Sammanfattning Bakgrund: Trycksår innebär ett sår som utvecklats när huden eller vävnaden exponeratsför ett långvarigt tryck eller skjuv och till följd av detta minskar syretillförseln till detskadade området. Några riskfaktorer för att utveckla trycksår är nedsatt hudkvalitet,försämrat/sänkt allmäntillstånd, immobilitet och nutritionsproblem. Inom hälso- ochsjukvården drabbas patienter årligen av vårdskador och av dessa är cirka 8%vårdrelaterade trycksår. Detta orsakar stort lidande för patienten, förlängda vårdtideroch höga kostnader för samhället.Syfte: Sjuksköterskors upplevelser av att arbeta preventivt med trycksår inomslutenvård Metod: I resultatet inkluderades 9 kvalitativa studier samt en multimetod studie somsöktes fram och sammanställdes efter sökning i databaserna PubMed och Cinahl.Studierna analyserades sedan av en tematisk analys enligt Aveyard. Resultat: Resultatet utformades av tre huvudrubriker samt tre underrubriker. 1)Organisatoriska och personliga faktorer som påverkar trycksårspreventionen medunderrubrikerna tidsbrist och konkurrerande prioriteringar, ledning samtkommunikation och kunskap. 2) Patientutbildning, delaktighet och anhöriga. 3)Teamarbete till övrig profession. Slutsats: Resultaten visade att sjuksköterskor var medvetna och villiga att arbeta medatt förebygga trycksår, men att de upplevde hinder såsom tidsbrist,kommunikationsbrister och kunskapsluckor. Stöd från ledning och engagemang frånpatienter och anhöriga framhålls som viktiga komponenter för ett välfungerande ochpatientsäkert arbete där utbildning ansågs vara en lösning till att skapa mer delaktighet.Sjuksköterskor upplevde att förutsättningarna för ett bra trycksårspreventivt arbete varbegränsade men att ett starkt ledarskap, gott samarbete och ökad kompetens skullekunna främja förebyggandet av trycksår och leda det framåt.

Bakgrund: Isolering är en vanligt förekommande vårdform inom den somatiska slutenvården som tillämpas för att förhindra smittspridning av smittsamma sjukdomar. Patienter som isoleras vårdas på enkelsal och får inte vistas på gemensamma ytor. Speciella försiktighetsåtgärder och hygienrutiner tillämpas även för att minimera spridning av smitta. Vårdmiljön har visat sig ha en direkt inverkan på patienters tillfrisknande och vårdtid. Sjuksköterskor har vittnat om en sämre vårdkvalité för isolerade patienter på grund av vårdpersonalens brister i kunskap om och rädslor för smittsamma sjukdomar. Syfte: Syftet med denna litteraturstudie var att beskriva patienters upplevelser av att vårdas under isolering inom somatisk slutenvård. Metod: En deskriptiv litteraturstudie med en tematisk dataanalysmetod. Resultatet grundar sig på tolv vetenskapliga artiklar av kvalitativ, kvantitativ och mixed-method ansats. Huvudresultat: Att vårdas under isolering resulterade i både positiva och negativa upplevelser. Ett huvudfynd var att patienterna upplevde sig fångna och kontrollerade på grund av restriktionerna. Avsaknaden av information samt dåligt bemötande från vårdpersonalen gjorde vistelsen påfrestande och bidrog till svåra känslor. Miljön på enkelsalen och möjlighet till aktivitet var viktiga faktorer för tillfrisknande och den totala upplevelsen av vården. Slutsats: Isoleringsvård för med sig starka känslor av ensamhet och lidande, detta kunde förhindras av ett gott bemötande och god information från sjuksköterskan samt en hemtrevlig miljö med något att distrahera sig med. Denna litteraturstudie kan inspirera sjuksköterskor i deras omvårdnadsarbete för att förbättra vårdkvalitén för isolerade patienter. / Background: Patient isolation is a common form of care in somatic inpatient care that is applied to prevent the spread of infectious diseases. Isolated patients are cared for in a single ward and may not stay in common areas. Special precautions and hygiene routines are also applied to minimize the spread of infection. The environment has a direct impact on patients recovery and length of stay. Nurses have testified to a poorer quality of care for isolated patients due to the healthcare staff's shortcomings in knowledge about and fear of infectious diseases. Aim: The purpose of this study was to describe patients experiences of patient isolation in somatic inpatient care. Method: A descriptive literature review with a thematic data analysis method. The result is based on twelve scientific articles with qualitative, quantitative and mixed-method approaches. Result: Isolation care resulted in both positive and negative experiences among patients. A major finding was that patients felt trapped and controlled due to the restrictions. The lack of information and poor treatment from the staff made the hospital stay stressful and contributed to difficult feelings. The environment in the single room and the possibility for activity were important factors for recovery and the overall experience of the care. Conclusion: Isolation care leads to strong feelings of loneliness and suffering, this could be prevented by a good attitude and information from the nurse as well as a homely environment with something to distract oneself with. This literature study can inspire nurses in their work to improve the quality of care for isolated patients.

Sammanfattning Bakgrund: En person med demenssjukdom upplever kognitiva svårigheter, vilket kan skapa missförstånd och problematik i vårdandet. Sjuksköterskan ska tillgodose en personcentrerad vård för att förbättra, bibehålla samt återfå patientens hälsa. Detta kan vara utmanande för sjuksköterskan att genomföra när patienter har en demenssjukdom. Syfte: Att beskriva sjuksköterskans erfarenhet av att vårda patienter med demenssjukdom inom slutenvården. Metod: En deskriptiv litteraturstudie. Databasen PudMed användes för identifiering av tio vetenskapliga artiklar med kvalitativ och kvantitativ ansats. Tematisk analysmetod har använts. Huvudresultat: Litteraturstudiens resultat visade på att sjuksköterskor inom slutenvården upplevde problematik i vårdandet av patienter med demenssjukdom. På grund av faktorer som miljö, utbildning, bemötande och brister i den personcentrerade vården. Sjuksköterskor upplevde känslor som ilska, frustration och sorg på grund av hög arbetsbelastning, bristande lokaler samt rutiner. Sjuksköterskorna upplevde kunskapsluckor om demenssjukdomar, detta skapar svårigheter i omvårdnaden, bemötandet och planering av vården. Vilket skapar svårigheter för sjuksköterskan att tillgodose personcentrerad vård samt skapa meningsfulla relationer till patienten. Slutsats: Demenssjukdom är en komplicerad sjukdom. Vilket gör vårdandet till en utmaning. Sjuksköterskan är ytterst ansvarig för omvårdnaden. Omvårdnaden ska vara tillfredställande och behov ska identifieras. Utan erfarenhet av patienter med demenssjukdom blir detta en svår uppgift för sjuksköterskan. Författarna har i föreliggande litteraturstudie kommit fram till att det finns kunskapsluckor om demensvård hos sjuksköterskor. Detta medför att arbetet upplevs som utmanande. / AbstractBackground: A person with dementia experiences cognitive barriers that can create misunderstandings and problematics in healthcare encounters. This can cause difficulties for the nurse. The nurse must provide a person-centered care to improve, maintain and regain the patient's health. Aim: To describe the nurse's experience of caring for patients with dementia in inpatient care. Method: A descriptive literature rewiev. The database PubMed has been used to identify 10 articles with qualitative and quantitative approaches. Thematic analysis method has been used. Main results: The results of the literature rewiev showed that nurses in inpatient care experienced problems in the care of patients with dementia. Due to factors such as the environment, education, treatment and lack of person-centered care. Nurses experienced emotions such as anger, frustration and sadness due to high workload, non-adaptive facilities and routines. The nurses knowledgegap about dementia and dementia care is making the nursing, treatment and care planning difficult. These difficulties are in turn making the nurse unable to provide person-centered care and create meaningful relationships with the patient. Conclusion: Dementia is a complicated disease. Which makes caring a challenge. The nurse is ultimately responsible for the care. The care must be satisfying and fulfill all the identified needs. Without experience of caring for patients with dementia the nurse will face difficulties. The authors of the present literature rewiev have concluded that there is a knowledge gap throughout the dementia care among nurses. This means that the work is perceived as challenging.

Bakgrund Anorexia nervosa är en typ av ätstörning som kännetecknas av viktnedgång, fobi för viktuppgång, ett lågt BMI samt en omfattande ångestproblematik. Sjukdomen är ett växande samhällsproblem både i Sverige och i världen. Samtidigt saknas det forskning om sjukdomsförloppet och evidens om en effektiv behandling. Patienter kan uppleva en enorm psykisk och fysisk påfrestning och kan behöva vård dygnet runt på en slutenvårdsavdelning. Sjuksköterskan har en viktig roll i omvårdnaden vid anorexia nervosa och det är därför väsentligt att sjuksköterskan har kunskap om patientgruppen och bemötandet av dessa patienter. Syfte Syftet var att beskriva patienters upplevelser av att vårdas för anorexia nervosa på en slutenvårdsavdelning. Metod Denna icke-systematiska litteraturöversikt är baserad på 21 vetenskapliga artiklar med kvalitativ design. De vetenskapliga artiklarna har tagits fram från databaserna CINAHL, PsycInfo samt PubMed med hjälp av relevanta sökordskombinationer för föreliggande syfte. Kvaliteten på artiklarna granskades med hjälp av Sophiahemmets bedömningsunderlag. Insamlad data analyserades och resulterade i huvudfynd som kategoriserades i tre huvudteman: patienters upplevelse av att behandlas för anorexia nervosa, patienters upplevelse av vårdmiljön och patienters upplevelse av vårdrelationen. Resultat Litteraturstudiens resultat beskriver patienters upplevelse att vårdas för anorexia nervosa på en slutenvårdsavdelning. Från de tre huvudteman skapades sex subteman där patienters upplevelse av behandling, behandlingsinriktning, tankar om tillfrisknande, medpatienter, vårdmiljön och relationen till vårdpersonalen beskrivs. Slutsats Litteraturöversikten visade på att patienters upplevelser av slutenvårdsbehandling skiljer sig mot varandra. En patients upplevelser kunde även förändras under behandlingstiden. Resultatet belyste således att dessa patienter inte kan behandlas homogent utan att det krävs ett holistiskt och personcentrerat förhållningssätt av sjuksköterskan och vårdpersonal vid behandling av dessa patienter. I litteraturöversikten framkom även att ytterligare forskning behövs för att utöka och förbättra vården för patienter med anorexia nervosa. Genom ökad kunskap och förståelse kan patienters upplevelse av behandling på slutenvården förbättras. Nyckelord: Anorexia nervosa, Patientperspektiv, Patientupplevelse, Slutenvård / Background Anorexia nervosa is a type of eating disorder that is characterized by weight loss, phobia of weight gain, a low BMI and an extensive anxiety problem. The illness is a growing societal issue in Sweden and in the world. There is currently a lack of research on the pathophysiology of the disease and evidence of effective treatment. Patients may experience enormous mental and physical strain and may need constant care in an inpatient ward. The registered nurse has an important role in the treatment of anorexia nervosa and it is therefore essential that the registered nurse has knowledge of the patient group and the treatment of these patients.   Aim The aim was to describe patients' experiences of being treated for anorexia nervosa in an inpatient setting. Method This non-systematic literature review is based on 21 scientific articles with qualitative design. The scientific articles have been produced from the databases CINAHL, PsycInfo and PubMed using relevant keyword combinations for the chosen purpose. The quality of the articles was assessed with the help of Sophiahemmet's quality assessment data. The data was analyzed and subsequently grouped into three main categories: patients' experience of being treated for anorexia nervosa, patients' experience of the care environment and patients' experience of the care relationship. Results The results of the literature study describes the experiences of patients with anorexia nervosa whilst being cared for in an inpatient ward. From the three main themes; six subthemes were constructed where patients' experiences of treatment, treatment focus, thoughts about recovery, the care environment, fellow patients and the relationship to the care staff are described. Conclusions The literature review showed that patients' experiences of inpatient treatment differ from each other. A patient's experiences could change during the treatment period. The result thus highlighted that these patients can not be treated homogeneously and a holistic and person-centered approach is required by the registered nurse and care staff. The literature review also revealed that further research is needed to expand and improve care for patients with anorexia nervosa. Through increased knowledge and understanding, patients' overall experience of treatment in inpatient care can be improved.

Topic: Structuring of inpatient behavioral programming in child-adolescent psychiatric, residential treatment, and juvenile justice settings. Purpose: To review the underlying theory underpinning current practices and recommend remedies to the uncovered problems. Sources: A review of the literature from 1965 to 2001 from selected nursing and medical psychiatric and mental health publications. Conclusions: Intensive professional and staff education and greater precision in communication about patients' behaviors are needed in many settings. There is also a need to move away from generic treatment approaches and return to individual treatment planning based on individual assessments and the unique needs of an increasingly volatile and complex in-patient population.

Substantial research has been done on inpatient provider order entry systems with varying degrees of clinical decision support. Such studies have examined how these technologies impact patient safety as well as the quality and cost of care. However, given that most medical care and prescriptions are administered in an ambulatory setting, the dearth of research on ACPOE systems is quite astonishing. This knowledge gap demonstrates the need for an integrative and systematic literature review that attempts to assess the research done on computerized patient safety interventions in ambulatory care. This review’s findings provided adequate evidence that ACPOE systems are effective interventions for reducing medication errors. Other evidence further indicated that, in terms of functional capabilities, commercial ACPOE and e-prescribing systems may be catching up with their homegrown counterparts. PDA-based CDSSs were depicted as useful tools for raising adherence to guidelines and inducing safer prescribing. These findings suggest that ACPOE And PDA-based CDS systems show promise for improving safety and healthcare quality in ambulatory settings. ACPOE specifically, tended to have more advanced CDS attributes but, nonetheless, showed more negative results compared to the e-prescribing systems. Close scrutiny should therefore be given to the elements of decision support that ambulatory physicians find most useful.

Falls remain one of the most reportable, serious and costly type of adverse events costing an estimated $3,500 to $27,000 depending on the injury. The research often focuses on the elderly and their risk for falls and injury. Increasingly higher rates of falls are being reported in the middle-age inpatient 45 to 64 years of age. While predictors of falls and injuries have been studied across all adult inpatients, research has not specifically addressed fall risk characteristics in the middle-age. The World Health Organization’s (WHO), “Risk factor model for fall in older age”, framework was adapted for the middle-age inpatient. This framework identifies extrinsic and intrinsic variables from four risk factor groupings of biological, socioeconomic, behavioral, environmental and related outcomes to describe characteristics of the middle-age inpatient’s fall injury risk. Hitcho et al. (2004) seminal article was also used to identify pertinent inpatient characteristics. The purpose of this exploratory retrospective quantitative study described fall risk factors specific to the middle-age inpatient. The aims: (1) described risk factors of falls and fall injury; (2) described unit specific data, fall numbers with type of falls, injuries from falls, and prevention strategies (3) compare the incidence of fall and injury rates in the middle-age (45- 64) patients to the other hospital adult age-groups (ages 21-44 and 65-90). This study used retrospective hospital occurrence data to identify middle-age inpatient falls and related characteristics reported by staff. Chart review of inpatient falls identified 439 individual falls occurring from January 2012 through July 2014. The study sample included inpatients that fell either one-time or had a repeat fall during the study period. Analysis for data included use of descriptive statistics, crosstabs, and Poisson regression. Outcomes collected included demographics, admitting diagnosis, chief complaints, cormorbities, and discharge status, type of falls and areas of falls. There was no significant difference in rates of falls between units or in staffing ratios that had a bearing on the middle-age inpatient. Fall prevention interventions were found to be universally applied, not specific to the individual, nor based on outcomes of risk screening of anticipated physiological risk factors. In comparison of the middle-age inpatient population with those age 65 -90 years of age the rates per 1000 patient days for both falls (p=.637) and injuries (p=.626) had no significant difference. Males fell at a significantly higher rate (p=.000) than females in the middle-age inpatient and those aged 64-90 years. The middle-age inpatient fell at an alarming rate of 42% of all falls. This research provided insight into a population with acute and multiple chronic disease conditions and comorbidities that contribute to altered mental status, abnormal gait and frequently awaking at night to void. This population often overestimates their limitations and strives to maintain their autonomy. The age of the patient should not influence staff assessment of alertness and orientation. The findings of the characteristics in this research provide rich information for further research in how to include the middle-age patient in clinical decision making and education of this age group.

Bakgrund År 2019 utbröt en pandemi vid namnet COVID-19. Den globala smittspridningen över 200 länder skapade stor inverkan på samhället och sjukvården. Sjukhusinläggningar och behov av intensivvårdsplatser ökade drastiskt. Sjuksköterskor ställdes inför ovissa arbetsförhållanden där evidens saknades. Basala hygienrutiner och användning av personlig skyddsutrustning blev en viktig del för att minska smittspridningen. Syfte Att sammanställa och belysa forskning om sjuksköterskors upplevelser av att vårda patienter i slutenvården som drabbats av COVID-19. Metod Studien genomfördes som en litteraturöversikt. Resultatet är baserat på 15 vetenskapliga originalartiklar publicerade mellan år 2020–2022. Databaserna CINAHL och PubMed användes för att hitta artiklar som svarar på syftet. Resultat I resultatet framkommer de känslor och upplevelser som har påverkat sjuksköterskor i sin profession och mötet med patienter under COVID-19 pandemin. Känslor som hopp, förtvivlan, sorg och rädsla att bli smittad och föra smittan vidare. Fysiska och psykiska upplevelser av skyddsutrustning. En stolthet att stå i frontlinjen och göra skillnad förvärlden. Slutsats Sjuksköterskor har som grund att arbeta evidensbaserat och bedriva god och säker vård. Pandemin har påverkat sjuksköterskor positivt och negativt både psykiskt och fysiskt. Trots ansträngt läge har stolthet och ökad kompetens vuxit fram i professionen och enkänsla av att vara förberedd vid nästkommande pandemi. / Background In 2019, a pandemic called COVID-19 broke out. The global spread of infection across 200 countries created a major impact on society and healthcare. Hospital admissions and the need for intensive care units increased drastically. The nurses was faced with uncertain working conditions where there was no evidence. Basic hygiene routines and the use of personal protective equipment became an important part of reducing the spread of infection. Aim To compile and highlight research on nurses' experiences of caring for patients in inpatient care affected by COVID-19. Method The study is conducted as a literature review. The results are based on 15 original scientific articles published between 2020-2022. Databases CINAHL and PubMed were used to find the articles who match the aim. Results The results show the feelings and experiences that have affected the nurses in her profession and the meeting with patients during the COVID-19 pandemic. Emotions such as hope, despair, sadness and fear of becoming infected and passing on the infection. Physical and mental experiences of protective equipment (PPE). A pride to be at the forefront and make a difference for the world. Conclusions The nurse's basis is to work evidence-based and conduct good and safe care. The pandemic has affected the nurses positive and negative mentally and physically. Despite the strained situation, pride and increased competence have emerged in the profession and a feeling of being prepared in the next pandemic.

The clinical practice problems addressed by the DNP project were the low patient satisfaction scores and the high number of falls on a hospital neurological step-down unit. The purpose of this project was to improve the Hospital Consumer Assessment of Healthcare Providers and Systems score on one patient satisfaction question and decrease the number of patient falls by implementing hourly rounding, using a script related to patient comfort and toileting needs. The scripted questions were expected to increase the satisfaction of patients and decrease unassisted falls due to increased attention to patient pain and positioning and timely help with toileting and retrieving personal items. The project was guided by Rosswurm and Larrabee's change model and facilitated by the plan, do, study, act model for rapid change. The satisfaction scores on the survey question 'I received help as soon as wanted' and the number of falls were compared before and after hourly rounding with scripting was introduced. During the 3 months of the project, the average monthly number of falls increased from 3 to 3.6 and changes in the patient satisfaction score were within upper and lower control limits indicating normal variation in the process. These findings indicated that barriers to the change on the unit need to be examined further and another short-term, rapid change cycle initiated to meet or exceed the national benchmarks for patient satisfaction and falls incidence. The project may inform quality improvement efforts at other hospitals and assist in social change by increasing scripted communication between nursing staff and patients to ensure that patients' needs (pain, positioning, pottying, and proximity of personal items) are addressed during each hourly rounding encounter.

It has been argued that individuals receiving traditional alcohol treatment do not necessarily perceive life-long abstinence from alcohol as a favorable treatment outcome, and that negative expectations associated with this abstinence goal may have an adverse effect on treatment outcome. However, "abstinence expectancies" have never been systematically explored. This study used the Theory of Planned Behavior to investigate the relationship between the abstinence outcome expectancies of alcoholics beginning treatment and subsequent alcohol consumption. The independent and combined effects of abstinence outcome expectancies, alcohol outcome expectancies, self-efficacy expectancies (to abstain from alcohol use), and the normative beliefs of individuals beginning inpatient abstinence-oriented alcohol treatment were related to level of drinking during the 90 days following treatment. One hundred ten individuals receiving inpatient alcohol treatment were recruited for the main portion of this study. A questionnaire that included belief-based measures of attitude toward alcohol and abstinence, a belief-based measure of social normative pressure to either use or abstain from alcohol, a belief-based measure of one's perceived behavioral control to abstain from alcohol, and a measure of behavioral intention to use alcohol during the 3 months following treatment was developed for use in this study. The questionnaire was administered to all subjects. During the 90-day Follow-Up period, subjects were sent brief questionnaires and asked to report any alcohol or drug use. Eighty-nine percent of the subjects provided follow-up information for the first 30 days, while 76% provided information for the entire 90 days. An analysis of the data indicated that scores obtained from the belief-based measure of perceived behavioral control and scores from the belief-based measure of attitude toward abstinence were moderately correlated with intention to abstain from alcohol, while alcohol attitude scores and subjective norm scores were uncorrelated. Contrary to expectations, scores obtained from a measure of intention to use alcohol and the measure of perceived behavioral control were minimally predictive of scores from follow-up measures of drinking. However, intention and perceived behavioral control were minimally predictive of scores from follow-up measures of drinking. However, intention and perceived behavioral control scores were somewhat more predictive of drug use for the 90-day Follow-Up period. These results were discussed in light of the Theory of Planned Behavior and the similarities between alcohol expectancies and drug expectancies.