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  • 301. Boström, Anne-Marie
    et al.
    Kajermo, Kerstin Nilsson
    Nordström, Gun
    Wallin, Lars
    Karolinska Institutet.
    Barriers to research utilization and research use among registered nurses working in the care of older people: does the BARRIERS scale discriminate between research users and non-research users on perceptions of barriers?2008In: Implementation science : IS, ISSN 1748-5908, Vol. 3, p. 24-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: One strategy to enhance research use and change current practice is to identify barriers and then implement tailored interventions to reduce these barriers. In nursing, the BARRIERS scale has been frequently used to identify nurses' perceptions of barriers to research utilization. However, this scale has not been applied to care of older people, and only one study has investigated how identified barriers link to research utilization. Therefore, the purpose of this study was twofold: to describe RNs' perceptions of barriers to and facilitators of research utilization and to examine the validity of the BARRIERS scale in relation to research use.

    METHODS: A cross-sectional survey design was used and registered nurses (RNs) working in the care of older people participated (response rate 67%, n = 140/210). Two questionnaires, the BARRIERS scale and the Research Utilization Questionnaire (RUQ), were used. Data were analyzed using descriptive and bivariate inferential statistics.

    RESULTS: Characteristics of the organization and the presentation of research findings were rated as the most prominent barriers. The three items most frequently reported as barriers were: the nurse is isolated from knowledgeable colleagues with whom to discuss the research (89%); the facilities are inadequate for implementation (88%); and, the relevant literature is not compiled in one place (81%). Surveyed RNs suggested more support from unit managers and better availability of user-friendly reports in Swedish to enhance research use.The RNs reported a modest use of research. A weak but significant correlation was found between the Research Use index in RUQ and the Presentation subscale in the BARRIERS scale (r = -0.289, p < 0.01), suggesting that the RNs reporting more research use were less likely to perceive presentation of research as a barrier. Dividing the sample into research users (n = 29) and non-research users (n = 105), the research users rated significantly lower on the subscales Presentation, Nurse and Research in the BARRIERS scale.

    CONCLUSION: The BARRIERS scale revealed differences in the perception of barriers between research users and non-research users. Thus, methodologically the scale appears useful in identifying some types of barriers to research utilization but not organizational barriers. The identified barriers, however, are general and wide-ranging, making it difficult to design useful specific interventions.

  • 302. Boström, Anne-Marie
    et al.
    Kajermo, Kerstin Nilsson
    Nordström, Gun
    Wallin, Lars
    Karolinska Institutet.
    Registered nurses' use of research findings in the care of older people2009In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 18, no 10, p. 1430-41Article in journal (Refereed)
    Abstract [en]

    AIMS: To describe registered nurses' reported use of research in the care of older people and to examine associations between research use and factors related to the elements: the communication channels, the adopter and the social system.

    BACKGROUND: Research use among registered nurses working in hospital settings has been reported in many studies. Few studies, however, have explored the use of research among registered nurses working in the care of older people.

    DESIGN: A cross-sectional survey.

    METHODS: In eight municipalities, all registered nurses (n = 210) working in older people care were invited to participate (response rate 67%). The Research Utilisation Questionnaire was adopted. Questions concerning the work organisation and research-related resources were sent to the Community Chief Nurse at each municipality. Descriptive statistics and logistic regression were applied.

    RESULTS: The registered nurses reported a relatively low use of research findings in daily practice, despite reporting a positive attitude to research. The registered nurses reported lack of access to research reports at the work place and that they had little support from unit managers and colleagues. Registered nurses working in municipalities with access to research-related resources reported more use of research than registered nurses without resources. The factors 'Access to research findings at work place', 'Positive attitudes to research' and 'Nursing programme at university level' were significantly associated with research use.

    CONCLUSIONS: There is a great potential to increase registered nurses' use of research findings in the care of older people. Factors which were linked to the communication channels and the adopter were associated with research use.

    RELEVANCE TO CLINICAL PRACTICE: Strategies to enhance research use should focus on access to and adequate training in using information sources, increased knowledge on research methodology and nursing science and a supportive organisation.

  • 303. Boström, Anne-Marie
    et al.
    Wallin, Lars
    Karolinska Institutet.
    Estabrooks, Carole A
    Kajermo, Kerstin Nilsson
    Commentary on Brown CE, Ecoff L, Kim SC, Wickline MA, Rose B, Klimpel K and Glaser D (2010) Multi-institutional study of barriers to research utilisation and evidence-based practice among hospital nurses. Journal of Clinical Nursing 19, 1944-1951.2012In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 21, no 19-20, p. 2995-6Article in journal (Refereed)
  • 304. Boström, Anne-Marie
    et al.
    Wallin, Lars
    Karolinska Institutet.
    Nordström, Gun
    Evidence-based practice and determinants of research use in elderly care in Sweden2007In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 13, no 4, p. 665-73Article in journal (Refereed)
    Abstract [en]

    RATIONALE AND OBJECTIVE: Evidence-based practice is a strategic ingredient in today's health care. Despite extensive efforts to produce and disseminate clinical guidelines, research uptake is still a difficult task. In Sweden, elderly care (EC) has shifted from hospital care to community-based care, and the major nursing-staff group in EC has no university education. These and other factors make implementation of evidence-based care particularly challenging in EC settings. The purpose of this study was to identify determinants of research utilization in EC.

    METHOD: Two questionnaires that cover research utilization and organizational climate were mailed to all staff (n = 132) working in seven EC units. The response rate was 67%.

    RESULTS: Of all respondents, 28% reported that they used research findings in daily practice (the RU group). Remaining respondents constituted the non-RU group. Significant differences existed between the RU group and the non-RU group as per six individual and six organizational factors. Using logistic regression models, four factors were significantly related to research utilization, namely: attitudes toward research (OR = 5.52, P = 0.004); seeking research that is related to clinical practice (OR = 5.56, P = 0.019); support from unit manager (OR = 4.03, P = 0.044) and access to research findings at work place (OR = 6.65, P = 0.005).

    CONCLUSIONS: Individual and organizational factors were associated with the use of research in EC. Despite distinguishing conditions in EC settings, identified factors reflect well-known determinants of research use that, as in many other health care contexts, should be considered in the endeavours of evidence-based practice.

  • 305. Boström, Anne-Marie
    et al.
    Wallin, Lars
    Karolinska Institutet.
    Nordström, Gun
    Research use in the care of older people: a survey among healthcare staff2006In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 1, no 3, p. 131-40Article in journal (Refereed)
    Abstract [en]

    Background.  Sweden has one of the largest proportions of older people in the world. To manage the healthcare needs of an aging population, there has been an alteration from hospital care to community-based care. In these settings, the majority of staff is enrolled nurses (EN) and nurse aides (NA) without university education. Aim and design.  The overall aim of this cross-sectional survey was to explore staff perceptions of factors related to research utilization in the care of older people. Method.  Questionnaires covering research utilization and demographics were sent to all staff (n = 132) working in seven units in older people care. The response rate was 67% (n = 89). The respondents consisted of ENs/NAs (n = 63), Registered Nurses (RN) and rehabilitation professionals (RP) as physiotherapists and occupational therapists (RN/RP n = 26). Results.  Most of staff reported positive attitudes towards research. The RNs/RPs stated more often than the ENs/NAs that they wanted to base their practice on research (81% vs. 25%; P = 0.001). The RNs/RPs also reported a greater extent of research use in daily practice (54% vs. 17%; P = 0.001). Support from colleagues (77% vs. 22%; P < 0.001) and unit managers (73% vs. 10%; P < 0.001) for implementing research findings was also more frequently reported by the RNs/RPs compared with the ENs/NAs. The majority of the ENs/NAs stated Do not know on many items concerning attitudes towards research, support for research utilization and actual use of research. Conclusions.  Despite overall positive attitudes towards research, the majority of staff did not use research findings in daily practice. This was particularly valid for the EN/NA group. Relevance to clinical practice.  There is an urgent need for managers and others in the care of older people to develop strategies for implementing evidence-based practice that involves the EN/NA group.

  • 306.
    Boström, Maria
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Persson, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Web-baserat stöd i astmavården – en randomiserad kontrollerad studie2018Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Objective

    The aim of this study was to examine the impact on asthma control and lung function of a web-based support program for asthma patients in primary care.

    Method

    The study was a quantitative, parallel, 2-arm, randomized controlled trial over a 6-month period.

    Both groups received asthma care based on how it was conducted at the health centers and the intervention group also gained access to a newly created web-based support program (Astmakollen) for asthma patients. In total, 83 participants completed the study, of whom 39 were in the intervention group and 44 in the control group.

    Results

    This study has showed significant improvement in asthma management in the sample group who had access to the web-based support program for 6 months. The mean score for asthma control test in the intervention group increased by 2,23 points while the score in the control group remained almost the same. The effect size for this change measured in Cohens

    d was 0,57. The mean score of lungfunction in the intervention group increased by 0,3% during the study period, while it deteriorated in the control group and the effect size amounted to 0,45. The difference between the groups were significant.

    Conclusions

    In this study, it appears that eHealth can provide improved asthma control and maintained lung function and be a complement in today's asthma care by increasing accessibility of personalized and evidence-based care.

  • 307. Bozkurt Ahman, H
    et al.
    Giedraitis, V
    Cedervall, Y
    Berglund, L
    McKee, Kevin
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Rosendahl, E
    Ingelsson, M
    Åberg, Anna Cristina
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Correlations Between Dual-Task Performance and Alzheimer’s Disease Cerebrospinal Fluid Biomarkers2018Conference paper (Refereed)
  • 308. Bozkurt Åhman, H
    et al.
    Cedervall, Y
    Giedraitis, V
    Berglund, L
    McKee, Kevin
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Rosendahl, E
    Ingelsson, M
    Åberg, Anna Cristina
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Combining Two Dual-Task Tests to Discriminate Between People with Dementia Disorder, Mild Cognitive Impairment, Subjective Cognitive Impairment, and Healthy Controls2019Conference paper (Refereed)
  • 309. Bozkurt Åhman, H
    et al.
    Giedraitis, V
    Cedervall, Y
    Berglund, L
    McKee, Kevin
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Rosendahl, E
    Ingelsson, M
    Åberg, Anna Cristina
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Correlations Between Dual-Task Performance and Alzheimer’s Disease Cerebrospinal Fluid Biomarkers2019Conference paper (Refereed)
  • 310. Brehmer, Lovisa
    et al.
    Alexanderson, Kristina
    Schytt, Erica
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Days of sick leave and inpatient care at the time of pregnancy and childbirth in relation to maternal age2017In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 45, no 3, p. 222-229Article in journal (Refereed)
    Abstract [en]

    AIMS: To explore whether older women differ from younger women with respect to sick leave and inpatient care at the time around their first pregnancy and delivery.

    METHODS: This was a descriptive population-based cohort study. The study population included all 236,176 nulliparous women registered as living in Sweden who gave birth to their first singleton infant in 2006-2010. Data from nationwide Swedish registers were used. Maternal age was categorized in five-year intervals. Time was calculated in years with the delivery date as the starting point, from two years before and up to three years after delivery. Descriptive statistics were used to calculate mean values and ANOVA tables were used to obtain the 95% confidence intervals of the means. Restriction was used to reduce potential confounding.

    RESULTS: Women aged ⩾35 years had a higher annual mean number of sick leave days from two years before to one year after their delivery date compared with younger women. The range for all age categories in the year before the delivery date, including pregnancy, was 15.3-37.4 mean sick leave days. The mean number of inpatient days increased with each age category during the year after the date of delivery in the range 1.4-4.3 days.

    CONCLUSIONS: This first explorative study indicates the need for more knowledge on morbidity among older primiparous women. They had a higher number of days with sick leave and hospitalization in the year before and after their delivery date. This might reflect higher health risks during pregnancy and childbirth among older women; however, social factors and reverse causation might also be influential.

  • 311. Breimer, Lars
    et al.
    Leksell, Janeth
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Longitudinal and cross-sectional study of registered nurses in Sweden who undertake a PhD showing that nurses continue to publish in English after their PhD but male nurses are more productive than female nurses2011In: Scientometrics, ISSN 0138-9130, E-ISSN 1588-2861, Vol. 87, no 2, p. 337-345Article in journal (Refereed)
    Abstract [en]

    A review of 649 PhDs undertaken by Swedish nurses and midwives found no evidence that they stop publishing in English after their PhD. The proportion of 70% for any publication in English was similar to that of MDs. A higher proportion of male than female nurses were high publishers of six or more (52% vs. 23%) and eight or more papers (44% vs. 14%) in a 5 year period. The standard of the PhDs of Swedish nurses was comparable to those of other biomedical PhDs and was consistent in pattern over the past two decades. The gender pattern of external examiners of female nurses evolved in that 1992–94, 75% were men, during 1996–97, 54% were men and from 2000 onwards 46% were men. Nurses were examined by foreign examiners in 20% of examinations. They came primarily from Norway and USA.

  • 312.
    Breivik, Mia
    Dalarna University, School of Education, Health and Social Studies, Caring Science.
    Midwives’ perceptions of HIV-positive women’s sexual and reproductive health and rights in urban Namibia: An interview study with ten midwives2017Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background:

    Namibia has challenges in the area of sexual and reproductive health and rights. Working with sexual and reproductive health care, midwives are an important facilitating factor for a better sexual and reproductive health in Namibia.

    Aim:

    To explore midwives’ perceptions of HIV-positive women's sexual and reproductive health and rights in urban Namibia.

    Method:

    A qualitative study with ten midwives at a hospital in Windhoek. Individual interviews were done using an interview guide. The method used for analysis was phenomenography. The phenomenon being studied was the sexual and reproductive health and rights of HIV-positive women and the phenomenon was studied through the perceptions of midwives.

    Findings:

    The midwives perceived that improvements of HIV-positive women’s reproductive health were obstructed. The midwives perceived that the HIV-positive women’s reproductive possibilities and decisions were related to HIV. According to the midwives’ perceptions, sexual relations could be complicated by HIV and it was difficult for HIV-positive women to use condoms.

    Conclusion:

    The findings of this study can be used to reflect on the current situation for HIV-positive women in Namibia. The midwives' perceptions highlight the need to reduce the remaining stigma related to HIV and to work towards the empowerment of HIV-positive women.

  • 313.
    Brelin, Rickard
    et al.
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    Färnström, Joel
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    Fenomenet Timeouter inom Idrotten Ishockey: Sammanställning av matchstatistik från SHL säsongen 2017/18 & spelare, samt tränares och spelares erfarenheter på fenomenet timeouter inom ishockey.2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Purpose

    The purpose of the study is to analyze match statistics of timeouts from the 2017/18 season of the Swedish Hockey League (SHL) and based on the analysis obtain coaches and players approach experiences off timeouts.

    Method

    Method during the study was a mixed method, whit both a qualitative and a quantitative research through interviews and statistical compilation of statistics from SHL seson 2017/18. The study's selection to the interviews was coaches and players at the elite level in the sports ice hockey and match statistics was taken and compiled from the Swedish Ice Hockey Association's database from the 2017/18 season in SHL.

    Results

    The result of the study shows that during the SHL season 2017/18 less than half of possible timeouts were taken and most of the timeouts were taken in the third period of teams in lower positions in games. During the timeouts, the trainers are most active and the interviewees' overall experience is that the powerbreak has a major impact on numbers of timeouts and that coaches are waiting to take their timeouts to the end of the matches.

    Conclusion

    The conclusions of this study are that the powerbreak has a major impact on that less than half of the timeouts being use. Powerbreaks has become an extra timeout when teams gets a longer break one time per period during the matches. This means that teams save their timeout to the end of the matches. Most timeouts are taken by teams in lower positions and by teams at the bottom of the table. Which is logical since teams at the bottom of the table are more often in lower position at the end of matches when most timeouts are used.

  • 314.
    Brisenheim, Therese
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Hagsköld, Ylva
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Patienters upplevelser av att vårdas på en akutmottagning: -en litteraturöversikt2015Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: The demands and expectations on a nurse in the emergency room

    are high. They are responsible for many patients and have to make many decisions

    on their own, sometimes with very short reflection time. They face a wide variety

    of patients with different problems and personalities, each requiring their own

    method of approach and interaction in order for him or her to feel acknowledged.

    Aim: The aim of the literature review is to examine patient's experiences of being

    cared for in an emergency room.

    Method: Articles for the work has been searched in different databases. Articles

    in-question has been read and the relevant finding has been highlighted, to analyze

    and compile the results.

    Results: The analysis resulted in three subheadings: Information, Treatment and

    Care environment, with sectioning of positive and negative experiences. Many

    patients were satisfied with the care, but had low expectations from the start.

    Conclusion: There is much that needs to be changed to allow patients to have a

    more positive experience of the emergency room. Care units must work harder

    with to ensure that patients will feel secure and safe, for example, better

    information on waiting times and a treatment where the nurse sees the whole

    patient.

  • 315.
    Brorson, Marie
    Dalarna University, School of Health and Social Studies.
    Doulors erfarenheter av sitt arbete med somaliska invandrarkvinnor En intervjustudie2014Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 316.
    Brorson, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Doulors erfarenheter av sitt arbete med somaliska invandrarkvinnor: En intervjustudie2014Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Doulor/kulturtolkar är kvinnor som ska ge sina kvinnliga landsmän stöd och hjälp i

    kontakten med den svenska hälso- och sjukvården. I Örebro läns landsting

    startades ett projekt med doulor/kulturtolkar under 2013. Syftet med denna studie

    är att utforska dessa doulors erfarenheter av sitt arbete och vilken information de

    anser är relevant för invandrarkvinnor som ska besöka en barnmorska i

    primärvården. Metoden har varit kvalitativ med individuella intervjuer med fem

    doulor i Örebro. Resultatet visade att invandrarkvinnor önskar stöd och

    information dels i form av hjälp att förstå språket och information i samband med

    besök i vården t.ex. på vårdcentral, dels i form av en djupare förklaring av

    innebörden i informationen. Doulornas uppgift har varit att förklara på ett sätt så

    att invandrakvinnorna förstår. Invandrarkvinnorna har också sökt stöd hos

    doulorna när de har haft oro angående kvinnlig könsstympning, och för att få veta

    vad cellprovtagning är. Slutsatsen är att denna studie visar överensstämmelse i

    hög grad med tidigare forskning inom området.

  • 317.
    Brorsson, Anna Lena
    Karolinska institutet.
    Diabetes during childhood and adolescence: studies of insulin treatment, patient-reported outcomes, and evaluation of an empowerment-based education2017Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    There is a lack of studies demonstrating positive effects on glycaemic control and HRQoL in children and adolescents starting CSII treatment. Guidelines recommend measuring perceived HRQoL routinely. It is important to have questionnaires, not overly comprehensive or timeconsuming, to measure HRQoL in children and adolescents as well as their parents. Structured and person-centred education has been emphasized as a key to successful selfmanagement. Guided Self-Determination-Young (GSD-Y) is a person-centred communication and reflection method. The overall aim of this thesis was to increase the knowledge regarding glycaemic control, type of treatment, HRQoL, and a theory-based education among youth with type 1 diabetes.

    Study I was a retrospective case-control study comparing children and adolescents starting CSII (n=216), with a control group treated with MDI (n=215). Children and adolescents who had started CSII showed improvement in glycaemic control, measured as HbA1c, during the first six months. For boys, this improvement could be identified throughout the first year.

    In Study II, 197 parents and their children with type 1 diabetes completed the proxy and child versions of the questionnaires Check your Health and DISABKIDS to test the psychometric properties of Check your Health by proxy. The test of the reliability and validity of this questionnaire showed acceptable psychometric properties.

    Study III, an RCT evaluating a GSD-Y education, included 71 adolescents starting CSII and their parents. The intervention group (n=37) attended seven group education sessions, lasting for about two hours each, using the GSD-Y method. The participants were followed for six months. The GSD-Y method showed a positive effect on glycaemic control, especially for participants with an HbA1c above 63 mmol/mol (n=48) at inclusion (p= 0.037); furthermore, readiness to change increased (p=0.037). A correlation was identified between HbA1c and goal achievement (rs=-0.475, p=0.001), and readiness to change (rs=-0.487, p=0.001).

    In Study IV, 13 adolescents were interviewed after the intervention with GSD-Y. From the qualitative analysis, two categories emerged: the importance of context, and growing in power through the group process. An overarching theme that emerged from the interviews was the importance of expert and referent power in growing awareness of the importance of self-management, as well as mitigating the loneliness of diabetes. Further, the findings showed that it is valuable for adolescents to meet other young people in the same situation, and to share their experiences from living with diabetes.

    In conclusion the four studies showed, treatment with CSII may initially result in improved HbA1c. Group education with the GSD-Y method, for adolescents and their parents, has the potential to further improve HbA1c, mitigate the loneliness of diabetes, and contribute to conscious reflection about self-management. The Check your Health questionnaire by proxy has shown acceptable psychometric characteristics, and may be useful in both studies and clinical settings.

  • 318.
    Brorsson, Anna Lena
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karolinska institutet.
    Leksell, Janeth
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Uppsala universitet.
    Franko, Mikael Andersson
    Lindholm Olinder, Anna
    A person-centered education for adolescents with type 1 diabetes - a randomized controlled trial2019In: Pediatric Diabetes, ISSN 1399-543X, E-ISSN 1399-5448Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Young people with type 1 diabetes and their parents need to receive person-centred education to be able to manage their diabetes. Guided Self-Determination-Young (GSD-Y) is a person-centred communication and reflection education model that can be used in educational programmes for young people with type 1 diabetes.

    OBJECTIVE: To evaluate whether GSD-Y leads to improved glycaemic control, increased self-perceived health and health-related quality of life, fewer diabetes-related family conflicts, and improved self-efficacy in a group-based intervention for adolescents starting continuous subcutaneous insulin infusion (CSII) and their parents.

    METHODS: This randomized controlled trial included 71 adolescents starting CSII. Participants were followed for twelve months. The intervention group (n=37) attended seven group training sessions over a period of five months, using the GSD-Y model, the control group received standard care. Variables evaluated were HbA1c, self-perceived health, health-related quality of life, family conflicts, self-efficacy, and usage of continuous glucose monitoring.

    RESULTS: When adjusted for sex and family conflicts, there was a difference in glycaemic control between the groups at twelve months, favouring the intervention group (62 vs. 70 mmol/mol, p=0.009). When analyses were performed on boys and girls separately and adjusted for family conflicts, the only difference detected was for boys after twelve months (p=0.019). The intervention showed no effect on self-perceived health, health-related related quality of life, family conflicts, or self-efficacy.

    CONCLUSIONS: An intervention with GSD-Y may have an effect on glycaemic control. The content of the GSD-Y groups may serve as a model for person-centred care in adolescents with type 1 diabetes. This article is protected by copyright. All rights reserved.

  • 319.
    Brorsson, Anna Lena
    et al.
    Department of Women's and Children's Health, Karolinska Institute and Hospital, Stockholm, Sweden.
    Leksell, Janeth
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Viklund, Gunnel
    Department of Women's and Children's Health, Karolinska Institute and Hospital, Stockholm, Sweden.
    Lindholm Olinder, Anna
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    A multicentre randomized controlled trial of an empowerment-inspired intervention for adolescents starting continuous subcutaneous insulin infusion: a study protocol2013In: BMC Pediatrics, ISSN 1471-2431, E-ISSN 1471-2431, Vol. 13, article id 212Article in journal (Refereed)
    Abstract [en]

    Background. Continuous subcutaneous insulin infusion (CSII) treatment among children with type 1 diabetes is increasing in Sweden. However, studies evaluating glycaemic control in children using CSII show inconsistent results. Omitting bolus insulin doses using CSII may cause reduced glycaemic control among adolescents. The distribution of responsibility for diabetes self-management between children and parents is often unclear and needs clarification. There is much published support for continued parental involvement and shared diabetes management during adolescence. Guided Self-Determination (GSD) is an empowerment-based, person-centred, reflection and problem solving method intended to guide the patient to become self-sufficient and develop life skills for managing difficulties in diabetes self-management. This method has been adapted for adolescents and parents as Guided Self-Determination-Young (GSD-Y). This study aims to evaluate the effect of an intervention with GSD-Y in groups of adolescents starting on insulin pumps and their parents on diabetes-related family conflicts, perceived health and quality of life (QoL), and metabolic control. Here, we describe the protocol and plans for study enrolment.

    Methods. This study is designed as a randomized, controlled, prospective, multicentre study. Eighty patients between 12-18 years of age who are planning to start CSII will be included. All adolescents and their parents will receive standard insulin pump training. The education intervention will be conducted when CSII is to be started and at four appointments in the first 4 months after starting CSII. The primary outcome is haemoglobin A1c levels. Secondary outcomes are perceived health and QoL, frequency of blood glucose self-monitoring and bolus doses, and usage of carbohydrate counting. The following instruments will be used to evaluate perceived health and QoL: Disabkids, 'Check your health', the Diabetes Family Conflict Scale and the Swedish Diabetes Empowerment Scale. Outcomes will be evaluated within and between groups by comparing data at baseline, and at 6 and 12 months after starting treatment.

    Results and discussion. In this study, we will assess the effect of starting an insulin pump together with the model of Guided Self-Determination to determine whether this approach leads to retention of improved glycaemic control, QoL, responsibility distribution and reduced diabetes-related conflicts in the family.

    Trial registration: Current controlled trials: ISRCTN22444034

  • 320.
    Brorsson, Anna Lena
    et al.
    Karolinska institutet.
    Lindholm Olinder, Anna
    Viklund, Gunnel
    Granström, Therese
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Uppsala University.
    Leksell, Janeth
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Uppsala University.
    Adolescents’ perceptions of participation in group education using the Guided Self-Determination-Young method: a qualitative study2017In: BMJ Open Diabetes Research & Care, ISSN 2052-4897, Vol. 5, no 1, article id e000432Article in journal (Refereed)
    Abstract [en]

    Objective Guided Self-Determination (GSD) is a person-centered communication and reflection method. Education in groups may have a greater impact than the content of the education, and constructive communication between parents and adolescents has been shown to be of importance. The purpose of this study was to describe adolescents’ perceptions of participation in group education with the Guided Self-Determination-Young (GSD-Y) method, together with parents, in connection with the introduction of continuous subcutaneous insulin infusion.

    Research design and methods In the present qualitative interview study, 13 adolescents with type 1 diabetes were included after completing a GSD-Y group education program in connection with the introduction of continuous subcutaneous insulin infusion at three hospitals located in central Sweden. The adolescents were interviewed individually, and qualitative content analysis was applied to the interview transcripts.

    Results Two categories that emerged from the analysis were the importance of context and growing in power through the group process. An overarching theme that emerged from the interviews was the importance of expert and referent power in growing awareness of the importance of self-management as well as mitigating the loneliness of diabetes.

    Conclusions GSD-Y has, in various ways, mitigated experiences of loneliness and contributed to conscious reflection about self-management in the group (referent power) together with the group leader (expert power). Overall, this highlights the benefits of group education, and the GSD method emphasizes the person-centered approach.

  • 321.
    Brorsson, Anna Lena
    et al.
    Karolinska institutet.
    Lindholm Olinder, Anna
    Wikblad, Karin
    Viklund, Gunnel
    Parent's perception of their children's health, quality of life and burden of diabetes: testing reliability and validity of 'Check your Health' by proxy.2017In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 31, no 3, p. 497-504Article in journal (Refereed)
    Abstract [en]

    AIM: To test the validity and reliability of the 'Check your Health by proxy' instrument in parents to children with diabetes aged 8-17 years.

    METHODS: One hundred and ninety-one caregivers and their children, aged 8-17 years, were included. All completed the 'Check your Health' questionnaire measuring quality of life and burden of diabetes, DISABKIDS self- or proxy version, and 45 completed the same questionnaires 2 weeks later.

    RESULTS: Test-retest reliability on the 'Check your Health' questionnaire by proxy was moderate to strong (r = 0.48-0.74), p < 0.002). Convergent validity was weak to moderate (r = 0.15-0.49, p < 0.05). The instrument showed acceptable discriminant validity. Parents reported lower scores than the children on emotional health and social relations and higher scores on physical and emotional burden and higher burden on quality of life. Poorer social relationships and quality of life were associated with higher reported disease severity. The diabetes burden domain of the questionnaire correlated to perceived severity of diabetes and to perceived health. Discriminant validity showed that poorer social relationships and quality of life were associated with higher severity of the disease. The diabetes burden domain of 'Check your Health' by proxy showed discriminant validity on perceived severity of diabetes.

    CONCLUSIONS: The instrument 'Check your Health' by proxy showed acceptable psychometric characteristics in parents to young people (8-17 years of age) with diabetes. We also concluded that parents reported that their children had lower health and higher burden of diabetes than the children did, and it correlated to reported disease severity.

  • 322.
    Brorsson, Anna Lena
    et al.
    Karolinska institutet.
    Viklund, Gunnel
    Örtqvist, Eva
    Lindholm Olinder, Anna
    Does treatment with an insulin pump improve glycaemic control in children and adolescents with type 1 diabetes? A retrospective case-control study.2015In: Pediatric Diabetes, ISSN 1399-543X, E-ISSN 1399-5448, Vol. 16, no 7, p. 546-53Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate long-term effects on glycaemic control, ketoacidosis, serious hypoglycaemic events, insulin requirements, and body mass index standard deviation scores (BMI-SDS) in children and adolescents with type 1 diabetes starting on continuous subcutaneous insulin infusion (CSII) compared with children and adolescents treated with multiple daily injections (MDI).

    METHODS: This retrospective case-control study compares 216 patients starting CSII with a control group on MDI (n = 215), matched for glycated hemoglobin (HbA1c), sex, and age during a 2-yr period. Variables collected were gender, age, HbA1c, insulin requirement, BMI, BMI-SDS, ketoacidosis, and serious hypoglycaemic events.

    RESULTS: In the CSII group there was an improvement in HbA1c after 6 and 12 months compared with the MDI group. For boys and girls separately the same effect was detected after 6 months, but only for boys after 12 months. The incidence of ketoacidosis was higher in the CSII group compared with the MDI group (2.8 vs. 0.5/100 person-yr). The incidences of severe hypoglycaemic episodes per 100 person-yr were three in the CSII group and six in the MDI group (p < 0.05). After 6, 12, and 24 months, the insulin requirement was higher in the MDI group.

    CONCLUSIONS: This study shows that treatment with CSII resulted in an improvement in HbA1c levels up to 1 yr and decreased the number of severe hypoglycaemic events, but the frequency of ketoacidosis increased. The major challenge is to identify methods to maintain the HbA1c improvement, especially among older children and teenagers, and reduce the frequency of ketoacidosis.

  • 323.
    Brorsson, Sofia
    et al.
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    Andersson, Niklas
    Herö, Johan
    Lundgren, Lina
    Högskolan i Halmstad.
    Increasing Activation of the Gluteus Medius using a New Training Device2012In: Journal of Sport and Health Research, ISSN 1989-6239, Vol. 4, no 3, p. 311-320Article in journal (Refereed)
    Abstract [en]

    Objective: The gluteus medius (GM) is a strong abductor and medial rotator of the thigh, and plays an important role in stabilizing the pelvis and controlling the knees during athletic activities.Weakness in the GM can have adverse effects onperformance and increase the risk of lower extremityinjuries. The aim of this study was to validate a newtraining device by comparing the activation of theGM when performing a squat with and without thedevice. Methods: Thirty-two female athletes (mean age 20 ± 3) performed body weight squats on and offthe device, while surface electromyography wasrecorded bilaterally on the GM. Results: All testsubjects were able to perform the squat and toactivate the GM. The activation of the GM was significantly higher when using the new device than when performing squats on the floor (Z=-4.9,P<0.001). Correlation tests between a complete sequence of three squats and one selected repetition revealed that activation was consistent throughout theexercise (right GM: rs=0.93, P<0.001, left GM:rp=0.92, P<0.001). No differences in activation were found between the right and left GM when squatting on the device. Conclusion: The newly developed training device increases muscle activity in the GM during squats. Moreover, the results showed thatsquatting on the device activates the left and rightside of the body equally, and that the GM was activated during the whole hip flexion exercise. This information and the new training device can be usedin training programs to improve stabilization of the pelvis and lower extremities during dynamic exercises.

  • 324.
    Brorsson, Sofia
    et al.
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    Boustedt, Cecilia
    Nordenskiöld, Ulla
    A grip force over 104 Newton is associated to less activity limitations and pain in women with hand ostheoarthritis2012Conference paper (Refereed)
  • 325.
    Brorsson, Sofia
    et al.
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    Bremander, Ann
    Lunds universitet.
    Qualitative differences in the muscle activity in the forearm flexor and extensor muscles in healthy men and women in different ages2012In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 71, no s3, p. 755-755Article in journal (Refereed)
  • 326.
    Brorsson, Sofia
    et al.
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    Carlsson, Tomas
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Carlsson, Magnus
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    A new electronic grip force measurement device for hand evaluation2013In: Abstracts of the Annual European Congress of Rheumatology EULAR. June 12-15, 2013. Madrid, Spain, 2013Conference paper (Refereed)
    Abstract [en]

    Background: Hand grip force is a good indicator of general muscle strength and can also be used to predict multiple outcomes such as changes in activities of daily living (ADL), disability, mortality and general upper extremity strength. Hand grip force is often measured as the amount of static grip force a subject can produce when measured with a hydraulic dynamometer such as the Jamar or with an electronic device such as the Grippit. The Grippit device measures an average grip force, a peak grip force and force over a set time period. Grippit has shown good reliability for healthy subjects. Grippit, which was developed over 20 years ago in Gothenburg, Sweden is no longer manufactured. Therefore, the need for anewly developed and modernized measurement instrument for use in evaluating hand rehabilitation has arisen.

    Objectives: The aim of this study was to evaluate the test-retest reliability of the newly developed instrument GRIP-it and to describe and validate the relationship between grip force measurements from GRIP-it and the original Grippit device.

    Methods: Healthy controls (n=43) were included in the study. Two devices were used to evaluate grip force (Newton, N), (i) GRIP-it a newly developed device and (ii) Grippit. Both instruments were used to measure mean and maximal force over 10 seconds.

    Results: GRIP-it displayed a mean measurement error of -1.7 ± 0.5% and the corresponding error for Grippit was -1.6 ± 1.9%. All subjects completed the grip force tests and the results for three attempts for each hand. The test-retest reliability was excellent for both pieces of equipment, with ICCs ranging from 0.963 to 0.947 (CI 95% between 0.103 and 0.041) for GRIP-it and from 0.979 to 0.968 (CI 95% between 0.087 and 0.042) for Grippit.

    Relationships between Grippit and GRIP-it

    There was a significant difference between the measured values derived from Grippit and GRIP-it for both the dominant hand (P < 0.001) and the non-dominant hand (P < 0.01). Grippit gives in general a higher grip force measurement than GRIP-it which is also indicated by the slope (β1) of the regression lines that deviates from 1. However, there were no substantial differences in the grip force when comparing the measurements for the dominant hand with the non-dominant hand for either Grippit (P = 0.071) or GRIP-it (P = 0.404). Based on these non-significant differences between hands and the fact that the model estimates for the intercept (β0) and the slope (β1) are contained within the confidence intervals of the model estimates for the opposite hand, a combined model was derived. The linear regression analysis, with grip force measurements for both hands included, gives: GRIP-it = 49.0 + 0.779 · Grippit. This explains 89.6% of the variance in grip force analyzed by GRIP-it (P < 0.001) see Figure 2. To enable an estimation of grip force measured by Grippit based on GRIP-it values a regression analysis with Grippit as dependent variable gives: Grippit = -18.1 + 1.15 · GRIP-it, which explains 89.6% of the variance in grip force analyzed by Grippit (P < 0.001).

    Conclusions: This study showed that GRIP-it has excellent test-retest reliability. Measurements of grip force with GRIP-it are strongly related to those from the original Grippit. The newly developed GRIP-it shows great potential for use in the assessment of hand function and the evaluation of hand rehabilitation.

  • 327.
    Brorsson, Sofia
    et al.
    PRODEA Research Group, Halmstad University, Halmstad.
    Hilliges, Marita
    PRODEA Research Group, Halmstad University, Halmstad.
    Sollerman, Christer
    Department of Hand Surgery, Sahlgrenska University Hospital, Göteborg, ; R & D Center, Spenshults Hospital of Rheumatic Diseases.
    Nilsdotter, Anna
    R & D Center, Spenshults Hospital of Rheumatic Diseases ; Department of Research and Education, Halmstad County Hospital, Halmstad, Sweden.
    A six-week hand exercise programme improves strength and hand function in patients with rheumatoid arthritis2009In: Journal of rehabilitation medicine, ISSN 1651-2081, Vol. 41, no 5, p. 338-42Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To evaluate the effects of hand exercise in patients with rheumatoid arthritis, and to compare the results with healthy controls.

    METHODS: Forty women (20 patients with rheumatoid arthritis and 20 healthy controls) performed a hand exercise programme. The results were evaluated after 6 and 12 weeks with hand force measurements (with a finger extension force measurement device (EX-it) and finger flexion force measurement with Grippit). Hand function was evaluated with the Grip Ability Test (GAT) and with patient relevant questionnaires (Disability of the Arm, Shoulder, and Hand (DASH) and Short Form-36). Ultrasound measurements were performed on m. extensor digitorum communis for analysis of the muscle response to the exercise programme.

    RESULTS: The extension and flexion force improved in both groups after 6 weeks (p < 0.01). Hand function (GAT) also improved in both groups (p < 0.01). The rheumatoid arthritis group showed improvement in the results of the DASH questionnaire (p < 0.05). The cross-sectional area of the extensor digitorum communis increased significantly in both groups measured with ultrasound.

    CONCLUSION: A significant improvement in hand force and hand function in patients with rheumatoid arthritis was seen after 6 weeks of hand training; the improvement was even more pronounced after 12 weeks. Hand exercise is thus an effective intervention for rheumatoid arthritis patients, leading to better strength and function.

  • 328.
    Brorsson, Sofia
    et al.
    Halmstad University.
    Nilsdotter, Anna
    Pedersen, Eja
    Högskolan i Halmstad.
    Bremander, Ann
    Lunds universitet.
    Thorstensson, Carina
    Lunds universitet.
    The relationship between finger flexion and extension force in healthy women and women with rheumatoid arthritis2012In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, ISSN 1650-1977, Vol. 44, no 7, p. 605-608Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    Balance between flexor and extensor muscle activity is essential for optimal function. The purpose of this pilot study was to compare the relationship between maximum finger flexion force and maximum finger extension force in women with rheumatoid arthritis and healthy women.

    METHODS:

    Twenty healthy women (median age 61 years) and 20 women with rheumatoid arthritis (median age 59.5 years, median disease duration 16.5 years) were included in the study. Finger extension force was measured with an electronic device, EX-it, and finger flexion force using Grippit. The Grip Ability Test and the score from the patient-reported outcome Disability Arm Shoulder and Hand were used to evaluate activity limitations.

    RESULTS:

    Patients with rheumatoid arthritis showed significantly decreased hand function compared with healthy controls. A correlation was found between extension force and flexion force in the healthy group (r = 0.65, p = 0.002),but not in the rheumatoid arthritis group (r = 0.25, p = 0.289).

    CONCLUSION:

    Impaired hand function appears to influence the relationship between maximum finger flexion and extension force. This study showed a difference in the relationship between maximum finger flexion and extension force in healthy controls and those with rheumatoid arthritis.

  • 329.
    Brorsson, Sofia
    et al.
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science. School of Business and Engineering, Department of Exercise Physiology, Biomechanics and Health, Halmstad University, Halmstad, Sweden.
    Nilsdotter, Anna
    Department of Research and Education, Halmstad County Hospital, Halmstad, Sweden.
    Thorstensson, Carina
    Department of Clinical Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden ; Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
    Bremander, Ann
    Department of Clinical Sciences, Lund, Section of Rheumatology, Lund University, Lund, Sweden 7 Research and Development Center, Spenshult, Oskarstrom, Sweden.
    Differences in muscle activity during hand dexterity tasks between women with arthritis and a healthy reference group2014In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 15, article id 154Article in journal (Refereed)
    Abstract [en]

    Background. Impaired hand function is common in patients with arthritis and it affects performance of daily activities; thus, hand exercises are recommended. There is little information on the extent to which the disease affects activation of the flexor and extensor muscles during these hand-dexterity tasks. The purpose of this study was to compare muscle activation during such tasks in subjects with arthritis and in a healthy reference group.

    Methods. Muscle activation was measured in m. extensor digitorium communis (EDC) and in m. flexor carpi radialis (FCR) with surface electromyography (EMG) in women with rheumatoid arthritis (RA, n = 20), hand osteoarthritis (HOA, n = 16) and in a healthy reference group (n = 20) during the performance of four daily activity tasks and four hand exercises. Maximal voluntary isometric contraction (MVIC) was measured to enable intermuscular comparisons, and muscle activation is presented as %MVIC.

    Results. The arthritis group used a higher %MVIC than the reference group in both FCR and EDC when cutting with a pair of scissors, pulling up a zipper and—for the EDC—also when writing with a pen and using a key (p < 0.02). The exercise “rolling dough with flat hands” required the lowest %MVIC and may be less effective in improving muscle strength.

    Conclusions. Women with arthritis tend to use higher levels of muscle activation in daily tasks than healthy women, and wrist extensors and flexors appear to be equally affected. It is important that hand training programs reflect real-life situations and focus also on extensor strength.

  • 330.
    Brorsson, Sofia
    et al.
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    Nilsdotter, Anna
    Department of Research and Education, Halmstad Central Hospital.
    Thorstensson, Carina
    Lunds universitet.
    Bremander, Ann
    Lunds universitet.
    Hand flexor and extensor muscle activity in daily activities and hand exercises in women with rheumatoid arthritis or hand osteoarthritis2012In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 71, no s3, p. 754-754Article in journal (Refereed)
  • 331.
    Brorsson, Sofia
    et al.
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    Parker, James
    Högskolan i Halmstad.
    Olsson, Charlotte
    Högskolan i Halmstad.
    Grip force and muscle activity are associated with kinematics in the golf swing2012Conference paper (Refereed)
  • 332.
    Brorsson, Sofia
    et al.
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    Petersson, Johan
    Riggberger, Kenneth
    Olsson, Charlotte
    Unilateral Strength Training With Maximal Velocity Improves Lower Body Power Outcome And Movement Velocity2012Conference paper (Refereed)
  • 333.
    Brorsson, Sofia
    et al.
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    Thorstensson, C.
    Nilsdotter, A.
    Bremander, A.
    Two different sets of hand exercises: improved grip strength after eight weeks in patients with arthritis2014Conference paper (Other academic)
  • 334.
    Brosius, Anders
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Markus, Sara
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Patienters upplevelse av bedsiderapportering: En litteraturöversikt2015Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Purpose: To compile the current studies on patients' experience and perception of bedside report in hospital care.

    Methods: The literature review was based on 16 scientific articles, eight qualitative, seven quantitative and one mixed methods. The articles were searched through databases Cinahl and PubMed and analyzed using content analysis, five themes were created based on the analysis.

    Results: Five themes were created based on the result: treatment and communication, expenditure of time, participation, safe and secure care and confidential information.

    Patients were generally positive to the method and felt that they were involved in their care. They stated that the transfer of information between nurse and patient was an important aspect that contributed to a sense of participation and safe care. Lack of time during the bedside reporting and that the nurses used an incomprehensible language were deficiencies raised by the patients related to the method.

    Conclusion: It is important that the nurses strive to create a balance of power in the relationship with the patient. This can be achieved by giving time and to adapt the language to the unique patient. This literature review can provide an understanding of how patients can experience bedside report and the factors that promote and inhibit participation. The result can be used as a guide in the introduction of the method in clinical practice.

  • 335.
    Broström, Britt
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Ernstsson, Marianne
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Postoperativ smärta: Metoder för bedömning och omvårdnadsåtgärder: En litteraturöversikt2016Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Postoperative pain is often undertreated. There are several

    reasons why it is important with good pain relief after surgery. Ease of the

    acute pain but also to prevent complications and long lasting pain.

    Aim: To describe the nurse´s assessment and nursing care of postoperative

    pain in adults.

    Methods: Literature review based on 16 articles, published between 2010-

    2016. The articles were found in the databases PubMed, CINAHL and Web

    of Science.

    Results: The nurse´s attitude and time for creating a relationship with the

    patient, is a prerequisite for correct pain assessment. Apart from

    administration of analgesics, there is nursing care that can relieve pain,

    which the nurse can use, for example change position or give information.

    Conclusion: There are many factors that influence the nurse´s pain

    assessment, where the patient´s participation and the nurse´s attitude are

    important components. Also nursing care can ease pain.

  • 336.
    Brottare, Emelie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Närståendes och vårdpersonals erfarenheter av kommunikation i den palliativa vården – En litteraturöversikt2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Abstract:

    It often means a grievous grief for relatives when a beloved person's life is coming to an end, which also means that the life you have collectively shared is coming to an end. In accordance with person-centered care, health care professionals should work for a partnership between relatives, the patient and the healthcare professional. In palliative care, relatives often take a major responsibility for the patient's care, while at the same time they are in crisis and they also have a need for support and information. Care interventions to the patient are often based on the needs that the relative´s communicated. In order to carry out a person-centered care, it is therefore important to make clear what experiences the relatives and the health professionals have of communication in palliative care.

    Aim:

    The aim was to compile studies describing how communication is experienced by relatives and healthcare professionals in palliative care.

    Methods:

    A literature review based on 15 scientific articles, all of which were collected in the CINAHL database. The articles were of qualitative and quantitative design.

    Results:

    It has positive significance for the patient and the relative´s that initially already at a breakpoint communication include relative´s. Structured communication models between related and health professionals favored the dialog between them. It was considered difficult to structure how communication shall be performed, when communication takes place at an individual level.

    Conclusions:

    There were differences of the quality of communication depending on whether the healthcare professional worked in specialized palliative care. When relative´s felt insecure and anxious, it affected the patients. Health professionals experienced differences in what the patient wanted for arrangements and what the relative´s mediated that the patient needed.

  • 337.
    Brun Sundblad, Gunilla
    et al.
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap.
    Mechbach, Jane
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap.
    Lundvall, Suzanne
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap.
    Nilsson, Johnny
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap.
    Orka hela vägen: Upplevd hälsa, idrotts- och träningsbakgrund bland studenter på en fysiskt inriktad yrkesutbildning.  Lärarstudenter GIH 2008 delrapport 1: 20092010Report (Other academic)
    Abstract [sv]

    Sammanfattning

    Ett sammanfattande porträtt av den nyantagna lärarstudenten vid GIH med utgångspunkt från enkätsvaren ger vid handen en bild av en person, som är ca 21 år gammal, född i Sverige och uppvuxen i en medelstor stad i Mellansverige. Studenten trivdes mycket bra i skolan och var som elev något över medel med MVG i idrott och hälsa.

    Valet av yrkesutbildning grundade sig på ett stort intresse för idrott, samt en önskan att få jobba med barn och ungdom. Studievalet hade för många påverkats av en tidigare idrotts-lärare, kompisar och familj. En bra lärare i idrott och hälsa är enligt studenten positiv, engagerad, rättvis, bestämd och kunnig.

    Lärarstudenten ser sig behärska bollspel väl. Störst kunskap och färdighet uppges i fot-boll och alpin skidåkning. Minst kunskap och färdighet skattades i softboll, baseboll, bergsklättring, långfärdsskridskoåkning och i konsten att kunna valla skidor. Många ser sig ha god kunskap om sambandet mellan hälsa, livsstil och miljö, men mindre god om hur en idrottsaktivitet har betydelse för kulturarvet, samband mellan miljö och männi-skans hälsa i ett historiskt och nutidsperspektiv samt i ergonomi.

    På sin fritid går lärarstudenten ofta på idrottsevenemang, café, tittar på TV och video eller umgås med vänner och familj. Lärarstudenten går sällan på bio och nästan aldrig på tea-ter, museum eller vernissager. "Vad är vernissage?" undrar en student.

    Hälsan, både fysiskt och psykiskt, skattas som tillfredsställande och man känner ofta hopp, glädje och meningsfullhet. Emellertid finner man sig även ofta stressad på grund av tidsbrist och alla krav. Många kvinnliga studenter (41%) rapporterade ryggont och många, både kvinnor och män, beskrev att de har besvär från en skadad fotled eller knä. De flesta lärarstudenterna är regelbundet fysiskt aktiva och de finner att mängden motion delvis är tillfredsställande.

    Förväntningarna är höga på utbildningen både att den är mångsidig och kommer att ge ökad kunskap inom olika områden. Under studietiden förväntar man sig att utvecklas och förbättra sin egen fysiska status och hälsa. En student uttrycker det med orden: "Mitt nya liv startar idag". Den sammanfattande bilden av lärarstudenten på GIH liknar den som tidigare har redovisats av Meckbach och Wedman i en liknande studie från maj 2005. Deras studie genomfördes på studenter efter ett års studier på GIH (Meckbach & Wed-man, 2007).

  • 338.
    Brändström, Sara
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    Olika chans beroende på födelsemånad: En kvantitativ undersökning av relative age effect på svenska längdskidgymnasier2015Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Aim

    The purpose of this study was to investigate if relative age effect occurs at Swedish cross-country ski schools and if there were a differences in the presence among boys and girls, and between Riksidrottsgymnasier (Country-wide sport academy) and Nationell Idrottsutbildning (National sport academy).

    Method

    To answer the aim, statistical data were analyzed using a Pearson Chi2-test. The analysis has been done by examining birth month, sex and education among students at Swedish cross-country ski schools between 2010-2015.

    Results

    The result shows that there is a significant evidence of relative age effect at Swedish cross-country ski schools (p= <0,05). When the results were partial between Riksidrottsgymnasier and Nationell Idrottsutbildning, the relative age effect was only seen at Riksidrottsgymnasierna. There were no significant evidence for relative age effect when boys and girls where analyzed separately.

    Conclusion

    The results show that relative age effect appears on Swedish cross-country ski schools; however, there were some varies between analyzed variables. Strongest evidence for relative age effect was seen at Riksidrottsgymnaiserna.

    Further research is needed to get a overview of the consequences of relative age effect at cross-country ski schools, and the consequences it has in Swedish cross-country skiing overall, both for younger and older skiers.

  • 339. Brück, Katharina
    et al.
    Jager, Kitty J
    Dounousi, Evangelia
    Kainz, Alexander
    Nitsch, Dorothea
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Uppsala university.
    Rothenbacher, Dietrich
    Browne, Gemma
    Capuano, Vincenzo
    Ferraro, Pietro Manuel
    Methodology used in studies reporting chronic kidney disease prevalence: a systematic literature review2015In: Nephrology, Dialysis and Transplantation, ISSN 0931-0509, E-ISSN 1460-2385, Vol. 30, no Supp. 4, p. iv6-iv16Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Many publications report the prevalence of chronic kidney disease (CKD) in the general population. Comparisons across studies are hampered as CKD prevalence estimations are influenced by study population characteristics and laboratory methods.

    METHODS: For this systematic review, two researchers independently searched PubMed, MEDLINE and EMBASE to identify all original research articles that were published between 1 January 2003 and 1 November 2014 reporting the prevalence of CKD in the European adult general population. Data on study methodology and reporting of CKD prevalence results were independently extracted by two researchers.

    RESULTS: We identified 82 eligible publications and included 48 publications of individual studies for the data extraction. There was considerable variation in population sample selection. The majority of studies did not report the sampling frame used, and the response ranged from 10 to 87%. With regard to the assessment of kidney function, 67% used a Jaffe assay, whereas 13% used the enzymatic assay for creatinine determination. Isotope dilution mass spectrometry calibration was used in 29%. The CKD-EPI (52%) and MDRD (75%) equations were most often used to estimate glomerular filtration rate (GFR). CKD was defined as estimated GFR (eGFR) <60 mL/min/1.73 m(2) in 92% of studies. Urinary markers of CKD were assessed in 60% of the studies. CKD prevalence was reported by sex and age strata in 54 and 50% of the studies, respectively. In publications with a primary objective of reporting CKD prevalence, 39% reported a 95% confidence interval.

    CONCLUSIONS: The findings from this systematic review showed considerable variation in methods for sampling the general population and assessment of kidney function across studies reporting CKD prevalence. These results are utilized to provide recommendations to help optimize both the design and the reporting of future CKD prevalence studies, which will enhance comparability of study results.

  • 340. Brück, Katharina
    et al.
    Stel, Vianda S
    Gambaro, Giovanni
    Hallan, Stein
    Völzke, Henry
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Uppsala universitet.
    Kastarinen, Mika
    Guessous, Idris
    Vinhas, José
    Stengel, Bénédicte
    CKD prevalence varies across the European general population2016In: Journal of the American Society of Nephrology, ISSN 1046-6673, E-ISSN 1533-3450, Vol. 27, no 7, p. 2135-2147Article in journal (Refereed)
    Abstract [en]

    CKD prevalence estimation is central to CKD management and prevention planning at the population level. This study estimated CKD prevalence in the European adult general population and investigated international variation in CKD prevalence by age, sex, and presence of diabetes, hypertension, and obesity. We collected data from 19 general-population studies from 13 European countries. CKD stages 1-5 was defined as eGFR<60 ml/min per 1.73 m(2), as calculated by the CKD-Epidemiology Collaboration equation, or albuminuria >30 mg/g, and CKD stages 3-5 was defined as eGFR<60 ml/min per 1.73 m(2). CKD prevalence was age- and sex-standardized to the population of the 27 Member States of the European Union (EU27). We found considerable differences in both CKD stages 1-5 and CKD stages 3-5 prevalence across European study populations. The adjusted CKD stages 1-5 prevalence varied between 3.31% (95% confidence interval [95% CI], 3.30% to 3.33%) in Norway and 17.3% (95% CI, 16.5% to 18.1%) in northeast Germany. The adjusted CKD stages 3-5 prevalence varied between 1.0% (95% CI, 0.7% to 1.3%) in central Italy and 5.9% (95% CI, 5.2% to 6.6%) in northeast Germany. The variation in CKD prevalence stratified by diabetes, hypertension, and obesity status followed the same pattern as the overall prevalence. In conclusion, this large-scale attempt to carefully characterize CKD prevalence in Europe identified substantial variation in CKD prevalence that appears to be due to factors other than the prevalence of diabetes, hypertension, and obesity.

  • 341. Burgaz, A.
    et al.
    Byberg, L.
    Rautiainen, S.
    Orsini, N.
    Hakansson, N.
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Sundstrom, J.
    Lind, L.
    Melhus, H.
    Michaelsson, K.
    Wolk, A.
    Confirmed hypertension and plasma 25(OH)D concentrations amongst elderly men2011In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 269, no 2, p. 211-218Article in journal (Refereed)
    Abstract [en]

    Objectives. The results of experimental studies suggest that vitamin D deficiency activates the renin-angiotensin system and predisposes to hypertension. Results of previous epidemiological studies investigating the association between 25-hydroxyvitamin D [25(OH)D] status and hypertension have not been consistent, perhaps because of their sole reliance on office blood pressure (BP) measurements leading to some misclassification of hypertension status. No previous studies have examined the association between 25(OH)D status and confirmed hypertension assessed with both office and 24-h BP measurements.

    Design. In this cross-sectional study, we investigated 833 Caucasian men, aged 71 +/- 0.6 years, to determine the association between plasma 25(OH)D concentrations, measured with high-pressure liquid chromatography mass spectrometry, and the prevalence of hypertension. We used both supine office and 24-h BP measurements for classifying participants as normotensive or confirmed hypertensive; participants with inconsistent classifications were excluded.

    Results. In a multivariable adjusted logistic regression model, men with 25(OH)D concentrations < 37.5 nmol L-1 had a 3-fold higher prevalence of confirmed hypertension compared to those with >= 37.5 nmol L-1 25(OH)D (odds ratio = 3.3, 95% CI: 1.0-11.0).

    Conclusions. Our results show that low plasma 25(OH)D concentration is associated with a higher prevalence of confirmed hypertension.

  • 342. Burholt, Vanessa
    et al.
    Winter, Bethan
    Aartsen, Marja
    Constantinou, Costas
    Dahlberg, Lena
    Dalarna University, School of Education, Health and Social Studies, Social Work. Karolinska institutet.
    Feliciano, Villar
    De Jong Gierveld, Jenny
    Van Regenmortel, Sofie
    Waldegrave, Charles
    A critical review and development of a conceptual model of exclusion from social relations for older people2019In: European Journal of Ageing, ISSN 1613-9372, E-ISSN 1613-9380Article in journal (Refereed)
    Abstract [en]

    Social exclusion is complex and dynamic, and it leads to the non-realization of social, economic, political or cultural rights or participation within a society. This critical review takes stock of the literature on exclusion of social relations. Social relations are defined as comprising social resources, social connections and social networks. An evidence review group undertook a critical review which integrates, interprets and synthesizes information across studies to develop a conceptual model of exclusion from social relations. The resulting model is a subjective interpretation of the literature and is intended to be the starting point for further evaluations. The conceptual model identifies individual risks for exclusion from social relations (personal attributes, biological and neurological risk, retirement, socio-economic status, exclusion from material resources and migration). It incorporates the evaluation of social relations, and the influence of psychosocial resources and socio-emotional processes, sociocultural, social-structural, environmental and policy contextual influences on exclusion from social relations. It includes distal outcomes of exclusion from social relations, that is, individual well-being, health and functioning, social opportunities and social cohesion. The dynamic relationships between elements of the model are also reported. We conclude that the model provides a subjective interpretation of the data and an excellent starting point for further phases of conceptual development and systematic evaluation(s). Future research needs to consider the use of sophisticated analytical tools and an interdisciplinary approach in order to understand the underlying biological and ecopsychosocial associations that contribute to individual and dynamic differences in the experience of exclusion from social relations.

  • 343.
    Bursell, Elisabeth
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Elverson, Susanna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Faktorer som påverkar patienters upplevelse av omvårdnad under sin vistelse på akutmottagning.: - En litteraturstudie2016Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: To an emergency department people arrives with various states and needs. It

    is the nurse who often do the initial assessments and therefore it is of great importance that the

    response from the nurse is positive, to provide a feeling of security for the patient. Increased

    patient flow and long waits are a few factors that are proven to influence patients´ experience

    of their stay at the emergency department.

    Purpose: The purpose of the literature review is to describe factors that influence patients’

    experience of care at the emergency department.

    Methods: The study was conducted as a literature review. CINAHL and PubMed databases

    were used to search for articles.

    Results: The analysis led to six subcategories: the encounter, participation, information,

    waiting time, communication and continuity, the Registered Nurse knowledge and skills.

    The results showed that many patients felt that the nurse was skilled with the nursing

    assignments and were happy with the response from the nurse, but the long waiting time and

    lack of information affected the experience of the nursing care at the emergency department.

    There was a clear desire from the patients to receive more information about their wait time,

    treatment and examination. Shortcomings of this, created insecurity and a feeling of being

    forgotten for the patients.

    Conclusion: Nurses at an emergency department need to possess great communication

    skills. To be able to give patients the best experience as possible at the emergency department.

    Conclusions of the results have shown the need for improvement in several areas, to increase

    a better experience for the patients during their stay at the emergency department.

  • 344.
    Busk, Ulrica
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Edvall, Anne
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Omvårdnadsåtgärder som kan lindra smärta i palliativ vård: En litteraturöversikt2018Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background:

    Pain was seen as only a physical problem but in the 1950’s pain began to be seen as a multidimensional problem. For patients in palliative care multidimensional pain is common. The key elements of palliative care should be a focus on: symptom relief, teamwork, continuity and communication as well as support for relatives.

    Aim:

    The aim is to compile research about which nursing measures can relieve pain in palliative care.

    Method:

    The study was conducted as a literature review and was based on 13 articles where quantitative and qualitative methods where reported.

    Result:

    The result is a number of complementary nursing measures that can alleviate pain in patients in palliative care. Knowledge of the pain's dimensions and pain assessment is a prerequisite for achieving optimal pain relief. Teamwork, psychosocial support and good communication between the patient and the careteam are important in palliative care.

    Conclusion:

    Patients should receive basic pharmacological pain relief together with complementary non-pharmacological pain management care measures.

    More research and knowledge about these nursing interventions and how these can be implemented in palliative care are needed. Greater knowledge about both the dimensions of pain and about pain scales is needed so that optimal pain assessment can be achieved.

  • 345.
    Busk, Victoria
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Sigfrids, Linda
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Sjuksköterskans erfarenheter av vård i livet slut på somatisk vårdavdelning – En litteraturöversikt2019Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Palliative care and end-of-life care aims to prevent and relief suffering. Today people live longer which shows an increased care of dying patients. It can be expressed as challenging to care for a dying patient since this form of care still can be foreign to many nurses. Aim: The purpose of this literature review was to compile research-based knowledge of things that can affect the nurse's experiences of care in the end of life for the patient in a somatic hospital setting. Method: The study was conducted as a literature review which was based on twelve qualitative and three quantitative studies. The results were based on scientific articles that were found in databases such as PubMed and Cinahl.  Results: The main result that was identified in the study was competence, challenges and resources of care. Nurses had a lack of knowledge when caring for dying patients in a somatic hospital setting. The competence was inadequate and it appeared that there was a need of more education and the basic nursing education needs to be further developed in end of life care. Nurses who received education in end of life care were more safe caring for dying patients. Communication, for example building trust and the nurse’s ability to express themselves, were important factors. Nurses thought it was challenging to earn trust from the patient's relatives. Conclusion: The results have shown that the nurse's knowledge is important and the need for education and training has been clearly prominent. Today there is a lack of nurses and there is a need for more nurses with the right knowledge. Education and practical experience can help the nurses feeling safer in the role of caring for dying patients and communicating with them and their relatives.  

  • 346.
    Butkute Steponavicius, Lina
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Hur sjuksköterskan kan motivera vuxna patienter med Diabetes Mellitus typ II att ändra sin livsstil genom kost- och motionsvanor: En litteraturöversikt2014Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Typ II diabetes är en sjukdom som kan påverkas av vissa livsstilsfaktorer, till

    exempel rökning, fysisk inaktivitet, fel kost, övervikt, stort alkoholintag och högt blodtryck.

    Behandling för Diabetes Mellitus typ II börjar med förändring av sin livsstil, det vill säga

    icke-farmakologiskt behandling genom att framförallt förändra sina kost- och motionsvanor.

    Att motivera patienter med Diabetes Mellitus typ II till att förändra sin livsstil, är en viktig

    uppgift för sjuksköterskan.

    Syfte: Syftet med denna studie var att beskriva hur sjuksköterskan kan motivera vuxna

    patienter med Diabetes typ II att ändra sin livsstil genom kost- och motionsvanor.

    Metod: Studie genomfördes som litteraturöversikt med sexton vetenskapliga artiklar, där sju

    av artiklarna hade kvalitativ ansats och nio hade en kvantitativ ansats. Datainsamlingen

    skedde via databaserna CINAHL, PubMed och Science Direct med samma sökord.

    Huvudresultat: De olika studierna i resultatet visar att sjuksköterskan spelar en viktig roll

    vad gäller att motivera patienter med Diabetes Mellitus typ II att förändra sin livsstil genom

    kost- och motionsvanor. Avgörande faktorer för att motivera patienter att göra

    livsstilsförändringar var sjuksköterskans bemötande av patienter, att understödja patienter och under denna förändringsprocess skapa en god relation mellan patient och sjuksköterska. Ytterliggare viktiga faktorer var att sjuksköterska hade kunskap inom området och en förmåga att undervisa, ge råd individuellt och i grupp.

  • 347.
    Bygg, Erika
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Morelius, Ellinor
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    KOL-patienters nutrition och sjuksköterskans omvårdnadsåtgärder: en litteraturöversikt2019Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Malnutrition is common in patients with chronic obstructive pulmonary disease (COPD). Malnutrition in patients with COPD can cause impaired immune system, increased dyspnoea, decreased quality of life, and the COPD risk being increased in severity as well as having a faster disease course. In 2030, COPD is estimated to be the third most common disease in the world. Therefore, it is important as a nurse to have knowledge of which nurse care can be used in malnutrition in COPD patients.

    Aim: The aim of this literature review was to compile COPD patients' perceived problems with nutrition and what nurse care the nurse can take in malnutrition.

    Method: A literature review based on 15 scientific articles.

    Results: There were problems that occur for COPD patients that were caused according to their nutrition. These conditions could be both physical and psychological. The nurse could seek advice from a dietician to be informed of the best solution regarding nutritional needs of the patient. As a nurse it was important to pass on knowledge and give support to the patient whilst also advising on selfcare according to the patient's current condition and preferences.

    Conclusion: The variety of nutritional problems COPD patients face were highly individual and are therefore a complex subject as the effects are both physical and psychological. In general, the nurse should work closely with the patient as there can be nutrition related problems and in doing so, ensures appropriate and safe care.

  • 348.
    Bylund, Frida
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Fjällborg, Anna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Patienters erfarenheter av att leva med långvarig ryggsmärta. En litteraturöversikt.2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background

    : Chronic back pain is one of the most common health problems and one of the most common causes of contact with primary care.

    Chronic back pain causes great socio-economic costs, but also costs in terms of

    human suffering. Chronic back pain cannot always be explained by pathophysiology and clinical findings, which often leads to missing diagnoses,

    impaired conditions for treatment and management strategies. The nurse in her

    health promotion has the task of relieving suffering, to enable this, suffering needs to be met, affirmed and understood as a whole. This literature review aimd to creating a deeper understanding of the whole by capturing individual experiences of living with chronic back pain.

    Aim:

    To compile knowledge about patient’s experiences of living with chronic back pain.

    Method:

    A literature review.

    Results:

    Five main categories emerged from the result; physical influence, psychological influence, social aspects, religious and cultural aspects, as well as experiences regarding the treatment of health care. Physical influences constituted barriers to everyday activities and life was forced to be shaped and adapted to the pain. The adaptation could lead to changed self-image and the opportunities for social interaction were limited. Mental illness was the experience that was found to the greatest extent in the result, and mainly in the form of depression and anxiety. Family, workplace and religious conviction turned out to have a great influence on how the chances of managing the pain were affected. The feeling of not being trusted strengthened the mental illness and contributed to worsening opportunities to deal with the pain.

    Conclusion:

    Suffering should be met, confirmed and understood on the basis of its entirety. The result of this study could contribute to an increased understanding and provide a deeper insight into how affected patients experience their pain, situation and environment. The knowledge could benefit the nurse in the health-promoting work.

  • 349. Byqvist Nilsson, Christina
    et al.
    Gammel, Camilla
    Specialistsjuksköterskors upplevelser av vårdandet av patienter med samsjuklighet2014Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Purpose: The purpose of this study is to describe how specialist nurses in psychiatric nursing experience caring for patients suffering from both mental illness and substance abuse problems.

    Method: Empirical qualitative study using semi-structured interviews were analyzed using qualitative content analysis. Five specialist nurses participated in the study.

    Results: From the analysis of the interviews revealed two categories wanting well and feel powerless. Moreover, it resulted in five categories follow the patient, the will to act, feel powerlessness, to feel resistance and fail in its competence.

    Conclusion: The current findings point at a connecting thought. This means that the specialist nurses express good intentions, want to do well and act for the best possible care for the patient. Also, there is a hope for the patients recovering. Due to insufficient skills, the nurses sometimes feel resistance to treat patients suffering from comorbidity. This creates a sense of powerlessness. The study has shown that supplementary training and further education will increase the

    possibilities for the specialist nurses to provide every patient with appropriate care. Also, it is important to note that the specialist nurses wish to give the patients this care.

  • 350.
    Byrskog, Ulrika
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Institutionen för kvinnors och barns hälsa, Uppsala Universitet. Centrum för klinisk forskning, Dalarna.
    'Moving On' and Transitional Bridges: Studies on migration, violence and wellbeing in encounters with Somali-born women and the maternity health care in Sweden2015Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    During the latest decade Somali-born women with experiences of long-lasting war followed by migration have increasingly encountered Swedish maternity care, where antenatal care midwives are assigned to ask questions about exposure to violence. The overall aim in this thesis was to gain deeper understanding of Somali-born women’s wellbeing and needs during the parallel transitions of migration to Sweden and childbearing, focusing on maternity healthcare encounters and violence. Data were obtained from medical records (paper I), qualitative interviews with Somali-born women (II, III) and Swedish antenatal care midwives (IV). Descriptive statistics and thematic analysis were used. Compared to pregnancies of Swedish-born women, Somali-born women’s pregnancies demonstrated later booking and less visits to antenatal care, more maternal morbidity but less psychiatric treatment, less medical pain relief during delivery and more emergency caesarean sections and small-for-gestational-age infants (I). Political violence with broken societal structures before migration contributed to up-rootedness, limited healthcare and absent state-based support to women subjected to violence, which reinforced reliance on social networks, own endurance and faith in Somalia (II). After migration, sources of wellbeing were a pragmatic “moving-on” approach including faith and motherhood, combined with social coherence. Lawful rights for women were appreciated but could concurrently risk creating power tensions in partner relationships. Generally, the Somali-born women associated the midwife more with providing medical care than with overall wellbeing or concerns about violence, but new societal resources were parallel incorporated with known resources (III). Midwives strived for woman-centered approaches beyond ethnicity and culture in care encounters, with language, social gaps and divergent views on violence as potential barriers in violence inquiry. Somali-born women’s strength and contentment were highlighted, and ongoing violence seldom encountered according to the midwives experiences (IV). Pragmatism including “moving on” combined with support from family and social networks, indicate capability to cope with violence and migration-related stress. However, this must be balanced against potential unspoken needs at individual level in care encounters.With trustful relationships, optimized interaction and networking with local Somali communities and across professions, the antenatal midwife can have a “bridging-function” in balancing between dual societies and contribute to healthy transitions in the new society.

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