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  • 201.
    Das, Lucky
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Chowdhury, Merry
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Mapping of eight education sites and exploration of feasible requirements in an accreditation tool to ensure quality midwifery education in Bangladesh: A questionnaire study in Barisal, Chittagong and Sylhet divisions2017Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background:

    An important component to ensure sustainable quality midwifery education is to have a country specific accreditation tool in place, based on evidence. In Bangladesh with a recently initiated new cadre of professional midwives, the accreditation system is in process of being developed. Objective: The objective of this thesis is twofold. First, to map eight midwifery education sites in Barisal, Chittagong and Sylhet divisions prior the development of an accreditation tool. Second, to explore requirements for the accreditation tool from the perspective of the midwifery faculty to ensure quality midwifery education in Bangladesh. Methods: This study is part of a national wide study. Thirty-six participants filled a semi-structured questionnaire with both open and closed response alternatives. Data were analyzed through essentially non-parametric statistics and qualitative descriptions. Results: The mapping showed that the proportion theory in relation to practice was 40% theory and 60% practice at the eight education sites. The content of a midwifery education that should be delivered in clinical placement by a midwifery clinical teacher or preceptor, mentoring the midwifery students, was identified as a main challenge. The possible solutions were having sufficient amount of well-trained midwifery teacher; negotiating with Gynecology and Obstetrics department and the policy makers on how mentoring of midwifery students could happen smoothly; and negotiating the need for training of trainers to head nurses of all labor wards. The relation between the education site and the clinical site was suggested to be included in an accreditation tool to improve the fulfillment of a midwifery education. Conclusion: The need of an accreditation tool was, perceived by midwifery faculty, as important in order to ensure sufficient standard in the midwifery education. Clinical implications: The clinical implication of this study lies in the development of strategies to increase the number of clinical mentors and trained midwifery teachers, and provision of training of trainers to the clinical nurse midwifes at all labor wards.

  • 202.
    Dellbrant, AnnaSofia
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Thunfors, Cristina
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    BHV-sjuksköterskans upplevelse av att bemöta och vägleda föräldrar som är tveksamma till vaccination av sitt barn: En kvalitativ intervjustudie2016Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Aim: The aim of the study was to highlight the child health care nurse’s experience of responding and guiding vaccine hesitant parents. Method: An empirical interview study with a qualitative approach was carried out. The study was based on semi-structured interviews with six child health care nurses. The analysis was formed as a manifest content analysis. Results: The analysis resulted in four main categories: Guiding by informing, Requirements to guide, Approaches to respond in a good way and The Child Health Care Nurse’s experiences of responding hesitant parents as well as thirteen subcategories. The main results showed that child health care nurse’s ways of guiding hesitant parents were quite similar to each other, but differences also occured. The key to guiding parents was to inform them about vaccination. It was important to individualize the information and guide after discussion about risks versus benefits and that parents were guided to take a considered decision. Conditions to guide parents in a good way was time, knowledge and support. The child health care nurse sought a good relationship with the parents through genuine consideration and respect for the decision that the parents made. The child health care nurse experienced emotions such as frustration, anxiety, nervousness, and that responding could feel awkward. It could even be difficult to responding hesitant parents, but that varied with the parent’s attitude. Conclusion: The child health care nurse can increase the possibility that parents may choose to vaccinate their child, through individualized guidance and responding hesitant parents in consideration and respect.

  • 203. Dindic, Azemina
    et al.
    Jonsson, Johanna
    Information och stöd anhöriga vill erhålla av sjuksköterskan vid den sena fasen av palliativ vård: En litteraturöversikt2014Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Syfte: Att ta reda på vad för information och vilket stöd anhöriga önskar erhålla av sjuksköterskan i den sena fasen av palliativ vård. Metod: Litteraturöversikt med urval av 13 artiklar av kvalitativ och kvantitativ ansats från databaserna Cinahl, PubMed och Medline. Resultat: Forskning visar att anhöriga önskar erhålla flera former av stöd och information i den sena fasen av palliativ vård. Den information som är mest önskvärd är information om sjukdomen, information om vårdandet samt att informationen ges både skriftligt och verbalt. Det stöd anhöriga anser som viktigast är familjecentrerad vård och stöd för delaktighet i vårdandet, gruppstöd och efterlevandestöd. Slutsats: Anhöriga med en närstående som vårdas i den sena fasen av palliativ vård önskar erhålla tydlig skriftlig och verbal information om sjukdomen och om vårdandet. De vill även erhålla stöd före, under och efter dödsfallet. Kunskap om anhörigas önskemål av stöd och information i den sena fasen av palliativ vård kan hjälpa sjuksköterskan att bättre bistå med hjälp i en tid som är svår för både patient och anhöriga. Detta ställer krav på sjuksköterskan att inkludera både patient, i denna studie benämnd som närstående, och dess anhöriga i vårdandet.

  • 204.
    Dittrich, Nick
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Akupressurens effekter och möjlig användninginom vård och omvårdnad: En litteraturöversikt2017Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background:

    The need for health care and nursing is increasing and new

    complementary approaches to address these are needed.

    Objective:

    To compile studies using acupressure and study the effects of

    acupressure on various symptoms, disorders and ill-health conditions.

    Method:

    The study was conducted as a literature review where 20 different

    articles were compiled.

    Result:

    Categorization was made in the three main headings: effects of

    acupressure

    , patient’s experience of acupressure and acupressure in health care

    and nursing

    . The application of acupressure was mainly threw fingers with a great

    variety of acupoints distributed over the entire body. Acupressure has a wide range

    of applications both in health care and nursing, and provides a non-invasive,

    uncomplicated, economical, simple and effective complementary intervention that

    nurses and patients can use. Identified areas where fatigue, sleep, depression,

    anxiety, stress, cognitive and functional recovery, agitated behavior,

    gastrointestinal function, hypertension, pain, thirst, incontinence, quality of life

    and health. Generally was acupressure an effective intervention that also patients

    experienced as positive.

    Conclusion:

    Acupressure proves to be a usable intervention in health care and

    nursing with different uses, although the effect is partly explained by placebo.

    Nevertheless acupressure offers a complementary intervention for patients, nurses

    and other health care professionals to relieve discomfort and to promote health and

    quality of life.

  • 205.
    Domeij, Anna
    et al.
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Lennström, Charlotte
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Barnmorskans erfarenhet av handläggning vid uppkommen grad II-bristning: Kvalitativ intervjustudie med barnmorskor verksamma vid förlossningsavdelning2018Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background:

    Many women sustain a second-degree tear when giving birth vaginally. The work field of a midwife includes managing these injuries. There is limited research regarding this field and the focus tend to be on third- and fourth-degree tears, even though second-degree tears may also result in long-term complications.

    Aim:

    The aim was to investigate the midwife’s experience of managing second-degree tears.

    Method:

    Eight semi-structured individual interviews were conducted with midwives working at a medium large maternity ward located in the middle of Sweden. Qualitative content analysis was used to analyze the material.

    Results:

    Four categories and two subcategories were identified. The categories were: Information, The support of colleagues, The need for follow-ups and Physical examination and the subcategories were: Feedback strategies and Documentation.

    Conclusion:

    The result show that midwives feel insecure when managing second-degree tears, especially the midwives with less experience. The midwives also requested more feedback from the women they sutured regarding their second-degree tears and the midwives also wished for a better follow-up for the women with second-degree tears. The result also showed that the midwives give different information to women regarding their tears. No pronounced routines were found regarding what information to give and in what way.

    Clinical application:

    The results of the study aim to increase the knowledge and to develop routines regarding second-degree tears. More knowledge is needed about information given about the tear and when it is the best time to give information.

  • 206.
    Drmac, Marijana
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Jörgensen, Angelica
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Omvårdnad vid smärta: En litteraturöversikt om könsskillnader2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background:

    Pain is a common cause to seek healthcare. Pain is a subjective feeling; however, the interpretation of "male" and "female behavior" could interfere with the healthcare staff judgement and care – even though quality of care should be given person-centered and on equal terms.

    Aim:

    The aim of the study was to examine the differences in care, that may exist, between men and women with pain and highlight the gender´s meaning in quality of care.

    Method:

    This study was conducted as a literature review investigating the existing literature within this area. Seventeen scientific articles from the PubMed and Cinahl databases were analyzed and compiled into a result.

    Results:

    This review brings out the differences between the treatment and ease for men and women in pain with regards to their gender. Often women have a tendency to be undervalued when they are being cared for compared to men. Physical symptoms are often regarded as psychosomatic. Even the age of the patients was a contributing factor.

    Conclusion:

    This literature study reveals differences between genders pain care. Gender differences were identified in many sections of care. Men’s pain is treated better than women, and the women generally needs to wait longer in receiving treatment. Registered nurses should utilize person-centered treatment in order to decrease this gender gap. Increased equality in care can support a sustainable future.

  • 207. Duong, Duc M.
    et al.
    Bergström, Anna
    Wallin, Lars
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Bui, Ha T. T.
    Eriksson, Leif
    Eldh, Ann Catrine
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Exploring the influence of context in a community-based facilitation intervention focusing on neonatal health and survival in Vietnam: a qualitative study2015In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, no 15, article id 814Article in journal (Refereed)
    Abstract [en]

    Background

    In the Neonatal health – Knowledge into Practice (NeoKIP) trial in Vietnam, local stakeholder groups, supported by trained laywomen acting as facilitators, promoted knowledge translation (KT) resulting in decreased neonatal mortality. In general, as well as in the community-based NeoKIP trial, there is a need to further understand how context influences KT interventions in low- and middle-income countries (LMICs). Thus, the objective of this study was to explore the influence of context on the facilitation process in the NeoKIP intervention.

    Methods

    A secondary content analysis was performed on 16 Focus Group Discussions with facilitators and participants of the stakeholder groups, applying an inductive approach to the content on context through naïve understanding and structured analysis.

    Results

    The three main-categories of context found to influence the facilitation process in the NeoKIP intervention were: (1) Support and collaboration of local authorities and other communal stakeholders; (2) Incentives to, and motivation of, participants; and (3) Low health care coverage and utilization. In particular, the role of local authorities in a KT intervention was recognized as important. Also, while project participants expected financial incentives, non-financial benefits such as individual learning were considered to balance the lack of reimbursement in the NeoKIP intervention. Further, project participants recognized the need to acknowledge the needs of disadvantaged groups.

    Conclusions

    This study provides insight for further understanding of the influence of contextual aspects to improve effects of a KT intervention in Vietnam. We suggest that future KT interventions should apply strategies to improve local authorities’ engagement, to identify and communicate non-financial incentives, and to make disadvantaged groups a priority. Further studies to evaluate the contextual aspects in KT interventions in LMICs are also needed.

  • 208.
    Dusinkiewicz, Fenja
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Liss-Back, Amanda
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Barnens upplevelser av att ha föräldrar som tidigt insjuknar i en demenssjukdom- en litteraturöversikt2015Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Objective: The purpose of this study was to describe research on children’s experiences of being a relative of a parent with early-onset dementia. Method: The study was conducted as a literature review where nine qualitative and two quantitative scientific articles were included in the analysis. Databases that were used to search for articles was Cinahl and Web of science. Results: The result was identified in four categories: Diagnosis, Role changes, Impact on daily life and Support. The result showed that the children felt that it was important to get information about the parent's diagnosis and that this information would be individualized. Furthermore, the children had negative experiences on the role changes within family. It was not unusual for the children to experience concern, grief and anxiety out of the role changes that occurred as a result of dementia. The children also expressed a need for time alone where they could do things such as spending time with friends, exercise or go on a vacation. The need to meet other children who were in similar situations was experienced by the children as an important part of being able to handle being a relative of a parent with early-onset dementia. Conclusion: The children experienced changes within the family. The nurse needs to pay attention to the childrens’ needs. However, this requires further research in the area to develop an adapted support for the children.

  • 209.
    Dykes, Fiona
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Maternal and Infant Nutrition and Nurture Unit (MAINN), University of Central Lancashire, United Kingdom; Chinese University of Hong Kong, Hong Kong; University of Western Sydney, Australia .
    Flacking, RenéeDalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Chinese University of Hong Kong, Hong Kong; Maternal and Infant Nutrition and Nurture Unit (MAINN), University of Central Lancashire, United Kingdom.
    Ethnographic research in maternal and child health2015Collection (editor) (Other academic)
  • 210.
    Dykes, Fiona
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Maternal and Infant Nutrition and Nurture Unit (MAINN), University of Central Lancashire, United Kingdom; Chinese University of Hong Kong, Hong Kong; University of Western Sydney, Australia .
    Flacking, Renée
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Chinese University of Hong Kong, Hong Kong; Maternal and Infant Nutrition and Nurture Unit (MAINN), University of Central Lancashire, United Kingdom.
    Introducing the theory and practice of ethnography2015In: Ethnographic Research in Maternal and Child Health / [ed] Fiona Dykes and Renée Flacking, Taylor & Francis, 2015, p. 1-14Chapter in book (Other academic)
  • 211.
    E. Adelved, Helen
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Rönnholm, Anne Sinikka
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Fysiska miljöns betydelse för välbefinnande för personer med demenssjukdom: En litteraturöversikt2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Aim: To describe different aspects of the physical environment which may affect

    the well-being for people with dementia. Method: The study was conducted as a

    literature review. Articles published between the years 2000-2016 was searched in

    the databases CINAHL, PubMed, PsycINFO and Web of Science. Results: Our

    results showed that physical factors such as sound, light, color, pattern, layout,

    furnishing and sensory stimuli as well as the possibility for activity had a positive

    impact on the behavioral and psychological symptoms for people with dementia,

    which led to well-being. Conclusion: Certain characteristics of the physical

    environment decreased behavioral and psychological symptoms of dementia,

    improved performance level, and reduced negative emotional symptoms.

    Observation of emotional symptoms for people with reduced communication skills

    is an important tool to identify the individual’s non-verbal expression.

  • 212.
    Easmin, Nazma
    et al.
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Khatun, Hamida
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Family members’ care of the newborn after birth, during maternal-infant separation or in the presence of the mother: A qualitative metasynthesis2018Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Newborn infants are sensitive and the neonatal mortality remains high in low resource settings for various reasons such as hyperthermia, hypoglycemia and infections. In both low and high income settings the bonding is important for children in the long run. Skin-to-skin care of the newborn both enhances the infant’s wellbeing and health.Aim: The aim of this meta- synthesis was to describe family members’ care of the newborn after birth, during maternal-infant separation or in the presence of the mother.Methods: Methasynthesis with metaethnography as analysis method. 15 scientific articles are included.Result: The content of the care provided is presence, emotional and practical support to the newborn. In presence, close body contact or preferably skin-to-skin contact is the main caring activity. Emotional support is provided through the presence when consoling the baby. Practical support is provided by changing diaper, through breastfeeding support etc. practical activities which in turn enhance emotions (bonding).Conclusion: The mother to the newborn should provide skin-to-skin care immediately after birth of the infant. When this is not possible the father or another family member such as grandmother, sister, or aunt could be close to the infant.Clinical implications: The results from this study can be used to foster midwives to provide evidence based care of the newborn including close contact and preferably skin-to-skin contact with the mother, father or other family member after birth. This to enhance health and wellbeing of the newborn. This thesis could be a lecture in the midwifery education.

  • 213. Edman, K
    et al.
    Öhrn, Kerstin
    Dalarna University, School of Education, Health and Social Studies, Health and Caring Sciences/Oral Health Science.
    Nordström, B
    Holmlund, A
    Hellberg, D
    Trends over 30 years in the prevalence and severity of alveolar bone loss and the influence of smoking and socio-economic factors: based on epidemiological surveys in Sweden 1983-20132015In: International Journal of Dental Hygiene, ISSN 1601-5029, E-ISSN 1601-5037, Vol. 13, no 4, p. 283-291Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Epidemiological studies of the prevalence of periodontitis over an extended time using the same methodology to investigate and classify periodontitis are sparse in the literature. Smoking and socio-economic factors have been proven to increase the risk for periodontal disease. The objective of this study was to investigate 30-year time trends, using the same methodology to classify the prevalence and severity in alveolar bone loss (ABL) and to investigate the influence of tobacco and socio-economic factors.

    METHODS: Four cross-sectional epidemiological studies in an adult population were performed in the county of Dalarna, Sweden, in 1983, 2003, 2008 and 2013. Random samples of 787-1133 individuals aged 35-85 who answered a questionnaire about tobacco use and socio-economic factors were radiographically and clinically examined. A number of teeth, ABL and calculus visible on radiographs were registered. The severity of ABL as detected on radiographs was classified into no bone loss, moderate or severe.

    RESULTS: The prevalence of moderate ABL decreased from 45% in 1983 to 16% in 2008, but increased to 33% in 2013 (P < 0.05). The prevalence of severe ABL remained the same from 1983 (7%) to 2013 (6%). Calculus visible on radiographs increased from 22% in 2008 to 32% in 2013 (P < 0.05). Socio-economic factors had limited impact on the severity of ABL.

    CONCLUSION: Moderate ABL and calculus visible on radiographs significantly increased between 2008 and 2013. Smoking was the strongest factor associated with ABL overall.

  • 214. Egeh, Abdi-Aziz
    et al.
    Dugsieh, Osman
    Erlandsson, Kerstin
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Osman, Fatumo
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    The views of Somali religious leaders on birth spacing: A qualitative study2019In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 20, p. 27-31Article in journal (Refereed)
    Abstract [en]

    Background

    Birth spacing is an important health intervention for women to attain good physical and mental health. In Somalia, religious leaders play a decisive role in approving or rejecting the use of family planning.

    Objective

    The study aimed to investigate Somali Islamic religious leaders’ views on birth spacing.

    Method

    Qualitative individual interviews were conducted with 17 Somali Islamic religious leaders aged 28–59 years and analysed through content analysis.

    Results

    The main category that emerged from the analysis was that the concept “birth spacing should be used and nor family planning to be in accordance with the Islamic religion. Two perspectives of views of birth spacing were identified: accepted ways and unaccepted ways. The accepted ways include breastfeeding, use of contraceptives causing no harm to the women’s health, and coitus interruptus. The preferred method should be determined by a joint agreement between the husband and wife, and that Muslim doctors should play a key role while the couples investigate their preferred method. Using contraceptives with the intention to limit the number of children was against Islamic values and practice. In addition, it was believed that using condoms promoted the temptation to engage in sex outside the marriage and was therefore prohibited.

    Conclusion

    According to the religious Islamic leaders, selected practice recommendations for contraceptive use is permitted in relation to birth spacing to promote the health of the mother and child. When providing professional contraceptive counselling to Muslim women, the word “birth spacing” is recommended to be used instead of “family planning”.

  • 215.
    Eggens, Marit
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Österback, Maria
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Distriktssköterskors erfarenheter av preventivt arbete och riktlinjerför hjärtsviktspatienter i hemsjukvården: En kvalitativ intervjustudie2014Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Aim: The aim of the study was to illuminate the district nurses' experience of guidelines and preventive work with heart failure patients in their homes to prevent re-hospitalization.Method: A qualitative study was used and semi structured interviews were held with eight district nurses. The interviews were tape recorded, transcribed and analysed with Granheim & Lundmans qualitative content analysis.Result: Five themes were revealed by the analysis: Observations, various checks and caregiving at home. Support the patient in self-care. To conduct the medication related to administration and monitoring. Knowledge and interaction with other professions and variation about using guidelines and prescription.The result showed that preventive work was often based on several different observations, they inspected the general condition, scanned for swollen legs, and checked the breathing and weight. They administrated and followed up the use of medicines. The district nurses supported the patients in their self-care they gave information about the disease to the patients and their relatives. The district nurses had different experiences about guidelines most of them felt they didn’t have guidelines in their homecare team and they followed the prescriptions from primary health care.Conclusion: The district nurse in homecare have an important role in the preventive work about heart failure patients. The district nurse did observations and did caregiving arrangements and supported the patient in self-care. This led ultimately to the patient could be symptom-free for a long time and to avoid hospitalization. There was, however, in the district nurses experience a lack of knowledge regarding heart failure and a lack of clear, common guidelines.

  • 216.
    Egnell, Tilda
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Ragnarsson, Johanna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Kvinnors kroppsuppfattning efter bröstcancerbehandling – En litteraturöversikt2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background:

    Breast cancer is the most common type of cancer that affects women. The side

    effects of treatments are many and stressful and may result in mental illness. Even though the

    chances for surviving are good women’s mental health are affected. This is, for instance,

    because of the changed body image after the treatments. The nurse’s aim with the personcentered-

    care is to include and support the patient.

    Aim:

    To describe what factors contribute to a changed body perception after breast cancer

    treatment.

    Method:

    A literature review based on 15 scientific articles.

    Results:

    Women’s changed perception of her body can be described in four categories, and

    these are; visible changes of the body, mental health, sexuality, need for support.

    Conclusion:

    There were many factors that changed the body image after breast cancer

    treatment. The side effects of the treatments affected women both physically and

    psychologically. Losing one or two breasts and hair loss caused the female identity to suffer.

    The physical changes affected mental health and women were at risk of depression and

    anxiety. Many experienced a dissatisfaction with their body and felt less attractive to their

    partner, which in turn led them to distance themselves from sexual activities. There was a

    great need for support and information from healthcare professionals.

  • 217.
    Ehlin, Catharina
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Österling, Emma
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Patientens erfarenheter av omvårdnad på en akutmottagning: En litteraturöversikt2020Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: At emergency departments patients with different conditions of illness requires that the nurse will make a correct assessment and care, and at the same time deliver a good nursing care. These short and intensive meetings can mean that the nurse is forced to prioritize the medical needs. The mission to provide quality emergency care while meeting the need for nursing care is complex. An increased understanding of the patient experience of nursing at an emergency department can help the nurse provide good nursing care.

    Aim: To describe the patients experience of nursing at an emergency department.

    Methods: The study has been conducted as a literature review were 15 scientific articles have been used in the results.

    Results: Several factors emerged in this literature review that have significance for the patient´s experience of nursing at the emergency department. One main category emerged: Meeting with the nurse and six categories were identified: Low participation and powerlessness, The nurse's attitudes, Collaboration within the healthcare team, The patient's individual needs, The interaction between the patient and the nurse and the nurse's body language.

    Conclusion: The results of the literature review showed that the patient experienced a powerlessness and low participation in the emergency department. When the nurse identified the patient's unique needs, opened up for participation and continuous information about the patient's health situation and treatment created a positive experience. Implementation of person-centered care may be an important tool for improving nursing care at the emergency department.

  • 218.
    Ehrenberg, Anna
    et al.
    Dalarna University, School of Health and Social Studies, Caring Science/Nursing.
    Häggblom, M
    Problem-based learning in clinical nursing education: Integrating theory and practice.2007In: Nurse Education in Practice, ISSN 1471-5953, E-ISSN 1873-5223, Vol. 7, p. 67-74Article in journal (Refereed)
  • 219.
    Ehrenberg, Anna
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Wallin, Lars
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Forsman, Henrietta
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Nyexaminerade sjuksköterskors användning av forskningsresultat och tillämpning av evidensbaserad vård2013In: Verksamhetsförlagd utbildning i högskolans vårdutbildningar – Att stödja lärande den 13-14 november 2013 i Skövde: Sammanfattningar av föredrag, 2013Conference paper (Other (popular science, discussion, etc.))
  • 220.
    Ehrs, Alexander
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Abro, Ban
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Domäner av betydelse för hälsorelaterad livskvalitet hos personer med diabetesfotsår: Litteraturöversikt2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background

    diabetes is a global and serious disease which is likely to become eaven more common in the future. Out of all people suffering from diabetes about 15 percent is at risk of developing diabetic foot ulcer in their lifetime. In quantitavie research health related quality of life is measured with tools containing domains of psychological, physical and social health. People need a sense of coherence to be able to percieve good health. Aim: was to describe which domains of health related quality of life have the greatest role for people with diabetic foot ulcer. Method a litterature review was conducted based on 13 quantitative research articles were health related quality of life was measured with generic tools in people with diabetic foot ulcer. Reserach was found on CINAHL, PubMed and Web of Science. Results people with diabetic foot ulcer have the least health related quality of life in the domain physical role. Mental health was shown to be the domain where most health related quality of life was found in people with diabetic foot ulcer. Conclusion was that diabetic foot ulcer have a great impact in the domain physical role. Devolepment in nursing needs to focus on this aspect of life. In the same way resource diagnoses can be found in regard of the mental health more often than in any other domain of health related quality of life.

  • 221.
    Eilegård Wallin, Alexandra
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Udo, Camilla
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Kreicbergs, Ulrika
    Ersta Sköndal Bräcke Högskola.
    Lövgren, Malin
    Ersta Sköndal Bräcke Högskola.
    Cancer-bereaved siblings' advice to peers: a nationwide follow-up survey2019In: Death Studies, ISSN 0748-1187, E-ISSN 1091-7683Article in journal (Refereed)
    Abstract [en]

    The aim of this nationwide survey was to explore, based on an open-ended question, cancer-bereaved siblings’ advice to peers with a brother or sister with cancer. Half of the advice related to being with the ill sibling and cherishing the time together. Other advice related to the value of communicating about the situation, letting go of guilt, and living life as usual. The results highlight the importance of health care professionals, family, and others facilitating for siblings to spend time together and communicate openly.

  • 222.
    Einarsson, Julia
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Johansson, Johanna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Personcentrerad vård vid demenssjukdom: En litteraturöversikt2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background:

    Approximately160 000 people in Sweden suffer from dementia. Behavioral and psychological symptoms of dementia (BPSD) affect about 90 % of all the people with dementia. These symptoms may reduce the quality of life of the person who suffers and be difficult to handle for staff and relatives. Care for people with dementia should be person-centered, which could be complicated by the fact that people with dementia may have difficulty in communication and being involved in their care. Hence, it is considered important to get an overview of existing knowledge about person-centered care for people with dementia.

    Aim:

    To describe person-centered care for people with dementia.

    Method:

    A literature review where 12 articles where included.

    Results:

    Staff gained understanding and knowledge of dementia through education. A personal environment and activities adapted to the person’s ability were of importance. Seeing the person behind dementia by taking part in their life story and involving relatives in the care, could staff provide important information which could be used in care to handle BPSD.

    Conclusion:

    Person-centered care is of importance to people with dementia. Person-centered care can reduce the incidence of BPSD, which is beneficial to both the person with dementia, relatives and staff. Person-centered care should be implemented in dementia care and focus should be on education to staff about dementia and person-centered care.

  • 223.
    Ek, Ann-Christin
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Larsson, Gina
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Personcentrerad omvårdnad vid demens: En deskriptiv kvalitativ studie2016Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Dementia is one of the major diseases and health professionals

    encounter these people with dementia both in emergency care and municipal care.

    At the end of life most people affected by dementia live in institutions. Personcentered

    care is described to be beneficial in the care of people with dementia and

    staff's experience of this is of great importance.

    Purpose: The aim was to study nurses, unit managers and staff nurses'

    experience of person-centered care in local health care.

    Method: The design was a descriptive study with qualitative approach which

    has been analyzed by means of an inductive content analysis. Participants enrolled

    in the interview study came from the same municipality. There were ten people

    and consisted of four registered nurses, four enrolled nurses and two managers for

    the organization. They were chosen by business manager and had worked with

    people with dementia in at least five years

    Results: The result showed four categories and 12 subcategories. Personcentered

    care was considered relevant in the context of good nursing care of

    people with dementia. In the process of person-centered care was the focus

    to; adapt to the person with dementia, to ensure the identity and personality.

    Furthermore, it was stressed relatives' participation, treatment and a common

    approach, which consisted of identifying the needs and sees the person

    Conclusion: The results showed that most interviewees had similar experiences

    in working with people with dementia. It emerged from the study that the patient

    specific approach had positive outcomes when caring for a person with dementia.

    Person-centered care was considered very important and necessary to ensure that

    people with dementia have good and dignified life after being diagnosed with the

    disease.

  • 224.
    Ekborn, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science.
    Att föda barn i vatten: Kvinnors upplevelse av utdrivningsskedet när det sker i vatten. En kvalitativ intervjustudie2015Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: To give birth in water is still and has for a long time been questioned regarding the benefits and safety in many countries. In Sweden there is no longer any a restriction or recommendations about water births. The aim of this study was to investigate women´s experience of the second stage of labour in water.

    Method: Interviews were conducted with six women three to four months after the water birth. The interviews were analyzed qualitative.

    Result: Four categories were identified; Handle the pain, kept integrity, feeling secure and natural childbirth.

    None of the women had planned for a water birth but all had a wish to avoid medical pain relief and have a natural birth if possible. Their experience was that the bath made it easier to support natural child birth and the women were positive to stay in the bath as long as the midwife told them everything was fine. The primiparas expressed the pain in the second stage of labour as mainly positive. The multiparas thought the pain was equal as previous experience. The most psychological benefit was the experience of kept integrity in the bath. The women felt less exposed in the water compared with previous experiences or ideas. Women´s opinion of the midwife as skilled and calm had importance for the choice of a water birth.

    Conclusions: The women experienced the water as protective and a way to support natural birth. The primiparas expressed the pain in the second stage of labour as mainly positive. The multiparas thought the pain was equal as previous experience. The women expressed the kept integrity as most beneficial about water birth. High confidence with the midwife had importance for feeling safe in with the water birth.

  • 225.
    Ekersund, Madeleine
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Effekter, upplevelser och erfarenheter av SBAR: En litteraturstudie2016Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background

    In today's healthcare the lack of communication between healthcare professionals is a big

    reason to care injuries. Communication between healthcare professionals can burst at several

    levels and occur throughout the whole healthcare system. To prevent communication failures

    and care injuries various communication tools can be used. SBAR is a nationally recommended

    communication tool that can be used by all healthcare professionals, throughout the whole

    healthcare system.

    Aim

    The aim of this literature review was to investigate the effects of SBAR in healthcare and

    healthcare professionals experiences from using SBAR.

    Method

    This degree project was conducted as a literature review and is based on 17 scientific articles

    published between the years 2006-2016. The search for articles was made in the databases

    SBAR and CINAHL.

    Result

    SBAR provided structure to the communication and improved communication between

    healthcare professionals, which led to increased patient safety. The use of SBAR also led to a

    increased professionalism among the healthcare professionals, which among other things

    supported new staff to report with the same quality as experienced ones. SBAR also flattened

    hierarchies and differences in communication styles between professional groups.

    Conclusion

    SBAR can be used to structure and improve communication between healthcare professionals

    and to increase patient safety.

  • 226.
    Ekholm, Katinka
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Oscarsson, Cecilia
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Sjuksköterskans hälsofrämjande arbete för vuxna patienter med övervikt och fetma:: En litteraturöversikt2014Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Syfte: Syftet med denna litteraturöversikt var att undersöka vilka hälsofrämjande omvårdnadsåtgärder sjuksköterskan kan vidta för patienter med övervikt och fetma. Ytterligare ett syfte var att undersöka möjligheter och hinder som sjuksköterskan kan möta i sitt hälsofrämjande arbete.

    Metod: Studien genomfördes som en litteraturöversikt med sökning i Pub Med, SweMed+ och CINAHL. 9 kvantitativa och 5 kvalitativa artiklar valdes ut.

    Resultat: Sjuksköterskans hälsofrämjande arbete för vuxna patienter med övervikt och fetma innebär att försöka få till stånd en livsstilsförändring genom kost och ökad fysisk aktivitet. Till sin hjälp har sjuksköterskan de nationella riktlinjerna i förebyggande hälsoarbetet. Vidare i det förebyggande häsloarbetet möter sjuksköterskan möjligheter och hinder i form av olika faktorer som kan påverka . De faktorer som belyses i den här litteraturöversikten är motivation, utbildning både ur sjuksköterskans och patientens synvinkel. Även sjuksköterskan som förebild och hur dennes attityder och fördomar speglas i arbetet.

    Slutsats: Sjuksköterskans hälsofrämjande omvårdnadsåtgärder för vuxna patienter med övervikt och fetma innebär att försöka få till stånd en livsstilsförändring. För att kunna nå en livsstilsförändring behöver sjuksköterkan vara medveten om de möjligheter som främjar patienten mot ett sådant mål. Det kan vara att ta till vara på patientens egna resurser och erfarenheter.

    Sjuksköterksan bör också vara medveten om de hinder som föreligger vid häslofrämjande omvårdnadsåtgärder för vuxna patienter med övervikt och fetma. Det som var ett tydligt och återkommande tema i denna litteraturöversikt var hur sjuksköterskans, men även patientens attiyd och föreställning kom att påverka det förebyggande hälsoarbetet.

    Vidare framkom även att det saknas kunskap, utbildning och tydliga riktlinjer i klinisk praxis vad gäller hälsofrämjande omvårdnadsåtgärder för vuxna patienter med övervikt och fetma.

  • 227.
    Ekholm, Katinka
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Storm, Erica
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Skolsköterskans erfarenheter och upplevelser av att arbeta med barn med övervikt i grundskolan: En kvalitativ intervjustudie2018Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background:

    Overweight and obesity in children and adolescents is an increasing public health problem around the world, where prevalence increases and has doubled since 1980. Research has shown that the increase in overweight and obesity in children has remained in Sweden, but despite this, too many children still have problems with overweight. Within the healthcare system, the school nurse is a very important player in the early detection of trends in overweight and obesity among pupils.

    Aim:

    To describe the school nurse's experience of working with overweight in primary school children. Method: A qualitative interview study with semi structured interview questions was made using an interview guide. 10 school nurses were interviewed with open questions. The material was analyzed with qualitative content analysis according to Graneheim and Lundman (2004). Result: The analysis resulted in three main categories and six subcategories. School nurses felt that it was a difficult and sensitive topic to talk about, especially with the child's parents. Misconceptions occured often and easily and the parents did not want to face the problem. The school nurses experiences was that the overweight children often had low self- esteem and were ashamed of themselves and their bodies. The health call was a major and important part of the overweight work. The school nurses felt that they had little knowledge of the subject. School nurses described a lack of cooperation between school and school health care, which many of the school nurses felt frustrating. School nurses said that cooperation could promote children's health and influence school outcomes positively. Conclusion: It is important that nurses receive more education in the subject overweight and related communication strategies to more effectively be able to work with overweight children, that better cooperation between school and school health care is developed and the subject needs to be played-down, in order for the work of overweight children to progress..

  • 228.
    Eklund, Emelie
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Jackson, Stina
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Faktorer som påverkar livskvaliteten hos personermed hjärtsvikt: En litteraturöversikt2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background

    : Heart failure is viewed as a public health issue which costs many

    people their life every year. Of those who are affected, approximately a 50 percent

    mortality is estimated. Living with heart failure imply suffering from inconvenient

    physical symptoms, but also having to extensively adapt ones lifestyle.

    Aim

    :

    To examine different factors that affects the perception of quality of life in

    people with heart failure.

    Method

    :

    A literature review has been done where 16 scientific articles were

    included.

    Results

    :

    Reduced mental health showed a greater influence on the percepted

    quality of life than reduced physical ability. An explicit correlation between

    mental health and quality of life was found, as well as the fact that quality of life

    being more important than a long lifetime. Having a close relationship with family

    and relatives was of great importance to feel comfort. However, the meaning of

    receiving information was shown to have less influence than expected.

    Conclusion

    :

    Heart failure leads to reduced physical-, as well as mental function

    and intrudes on the persons social wellbeing, which therefore also comes to affect

    their quality of life. This review presents the importance of an early addressing of

    persons with reduced mental health to enhance their well-being and quality of life.

  • 229.
    Eklund, Klara
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Ström, Martina
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Faktorer som påverkar vårdmötet mellan sjuksköterskan och föräldrar till överviktiga barn: Litteraturstudie2016Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Overweight and obesity among children and adolescents has

    increased dramatically over the past 20 years. In Sweden, the prevalence of obesity

    increased from 1 % to 4 %. There are several causes of overweight and obesity in

    children and adolescents. Some of them are genetic factors, food consumption,

    environmental factors and lifestyle factors.

    Aim: The aim is to describe the factors that affect health care encounter between

    the nurse and the parents of children and adolescents who are overweight or obese.

    Method: The study was conducted as a literature review and consisted of 13

    articles, 10 with qualitative approach and three with quantitative approach. These

    were brought from the databases CINAHL and PubMed.

    Results: Both obstacles and opportunities that may arise in the care encounter

    between the nurse and the patients was identified. These obstacles and

    opportunities were presented in two categories with a total of five subcategories;

    Guilt and shame of the parents, denial by the parents regarding the child's weight,

    raising of the awareness of the benefits from weight loss, long-term trust facilitates

    care meetings, and customized care in the meeting between the nurse and parent.

    Conclusion: Several factors were identified which are important for the care

    encounter between nurses and parents. The factors that preclude the health care

    encounter, both parties may influence for the better.

  • 230.
    Eklöf, Helena
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Lissel, Therese
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Sjuksköterskans upplevelse av att ta emot telefonsamtal från självmordsnära patienter: På callcentra i Sverige2016Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Aim: To describe the experiences of nurses who receive phone calls from suicidal persons at call centers in Sweden.

    Method: Empirical qualitative interview-based study with a phenomenological hermeneutical approach.

    Results: The study resulted in eight themes and two subcategories. There were striking similarities and sizeable differences alike among the respondents’ experiences concerning receiving phone calls from suicidal persons. The calls were perceived as different, demanding focus and difficult to handle. The respondents describe a need for increased internal education in psychiatry. The interaction with psychiatric care is perceived as lacking and handling the patient call simultaneously while maintaining contact with a third party was perceived as frustrating. Regardless of the individual experiences regarding the process during the suicidal calls, it was unanimously described as only making use of the listening phase.

    Conclusion: The suicidal calls are clearly distinct from the somatic. The respondents unanimously describe entering a different state of mind when the patient expresses suicidal thoughts. The respondents also experience that the psychiatry works poorly, regardless of where in the country they work. Approaching patients with suicidal tendencies is becoming increasingly requested within psychiatry. This is reinforced by some of the respondents also subscribing to the myths surrounding suicide.

  • 231.
    Ekman Källkvist, Isabella
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Rothman, Hanna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Arbetsrelaterade stressfaktorer hos sjuksköterskor– En litteraturöversikt2019Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background:

    Working as a nurse is a stressful job today, where nurses meet work-related stress

    factors in their daily work. Regardless of the fact that work

    requirements have increased, the

    nurse must be able to carry out good care and have knowledge in several areas. It is important

    to highlight which stress factors affect the nurse's work in order to provide good and safe care

    and to reduce the stress of nurses.

    Purpose: The purpose was to describe work-related stress

    factors in nurses.

    Method: A literature study was conducted using quantitative and qualitative

    articles, fifteen articles were included.

    Results: Work-related stress factors in nurses were

    identified as high workloads, collaborative problems and conflicts, and emotional stressors,

    which negatively affected the nurse's nursing work.

    Conclusion: It is important to highlight

    work-related stress factors to prevent stress at work and to give nurses a better working

    environment.

  • 232.
    Ekstam, Bodil
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Familjecentrerad omvårdnad till familjer med barn som har funktionsnedsättning2016Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: The health of children with disabilities is worse than other children.

    The state is influenced by the family that the child live in and the surrounding

    environment. The families have many partners in health care and the child needs

    more support and care than children in general need of their parents. It is important

    to find ways to reduce stress and prevent illness in the family.

    Purpose: The purpose of this study was to describe parents, children and healthcare

    experience of family-centered care, the FCC, which is aimed at families who have

    children with disabilities.

    Method: Literature review was elected as a method and is based on 16 scientific

    articles with both qualitative and quantitative approach analyzed.

    Results: The FCC defined in the Articles in terms of quality and availability, but

    also as a parent to be listened to, given enough time, be treated with respect, have a

    joint decision between parents and professionals and to get information, if necessary,

    adapted. Through flexible approaches that are tailored to the child and family's needs

    both in inpatient and outpatient care, and in rehabilitation, stress can reduce both the

    family and the health professionals. However, there are groups with disabilities who

    perceive health care as a less family-centered than other families.

    Conclusion: The cornerstone of family-centered care is the collaboration between

    caregivers and family, which is promoted by the health care provider will take into

    account and respect the family's culture and background. Articles in the study shows

    that family-centered care provides support to be a success factor in health care. FCC

    promotes child and family health, which benefits the economy in the long term.

  • 233.
    Eldh, Ann Catrine
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Delaktighet och gemenskap2014In: Omvårdnadens grunder: Hälsa och ohälsa / [ed] Anna-Karin Edberg, Helle Wijk, Lund: Studentlitteratur AB, 2014, 2Chapter in book (Refereed)
  • 234.
    Eldh, Ann Catrine
    Örebro universitet, Hälsovetenskapliga institutionen.
    Patient participation: what it is and what it is not2006Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    In general, patient participation is regarded as being informed and partaking in decision making regarding one’s care and treatment. This interpretation is common in legislation throughout the Western world and corresponding documents guiding health care professionals, as well as in scientific studies. Even though this understanding of the word participation can be traced to a growing emphasis on individuals’ autonomy in society and to certain dictionary defi nitions, there are other ways of understanding participation from a semantic point of view, and no trace of patients’ descriptions of what it is to participate can be found in these definitions.

    Hence, the aim of this dissertation was to understand patients’ experience of the phenomenon of patient participation. An additional aim was to understand patients’ experience of non-participation and to describe the conditions for patient participation and non-participation, in order to understand the prerequisites for patient participation.

    The dissertation comprises four papers. The philosophical ideas of Ricoeur provided a basis for the studies: how communication can present ways to understand and explain experiences of phenomena through phenomenological hermeneutics. The first and second studies involved a group of patients living with chronic heart failure. For the fi rst study, 10 patients were interviewed, with a narrative approach, about their experience of participation and non-participation, as defi ned by the participants. For the second study, 11 visits by three patients at a nurse-led outpatient clinic were observed, and consecutive interviews were performed with the patients and the nurses, investigating what they experience as patient participation and non-participation. A triangulation of data was performed to analyse the occurrence of the phenomena in the observed visits. For paper 3 and 4, a questionnaire was developed and distributed among a diverse group of people who had recent experience of being patients. The questionnaire comprised respondent’s description of what patient participation is, using items based on findings in Study 1, along with open-ended questions for additional aspects and general issues regarding situations in which the respondent had experienced patient participation and/or non-participation.

    The findings show additional aspects to patient participation: patient participation is being provided with information and knowledge in order for one to comprehend one’s body, disease, and treatment and to be able to take self-care actions based on the context and one’s values. Participation was also found to include providing the information and knowledge one has about the experience of illness and symptoms and of one’s situation. Participation occurs when being listened to and being recognised as an individual and a partner in the health care team. Non-participation, on the other hand, occurs when one is regarded as a symptom, a problem to be solved. To avoid non-participation, the information provided needs to be based on the individual’s need and with recognition of the patient’s knowledge and context.

    In conclusion, patient participation needs to be reconsidered in health care regulations and in clinical settings: patients’ defi nitions of participation, found to be close to the dictionaries’ description of sharing, should be recognised and opportunities provided for sharing knowledge and experience in two-way-communication.

  • 235.
    Eldh, Ann Catrine
    et al.
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden ; School of Health and Medical Sciences, Orebro University.
    Carlsson, Eva
    Department of Quality and Patient safety, Lindesberg hospital and Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden.
    Seeking a balance between employment and the care of an ageing parent2011In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 25, no 2, p. 285-293Article in journal (Refereed)
    Abstract [sv]

    Rationale:  A growing number of middle-aged people are engaged in informal care of their parents while employed. To provide support as employers, co-workers or staff, health care professionals need insight into the experiences of people managing these responsibilities.

    Aim:  To elucidate the experience of providing informal care to an ageing parent while managing the responsibilities of a working life.

    Methods:  Narrative interviews were performed with 11 persons with experience of the phenomenon. Transcribed interviews were analysed with phenomenological hermeneutics.

    Ethics:  Informed consent was given prior to the interviews. The study was approved by a research ethics committee.

    Findings:  Providing informal care to an ageing parent while also pursuing a working life implies seeking balance: a balance between providing support to the parent’s needs and one’s responsibilities at work. Being employed supports this balance as it provides both fulfilment and refuge. Being capable of managing both roles grants a sense of satisfaction, supporting one’s sense of balance in life. The balance can be supported by sharing the responsibility of caring for the ageing parent with others.

    Study limitations:  Despite perceived saturation and an effort to provide for the possibility to consider internal consistency, the findings should be considered as a contribution to the understanding of the phenomenon, as experienced by individuals in their life world.

    Conclusions:  It is essential to recognise the impact that providing care for an ageing parent may have on the lives of a growing number of people, particularly if they have employment responsibilities. Acknowledgement by others supports one’s ability to attain balance; as co-workers and managers, we can acknowledge the efforts of an informal caregiver and as health care staff recognise the valuable contribution made by people in mid-life who provide informal care for their ageing parents.

  • 236.
    Eldh, Ann Catrine
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Örebro universitet.
    Ehnfors, M
    Örebro universitet.
    Ekman, I
    Göteborgs universitet.
    Inconsistent meanings to ‘patient participation’ impacts conditions for education2005Conference paper (Refereed)
  • 237.
    Eldh, Ann Catrine
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Örebro universitet.
    Ehnfors, M
    Örebro universitet.
    Ekman, I
    Göteborgs universitet.
    The right to participate in my own health care. How patients attending a nurse-led clinic for chronic heart failure experience the meaning of participation2004Conference paper (Refereed)
  • 238.
    Eldh, Ann Catrine
    et al.
    Örebro universitet, Hälsovetenskapliga institutionen.
    Ehnfors, Margareta
    Örebro universitet, Institutionen för vårdvetenskap och omsorg.
    Ekman, Inger
    The Sahlgrenska Academy at Göteborg University, Faculty of Health and Caring Sciences, Institute of Nursing, Göteborg.
    The meaning of patient participation for patients and nurses at a nurse-led clinic for chronic heart failure2006In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 5, no 1, p. 45-53Article in journal (Refereed)
    Abstract [en]

    BackgroundThe legislation of many Western countries emphasizes active patient participation. Patients with chronic heart failure (CHF), however, have experienced participation differently from the general interpretation of legal definitions. Education improves uptake of self-management strategies yet knowledge is lacking about support of patients' own resources in CHF.

    AimTo explore the phenomena of patient participation and non-participation as shown in patient visits to a nurse-led clinic for CHF and as experienced by the patients and nurses.

    MethodsData triangulation of field notes from participatory observations and texts from narrative interviews with the patients and assigned nurse specialists. Data were analyzed according to the phenomenological hermeneutic tradition.

    FindingsPatients' experience of participation and non-participation was interpreted as “Being responsible and accepting responsibility” and “Lacking an equal relationship while being controlled”, respectively. Nurses experienced patient participation as “Getting information and security to act” and patient non-participation as “Not accepting”.

    ConclusionConflicting values of patients and nurses, which were interpreted with respect to participation and non-participation, presumably might influence patient information and education negatively. The issue of participation should be raised as a means of attaining concordance and to facilitate patient participation with education specifically tailored to the individual patient's needs.

  • 239.
    Eldh, Ann Catrine
    et al.
    Örebro universitet, Hälsovetenskapliga institutionen.
    Ehnfors, Margareta
    Örebro universitet, Institutionen för vårdvetenskap och omsorg.
    Ekman, Inger
    The Sahlgrenska Academy at Göteborg University, Faculty of Health and Caring Sciences, Institute of Nursing, Göteborg.
    The phenomena of participation and non-participation in health care: experiences of patients attending a nurse-led clinic for chronic heart failure2004In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 3, no 3, p. 239-246Article in journal (Refereed)
    Abstract [en]

    Background: Patient participation is stressed in the health care acts of many western countries yet a common definition of the concept is lacking. The understanding of experiences of patients with chronic heart failure (CHF) who attend nurse-led specialist clinics, a form of care suggested as beneficiary to this group, may promote a better understanding of participation. Aim: To investigate the meanings of participation and non-participation as experienced by patients living with CHF. Methods: Narrative interviews analysed in the phenomenological hermeneutic tradition inspired by Ricoeur where the interpretation is made in the hermeneutic circle, explaining and understanding the experienced phenomena. Findings: Participation was experienced as to “be confident”, “comprehend” and “seek and maintain a sense of control”. Non-participation was experienced as to “not understand”, “not be in control”, “lack a relationship” and “not be accountable”. The findings indicate that the experiences of participation and non-participation can change over time and phases of the disease and treatment. Conclusion: The study suggests an extended view on the concept of participation. Patients' experiences of participation in health care can vary and should therefore be an issue for dialogue between nurses and patients with CHF in nurse-led specialist clinics.

  • 240.
    Eldh, Ann Catrine
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Örebro universitet.
    Ekman, I
    Göteborgs universitet.
    Ehnfors, I
    Örebro universitet.
    Communication errors as definitions of patient participation lacks patient's point of view2007In: ACENDIO 2007: 6th European Conference of Acendio, 2007, p. 114-117Conference paper (Refereed)
  • 241.
    Eldh, Ann Catrine
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Örebro universitet.
    Ekman, I
    Göteborgs universitet.
    Ehnfors, M
    Örebro universitet.
    Patient participation: the patient's view2003Conference paper (Refereed)
  • 242.
    Eldh, Ann Catrine
    et al.
    Örebro universitet.
    Ekman, I
    Göteborgs universitet.
    Ehnfors, M
    Örebro universitet.
    Providing for patient participation and preventing non-participation – two sides of the same coin?2006Conference paper (Refereed)
  • 243.
    Eldh, Ann Catrine
    et al.
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet ; School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Ekman, Inger
    Sahlgrenska Academy at Göteborg University, Institute of Health and Care Sciences, Göteborg, Sweden.
    Ehnfors, Margareta
    School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    A comparison of the concept of patient participation and patients’ descriptions as related to health care definitions2010In: International Journal of Nursing Terminologies and Classifications, ISSN 2047-3087, E-ISSN 2047-3095, Vol. 21, no 1, p. 21-32Article in journal (Refereed)
    Abstract [en]

    PURPOSE. To depict what patients describe as patient participation and whether descriptions of patient participation are affected by gender, age, healthcare contact, and duration of disease. DATA SOURCES. Current patients (n= 362) responded to a questionnaire on participation. DATA SYNTHESIS. Patients' descriptions focused on having knowledge, rather than being informed, and on interacting with health professionals, rather than merely partaking in decision making. CONCLUSIONS. Patients' descriptions of participation correspond with the International Classification of Functioning, Disability and Health's definition, which includes "being involved in a life situation." Healthcare legislation and professionals employ a narrower concept of patient participation as defined by, e.g., Medical Subject Headings. PRACTICE IMPLICATIONS. Findings suggest that health professionals need to embrace what patients describe as participation.

  • 244.
    Eldh, Ann Catrine
    et al.
    Örebro universitet, Hälsovetenskapliga institutionen.
    Ekman, Inger
    The Sahlgrenska Academy at Göteborg University, Faculty of Health and Caring Sciences, Institute of Nursing, Göteborg.
    Ehnfors, Margareta
    Örebro universitet, Institutionen för idrott och hälsa.
    Conditions for patient participation and non-participation in health care2006In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 13, no 5, p. 503-514Article in journal (Refereed)
    Abstract [en]

    This study explored patients' experiences of participation and non-participation in their health care. A questionnaire-based survey method was used. Content analysis showed that conditions for patient participation occurred when information was provided not by using standard procedures but based on individual needs and accompanied by explanations, when the patient was regarded as an individual, when the patient's knowledge was recognized by staff, and when the patient made decisions based on knowledge and needs, or performed self-care. Thus, to provide conditions for true patient participation, professionals need to recognize each patient's unique knowledge and respect the individual's description of his or her situation rather than just inviting the person to participate in decision making.

  • 245.
    Eldh, Ann Catrine
    et al.
    Örebro universitet, Hälsoakademin.
    Ekman, Inger
    Ehnfors, Margareta
    Örebro universitet, Hälsoakademin.
    Considering patient non-participation in health care2008In: Health Expectations, ISSN 1369-6513, E-ISSN 1369-7625, Vol. 11, no 3, p. 263-271Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The aim of this study was to depict patient non-participation as described by a diverse group with recent experiences of being patients. BACKGROUND: Patient participation is regarded as a primary condition for optimal quality of care, suggesting that non-participation should be avoided. A common understanding of the concept of patient non-participation is needed. A discrepancy in definitions of patient non-participation has been found in health-care interactions, health-care classifications and health-care research, and little is known of what patient non-participation represents to patients. STUDY DESIGN: A survey consisting of closed-ended and open-ended questions was administered to persons that had recently been patients to gather respondents' descriptions of what they considered as patient non-participation. Qualitative content analysis was used to analyse free-text descriptions, and descriptive statistics were used for the close-ended alternatives. FINDINGS: Lacking information (e.g. not being provided with appropriate information) and lacking recognition (e.g. not being listened to and/or lacking recognition as an individual with individual needs and concerns) were significant aspects of patient non-participation. Furthermore, non-participation encompassed facing organization-centred, as opposed to patient-centred, health care as well as feeling insecure in health care interactions. CONCLUSION: The findings provide input for a better understanding of what patients experience as non-participation. Organising for the caregivers to be able to thoroughly listen to the patients' illness narratives would easily reduce the risk of patient's experiencing what is described as non-participation and would provide a sound base for patient learning needs.

  • 246.
    Eldh, Ann Catrine
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Hälleberg-Nyman, M.
    Örebro universitet.
    Forsman, Henrietta
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Hommel, A.
    Lunds universitet.
    Rycroft-Malone, J.
    Bangor University.
    Wallin, Lars
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Onset prevention of incontinence in orthopaedic nursing and rehabilitation: a multifaceted undertaking2015Conference paper (Refereed)
  • 247.
    Eldh, Ann Catrine
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Tollne, AM
    Karolinska Institutet.
    Förberg, U
    Karolinska Institutet.
    Wallin, Lars
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    What registered nurses do and do not in the management of pediatric peripheral venous catheters and guidelines: unpacking the outcomes of computer reminders2016In: Worldviews on Evidence-Based Nursing, ISSN 1545-102X, E-ISSN 1741-6787, Vol. 13, no 3, p. 207-215Article in journal (Refereed)
    Abstract [en]

    Background: Clinical practical guidelines (CPGs) may enhance evidence-based practice, but require implementation. Computer reminders have previously shown various effects in supporting implementation; in a concomitant study, we found no effect on complications in peripheral venous catheters (PVCs) or registered nurses' (RNs) adherence to a CPG in pediatric care. Yet, there is a need to determine how reminders operate in particular contexts.

    Aim: To depict if, in what context, and how computer reminders regarding evidence-based management of PVC in pediatric care are applied according to RNs' actions and experience.

    Methods: Qualitative data from nonparticipant observations and interviews with 18 RNs in four intervention units at a pediatric hospital were analyzed with content analysis.

    Findings: Attention given to the computer reminders varied; the RNs noticed them in units where there was an agreement about the management and recording of PVCs, but not elsewhere. Rather, computer reminders did not facilitate adherence to the PVC-CPG where the CPG was not acknowledged from the start. RNs who knew how to manage PVCs had peer support and received additional reminders, which suggested that the computer reminders added to the significance of PVCs in pediatric care.

    Linking evidence to action: While the computer reminders alone did not support CPG implementation, they further increased the attention to PVCs in contexts where there was a readiness to change along with a supportive culture. We suggest further studies tailoring implementation strategies to include electronic means if there is a beneficial context.

  • 248.
    Eldh, Ann Catrine
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karolinska Institutet.
    van der Zijpp, T.
    Fontys University.
    McMullan, C.
    McCormack, B.
    Seers, K.
    Rycroft-Malone, J.
    "I have the world’s best job": staff experience of the advantages of caring for older people2016In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 30, no 2, p. 365-373Article in journal (Refereed)
    Abstract [en]

    Rationale

    Besides a growing demand for safe high-quality care for older people, long-term care (LTC) often struggles to recruit appropriately qualified nursing staff. Understanding what LTC staff value in their work may contribute to a more comprehensive understanding of what can attract staff and support person-centred care.

    Aim

    To explore staff experience of the advantages of working in LTC settings for older people.

    Methods

    Narrative descriptions of 85 LTC staff in Ireland, the Netherlands and Sweden on what they value in their work were analysed with qualitative content analysis.

    Ethics

    Ethical approval was obtained according to the requirements of each country, and participants provided informed consent prior to the individual interviews.

    Findings

    Working in LTC signifies bonding with the older people residing there, their next of kin and the team members. It means autonomy in one's daily tasks amalgamated with being a part of an affirmative team. Participants reported a sense of accomplishment and fulfilment; caring meant consideration and recognition of the older people and the relationships formed, which provided for professional and personal growth. The sharing of compassion between staff and residents indicated reciprocity of the relationship with residents.

    Study limitations

    The findings may be transferable to LTC in general although they address only the positive aspects of caring for older people and only the experiences of those staff who had consented to take part in the study.

    Conclusions

    The findings add to what underpins the quality of care in nursing homes: compassion in the nurse–resident relationship and person-centred care in LTC. They indicate reciprocity in the relations formed that may contribute to the empowerment of older people, but further studies are needed to explore this in more detail.

  • 249.
    Eldh, Ann Catrine
    et al.
    Research Fellow, Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Stockholm, Sweden.
    Vogel, Gisela
    Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Stockholm, Sweden.
    Söderberg, Anna
    Senior Lecturer, Division of Nursing, Umeå University, Umeå, Sweden.
    Blomqvist, Hans
    Associate Professor, Karolinska Institutet, Department of Clinical Sciences, Stockholm, Sweden.
    Wengström, Yvonne
    Associate Professor, Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Stockholm, Sweden.
    Use of Evidence in Clinical Guidelines and Everyday Practice for Mechanical Ventilation in Swedish Intensive Care Units2013In: Worldviews on Evidence-Based Nursing, ISSN 1545-102X, E-ISSN 1741-6787, Vol. 10, no 4, p. 198-207Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND AIM: One way to support evidence-based decisions in health care is by clinical guidelines, in particular, in highly specialized care such as intensive care units (ICUs). The aim of this study was to explore the development and dissemination of guidelines regarding mechanical ventilation (MV) in Swedish ICUs, and the use of evidence on MV in guidelines and everyday practice.

    METHODS: Inviting all general ICUs in Sweden (N = 65), a national survey was performed on occurrence of MV guidelines, and a review of submitted ICU guidelines by four evidence items from the AGREE instrument. In addition, ICU head nurses and senior physicians were interviewed using semistructured and open-ended questions to explore development and dissemination of MV guidelines, staff adherence or nonadherence to guidelines, and everyday practice of MV management bedside.

    FINDINGS: Fifty-five ICUs (85%) participated in the study; 51 ICUs submitted a total of 245 guidelines, including recommendations for medical or nursing MV actions. None of the documents included how evidence had been sought or assessed, while 22% included a list of references (n = 54). No guidelines included patients' experiences of MV. According to the managers, the guidelines were most often compiled by a multiprofessional team sharing the information through the ICU's website. The guidelines were mainly used as a basis for MV management bedside, but variation occurred as a result of personal preferences, lack of awareness, and adjustment to patients' needs.

    CONCLUSIONS: Local MV guidelines seem to constitute a basis for healthcare practice in Swedish ICUs, even though the evidence proposed was limited with respect to how it was attained and lacked patient perspectives. In addition, the strategies used for dissemination were limited, suggesting that further initiatives are needed to support knowledge translation in advanced healthcare environments such as ICUs.

  • 250.
    Eldh, Ann Catrine
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karolinska institutet.
    Wallin, Lars
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karolinska institutet.
    How single is ‘single’: some pragmatic reflections on single versus multifaceted interventions to facilitate implementation2015In: International Journal of Health Policy and Management, ISSN 2322-5939, E-ISSN 2322-5939, Vol. 4, no 10, p. 699-701Article in journal (Refereed)
    Abstract [en]

    An earlier overview of systematic reviews and a subsequent editorial on single-component versus multifaceted interventions to promote knowledge translation (KT) highlight complex issues in implementation science. In this supplemented commentary, further aspects are in focus; we propose examples from (KT) studies probing the issue of single interventions. A main point is that defining what is a single and what is a multifaceted intervention can be ambiguous, depending on how the intervention is conceived. Further, we suggest additional perspectives in terms of strategies to facilitate implementation. More specifically, we argue for a need to depict not only what activities are done in implementation interventions, but to unpack functions in particular contexts, in order to support the progress of implementation science.

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