Sjuksköterskors upplevelser av att vårda patienter med smärta En litteraturöversikt

Bakgrund: Smärta är en individuell upplevelse och smärta är en stor orsak till att befolkningen söker vård. För att ge säker och god vård krävs det att sjuksköterskor ska kunna bedöma och utvärdera patienternas smärta. Sjuksköterskors upplevelser kan orsaka ett flertal hinder som kan göra att en god och säker vård inte kan uppnås. Syfte: Att beskriva sjuksköterskors upplevelser av att vårda patienter med smärta. Metod: Litteraturöversikt som är baserad på 15 vetenskapliga artiklar med både kvalitativ- och kvantitativansats. Resultat: Denna litteraturstudies resultat visade att sjuksköterskor upplever kunskapsbrist när det gäller att vårda patienter med smärta. Sjuksköterskor upplever sig otillräckliga och frustrerade över att inte kunna ge en optimal smärtlindring samt en stor rädsla att starta ett missbruk hos patienterna. Slutsats: Det är viktigt att fortsätta forska på sjuksköterskors upplevelser för att kunna tydliggöra eventuella hinder som försvårar arbetet med att ge god och säker vård till patienter med smärta.

KONTAKTMANNASKAP INOM HEMTJÄNSTEN : EN KVALITATIV STUDIE AV KONTAKTMANNASKAP OCH DESS MÖJLIGHET TILL BRUKARINFLYTANDE

The present study's purpose was to investigate the home care staff's experiences of working as key workers, which factors they consider is relevant to key working and what obstacles and opportunities they experience in their work as a key worker. The study also focused on how the home care staff perceive that key working can enable user influence. A qualitative approach was used and the material for the study was collected through semi-structured interviews. The result shows that there are areas for improvement that may develop key working. The study shows that the staff generally feel that working as a key worker works well and that it can enable user influence in many areas. The study finally illustrates factors such as continuity, working relationship oriented, and taking responsibility, as significant for key working to work as successfully as possible.

Medical students’ knowledge, attitudes, and perceptions on contraceptive use and counselling : a cross-sectional survey in Maharashtra, India

Objectives. This study aimed to investigate the knowledge, attitudes and perceptionstowards contraceptive use and counselling among medical students in Maharashtra, India. Setting. Considerable global maternal mortality and morbidity could be avoided through theuse of effective contraception. In India, contraception services are frequently unavailable or there are obstacles to obtaining modern, reversible contraceptives. Participants. A cross-sectional descriptive study using a self-administered questionnaire was conducted among 1996 medical students in their fifth year of study at 27 medical colleges in the state of Maharashtra, India. Descriptive and analytical statistics interpreted the survey instrument and significant results were presented with 95% CI. Results. Respondents expressed a desire to provide contraceptive services. A few studentshad experienced training in abortion care. There were misconceptions about moderncontraceptive methods and the impact of sex education. Attitudes towards contraceptionwere mainly positive, premarital counselling was supported and the influence of traditional values and negative provider attitudes on services was recognised. Gender, area of upbringing and type of medical college did not change the results. Conclusions. Despite mostly positive attitudes towards modern contraceptives, sex education and family planning counselling, medical students in Maharashtra have misconceptions about modern methods of contraception. Preservice and in-service training in contraceptive counselling should be implemented in order to increase women's access to evidence-based maternal healthcare services.

Effects of approach velocity and foot-target characteristics on the visual regulation of step length

Two questions emerge from the literature concerning the perceptual-motor processes underlying the visual regulation of step length. The first concerns the effects of velocity on the onset of visual control (VCO), when visual regulation of step length begins during goal-directed locomotion. The second concerns the effects of different obstacles such as a target or raised surface on step length regulation. In two separate experiments, participants (Experiment 1 & 2: n=12, 6 female, 6 male) walked, jogged, or sprinted towards an obstacle along a 10 m walkway, consisting of two marker-strips with alternating black and white 0.50 m markings. Each experiment consisted of three targeting or obstacle tasks with the requirement to both negotiate and continue moving (run-through) through the target. Five trials were conducted for each task and approach speed, with trials block randomised between the six participants of each gender. One 50 Hz video camera panned and filmed each trial from an elevated position, adjacent to the walkway. Video footage was digitized to deduce the gait characteristics. Results for the targeting tasks indicate a linear relationship between approach velocity and accuracy of final foot placement (r=0.89). When foot placement was highly constrained by the obstacle step length shortened during the entire approach. VCO was found to occur at an earlier tau-margin for lower approach velocities for both experiments, indicating that the optical variable ‘tau' is affected by approach velocity. A three-phase kinematic profile was found for all tasks, except for the take-off board condition when sprinting. Further research is needed to determine whether this velocity affect on VCO is due to ‘whole-body' approach velocity or whether it is a function of the differences between gait modes.

Resuming the dialogue: rhizomic actualisations

Since 1996, we have organised conferences on the discourse of the arts. The conferences have, in turn, led to a journal entitled Double Dialogues, the first of which was in hard copy under the sole editorship of Ann McCulloch and has been distributed internationally. After innumerable obstacles, we decided to situate articles, essays, exhibitions, and the like, from both these conferences and contributions related to our themes from interested parties, on-line. This refereed electronic journal deals with the discourse and practice of the arts, ranging across the visual arts, film, multi-media, dance, music, creative writing and theatre. Our decision to do this is manifold, but one of the reasons has been determined by our wish to become part of a global debate. We recognise that our interests are ones that are being experienced within academic institutions and art-centres world-wide. Before exploring the central theme of this Issue, perhaps we ought to contextualise it in terms of a journey over the last six years and into the future.

Integrated management system:the experiences of three Australian organisations

Purpose – Management systems and standards have become a key part of the organisation's lifeline and a prerequisite for survival in the twenty-first century. Systems for quality environmental and occupational health and safety (OHS) now form the three main pillars of the organisation, the fourth one being financial accounting. In light of the increasing pressure and demands from different stakeholders, it is becoming necessary for organisations to adopt the different systems/standards. However, to achieve the benefits from the implementation and subsequently maintenance of these systems it is only a practical and logical step that the existing management systems/standards be integrated into a single system.

Design/methodology/approach – This paper presents the experiences of three Australian-based organisations that have successfully undertaken the integration of their management systems/standards. Data for this paper were collected through in-depth interviews conducted with the managers responsible for quality, environment and OHS systems.

Findings – The interviews revealed a number of quantifiable and unquantifiable benefits experienced by the companies from operating one integrated system, such as saving of dollars, better utilisation of resources and improved communication across the organisation, to name a few. However, for the benefits to be realized it is essential that organisations are aware of the challenges and obstacles accompanying integration of systems/standards. If these challenges are not addressed early in the process they can delay the completion of the integration process.

Originality/value – Recommendations for other organisations contemplating integrating their management system include: obtaining commitment from the top management; having adequate resources to integrate the systems; having communication and training across the organisation in aspects of integration; and, last but not the least, having integrated audits. Implementation of these recommendations may vary from one organisation to another; however, it would result in lesser resistance for the organisations following them.

Teaching social work online: dilemmas and debates

The stampede towards delivering tertiary education online has been well documented in the academic literature and newspaper media. A great deal of this writing has been characterised by an acute division between those who support and those who deplore this paradigm shift in the way education is offered to students. Not withstanding a few notable exceptions, social work as a discipline has yet to fully engage in this debate, watching, as emerging technologies radically change the way education and social services are delivered. This article provides an overview of the literature related to online learning in social work. In particular the global context influencing the delivery of education is investigated; the major themes emerging from the literature are highlighted; the opportunities and obstacles for teaching and learning social work online are examined, and finally questions relating to the cultural implications for delivering social work education online are identified using a constructivist framework.

Gait termination : a review of experimental methods and the effects of aging and gait pathologies

The study of human gait has expanded and diversified to the extent that it is now possible to identify a substantive literature concerning a variety of gait tasks, such as gait initiation [Halliday SE, Winter DA, Frank JS, Patla AE, Prince F. The initiation of gait in young, elderly, and Parkinson's disease subjects. Gait Posture 1998;8:8–14; Mickelborough J, van der Linden ML, Tallis RC, Ennos AR. Muscle activity during gait initiation in normal elderly people. Gait Posture 2004;19:50–57], stepping over and across obstacles [Patla AE, Prentice SD, Robinson C, Newfold J. Visual control of locomotion: strategies for changing direction and for going over obstacles. J Exp Psych 1991;17:603–34; Chen, HC, Ashton-Miller JA, Alexander NB, Schultz AB. Effect of age and available response time on ability to step over an obstacle. J Gerontol 1994;49:227–33; Sparrow WA, Shinkfield AJ, Chow S, Begg RK. Gait characteristics in stepping over obstacles. Hum Mov Sci 1996;15:605–22; Begg RK, Sparrow WA, Lythgo ND. Time-domain analysis of foot–ground reaction forces in negotiating obstacles. Gait Posture 1998;7:99–109; Patla AE, Rietdyk S. Visual control of limb trajectory over obstacles during locomotion: effect of obstacle height and width. Gait Posture 1993;1:45–60] negotiating raised surfaces such as curbs and stairs [Begg RK, Sparrow WA. Gait characteristics of young and older individuals negotiating a raised surface: implications for the prevention of falls. J Gerontol Med Sci 2000;55A:147–54; Mcfayden BJ, Winter DA. An integrated biomechanical analysis of normal stair ascent and descent. J Biomech 1988;21:733–44]. In addition, increasing research interest in age-related declines in gait that might predispose individuals to falls has engendered a very extensive literature concerning ageing effects on gait. While rapid locomotor adjustments are common in the course of daily activities there has been no previous review of the findings concerning gait adaptations when walking is terminated both rapidly and unexpectedly. The aims of this review were first, to summarise the key research findings and methodological considerations from studies of termination. The second aim was to demonstrate the effects of ageing and gait pathologies on termination with respect to the regulation of step characteristics, lower-limb muscle activation patterns and foot–ground reaction forces.

Acculturation experiences of Iraqi refugees in Australia: the impact of visa category

This paper examines the acculturation challenges facing Iraqi refugees in Australia, and the impact of humanitarian visa category. Semi-structured interviews were conducted with Temporary Protection Visa (TPV) holders and Permanent Protection Visa (PPV) holders living in Melbourne. The findings indicate that TPV holders identify the temporary visa regime as the primary obstacle to successful integration into Australian society. The findings also suggest that TPV refugees have developed a greater level of social ties outside their ethnic groups and are less focused on issues of cultural maintenance than refugees with PPVs. The insecurity associated with the temporary protection regime appears to have led to a decreased focus on cultural maintenance, in favour of the more immediate “survival” focus on material settlement needs and visa status. While the increased social contacts of TPV refugees with some mainstream groups may be considered a partial indicator of successful acculturation, these developments cannot be equated with “settlement” as the social ties are of a temporary or unstable nature. The overriding impact of the temporary visa regime is one of creating obstacles to the effective integration of TPV refugees.

Voices of experience : developing export capability through eCommerce in Australian SMEs

This paper reports an exploratory study of 19 Australian SMEs which had successfully used eCommerce develop to or enhance their export capability. The purpose of the study was to identify both successful adoption processes and impediments to using eCommerce for export. Few companies had  adopted a strategic and planned approach to managing this adoption. The lack of easily accessed and trustworthy information and advice was partly responsible. The study identified a number of other obstacles to  eCommerce export development, including infrastructure and technical deficiencies, lack of awareness and expertise, problems with banking and finance and problems with physical links into export destinations. The developments that would most enable Australian companies to use eCommerce for export are identified as: improvements in the infrastructure on which eCommerce depends; the provision of consolidated, impartial information and advice about the use of eCommerce for export; and training and skills development to facilitate the implementation of eCommerce for export.

Evaluation of phenomenological findings in IS research : a study in developing web-based IS

This paper presents a phenomenological investigation of project managers’ experiences with the implementation of web-based employee service systems (ESS), a domain that has witnessed sharp growth in Australia in recent times. The rich, multidimensional account of project managers’ experiences with the implementation of ESS revealed the social obstacles and fragility of intraorganizational relationships that demanded a cautious and tactful approach. While arriving at such findings usually concludes the cyclical process of phenomenological study, Information Systems (IS) research usually demands some independent assessment of the empirical discovery, which led us to conducting a further study focusing on the evaluation of the collected and packaged project managers’ experience. This phenomenological evaluation is in the focus of this paper. By means of a small case study, this project engaged a number of professional teams to reflect upon the previously captured problem-solving experience and determine its applicability, usefulness and relevance in developing new web-based ESS products and services.

Ultrafine grained structure formation in steels using dynamic strain induced transformation processing

The refinement of ferrite grain size is the most generally accepted approach to simultaneously improve the strength and toughness in steels. Historically, the level of ferrite refinement is limited to 5-10 μm using conventional industrial approaches. Nowadays, though, several thermomechanical processes have been developed to produce ferrite grain sizes of 1-3 μm or less, ranging from extreme thermal and deformation cycles to more typical thermomechanical processes. The present paper reviews the status of the production of ultrafine grained steels through relatively simple thermomechanical processing. This requires deformation within the Ae3 to Ar3 temperature range for a given alloy. Here, the formation of ultrafine ferrite (UFF) involves the dynamic transformation of a significant volume fraction of the austenite to ferrite. This dynamic strain induced transformation (DSIT) arises from the introduction of extensive intragranular nucleation sites that are not present in conventional controlled rolling. The DSIT route has the potential to be adjusted to suit current industrial infrastructure. However, there are a number of significant issues that have been raised, both as gaps in our understanding and as obstacles to industrial implementation. One of the critical issues is that it appears that very large strains are required. Combined with this concern is the issue of whether a combination of dynamic and static transformation can be used to achieve an adequate level of refinement. Another issue that has also become apparent is that grain sizes of 1 μm can lead to low levels of ductility and hence many workers are attempting to obtain 2-3 μm grains, or to introduce a second phase to provide the required ductility. There are also a number of areas of disagreement between authors including the role of dynamic recrystallisation of ferrite in the production of UFF by DSIT, the reasons for the low coarsening rate of UFF grains, the role of microalloying elements and the effects of austenite grain size and strain rate. The present review discusses these areas of controversy and highlights cases where experimental results do not agree.

Ageing effects on knee and ankle joint angles at key events and phases of the gait cycle.

The objective of this research was to determine whether joint angles at critical gait events and during major energy generation/absorption phases of the gait cycle would reliably discriminate age-related degeneration during unobstructed walking. The gaits of 24 healthy adults (12 young and 12 elderly) were analysed using the PEAK Motus motion analysis system. The elderly participants showed significantly greater single (60.3% versus 62.3%, p < 0.01) and double ( p < 0.05) support times, reduced knee flexion (47.7° versus 43.0°, p < 0.05) and ankle plantarflexion (16.8° compared to 3.3°, p = 0.053) at toe off, reduced knee flexion during push-off and reduced ankle dorsiflexion (16.8° compared to 22.0°, p < 0.05) during the swing phase. The plantarflexing ankle joint motion during the stance to swing phase transition (A₂) for the young group (31.3°) was about twice ( p < 0.05) that of the elderly (16.9°). Reduced knee extension range of motion suggests that the elderly favoured a flexed-knee gait to assist in weight acceptance. Reduced dorsiflexion by the elderly in the swing phase implies greater risk of toe contact with obstacles. Overall, the results suggest that joint angle measures at critical events/phases in the gait cycle provide a useful indication of age-related degeneration in the control of lower limb trajectories during unobstructed walking.

Voices of the Poor: Poverty and Growth in Albania

This paper uses three waves of panel surveys at the household level to study growth and poverty in Albania over the period 2002-2004. It attempts to answer two main questions. The first question is directed at finding the micro determinants of growth and aims to expose the obstacles households face to improve their economic situation. The main focus of the analysis is to investigate the importance of health, education, and infrastructure indicators for income growth. The second question asks whether growth in Albania during the period 2002-2004 has been pro-poor. I find that there is some evidence for a convergence of incomes and a pro-poor growth, which has led to a substantial decrease in the number of people living under the poverty line. I also find that infrastructure has not been an important determinant for income mobility, and neither has health. Only the higher education of poor urban households seems to have affected prospects for growing out of poverty, and unexpectedly, the relationship is negative.

Insuring cleaner oceans: the economics of oil pollution prevention

The current system of controlling oil spills involves a complex relationship of international, federal and state law, which has not proven to be very effective. The multiple layers of regulation often leave shipowners unsure of the laws facing them. Furthemore, nations have had difficulty enforcing these legal requirements. This thesis deals with the role marine insurance can play within the existing system of legislation to provide a strong preventative influence that is simple and cost-effective to enforce. In principle, insurance has two ways of enforcing higher safety standards and limiting the risk of an accident occurring. The first is through the use of insurance premiums that are based on the level of care taken by the insured. This means that a person engaging in riskier behavior faces a higher insurance premium, because their actions increase the probability of an accident occurring. The second method, available to the insurer, is collectively known as cancellation provisions or underwriting clauses. These are clauses written into an insurance contract that invalidates the agreement when certain conditions are not met by the insured The problem has been that obtaining information about the behavior of an insured party requires monitoring and that incurs a cost to the insurer. The application of these principles proves to be a more complicated matter. The modern marine insurance industry is a complicated system of multiple contracts, through different insurers, that covers the many facets of oil transportation. Their business practices have resulted in policy packages that cross the neat bounds of individual, specific insurance coverage. This paper shows that insurance can improve safety standards in three general areas -crew training, hull and equipment construction and maintenance, and routing schemes and exclusionary zones. With crew, hull and equipment, underwriting clauses can be used to ensure that minimum standards are met by the insured. Premiums can then be structured to reflect the additional care taken by the insured above and beyond these minimum standards. Routing schemes are traffic flow systems applied to congested waterways, such as the entrance to New York harbor. Using natural obstacles or manmade dividers, ships are separated into two lanes of opposing traffic, similar to a road. Exclusionary zones are marine areas designated off limits to tanker traffic either because of a sensitive ecosystem or because local knowledge is required of the region to ensure safe navigation. Underwriting clauses can be used to nullify an insurance contract when a tanker is not in compliance with established exclusionary zones or routing schemes.