great extent the traditional top-down approach to the problem and revolved around two axes: 1. How effective the labour market was/is to make use of migrants’ skills. 2. Whether there were patterns of over-education as expression of institutional and societal discrimination. The focus of the present study is, however, quite different: We examine the pattern of deviance in relation to labour market participation (not integration), and instead of searching for explanations for the lack of integration, we attempt to identify and explain the deviance pattern as a product of institutionally inherent possibilities and barriers on the one hand and articulating immigrants as rational actors (not victims) on the other. We argue that deviance is not only a more fruitful theoretical and analytical framework than integration and discrimination. Taking departure in empirical evidence on immigrants’ preferences and behaviour as bounded rational actors, and how they actually articulate their everyday life practical experiences, including adjustment of what they want and what they can, the deviance perspective, we believe, also reduces the theoretical and normative biases, that characterises the discrimination and integration framework, and provide more reliable explanations. 

Pricing and competition in the Swedish retail market for electricity

Sweden, together with Norway, Finland and Denmark, have created a multi-national electricity market called NordPool. In this market, producers and retailers of electricity can buy and sell electricity, and the retailers then offers this electricity to end consumers such as households and industries. Previous studies have shown that pricing at the NordPool market is functioning quite well, but no other study has to my knowledge studied if pricing in the retail market to consumers in Sweden is well functioning. If the market is well functioning, with competition and low transaction costs when changing electricity retailer, we would expect that a homogeneous good such as electricity would be sold at the approximately same price, and that price changes would be highly correlated, in this market. Thus, the aim of this study is to test whether the price of Vattenfall, the largest energy firm in the Swedish market, is highly correlated to the price of other firms in the Swedish retail market for electricity. Descriptive statistics indicate that the price offered by Vattenfall is quite similar to the price of other firms in the market. In addition, regression analysis show that the correlation between the price of Vattenfall and other firms is as high as 0.98.