Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2016-02-01T16:20:50Z No. of bitstreams: 1 Rosane Brinques Lourenci.pdf: 1237369 bytes, checksum: 29d6bb70a92fd7edd03baf4e712c7a9e (MD5) / Made available in DSpace on 2016-02-01T16:20:50Z (GMT). No. of bitstreams: 1 Rosane Brinques Lourenci.pdf: 1237369 bytes, checksum: 29d6bb70a92fd7edd03baf4e712c7a9e (MD5) Previous issue date: 2006 / Mestrado Profissional em Enfermagem Assistencial / Atualmente as doenças cardiovasculares representam um grave problema para saúde publica no Brasil e no mundo, esforços têm sido feitos no intuito de prevenir as intercorrências hospitalares, porém em alguns casos há necessidade da hospitalização em decorrência dessas doenças o que cria uma forte carga emocional para o paciente, que se sente carente de informações sobre a sua patologia e necessita sistematicamente da assistência dos profissionais, para o enfrentamento do desconhecido, principalmente em relação a sua imaginação acerca da gravidade do problema. O presente estudo surgiu da necessidade de buscar novos conhecimentos que venham nortear a prática dirigida para o cuidado aos pacientes coronários que se submeteram ao procedimento diagnóstico invasivo denominado Cateterismo Cardíaco - CAT. O objetivo deste estudo foi elaborar uma sistematização do cuidado ao paciente internado submetido ao cateterismo cardíaco identificando as necessidades do paciente discutindo a partir da literatura e dos modelos de sistematização. Utilizamos a abordagem qualitativa como técnica que permitiu a obtenção dos elementos que compõem a coleta dos dados, os sujeitos do estudo foram os pacientes submetidos ao cateterismo cardíaco internados em um hospital filantrópico do Município do Rio de Janeiro. A analise dos dados foi organizada em três etapas, sendo: Pré-análise (contato com o material a ser analisado), Exploração (transformação dos dados brutos) e Tratamento (a inferência e a interpretação dos resultados) seguindo a metodologia do discurso do sujeito coletivo de Lefèvre. A coleta dos dados teve início após a aprovação pelo Comitê de Ética em Pesquisa da Instituição do Hospital Universitário Antonio Pedro da Universidade Federal Fluminense - HUAP/UFF. Concluímos que os pacientes desconhecem a finalidade do exame e estes expressam seus sentimentos que oscilam entre a total falta de preocupação com o exame pela insuficiência de informação e a excessiva tensão e ansiedade pelo medo dos riscos advindos deste procedimento principalmente com a possibilidade da morte e a afastamento dos familiares. Portanto caberá aos profissionais uma aproximação mais humana ao paciente considerando a pessoa em equilíbrio harmônico com o conhecimento tecnológico e ofertando informações em linguagem acessível o que possibilitou neste estudo a criação de uma cartilha de orientação como produto da sistematização do cuidar / Nowadays, cardiac diseases represent a critical problem for public health in Brazil and around the world. Efforts are made to prevent hospital intercurrences, however, in some cases, there is a need of hospitalization due to these diseases, what crates a strong emotional effect to the patient that feels uninformed about his/her pathology and needs systemic professional care to face the unknown, mainly concerning his/her imagination towards the severity of the problem. The present study emerged due to the necessity of new knowledge to the practice given to cardiac patients submitted to the invasive diagnostic procedure called Cardiac Catheterization – CAT. The purpose of this study is to create a systematization of the nursing care to an admitted to hospital patient submitted to cardiac catheterization, identifying the patients‟ needs and discussing from systematization literature and models. We used qualitative approach as technique that made possible to obtain the elements of data collect; the subjects of the study were the patients submitted to cardiac catheterization admitted to a philanthropic hospital in Rio de Janeiro. The data analysis was organized in three steps: Pre-analysis (contact with the material to be analyzed), Exploration (transformation of data in the rough) and Treatment (inference and interpretation of results) following the methodology of the collective subject discourse from Lefèvre. The data collect started after the approval of the Research Ethics Committee at the Antonio Pedro University Hospital of the Fluminense Federal University. APUH/FFU. We conclude that the patients do not know the purpose of the exam and so they express their feelings that go from total relief of concern due to lack of information to excessive anxiety by the fear of the risks derived from this procedure, mainly with the possibility of death or keeping relatives apart. So, it is the professionals‟ duty to have a more humanized approach to the patient, making possible a harmonic balance between technological knowledge and information with an accessible language use, what generated the creation of a guideline as a product the care systematization

Orientadores: Roberta Cunha Rodrigues Colombo, Maria Cecilia Jayme Bueno Gallani / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-04T16:08:54Z (GMT). No. of bitstreams: 1 Pinto_CristianoJoseMendes_M.pdf: 11508571 bytes, checksum: 3c11ab6f502e13fad691910fcd7f1e96 (MD5) Previous issue date: 2004 / Resumo: Este estudo teve como objetivo identificar, a partir da Teoria do Comportamento Planejado (TPB), os fatores que contribuem para a formação da intenção comportamental do enfermeiro para realizar o estudo hemodinâmico por meio do cateter de artéria pulmonar (CAP). Os dados foram obtidos por meio de entrevista semi-estruturada junto a 23 enfermeiros de Unidades de Terapia Intensiva de dois hospitais públicos e um privado do município de Campinas-SP. A natureza exploratória deste estudo com o emprego de questões abertas permitiu uma análise de caráter qualitativo dos dados coletados, que foram apresentados de acordo com as Unidades Temáticas Centrais: Crenças de Atitude, Normativas, de Controle e Gerais. A análise das entrevistas evidenciou que entre as Crenças de Atitude destacam-se as crenças afetivas negativas e positivas em relação ao comportamento e aquelas relativas às vantagens e desvantagens da realização do estudo hemodinâmico. Na unidade Crenças Normativas, foram evidenciados os referentes sociais positivos para a execução do comportamento: médico, enfermeiro, paciente, bem como os fatores estimuladores do comportamento: "responsabilidade do enfermeiro no cuidado do paciente" e "interesse na recuperação do paciente"; como referentes negativos: equipe médica e serviços de educação continuada, e, como fatores que desestimulam: "déficit de conhecimento", "dificuldades para execução do procedimento" e "pequena utilização dos dados do estudo hemodinâmico pela equipe médica". Dentre as Crenças de Controle, destacaram-se os fatores facilitadores e/ou dificultadores: material, equipamento, número de profissionais, conhecimento, tempo, sobrecarga de atividades, equipe de enfermagem e médica. Os dados obtidos subsidiarão a construção de uma escala psicométrica para a compreensão e predição do comportamento em estudo / Abstract: The purpose of this study was to identify, by means of the Theory of Planned Behavior (TPB), the elements leading to the development of nurses' behavioral intention when performing a hemodynamic study in patients through pulmonary artery catheter (PAC). Data were obtained by using semi-structured interviews made with 23 Intensive Care Unit nurses from two public and one private hospitais in the city of Campinas, São Paulo state, Brazil. The exploratory nature of this study allowed a qualitative sort of analysis of the data collected, which were then presented according to the following Central Theme-based Units: Attitude, Normative, Control and General Beliefs. The analysis of the interviews highlighted that, conceming the Attitude Beliefs, there are positive and negative aftective beliefs regarded to both behavior and to the advantages and disadvantages in carrying out the hemodynamic study. As to the Normative Beliefs Unit it is possible to emphasize some positive social references present in the behavioral response such as the physicians, nurses and patients, as well as some elements proved to stimulate behavior: nurses' responsibility towards the patients' care and interest in the patients' recovery; among the negative references are: the medical staft and continuing education services; regarding the non-stimulating elements we can mention: knowledge deficit, difficulties in carrying out the procedures and low use of the hemodynamic study data by the medical staft. The Control Beliefs displayed some elements which can either facilitate and I or make the behavior difticult: material, equipment, number of professional people, knowledge, time, tasks overload, nurse and medical staft. The data obtained will enable the creation of a psychometric scale which will be used to understand and predict the behavior presently studied. / Mestrado / Enfermagem e Trabalho / Mestre em Enfermagem

Orientadores: Carlos Arturo Levi D'Ancona, Cássio Luíz Zanettini Riccetto / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-26T23:13:06Z (GMT). No. of bitstreams: 1 Kos_RodolfoSilva_M.pdf: 2065885 bytes, checksum: 76b4bdc123fa42204d321a899cd184f6 (MD5) Previous issue date: 2015 / Resumo: Mielomeningocele (MMC) é a principal causa de bexiga neurogênica na infância, descrita por disfunção na inervação vésico-esfincteriana e da musculatura perineal, interferindo no funcionamento correto do trato urinário inferior e alterando o processo de micção normal. O tratamento urológico conservador é orientado com base nos resultados de todos os exames relacionados à função vesical e deve-se levar em consideração os sintomas apresentados pelo paciente. A disfunção vesical sem o adequado tratamento pode inibir o indivíduo socialmente e contribuir para influências negativas sobre a qualidade de vida de seus portadores, definida por sensação subjetiva de felicidade e satisfação pessoal do indivíduo. Pela imaturidade da criança com MMC as responsabilidades relacionadas ao tratamento urológico são atribuídas ao cuidador, sendo possível observar aumento da sobrecarga global neste. O objetivo deste trabalho foi avaliar a influência do tratamento urológico conservador na qualidade de vida de crianças com MMC e na sobrecarga de seus cuidadores. Foram estudadas 24 crianças com MMC, divididos em grupos de acordo o tratamento urológico em que a criança estava atualmente de cateterismo intermitente limpo ou uso contínuo de fraldas. Os procedimentos da avaliação contaram com ficha para caracterização da amostra, Teste do Absorvente, Diário Miccional, além dos questionários Burden Interview feito com o cuidador, e AUQUEI e Qualiveen, feitos com a criança. Os resultados obtidos demonstraram que não houve diferença significativa com relação à qualidade de vida da criança quando comparadas entre os grupos de tratamentos urológicos diferentes, entretanto, os cuidadores do grupo que realizava o cateterismo intermitente limpo apresentaram maior sobrecarga global, sendo afetados pelo tratamento urológico com mais ênfase que as próprias crianças / Abstract: Myelomeningocele (MMC) is the leading cause of neurogenic bladder in children, described by dysfunction in vesical-sphincter innervation and the perineal muscles, interfering in the proper function of the lower urinary tract and altering the normal urination process. The conservative urological treatment is targeted based on the results of all tests related to bladder function and should take into account the symptoms presented by the patient. A bladder dysfunction without proper treatment can inhibit the individual socially and contribute to adverse effects on the quality of life of their patients, defined by subjective feeling of happiness and satisfaction of the individual. Because of the immaturity of the children with MMC, the responsibilities related to urological treatment are assigned to the caregiver and are recording increasing global burden on them. The objective of this study was to evaluate the influence of conservative urological treatment on quality of life of children with MMC and overload on their caregivers. 24 children with MMC were studied, divided into groups according to the current urological treatment of clean intermittent catheterization or continuous use of diapers. The evaluation procedures relied on file for sample characterization, Pad Test, Voiding Diary, and the questionnaires Burden Interview done with the caregiver, and AUQUEI and Qualiveen, made with the child. The results showed no significant difference with regard to the quality of a child's life when compared between different urological treatment groups, however, the group of caregivers who performed clean intermittent catheterization showed higher overall burden, being affected by the distinct urological treatment with more emphasis that children themselves / Mestrado / Fisiopatologia Cirúrgica / Mestre em Ciências

Orientador: Marla Andréia Garcia de Avila / Resumo: Trata-se do levantamento de vídeos sobre o cateterismo intermitente limpo no YouTube e avaliação dos acessos de conteúdos voltados do website Cateterismo Digital nas redes sociais. Estudo metodológico dividido em duas etapas com abordagem quantitativa e descritiva para avaliar os conteúdos existentes no YouTube que abordam o cateterismo intermitente limpo e na segunda etapa avaliar os acessos de tecnologias educativas disponibilizadas em redes sociais acerca da temática. Na primeira etapa a amostra constituiu-se por 07 vídeos que descreviam a técnica do cateterismo intermitente limpo com disponibilização gratuita no YouTube. O material foi avaliado por enfermeiros baseado nas recomendações da Sociedade Brasileira de Urologia. A segunda etapa constituiu-se pela avaliação dos acessos das redes sociais Cateterismo Digital, sendo o YouTube a rede social com maior média de visitas ao perfil e impressão de conteúdos. De acordo a avaliação dos acessos das redes sociais Cateterismo Digital pode concluir que os perfis responderam positivamente às expectativas de divulgação dos conteúdos do website aos usuários. Nesse contexto, é importante considerar o potencial que as redes sociais desenvolvidas por profissionais de saúde apresentam como ferramentas tecnológicas educativas, podem ser utilizadas tanto pelos usuários quanto por demais profissionais para nortear a busca por informações seguras online colaborando com a promoção da saúde. / Abstract: This involves surveying videos about clean intermittent catheterization on YouTube and evaluating access to content on the Cateterismo Digital website on social networks. Methodological study divided into two stages with a quantitative and descriptive approach to evaluate the existing content on YouTube that address clean intermittent catheterization and in the second stage to assess the access of educational technologies available on social networks on the subject. In the first stage, the sample consisted of 07 videos that described the technique of clean intermittent catheterization with free availability on YouTube. The material was evaluated by nurses based on the recommendations of the Brazilian Society of Urology. The second stage consisted of assessing the accesses of the social networks Cateterismo Digital, with YouTube being the social network with the highest average number of visits to the profile and content printing. According to the evaluation of the accesses of the social networks Cateterismo Digital can conclude that the profiles responded positively to the expectations of disclosing the contents of the website to users. In this context, it is important to consider the potential that social networks developed by health professionals present as educational technological tools, which can be used by both users and other professionals to guide the search for safe information online, collaborating with health promotion. / Mestre

Die vorliegende Arbeit beschäftigt sich mit der altersabhängigen Inzidenz und den Risikofaktoren für das Auftreten von lokalen Gefäßkomplikationen nach Herzkathetern über den femoralen Zugang. Diese sind die häufigsten Komplikationen nach Herzkatheteruntersuchungen überhaupt. Besonders berücksichtigt wurden multimorbide und sehr alte Patienten. Durch den demographischen Wandel und eine stetig wachsende Zahl an durchgeführten Herzkatheterprozeduren wird das Aufkommen solcher Patienten in der Zukunft weiter ansteigen. Der Zugang über die Leistengefäße stellt vielerorts noch immer den meistgenutzten dar. Frühere Studien konnten bereits diverse Risikofaktoren für das Auftreten von lokalen Gefäßkomplikationen nach Herzkathetern ermitteln, unter anderem hohes Alter und typische Alterskrankheiten. In den untersuchten teils sehr kleinen Kohorten wurden oft außerordentlich hohe Komplikationsraten ermittelt. Um zu verhindern, dass alten Patienten aus Sorge um mögliche Komplikationen potentiell lebensrettende invasive Maßnahmen vorenthalten werden, ist eine stetige Risikoevaluation notwendig. In dieser Studie wurden 42.628 Prozeduren bei Patienten, die am Herzzentrum Leipzig zwischen 2005 und 2009 einen diagnostischen Herzkatheter oder eine perkutane Koronarintervention (PCI) erhielten, ausgewertet. Ziel der Arbeit war es, die altersabhängigen Komplikationsraten sowie Prädiktoren für das Auftreten von Komplikationen zu ermitteln. Dazu wurden für drei Altersgruppen (Patienten unter 65, zwischen 65 und 79 sowie über 80 Jahre) jeweils prozedurale und klinische Parameter analysiert. Es wurde ein moderater Anstieg der Komplikationsraten festgestellt. Dies zeigt, dass Herzkatheter über einen Leistenzugang bis ins hohe Alter ein sicheres Verfahren sind. Die ermittelten Prädiktoren können einer klinischen Risikostratifizierung dienen.

Bakgrund: Invasiv monitorering och behandling inom intensivvården ökar risken för VRI, vilket hotar patientsäkerheten. CVK-relaterad blodburen infektion utgör 20 % av infektionerna inom intensivvården och leder till ökad mortalitet. Dock anses dessa infektioner i hög grad vara undvikbara. Sjuksköterskor inom intensivvården hanterar CVK dagligen och ansvarar för att detta görs på ett patientsäkert sätt, om patientsäkerheten brister kan det leda till vårdlidande för patienten. En viktig del av patientsäkerhetsarbetet är att sammanställa kunskap om vilka åtgärder sjuksköterskor kan genomföra för att minska antalet CVK-relaterade blodburna infektioner.  Syfte: Beskriva de åtgärder som sjuksköterskor kan genomföra vid hantering av CVK för att minska frekvensen av CVK-relaterade blodburna infektioner hos vuxna patienter inom intensivvården.  Metod: Litteraturstudie med systematisk ansats av observations- och interventionsstudier. Artikelsökning genomfördes i PubMed och CINAHL. Kvalitetsgranskning genomfördes med mall från Willman, Stoltz och Bahtsevani (2011). Resultatet utformades genom narrativ syntes och presenteras i löpande text samt sammanfattande tabeller. Resultat: Baserat på 20 kvantitativa studier med fokus på vuxna patienter med CVK som vårdas på IVA beskrivs de sex kategorierna: förband, hudtvätt, hängtid, proppar och ventiler, utbildning samt åtgärdspaket. Inom alla dessa kategorier fanns studier som visade på åtgärder som ledde till minskning av CVK-relaterad blodburen infektion.  Slutsats: Denna studie tydliggör att sjuksköterskan vid CVK-hantering har möjlighet att arbeta infektionsförebyggande. Genom att använda desinfektionsproppar och injektionsventiler med desinfektionsbara membran, hudtvätt med klorhexidin, utbildning och åtgärdspaket kan sjuksköterskan således minska risken för patienters vårdlidande. Denna studie föreslår forskning av hur implementering ska ske för att öka följsamheten kring åtgärder för förebyggande av CVK-relaterad blodburen infektion. / Background: Invasive monitoring and treatment in intensive care increases the risk of healthcare associated infections, which is a threat for patient safety. Central line-associated bloodstream infection [CLABSI] accounts for 20 % of all infections in intensive care and leads to increased mortality. However, CLABSI is largely considered avoidable. Nurses in the ICU handle these devices on a daily basis and are responsible for ensuring that this is performed in a manner that complies with patient safety; lack of patient safety can cause suffering for the patient. An important part of improving patient safety is to compile knowledge about what measures nurses can implement to reduce the number of CLABSI. Aim: To describe the measures that nurses can implement when managing the central line to reduce the frequency of CLABSI in adult patients in intensive care. Method: Quantitative literature study with a systematic approach of observational and interventional studies. Search was performed in PubMed and CINAHL. Quality review was conducted using templates from Willman, Stoltz and Bahtsevani (2011). The results were developed through narrative synthesis and presented in text and summary tables. Results: Based on 20 quantitative studies focusing on adult patients with central lines cared for at the ICU, the six described categories are: dressings, bathing, hang time, port protectors and connectors, education and bundles. In all these categories, there were studies that showed measures that led to a reduction in CLABSI. Conclusion: This study clarifies that the nurse in central line-management has the opportunity to prevent infection. By using port protectors and connectors with disinfectable membranes, bathing with chlorhexidine, education and bundles, the nurse can therefore reduce the risk of patients suffering from care. This study proposes research on how implementation should take place to increase compliance with measures for the prevention of CLABSI.

Each year hundreds of thousands of women in Europe need to catheterize themselves instead of urinating the usual way, because of diseases or injuries. However, self-catheterization is hard for a lot of women due to the location of the urethra, and they need some type of aid to help them. The design company MMID in the Netherlands developed a concept with a mirror and a light, which is attached to a toilet seat. Though, it was noticed that it was too hard to handle for the users, hence the authors were asked to improve the user friendliness with the product. Since the intuition aspect was the largest problem they decided to focus on intuition. MMID’s original prototypes were tested by patients and continence nurses to get relevant information that only real users can give, and by mixed women without troubles, to get an insight in the intuition aspect. The nurses and the patients tested the prototypes and were observed, whereupon they took part in a semi-structured interview and a questionnaire, respectively. During the intuition tests the women’s interactions with the prototypes were filmed, and they answered a short questionnaire. The films were then analyzed. The tests showed that the product was very hard to understand and that it gave a feeling of being unstable. This gave the project the focus to make the product easy to open up, without having to assemble it before each use. All important aspects were gathered and several ideation sessions were performed. The results were put together into three concepts and 3D printed prototypes. These models were tested by women interacting with them to see their intuitive actions, which were also filmed. The women also participated in semi-structured interviews. Based on these results a concept choice was made where the simplest solution with one pivoting point was chosen. The concept was further developed and functional prototypes and non-functional prototypes were made. The non-functional models were tested for only intuition among random women, the same way as before. The functional models were tested by patients and nurses at four hospitals in the Netherlands, also these tests were similar to the ones in the first round. The overall results were positive and the product had been significantly improved; a lot thanks to the fact that it did not need to be assembled before it could be used. The biggest negative aspect was that a signifier for opening the product was missing. / Varje år behöver hundratusentals kvinnor i Europa katetrisera sig själva istället för att urinera som vanligt, på grund av sjukdomar eller skador. Självkatetrisering är dock krångligt för många kvinnor på grund av placeringen av urinrörets öppning. Designföretaget MMID i Nederländerna tog fram ett koncept med en spegel och en lampa som fästs på toalettsitsen för att hjälpa dessa kvinnor. Det upptäcktes dock att detta koncept var svårförstått och således ombads författarna att förbättra användarvänligheten hos produkten. Då intuitionsaspekten hos produkten var det största problemet bestämde de sig för att fokusera på intuitionen. MMIDs ursprungliga prototyper testades av patienter och urologisköterskor för att få relevant information som bara riktiga användare kan ge, samt av blandade kvinnor utan åkommor för att få inblick i intuitionsaspekten. Sköterskorna och patienterna testade prototyperna och observerades, varpå de deltog i semistrukturerade intervjuer respektive fyllde i ett frågeformulär. Under intuitionstesterna filmades kvinnornas interaktion med prototyperna, varpå de svarade på ett kort frågeformulär. Filmerna analyserades sedan. Testerna visade bland annat att produkten var väldigt svårförstådd samt gav en känsla av att vara ostadig. Detta gav projektet fokuset att skapa en produkt som kan öppnas upp på ett enkelt sätt utan att behöva monteras ihop innan varje användning. Alla viktiga aspekter sammanställdes och flertalet idégenereringar genomfördes. Resultaten från dessa sattes ihop till tre koncept, vilka överfördes till 3D-printade modeller. Modellerna testades genom att kvinnor fick interagera med dem varpå deras intuitiva handlingar observerades. Detta spelades in på video och kvinnorna ombads även att svara på frågor i en kort semistrukturerad intervju. Baserat på dessa resultat gjordes ett konceptval där den enklaste lösningen, med en rotationspunkt, valdes. Efter detta utvecklades konceptet vidare och funktionella samt icke-funktionella prototyper tillverkades. Dessa prototyper testades i en tredje testomgång, där de icke-funktionella prototyperna testades för enbart intuition av godtyckliga kvinnor, på samma sätt som tidigare. De funktionella prototyperna testades av patienter och sköterskor på fyra sjukhus i Nederländerna, likt första testomgången. De övergripande resultaten var positiva och produkten var signifikant förbättrad, mycket tack vare att den inte behövde sättas ihop innan den kunde användas. Den största negativa aspekten var att det saknades en indikator som underlättade öppnandet av produkten.

SAMMANFATTNING  Bakgrund  Kateterisering av urinblåsan är en vanligt förekommande behandlingsåtgärd inom hälso- och sjukvården som kan vara indicerad vid exempelvis urinretention och residualurin efter miktion. Kateterisering kan orsaka komplikationer, såsom urinvägsinfektioner och urinläckage, vilket kan medföra lidande. Sjuksköterskan har som uppgift att lindra lidande genom bland annat personcentrerad och säker vård. Att förstå hur kateterisering kan påverka den individ som är i behov av den är därför viktigt för sjuksköterskans yrkesutövande.  Syfte  Syftet var att beskriva patienters upplevelser relaterade till kateterisering och att leva med urinkateter.  Metod  En icke systematisk litteraturöversikt genomfördes och baserades på 16 vetenskapliga artiklar av kvalitativ och kvantitativ design. Inkluderade artiklar söktes fram i databaserna PubMed och CINAHL med hjälp av lämpliga sökord. Med Sophiahemmet högskolas bedömningsunderlag kvalitetsgranskades inkluderade artiklar och sedan analyserades innehållet för att sammanställas i tre övergripande kategorier; ‘En vardag med urinkateter’, ‘livskvalitet’ och ‘patientens relation till hälso- och sjukvården’.  Resultat  De övergripande kategorierna är indelade i sju underkategorier där patienters upplevelser relaterat till kateterisering av urinvägarna beskrivs. Komplikationer som urinvägsinfektion, urinläckage och trycksår; bristande bemötande och förhållningssätt hos sjuksköterskan; svårigheter i vardagen; informationsbrist samt påverkan på sexuell aktivitet är aspekter som kan påverka upplevelsen enligt patienter.  Slutsats  Föreliggande litteraturöversikt beskriver hur olika faktorer påverkar upplevelsen av kateterisering och att leva med urinkateter samt vad de olika metoderna för kateterisering har för betydelse i upplevelsen. Faktorer såsom komplikationer med smärta, urinläckage och urinvägsinfektioner; förändrad självbild och påverkad sexuell aktivitet; bristande information och bemötande från vårdgivare samt skattad livskvalitet hade betydelse för patientens upplevelse och eventuella lidande. Utifrån dessa upplevelser kan hälso- och sjukvård identifiera bristfälligt handhavande med personer och medicintekniska vårdmoment samt initiera förbättringsarbete i syfte att stärka patienters upplevda livskvalitet relaterat till urinkateterisering. / ABSTRACT  Background  Urinary catheterization is a common treatment in health care and there are several reasons why catheter is indicated. It is often due to urinary retention and residual urine volume after urination. Urinary catheterization can cause complications, such as urinary tract infections and leakage, which can cause suffering. The nurse's task is to relieve suffering through, among other things, person-centered and safe care. Understanding how catheterization can affect the individuals who are in need of it, and it is therefore important for the nurses’ professional practice.  Aim  The aim of this study was to describe patients experiences related to urinary catheterization and living with urinary catheter.  Method  A non-systematic literature review was conducted and based on 16 scientific articles, with both qualitative and quantitative design. Included articles were searched in the databases PubMed and CINAHL using appropriate keywords. With the Sophiahemmet university's quality framework the articles were quality examined and then the content was analyzed to be grouped into three general categories; 'A daily life with a urinary catheter', 'quality of life' and 'the patient's relationship to health care'.  Results  The general categories are divided into seven subcategories where patients' experiences related to catheterization of the urinary tract are described. Complications such as urinary tract infection, urinary leakage and pressure ulcers; the deficient conduct and approach of nurses; difficulties in everyday life; Lack of information and influence on sexual activity are aspects that can affect the experience according to patients.  Conclusions  This literature review describes how various factors affect the experience of catheterization and living with urinary catheters, and what the different methods of catheterization have for the impact on the experience. Factors such as complications with pain, urinary leakage and urinary tract infections; altered self-image and affected sexual activity; lack of information and response from caregivers as well as estimated quality of life had significance for the patient’s experience and possible suffering. With these experiences, health care can identify inadequate handling with persons and medical devices, and initiate improvement work with the aim of strengthening the patients’ perceived quality of life related to urinary catheterization.

För att kunna ge vård av säker och god kvalitet krävs att sjuksköterskor har kunskap inom många områden, eftersom de har ansvar för såväl bedömning, planering och genomförande, som utvärdering och dokumentation av omvårdnadsarbetet. Ett av flera ansvarsområden för sjuksköterskor i deras dagliga arbete är beslutsfattande om insättning och skötsel av perifera venkatetrar (PVK). En PVK är en tunn plastkateter som sätts in i ett blodkärl via en kanyl. PVK används vid intravenös behandling med till exempel antibiotika och andra läkemedel, blodkomponenter eller näringslösningar. En stor andel av alla patienter inom hälsooch sjukvård kommer någon gång i kontakt med en PVK och riskerar då också att utsättas för komplikationer. En vanlig komplikation i samband med PVK är tromboflebit. Tromboflebit förekommer i olika svårighetsgrader och innebär att inflammation har uppstått i blodkärlet i kombination med samtidig blodpropp. Symtom som kan uppstå är rodnad, svullnad, smärta, hårdhet i kärlet och varig infektion. Det finns kliniska riktlinjer om PVK framtagna både på nationell och på lokal nivå som fungerar som ett stöd i beslutsfattandet. Tidigare forskning har visat att kliniskt verksamma ibland inte följer riktlinjer. Anledningar till att inte riktlinjer följs kan till exempel vara att de kliniskt verksamma inte håller med om det som rekommenderas, inte känner till rekommendationerna, inte har tid eller möjlighet att påverka de beslut som fattas eller att det finns individuella faktorer att ta hänsyn till för den enskilda patienten. 52 Frågan kan ställas om sjuksköterskor använder sig av kliniska riktlinjer i sitt dagliga arbete eller om det är andra faktorer och aspekter som har betydelse och påverkar beslutsfattandet. Denna licentiatavhandling syftade till att beskriva sjuksköterskors kliniska beslutsfattande genom att fokusera på deras följsamhet till riktlinjer och beslutsresonemang om PVK. Två studier har genomförts inom ramen för denna licentiatavhandling. Studie I undersökte i vilken utsträckning sjuksköterskor följer nationella och lokala riktlinjer om PVK. PVKns placering och storlek, tiden som PVKn varit placerad i blodkärlet, dokumentation vid PVKns förband samt om det fanns tecken på tromboflebit vid PVKn var variabler som undersöktes i relation till de rekommendationer som fanns. Utifrån två protokoll samlades strukturerad data in och analyserades. Totalt 343 PVK ingick i analysen. I studie II undersöktes de tecken och påverkande faktorer som har betydelse när sjuksköterskor fattar beslut om skötsel av PVK. I studien observerades 43 sjuksköterskor i sitt dagliga arbete. Sjuksköterskorna intervjuades också dels om PVK-besluten som de fattade under observationerna, dels om deras beslutsfattande om PVK-skötsel i allmänhet. Studie I visade att sjuksköterskor delvis följer riktlinjer. Det fanns skillnader mellan de vårdavdelningar som hade nationella riktlinjer och de som hade lokala riktlinjer, i hur de olika avdelningarna valde placering, storlek och dokumenterade vid PVKns förband. PVKn hade suttit längre tid än rekommenderat i varierande utsträckning. Andelen tromboflebiter var låg (7.0%) och tromboflebiterna var milda. Det tyder på att sjuksköterskor är noga med att ta bort PVK vid tecken på komplikationer. Studie II visade att sjuksköterskor i sitt kliniska resonemang om PVK-skötsel tar hänsyn till den individuella patientsituationen, sjuksköterskans arbetssituation och erfarenhet av PVK-skötsel. Det framkom även att sjuksköterskor balanserar mellan att undvika eller minimera obehag och smärta för patienten och samtidigt förebygga komplikationer från PVKn. Resultaten från denna licentiatavhandling kan få betydelse för undervisning av sjuksköterskestudenter och även när kliniska riktlinjer ska införas på vårdavdelningar. / Every working shift nurses make several decisions, including decisions about management of peripheral venous catheters (PVC). Peripheral catheterisation is a common procedure, which affects numerous patients in health care today. PVC are for example used for intravenous infusions with antibiotics, nutrients and blood components. Having PVC in situ may lead to complications such as thrombophlebitis. Clinical guidelines have been developed within the area to assist nurses in their decision-making, but clinical guidelines are not always adhered to. There are several reasons why clinicians do not always adhere to clinical guidelines, although such adherence may lead to fewer complications. Choices for decisions regarding PVC management have been investigated in previous studies, but not in a naturalistic setting. The overall aim of this licentiate thesis was to describe nurses’ clinical decision-making through focusing on their adherence to clinical guidelines and their clinical reasoning concerning decisions of PVC. Two studies have been conducted and data were collected during a six-month period, from December 2004 to June 2005. Study I investigated nurses’ adherence to national and local PVC guidelines by focusing on time in situ, site, size and documentation at the dressing. The thrombophlebitis frequency associated with PVC in situ was also investigated. Structured observations through two protocols were carried out and data about 343 PVC were analysed. Study II investigated nurses’ clinical reasoning regarding PVC management and cues and factors of importance in the decision10 making process were analysed. Nurses were observed in their daily work with focus on PVC management. They were interviewed both about the PVC decisions made in the observed situations and about factors influencing their reasoning regarding PVC management in general. The observations facilitated the interviews. Transcribed interview texts were analysed with content analysis. The results in study I showed that thrombophlebitis frequency was 7.0% and the nurses seemed to replace or remove PVC before any severe complications arose in accordance with clinical guidelines. Nurses partly adhered to national and local guidelines concerning site, size, documentation at the dressing and time in situ. Differences in guideline adherence were observed for wards with local or national guidelines, as well as for wards with different specialities. The results indicate that local guidelines may have an impact on guideline adherence but these results need further exploration. Analysis of interview texts in study II resulted in a category system with three main categories describing cues and factors of importance in the nurses’ clinical reasoning about PVC: the individual patient situation, the nurse’s work situation, and experience of PVC management. An overall theme was also revealed in the interview texts and the nurses balance in their clinical reasoning between avoiding or minimizing discomfort and pain for the patient and preventing complications from the PVC. The results from this licentiate thesis have implications for the education of nurses as well as during implementation of clinical guidelines. / <p>Note: The papers are not included in the fulltext online.</p><p>Paper I in thesis as accepted manuscript, paper II as manuscript.</p><p></p>

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