Att vårda patienter i rättspsykiatrisk vård som uppvisar självskadebeteende : sjuksköterskors erfarenheter och upplevelser

Deliberate self harm as defined pathologically as well as socially is becoming an increasing phenomenon within forensic psychiatry. Nurses working with patients who have self harm behaviour and are confined to forensic psychiatry face different challenges which affect their feelings and attitudes in different ways, in their nursing practice. Purpose: To explore nurses’ experiences of caring for patients who suffer from deliberate self harm behaviour and are confined to forensic psychiatry. Method: Qualitative semi- structured interview s from eight nurses working within the forensic psychiatric clinic. Interviews were analysed by using a qualitative content analysis. Results: They worked strategically and emphasized the importance of teamwork, good communication and urged for the need to get necessary education, staff focused tutoring and patient focused therapy. Conclusion: Need for necessary education, patient focused therapy and staff focused tutor is needed to empower staff working with patients who are confined within forensic psychiatry and suffer from deliberate self harm behaviour.

Factors associated with evidence-based practice among registered nurses in Sweden : a national cross-sectional study

Background: Evidence-based practice (EBP) is emphasized to increase the quality of care and patient safety. EBP is often described as a process consisting of distinct activities including, formulating questions, searching for information, compiling the appraised information, implementing evidence, and evaluating the resulting practice. To increase registered nurses' (RNs') practice of EBP, variables associated with such activities need to be explored. The aim of the study was to examine individual and organizational factors associated with EBP activities among RNs 2 years post graduation. Methods: A cross-sectional design based on a national sample of RNs was used. Data were collected in 2007 from a cohort of RNs, included in the Swedish Longitudinal Analyses of Nursing Education/Employment study. The sample consisted of 1256 RNs (response rate 76%). Of these 987 RNs worked in healthcare at the time of the data collection. Data was self-reported and collected through annual postal surveys. EBP activities were measured using six single items along with instruments measuring individual and work-related variables. Data were analyzed using logistic regression models. Results: Associated factors were identified for all six EBP activities. Capability beliefs regarding EBP was a significant factor for all six activities (OR = 2.6 - 7.3). Working in the care of older people was associated with a high extent of practicing four activities (OR = 1.7 - 2.2). Supportive leadership and high collective efficacy were associated with practicing three activities (OR = 1.4 - 2.0). Conclusions: To be successful in enhancing EBP among newly graduated RNs, strategies need to incorporate both individually and organizationally directed factors.

Sjukvårdspersonals upplevelser av underlättande och försvårande faktorer vid förskrivning av fysisk aktivitet på recept, FaR : Intervjustudie

Inledning: Studier påvisar att livsstilsrelaterade sjukdomar ständigt ökar och att fysisk inaktivitet bidrar till detta, likaså att FaR ej används i den utsträckning som det skulle behövas. Syfte: Att belysa för distriktssköterskor vilka underlättande och försvårande faktorer sjukvårdspersonal kan uppleva vid förskrivning av fysisk aktivitet på recept, FaR. Metod: En empirisk fenomenografisk intervjustudie med kvalitativ ansats. Fokusgruppsintervjuer med nio deltagare utfördes på tre vårdcentraler. Huvudresultat: Underlättande och försvårande faktorer framkom inom organisation samt i mötet mellan sjukvårdspersonal och patient, exempelvis stöd från cheferna, utbildning och motiverade patienter var underlättande faktorer. Försvårande faktorer var exempelvis tidsbrist, avsaknad av teamarbete samt negativ inställning till FaR. Konklusion: Chefernas engagemang samt patienternas inställning till fysisk aktivitet och FaR var områden som framkom vara av stor betydelse när sjukvårdspersonal skulle förskriva FaR. Att chefer gav sjukvårdspersonalen resurser för att möjliggöra arbetet med FaR, i form av tid, utbildning och teamarbete ansågs vara en grundläggande faktor. Hälsofrämjande synsätt och prioritering av FaR hos cheferna ger spridning och förankring hos sjukvårdspersonalen. Patienternas inställning till egenvård och fysisk aktivitet var en betydande faktor vid förskrivning av FaR. Där har distriktssköterskor en huvuduppgift i att motivera patienterna till livsstilsförändringar och egenvård samt informera om fysisk aktivitets inverkan på hälsan.

Att arbeta med återhämtning inom rättspsykiatrin : Personalens erfarenheter av återhämtningsprocesser hos patienter inom rättspsykiatrin

Denna studie handlar om den rättspsykiatriska personalens erfarenheter av patienternas återhämtningsprocesser. Studien syftar till att försöka belysa de erfarenheter som personalen besitter, med fokus på återhämtning. Studien bygger på en kvalitativ metod och består av intervjuer som gjorts med personal som arbetar inom en av Sveriges rättspsykiatriska vårdkliniker. Resultatet visar att personalen har erfarenheter av att det finns både gynnsamma och hindrande faktorer som påverkar patienternas återhämtning. Resultatet visar även att relationerna mellan personalen och patienten är en viktig förutsättning för patienternas återhämtning.

Sjuksköterskors erfarenheter av andliga och existentiella frågor i palliativ vård : En litteraturöversikt

Bakgrund: Andliga och existentiella frågor hamnar i allt större utsträckning hos sjukvårdspersonal. Det palliativa förhållningssättet betonar vikten av att ge en god omvårdnad vad gäller andliga och existentiella frågor. Sjuksköterskans roll är att genom goda relationer skapa en anpassad och balanserad omvårdnad för att öka välbefinnandet för patienten den sista tiden i livet. Syfte: Syftet med litteraturöversikten var att sammanställa hur andliga och existentiella frågor beskrivs i forskning utifrån sjuksköterskors erfarenheter av palliativ vård. Metod: En litteraturöversikt som sammanställer aktuell forskning inom det valda omvårdnadsområdet. Resultat: I resultatet framträdde att tid är det vanligaste hindret och utbildning är det som främjar givandet av andlig och existentiell omvårdnad. Att skapa relationer och kommunicera är viktiga aspekter inom vårdandets konst. Egenskaper som sjuksköterskan bör inneha för att underlätta givandet av andlig och existentiell omvårdnad är; en god självkännedom, empati, intuition och observationsförmåga. Slutsats: För att kunna ge en bättre andlig och existentiell omvårdnad behöver de yttre förutsättningarna ge tid för mötet mellan sjuksköterska och patient, vårdmiljön organiseras så detta möjliggörs, teamarbete tillämpas och utbildning ges.

Omvårdnadsåtgärder till patienter med diagnosen KOL : En litteraturstudie

Bakgrund: Kronisk obstruktiv lungsjukdom(KOL) är en långsiktig sjukdom som tar tid innan den visar symtom. När patienten kommer och vill ha information och åtgärder för sina symtom har sjukdomsförloppet redan pågått ett tag. Eftersom den är långdragen är omvårdnadsåtgärderna olika beroende på vart i tiden man ligger i sjukdomen. År 2020 kommer denna patientgrupp vara den tredje största i världen, finns det omvårdnadsåtgärder som ökar livskvalitén för denna patientgrupp? Syfte: Syftet med litteraturstudien var att sammanställa resultat avseende forskning om omvårdnad vid kronisk obstruktiv lungsjukdom som leder till förbättrad livskvalité. Metod: Litteratur studie. Resultat: Kunskapsutbytet mellan patient och sjuksköterska: Hur viktigt det är med en klar och tydlig information vid möte mellan sjuksköterska och patient. Att ge stöd och trygghet: Viktigt att sjuksköterskan finns tillgänglig för patienten, underlätta för patienten: Sjuksköterskan har en viktig roll hos patienter med KOL för att förbättra deras förutsättningar för god livskvalité. Slutsats: Viktigt att skapa en tillit mellan sjuksköterskan och patienten, detta skapar trygghet och resulterar till en god fysisk omvårdnad. När trygghet och tillit har byggts upp mellan sjuksköterskan och patienten blir kommunikationen god och man kan tillsammans komma fram till den bästa lösningen för varje enskild patient.

Främjande faktorer för sjuksköterskor att bedriva en evidensbaserad vård

Bakgrund Evidensbaserad vård (EBV) är ett välkänt begrepp som används för att tillförsäkra patienter en säker vård som vilar på bästa tillgängliga bevis, beprövad erfarenhet och patientens individuella preferenser. Många studier har tidigare undersökt hinder för sjuksköterskor att bedriva och/eller implementera EBV för att förklara gapet som kan uppstå mellan teori och praktik. Färre studier har undersökt vilka faktorer som främjar sjuksköterskors användande av EBV. Syfte Att genom en litteraturöversikt beskriva vilka faktorer som främjar sjuksköterskors möjligheter att bedriva en evidensbaserad vård. Metod Studien genomfördes som en litteraturöversikt. Databaserna CINAHL, PubMed och Web of Science genomsöktes och 15 artiklar valdes ut (8 kvalitativa, 4 kvantitativa och 3 mixedmethod). Resultat Fem kategorier identifierades som främjande faktorer för sjuksköterskor att bedriva och/eller implementera EBV; arbetsmiljö, stöd, kunskap, sjuksköterskans inställning och organisation. Stöd i form utav underlättare var den mest framträdande faktorn. Slutsats Sjuksköterskan har ett individuellt ansvar att bedriva EBV och kan genom sin egen inställning påverka att en sådan vård bedrivs. De flesta främjande faktorer som framkom var dock tydligare kopplade till ledningen och chefens del i att främja användandet av EBV.

Beröringsbehandling hos patienter med cancer : En litteraturöversikt

Bakgrund: Varje år diagnostiseras cirka 64 000 personer med cancer och tumörsjukdomar är den näst vanligaste dödsorsaken i Sverige. Att få diagnosen cancer innebär en påfrestande tid både fysiskt och psykiskt. Sjuksköterskans arbetsuppgift är bland annat att lindra lidande och främja för god hälsa. Beröring är ett allmänmänskligt livslångt behov och blir extra tydligt när en dödlig sjukdom drabbar en människa. Syfte: Syftet är att belysa erfarenheter av beröringsbehandling hos sjuksköterskor och patienter med cancer. Metod: Studien har valt att genomföras som en litteraturöversikt, där 14 vetenskapliga artiklar användes varav 5 kvalitativa och 9 kvantitativa. Resultat: Resultatet delades in i två områden: Patienters erfarenheter av beröringsbehandling och sjuksköterskors erfarenheter av beröringsbehandling. Under området patienters erfarenheter framkom två kategorier: lindrande inverkan och främjande inverkan, samt underkategorierna: fysiskt obehag, psykiskt obehag, välbefinnande och närhet. Under området sjuksköterskors erfarenheter framkom en kategori: utbildning i beröringsbehandling samt underkategorin: upplevelser av beröringsbehandling. Slutsats: Beröringsbehandling har en kortvarig symtomlindrande inverkan på smärta, ångest, illamående samt ger ökat välbefinnande och livskvalitet. Därtill förbättrades kontakten mellan sjuksköterska och patient som bidrog till att den existentiella ensamheten minskades. Sjuksköterskorna såg patienten som en individ istället för en patient med en sjukdom.

Hospital humano: etnografia da humanização hospitalar na perspectiva de usuários

This ethnographic work studies the experiences of patients admitted in public (PUH) and private (PRH) hospitals in the Brazilian northeastern region. 28 adult patients of different clinics participated in the study. Data were analyzed by the patient path method, consisting in a combination of complemented and articulated techniques free observation, participating observation, ethnographic interview and patient testimonials collected prospectively during the patients admissions, from their arrival and until their discharge. The analysis was carried out according to the Thematic Categories Analysis Technique and the data were interpreted pursuant to medical anthropology, healthcare humanization and healthcare promotion theoretical references. The ethical principles of Resolution 196/96 were followed. The human hospital, as revealed by the patient, highlights the significance of subjectivity. 225 (54.7%) out of 411 mentioned concepts were collected in a public hospital (PUH) and 186 (45.3%) in a private institution (PRH). The results show that the patient at the PUH and PRH ethnoevaluates different aspects of the healthcare professionals´ human and technical competence, the hospital´s functioning structure, the access to and the ethics in the financial management, and develops overcoming strategies for his stay at the hospital. This ethnoevaluation is mediated by different factors, namely: social and economic status, personality, religiosity, ironic speech, somber diagnosis and satisfied needs, prior hospital experiences and the conditions under which the interview was carried out. A pedagogic proposal for the hospital humanization must include structural, managerial and organizational changes of the offered services and use active methodologies aimed to the political resolution of problematic situations at work and the inclusion of affective and subjective factors, and become as well a tool for the collective learning. This study shows the importance for the user´s ethnoevaluation to be incorporated into the hospital management and care as a guideline in the decision making and clinical action, thus promoting practices that shall lead to a decent and humanized care. The multidisciplinary nature of this study allowed a wide understanding of the user´s perspective as a socially critical ethnoevaluator

A experiência da pré-eclâmpsia vivenciada por gestantes e profissionais de saúde

The aim of this study is to understand the perceptions of pregnant women, mothers and health professional about preeclampsia and the relation between professional and patient. A qualitative approach was chosen, together with semi-structured interviews, participative observation and Test of Free Association of Words (TFAW). The data were collected in February and June 2007 at Maternidade-Escola Januário Cicco (MEJC), Natal, RN, Brazil with 61 pregnant women and 87 professionals, 20 of each group were interviewed. An interpretative and understanding perspective was used similar to that of Gadamer s hermeneutics and with the construction of themes and empirical categories. The pregnant women showed fear preeclampsia and its consequences, and to know very little about the subject and also a desire to know more. The changes that occurred with the illness were more related to the emotional order than to the healthy lifestyle they have adopted. Some lack of preparation of the basic units was observed, in order to meet and guide the pregnant women to the reference unit. Professionals knew the customers characteristics, about their fear and about their little knowledge on this illness. Nevertheless, they did not include them in the treatment. It was observed the absence of conversation over the illness between professionals and patients and also the inability of the former to deal with emotional issues. A new way of looking into the preeclampsia assistance is necessary. A way that focuses on the collective construction of intervention and approach strategies; one which includes subjective aspects in an hermeneutic perspective of health

O tratamento ortodôntico em uma perspectiva a longo prazo: avaliação da estabilidade oclusal e do grau de satisfação dos pacientes

This study aimed to evaluate factors associated to orthodontic treatment stability and patient satisfaction in the long-term. A total of 209 patients (88 class I and 121 class II) treated with straight wire fixed appliance were selected at least 5 years post treatment. Six hundred twenty seven dental casts were examined with the PAR Index at pretreatment (T1), end of treatment (T2), and at long-term follow up (T3, mean 8.5 years post treatment). At T3, a Dental Impact on Daily Living questionnaire was used to assess patient satisfaction with the dentition in the long-term. Friedman test and multiple regression analysis were used to evaluate changes among the time points and factors associated with stability and patient satisfaction. Predictive factors used to exam the occlusion were: PAR Index at T1 and T2, age at T1, the amount of time without retainer, length of Hawley retainer wear, length of follow-up, sex, extraction and third molar status. To assess patient satisfaction were considered: changes produced by the orthodontic treatment (PAR T2-T1), post treatment stability (PAR T3), age at the start of treatment (T1), length of treatment (T2-T1), gender, and extraction. Orthodontic treatment produced a significant improvement of 94.2% in the PAR Index (T2-T1), but this change was not associated with the level of satisfaction when the patient was questioned at T3. No significant change was observed between T2 and T3. However, when the sample was divided according to the level of finalization (PAR T2), it was observed that well-finished patients experienced some deterioration (P<.001), whereas the less well-finished ones showed some improvement (P<.05). Even with the deterioration, the well-finished patients still had a better PAR Index at T3 compared to the less well-finished ones (PAR T2- T3). Regression analysis showed that PAR Index at T1 and T2, age at T1, and length of retainer wear had a slight association with occlusal stability (R2 = 0.27). Patient satisfaction was significantly associated only with PAR Index at T3 (r2=0.125, P<.0001). We can conclude that, even thought orthodontic treatment is quite stable, not so well-finished treatments tend to show some improvement and well-finished ones deteriorate some in the long-term. Despite of that, well-finished patients still have better occlusal characteristics. Patient satisfaction is not related to the result of orthodontic treatment; nevertheless, there is a slight association with dentition in the long-term

A concepção de ensino sob medida na obra hygiene mental e educação (1927), de Luiz Antônio dos Santos Lima

This dissertation examines the concept of the personalized teaching proposed by the physician and educator from Rio Grande do Norte Luiz Antonio dos Santos Lima, in his doctoral thesis "Mental Hygiene and Education," published in 1927. To do so, we start from the assumption that this thinker appropriated part of the educational theory formulated by Èdouard Claparède - specifically, in the case of the teaching concepts of the personalized teaching and comprehensive education designed by the Swiss intellectual - and, considering the Brazilian social reality of early twentieth century, reframed these concepts, adapting them to the country context. To implement the proposed idea, the bibliographical study was the option chosen, and so was done through a theoretical research which had as a reference authors whose studies referred to the Brazilian historical moment in the late nineteenth and early twentieth century, our examined time frame. As for the understanding and the methodological analysis of discourse, seen as socially constructed, the Foucault postulations were studied under an analytical approach, in which the disciplinary society is analyzed from the relations of power and knowledge that exist in it. The main source of this research was the work of "Mental Hygiene and Education," published as a requirement to the obtainment of Luiz Antonio s medical degree by the Rio de Janeiro Medicine School. Thus, it was found that the conception of personalized learning to the comprehensive education of students, as proposed in the doctoral thesis of Luiz Antonio dos Santos Lima, was related to abnormalities of mental character that children could present. School education was thought in a way by the potiguar thinker that it could be applied as deep as the moral, intellectual and behavioral deviations of the individual were, making use of hygiene practices of the minds through a normalizing process towards a civilized and developed future of the Brazilian nation which would manage, watch and fix the thoughts of the school students

O processo de cuidar em Unidade de Terapia Intensiva

The environment of Intensive Care Unit (ICU) is commonly referred to as a place where caring is inextricably linked to high technology. The care in ICU often changes the patient into a taxpayer being left apart from its complexity and sometimes seen through a reductionist perspective. Thus, studies circa the care process are needed oriented from a historical ransom, raising the prospect of a more centralized human care. Hence, this study aimed to analyze the care process in a nursing intensive care unit from the perspective of the professional, family and patients. The study is characterized from a qualitative, descriptive and exploratory methodological approach. The actors were participating nursing professionals, patients and family members of an intensive care unit of Mossoró / RN. Data were collected in the period of May-June 2011, through interviews and observation of activities performed by nursing professionals, and their records in the chart. Data analysis was divided into topics and subtopics representing the phases and shapes that formed the collection. The analysis and discussion of the interviews were based on Bardin's proposal, when we created categories from a process of sorting and grouping criteria adequately defined. The observation of nursing records intended to observe the emphasis which is described in those notes as well as their consistency with practice of FCN and resolution 358/2009. The analysis showed that the nursing staff also performs work focused on mechanized activities and technical-bureaucratic institution that seem to override the needs of patients. In an overview, the care provided by professionals occurs either fragmented or insipient, however there is a service that involves other aspects beyond technical-curative practice, considering that major attention is given to the family and patient, focused on the concern of Nursing guiding their actions in not only the performance of procedures. However, the process of humanizing not always ends with an engagement between professional and patient, which mischaracterizes the true meaning of human care. The records also showed a tendency to focus on caring in a positivist line, where, in most cases, the factors of the disease and the obligation to meet the productivity have overshadowed other relevant aspects to a holistic understanding of caring. Regarding FCN Resolution No. 358/2009, which guides a systematization of nursing care, it is confirmed a technical view, a fragmented and superficial view of the patient, as well as a weakness of care, caused by ignorance and unpreparedness of the entire team. The perspective of caring demonstrates a reality with dialectic between what is proposed in a humane nursing and what happens in this performance space. Besides, it was shown a daily full of important considerations that arise in professional practice, in their views and also those people who were participants in the process

Protocolo de avaliação do cuidado de enfermagem e da segurança do paciente em unidades de terapia intensiva

The reports of adverse events date from 1990 up to the present day. Conceptually, these adverse events are unintentional injuries unrelated to the underlying disease, causing measurable lesions in patients, extending the period of hospitalization, or leading to death. These issues require discussions with regard to patient safety, improved quality of service, and preventing medical errors. In the Intensive Care Units, this concern is greater because these are sectors of intensive care to individuals with hemodynamic changes and imminent risk of death. Therefore, it is essential to conduct evaluation processes to investigate aspects of quality of nursing care and patient safety in these spaces. For that reason, we aimed to propose the Evaluation protocol of nursing care and patient safety in Intensive Care Units. For its achievement, we needed to: 1) analyze the evolution of the patient safety concept used in scientific productions, under Rodgers evolutionary concept; 2) identify the necessary items to build the evaluation protocol of nursing care and patient safety in the Intensive Care Unit, from the available evidence in literature; 3) construct an instrument for content validation of the evaluation protocol of nursing care and patient safety in the Intensive Care Unit; and 4) describe and evaluate the appropriateness of the content for an evaluation protocol of nursing care and patient safety in the Intensive Care Unit. This is a methodological study for the content validation of the abovementioned protocol. To meet the first three specific objectives, we used the integrative literature review in Theses Database of the Coordination for the Improvement of Higher Education Personnel and the portal of the Collaborating Centre for Quality of Care and Patient Safety. The fourth specific objective happened through the participation of judges, located from the Lattes curricula, in the content validation process developed in two stages: Delphi 1 and Delphi 2. As instrument, we used the electronic form of Google docs. We present in tables the answers from the evaluation instruments by Delphi consensus and Content Validity Index (CVI) of the entire protocol. We summarized the results in articles entitled Analysis of the patient safety concept: Rodgers evolutionary concept ; Scientific evidence regarding patient safety in the Intensive Care Unit ; Technological device for the content validation process: experience report ; and Evaluation protocol of nursing care and patient safety in Intensive Care Units. The Embodied Opinion of the Research Ethics Committee of the Universidade Federal do Rio Grande do Norte, No. 461,246, under CAAE 19586813.2.0000.5537, approved the study. Thus, we conclude the protocol valid in its content, constituting an important tool for evaluating the quality of nursing care and patient safety in Intensive Care Units

Prognostic significance of beta-2 adrenergic receptor in oral squamous cell carcinoma

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)