Lindgren, H. Patienters erfarenheter av hur deras sömn påverkas inom slutenvården – en litteraturstudie. Examensarbete i omvårdnad 15 högskolepoäng. Malmö universitet: Fakulteten för hälsa och samhälle, institutionen för vårdvetenskap, 2023.  Bakgrund: Sömnrelaterade problem kan resultera i både kortsiktiga och långsiktiga hälsokonsekvenser som leder till ett ökat omvårdnadsbehov. Kunskapen om betydelsen av sömn är bred men trots det är inte sömnen högt prioriterad inom slutenvården.  Syfte: Syftet med denna litteraturstudie var att belysa patienters erfarenheter av hur deras sömn påverkas inom slutenvården. Metod: Litteraturstudien baseras på tio vetenskapliga studier, sex stycken med kvalitativ studiedesign och fyra stycken med mixed metod. Databassökningen gjordes i PubMed, Cinahl och Psychinfo. Studierna kommer från olika länder, är från åren 2005–2021 och var skrivna på engelska. Granskningen gjordes med SBU:s kvalitetsgranskningsmall. En av studierna var av hög kvalitet och nio av studierna var av medelhög kvalitet. Resultat: Fyra huvudteman identifierades: Patienters sömnupplevelser relaterade till vårdmiljön, Omvårdnadsarbetets påverkan på sömn, Fysiologiska och psykologiska faktorer och Upplevelsen av individualiserad vård och dess påverkan på sömn. Huvudtemana består upp av 12 subteman.  Slutsats: Sömn är en viktig faktor för hälsa, men patienters sömn på sjukhus påverkas negativt av olika faktorer som exempelvis vårdmiljö, smärta och ångest samt avsaknaden av individualiserad vård. Patienter behöver en mer personcentrerad vård som är individuellt anpassad efter patientens behov och preferenser. / Lindgren, H. Patients’ experience of how their sleep is affected in inpatient care – a literature review. Degree project in Nursing science 15 Credit point. Malmö University: Faculty of Health and Society, Department of Care science, 2023.  Background: Sleep-related problems can result in both short-term and long-term health consequences which leads to an increased need for care. Knowledge about the importance of sleep is broad, but despite this, sleep is not a high priority in inpatient care. Aim: The aim of this literature study was to highlight patients’ experiences of how their sleep is affected in inpatient care. Method: The literature study is based on ten scientific articles, six with a qualitative study design and four with a mixed method. The database search was done in PubMed, Cinahl and Psychinfo. The studies come from different countries, are from the years 2005–2021 and were written in English. The review was based on SBU's quality review template. One of the studies was of high quality and nine of the studies were of medium quality.Results: Four main themes were identified: Patients' sleep experiences related to the care environment, Nursing Work's impact on sleep, Physiological and psychological factors and The experience of individualized care and its impact on sleep. The main themes consist of 12 subthemes.Conclusion: Sleep is an important factor for health, but patients' sleep in hospital is negatively affected by various factors such as the care environment, pain and anxiety and the lack of individualized care. Patients need more person-centred care that is individually adapted to the patient's needs and preferences.

The background to this empirical study is the recent media attention that children and young people in compulsory and inpatient care have received in Sweden. The media has described the care as ineffective and that many young people experience increased mental illness within the care period. Therefore we want to investigate children's and young people's experiences which they have shared in an online forum setting, with emphasis on their personal recount of coercion and inpatient care, as well as how they describe the long-term consequences the care has had on them. Such online forums give access to the narratives of young people that has been in compulsory and inpatient care. The results of the care has shown to be counterproductive and in some cases their medical conditions have worsened after the period of compulsory care. Hence, the continuation of this study is encouraged as further research is needed for the subject matter. The study is based on a qualitative method. The material has been collected through an online forum where young people can share their experiences of compulsory and inpatient care. The selection of forum posts was directed by the inclusion criteria: the author describing themselves as being under 18 years of age and having experience of compulsory and inpatient care. Included posts were analyzed with a thematic analysis method with an abductive approach. The result of the research analysis shows that a majority of the personal recounts indicate that children and young people who have been in compulsory and inpatient care have been negatively affected. A result pattern of increased mental illness for the focus group was observed as a result of the care the individual had been exposed to. The results also showed that compulsory and inpatient care caused long-term consequences for the focus group. The worsened mental health of the young patients both short and long term, could be strongly correlated to the professional care given to them by the staff. / Bakgrunden till denna empiriska studie är den senaste tidens medieuppmärksamhet som barn och unga i tvångs- och slutenvård har fått i Sverige. Media har beskrivit vården som ineffektiv och att många unga upplever ökad psykisk ohälsa inom vårdtiden. Därför vill vi undersöka barn och ungas erfarenheter som de har delat i ett onlineforum, med tonvikt på deras personliga berättelser om tvångs- och slutenvård, samt hur de beskriver de långsiktiga konsekvenser som vården har haft på dem. Sådana onlineforum ger tillgång till berättelser om ungdomar som varit i tvångs- och slutenvård. Vårdens resultat har visat sig vara kontraproduktivt och i vissa fall har deras sjukdomstillstånd förvärrats efter att de tvångsvårdats. Därför är det angeläget att denna studie görs för att bidra med ytterligare forskning inom ämnet. Studien bygger på en kvalitativ metod. Materialet har samlats in genom ett onlineforum där unga kan dela med sig av sina erfarenheter av tvångs- och slutenvård. Valet av foruminlägg styrdes av inklusionskriterierna: författaren beskrev sig vara under 18 år och med erfarenhet av tvångs- och/eller slutenvård. Berättelserna analyserades med en tematisk analysmetod och med en abduktiv ansats. Resultatet av forskningsanalysen visar att en majoritet av de barn och unga som varit i tvångsoch slutenvård har påverkats negativt. Vidare framkommer en ökad psykisk ohälsa av de unga som tvångs- eller slutenvårdats samt även långsiktiga konsekvenser till följd av den vård individen utsatts för. Vi såg även ett samband mellan den psykiska ohälsan hos de unga på kort- och långsikt och hur de bemöttes av den professionella vården.

Bakgrund: Covid-19 uppkom 2019 från Kina och är ett virus som spred sig tillstora delar av världen och klassades därför som en pandemi. Covid-19 har bidragit med stora utmaningar för hälso- och sjukvård där sjuksköterskors arbetsmiljö drastiskt var tvungen att anpassas. Syfte: Syftet med litteraturstudien var att undersöka sjuksköterskans upplevelse av sin arbetsmiljö under covid-19 inom slutenvården. Metod: En strukturerad litteraturstudie som resulterade i granskning av tio vetenskapliga artiklar som analyserade med en kvalitativ dataanalysmodell. Resultat: Analysen resulterade i tre kategorier: Rädslor och utmaningar med covid-19, En förändrad arbetsmiljö och teamarbete samt Chefernas påverkan på arbetsmiljön. Resultatet visade att arbetsgivaren spelar en stor roll för hur arbetsmiljön upplevs av sjuksköterskor. Resurser i from av skyddsutrustning och tillräcklig bemanning var två faktorer som visade sig betydelsefulla för att en god omvårdnad skulle bevaras trots en förändrad arbetsmiljö. Slutsats: Resultatet från litteraturstudien kan användas för att öka kunskapen om hur en pandemi kan påverka arbetsmiljön för sjuksköterskor. Även vad som ansågs betydelsefullt för sjuksköterskor som befann sig i covid-19 situationen inom slutenvården. Litteraturstudien har kommit fram till vikten av att belysa vad som är en bra arbetsgivare och inte. Detta för att resultatet har visat på att sjuksköterskors upplevelse av sin arbetsmiljö har upplevts olika beroende på hur arbetsgivaren har uppfyllt sin roll. / Background: Covid-19 emerged in 2019 from China and is a virus that spread tolarge parts of the world, therefore classified as a pandemic. Covid-19 has posedsignificant challenges to healthcare, particularly the working environment ofnurses, which had to be drastically adapted. Purpose: The purpose of theliterature study was to investigate the nurse's experience of their workingenvironment during covid-19 in inpatient care. Method: A structured literaturereview resulting in the review of ten scientific articles analyzed with a qualitativedata anlysis model. Results: The analysis resulted in four categories: Differentfears, Various challenges with covid-19, A changed working environment andteamwork and The managers impact on the working environment. The resultsshowed that the employer plays a significant role in how the working environmentis experienced by nurses. Resources such as protective equipment and sufficientstaffing were two factors that proved to be important for maintaining good caredespite a changed working environment. Conclusion: The results of the literaturereveiw can be used to increase knowledge about how a pandemic can affect the working environment for nurses. In addition, what was considered significant forthose in the covid-19 situation in inpatient care. The literature study further showsthe importance of highlighting what a good versus less good employer is.

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The emergency department (ED) has often been considered the safety net of the American healthcare system. It earned this distinction because every person in the United States has access to a medical screening exam and stabilization at an ED regardless of their ability to pay. Unfortunately, over the past several decades, decreasing numbers of EDs and inpatient beds, coupled with increasing rates of ED usage, has led to crowding of EDs across the country. Crowding leads to unsafe conditions that may increase morbidity and mortality for patients, or cause patients to leave the ED without being evaluated by a physician. Essentially, crowding causes a barrier for patients to access their right to emergency evaluation. The problem of crowding is most pronounced in large urban communities, and these already frequently underserved patients suffer the most from the crowding burden. The main cause of crowding seems to be the boarding of admitted patients in the ED, however many often cite high rates of non-urgent patients presenting to the ED as a cause of crowding. Some have even suggested diverting non-urgent patients to help solve the problem of crowding. I became interested in this topic due to crowding concerns and initiatives to decrease the number of patients who left without being seen at my own institution. As I reviewed relevant research, I became aware of my own misconceptions and noted a trend of literature suggesting non-urgent patients are not the cause of crowding. Drawing on research from many different sources, paired with evaluation based on principles in bioethics, I have come to several conclusions. I believe the systematic diversion of non-urgent patients is unsafe, and that the unequal burden of ED crowding on urban communities represents an unjust barrier in access to care. We must continue to carefully research the demographics of patients frequently presenting to EDs to avoid perpetuating stereotypes about which types of patients are responsible for crowding. We should also look for ways to ease the crowding burden in urban communities. Additionally, we should take a qualitative assessment of our individual communities to determine if there are any particular reasons in our community that people choose to use the ED rather than other healthcare options. I believe these suggestions can be an important addition to the efforts already in motion to help reduce ED crowding and provide equitable access to emergency medical evaluation. / Urban Bioethics

During inpatient rehabilitation, arm-ergometry training is utilized to improve the physical capacity of patients with a sub-acute spinal cord injury (SCI) to a level that is desirable for performing activities of daily living (ADLs). Previous work has demonstrated that ≥ 20 minutes of moderate-intensity continuous training (MICT) during inpatient rehabilitation, at a frequency of ≥ 3 times per week, is useful for increasing the physical capacity of these patients. However, considering that inpatient rehabilitation is an intensive program, and given the trend towards a shortened length of stay during inpatient rehabilitation, performing MICT on the arm-ergometer can consume a valuable amount of therapy time. Low-volume sprint interval training (SIT) is a time-efficient alternative to MICT for improving indices of physical fitness in healthy and diseased populations. To date, however, there are no published studies comparing SIT to MICT in persons with sub-acute SCI undergoing inpatient rehabilitation.The purpose of this thesis was to evaluate the efficacy of a five-week, thrice weekly low-volume SIT protocol on the arm-ergometer and compare fitness outcomes to traditional MICT in patients with sub-acute SCI undergoing inpatient rehabilitation. Participants with sub-acute SCI undergoing inpatient rehabilitation were recruited and randomly allocated to the SIT or MICT training group. Both types of training utilized the same 2 min. warm-up and 3 min. cool-down. SIT consisted of 3 x 20 sec. “all-out” cycle sprints (≥ 100% of peak power output [POpeak]), interspersed with 2 min. of low activerecovery (≈ 10% of POpeak; total time commitment, 10 mins). MICT involved 20 min. of arm cycling (45 – 60% of POpeak; total time commitment, 25 mins). SIT elicited a higher relativheart rate response, and ratings of perceived exertion than MICT. Following training, we found similar improvements in maximal and sub-maximal physical capacity across groups. Both exercise modes were equally well tolerated, and enjoyable, and there were no differences in self-efficacy across groups. The significance of this work is that it is the first randomized-controlled trial comparing SIT to MICT on the arm-ergometer in individuals with sub-acute SCI undergoing inpatient rehabilitation. The fact that SIT is palatable and can promote similar increases in physical capacity as MICT, despite less than half the time commitment and training volume, means that clinical rehabilitation specialists can now offer a new, more time-efficient, exercise training strategy to elicit improvements in their patients. / Thesis / Master of Science (MSc)

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