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Title: A systematic review of pain assessment tools Objectives: The aim of this thesis is to create a systematic review of the most widely used multidimensional tools (questionnaires) for assessing pain in patients with nonspecific pain of the cervical and lumbar spine. From the available sources, describe their use, the purpose it was generated for, their reliability, validity, and finally arrange the questionnaires from the most used and assess their advantages and disadvantages for use in clinical practice of physiotherapist. Method: The thesis is processed through a systematic review. The subject of the thesis are pain evaluating tools, especially in the cervical and lumbar spine. The studies containing questionnaires used to assess pain in the cervical and lumbar spine were searched out. Data extraction was carried out according to pre-specified criteria. Unsatisfactory studies were excluded. After the relevant questionnaires selection a content analysis of each tool was conducted, built a systematic review of the most commonly used questionnaires and their critical evaluation. Results: On the basis of the entire set of relevant studies I described and evaluated 14 questionnaires. Five of them are designed specifically for low back pain. They are the Roland Morris Disability Questionnaire,...

Bakgrund: Det är vanligt att patienter inom den kommunala hälso- och sjukvården lider av smärta. Upprepade studier pekar på att validerade smärtskattningsinstrument inte används i någon större utsträckning. Sjuksköterskors bristande kunskap om smärta, smärtskattning och smärtbehandling leder till sämre smärtlindring och försämrad livskvalitet för patienten. Syfte: Studiens syfte är att undersöka sjuksköterskors uppfattning om smärtskattning och smärtskattningsinstrument inom den kommunala hälso- och sjukvården. Metod: En litteraturöversikt valdes för att genomföra studien. I studien ingår elva artiklar som analyserades med kvalitativinnehållsanalys. Resultat: I analysen framkom tre kategorier; kunskap, teamsamverkan och barriärer. Studien visar att sjuksköterskor sällan använder sig av smärtskattningsinstrument i sitt dagliga arbete. De anser att det är svårt att smärtskatta en icke-verbal patient samt de patienter som drabbats av kognitiv svikt. Sjuksköterskor saknar kunskap om smärta och smärtlindring. Det framkommer även flera olika barriärer för smärtskattning så som tidsbrist och personalbrist. Teamet runt patienten ansågs viktigt för att förbättra smärtskattning och smärtbehandling. Slutsats: Resultatet visar att sjuksköterskors kunskaper om smärta och smärtskattning är bristfällig. Arbetslivserfarenhet bidrar inte heller till att sjuksköterskor blir mer benägna att smärtskatta. Det behövs mer utbildning om smärta och smärtskattningsinstrument. / Background: It is common for patients in municipal healthcare to experience pain. Repeated studies indicate that validated pain assessment tools are rarely used. Nurses' lack of knowledge concerning pain, pain assessment and pain relief leads to poor quality pain management which leads to poor quality of life. Aim: The aim of the study was to investigate nurses' opinions of pain assessment and pain assessment tools in municipal healthcare. Method: A literature review was conducted in which eleven scientific studies were examined and analyzed according to qualitative content analysis. Result: Three categories: knowledge, teamwork and barriers, emerged from the analyses. The study shows that nurses rarely use pain assessment tools in their daily work. Nurses generally think it is complicated to assess pain in non- verbal patients or in patients with cognitive impairment. They also feel that they have a lack of knowledge when it comes to pain relief and pain assessment. Other barriers is lack of time and personnel. The multi professional team is seen as an important part to improve pain assessment and pain management. Conclusion: The result points towards the fact that nurses lack skills in pain management. It is not enough to learn from work experience. More extensive education is needed to gain nurses' interest and skills about pain.

A avaliação somativa é a que prevalece nas instituições de ensino superior, os instrumentos de avaliação tradicionalmente utilizados (provas e relatórios) fornecem informações sobre a aprendizagem de conteúdos conceituais e ficam à margem a avaliação dos conteúdos procedimentais e atitudinais. Além disso, provas e relatórios são realizados num momento final das atividades, tardio para um feedback adequado, não havendo tempo para intervir na aprendizagem. Emerge nesse contexto a necessidade de se estudar e refletir sobre os processos avaliativos utilizados na disciplina de Química Analítica Qualitativa (QAQ). Diante disto, tinha-se uma pergunta: haveriam instrumentos adequados e ao mesmo tempo abrangentes que permitissem melhorar o processo avaliativo na disciplina QAQ? Com o objetivo de responder a esta questão foram aplicadas e analisadas duas modalidades de instrumentos de avaliação: pré-exercícios de laboratório (PEL) e grades de observação (GO). Esta pesquisa é de natureza qualitativa, e foi fundamentada em contribuições teóricas de autores que são a favor da avaliação no decorrer do processo de ensino. Sendo assim, teve-se como uma das principais referências Fernandes (2006), que propõe a expressão Avaliação Formativa Alternativa (AFA), alternativa a tradições avaliativas em que o resultado é obtido após o processo de ensino e aprendizagem. Na AFA o professor vai obtendo informações sobre a aprendizagem dos alunos, permitindo assim, o feedback das atividades propostas, interações aluno-professor, e as notas são consideradas pois estas servem como registro. A pesquisa foi desenvolvida no decorrer da disciplina QAQ, com a turma do terceiro semestre do curso de Licenciatura em Química noturno na Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Universidade de São Paulo (FFCLRP/USP). Concluiu-se que os instrumentos de avaliação PEL e GO foram eficientes no acompanhamento da aprendizagem dos alunos no decorrer da disciplina. Estes instrumentos proporcionaram a AFA, e complementam a avaliação realizada tradicionalmente na disciplina QAQ, dessa forma reforçam o acompanhamento dos alunos contribuindo para a melhoria na aprendizagem e no processo de avaliação da disciplina. / The summative assessment is prevailing in higher education institutions, the traditional evaluation tools used (tests and reports) provide information on conceptual learning does not include assessments of experimental procedures and attitudinal content. Besides, examinations and reports are performed in a final stage of activities without proper feedback, there is no time to help in the learning. Emerges in this context the need to study and reflect on the assessment processes used in the discipline of Qualitative Analytical Chemistry (QAC). This rises to the following question: are there more specific and more comprehensive instruments, which allow an improvement of the evaluation process in the Qualitative Analytical Chemistry (QAC)? In order to answer this question, we applied and analyzed two types of assessment tools: pre-lab work (PLW) and observation grids (GO). This research qualitative in nature was based on theoretical contributions of the authors that are in favor of the assessment during the teaching process. Fernandes (2006) was as one of the main references, he proposed the term Alternative Formative Assessment (AFA), the alternative assessment traditions in which the result is obtained after the process of teaching and learning. While using AFA, the teacher obtains information about students\' learning, allowing the feedback of the proposed activities, student-teacher interactions and considering the marks, as they serve as a record. The research was developed during the discipline of QAC, with the class of the third semester of the degree chemistry at night in the Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Universidade de São Paulo (FFCLRP/USP). It was concluded that the assessment instruments PLW and GO were effective in accompaniment students\' learning during the discipline. These instruments provided the AFA, for the evaluation supplement traditionally held in the discipline QAC, and thus reinforce the monitoring of students contributing to the improvement in learning and evaluation process of the discipline.

Bakgrund: Smärta är ett flerdimensionellt fenomen och ett vanligt problem inom äldrevården. Smärtbehandling finns att tillgå, trots detta är smärta underbehandlat hos äldre patienter. Syftet: Syftet med studien är att belysa hur sjuksköterskor bedömer fysisk smärta i omvårdnad av äldre patienter. Metod: Litteraturöversikt med kvalitativ ansats har använts. Datamaterialet bestod av fem kvantitativa och fyra kvalitativa vetenskapliga artiklar. Resultat: Det framkom tre huvudkategorier: smärtbedömningsprocesser, smärtbedömningsmetoder och smärtbedömningsredskap. Ur huvudkategorierna urskildes sex underkategorier: smärtidentifiering, smärtbedömningssvårigheter, kommunikation med patienterna för att bedöma smärta, smärtobservation, smärtbedömningsinstrument och dokumentation. Slutsatser: För att göra en smärtbedömning behövs en god relation till patienten, närstående och övrig personal där kommunikation har central roll. Sjuksköterskan måste tro på patientens egen skattning och smärtupplevelse. / Background: Pain is a multidimensional phenomena and a common problem in care of elderly patients. There are several pain treatment methods available however pain is often not fully treated. Aim: The aim of this study is to illustrate how nurses assess physical pain in care of elderly patients. Method:  A literature review based on a qualitative approach has been used. The study consists of an analysis of five quantitative and four qualitative research articles.  Results: Three main categories were found: the process of pain assessment, the methods of pain assessment and the tools of pain assessment. Those categories were further divided into six subcategories: pain identification, pain assessment difficulties, patient communication to assess pain, pain observations, pain assessment instruments and documentation. Conclusions: Pain assessment requires a good relation to the patient as well as relatives and other staff. Communication takes a central part of the pain assessment. A nurse must believe in the patient's own estimation and pain perception.

Bakgrund: svårigheter uppstår med kommunikationen mellan patient och sjuksköterskan vid insjuknande i Alzheimers sjukdom vilket leder till hinder i smärtbedömning av personer med Alzheimers sjukdom jämfört med bedömningen avpersoner utan kognitiv nedsättning. Syfte: syftet med litteraturstudien var att belysa vikten av korrekt smärtbedömning hos patienter med Alzheimers sjukdom. Metod: studien var en litteraturstudie, 12 artiklar samtliga kvantitativa som svarade mot studiens syfte har granskats och analyserats. Resultat och konklusion: bedömning av smärta hos patienter med Alzheimers sjukdom är komplex, slutsatsen är tvetydig då resultatet visar dels att personer med Alzheimers sjukdom har mer smärta respektive mindre smärta än personer utan kognitiv nedsättning. Bedömningsinstrumenten som undersöktes i studien visade sig vara relevanta men ansvar och kunskap från sjukvårdspersonalen som använder instrumentet var ett krav för att kunna utesluta felkällor av tecken på smärta så som onormala rörelser, beteende och ljud. Implikation: vidare forskning bör göras där fokus ligger på de enskilda diagnoserna istället för gruppen demenssjukdomar samt ökad kunskap hos sjukvårdspersonal på smärta i relation till Alzheimers sjukdom. / Background: difficulties with communication is shown in the progress of Alzheimer’s disease which leads to a difference in assessment of pain in persons with Alzheimer’s disease compared to persons without a cognitive impairment. Aim of the study: the aim of the study was to illuminate the importance of correct pain assessment in patients with Alzheimer’s disease. Method: the study was a literature review, 12 quantitative articles which met the study’s purpose was reviewed and analyzed. Results and conclusions: pain assessment in patients with Alzheimer’s disease is complex, the conclusion is ambiguous since the results show that people with Alzheimer’s disease has more in some studies and less pain in others in comparison with people without a cognitive impairment. The pain assessment tools that were examined in this study were shown to be relevant, but it was important that the staff using the instruments had to be able to rule out confounders of pain such as unusual movements, behaviour and sounds. Implication: further research should focus on the the separate diagnoses that are included in the dementia genre. Also an increased knowledge and awareness in the staff about pain in correlation with Alzheimer’s disease.

Abstract Title: Client Information Needs of MFIs: A Case Study of ASA Bangladesh Author: Juber Ahmed Academic Advisor: Dr. Klaus Solberg Søilen Department: School of Management, Blekinge Institute of Technology Course: Master Thesis in Business Administration Purpose: To enrich the knowledge base of client’s needs of financial services and assessing the tools MFIs used to collect clients’ information and how they utilized the information for developing new products and services or modifying existing products and services or their terms and conditions to meet the needs of financial services of their clientele. Also how MFIs organized and managed the information and how they categorized their clients using that information. Method: The investigation conducted from both a theoretical and an empirical point of view. The deductive approach used for the study and the case study method deployed. I studied ASA which is an MFI renowned in Bangladesh and beyond. At first, I had gone through a secondary research for collecting a number of successful methods and standard types of information used by successful MFIs from existing literature. In primary research, I interviewed 10 Managers (Assistant Directors) for ASA to determine which of the methods found in the literature were more effective for collecting clients’ information for them and also asked them to add their ideas to the list. At last I asked interviewees to rate the methods and results presented in this paper. Theory: This study was an exploratory one where I discussed the related aspects for the study - Microfinance, Client Assessment, Clients of Microfinance, Information needs and Management Information System. Findings: The study showed that ASA utilized client information for developing their credit products and services and based on number of loans taken by the clients they categorized their clients and modified or developed new products and services for each category of clients. Although ASA executed several tools for collecting client information but the managers think that their staffs’ collection of information from regular meeting with clients was more effective than others for modifying products’ terms and conditions and modifying or developing new products and services to their women and small enterprise clients. The conducted study also revealed that in ASA impact study was necessary to know clients’ overall level of satisfaction but management needed specific information on what aspects of ASA and its credit products and services clients preferred and did not prefer and the reasons of the preferences. Also they needed action plan to address clients’ specific concerns, so they needed the information on a continual basis and they were successful to achieve this continuous flow of information. For ASA, the best way to get this type of information would be through client satisfaction Focus Group Discussions (FGDs), although they utilized several tools but not often as discussed in part 3 in chapter 5. ASA owned an MIS (AMMS) for monitoring and managing clients’ information and they utilized this to categorize their clients based on the collected information about their number of loans. Conclusion: This study revealed that ASA served only women and small enterprise clientele that included the vulnerable non-poor and could contribute to the profitability of ASA. There was no attempt to diversify the products to include all poor that should be the goal of microfinance to alleviate poverty. Moreover client treated as individual client but the loans used to fulfill household or family needs of the clients. There were tools for collecting information on household about impact of credit programs participation but they took seldom effort for collecting information of the household money management or in other words how they utilized the loans for variety of household needs. There is lack of access to a variety of financial services for poor clients, even though MFIs are mostly serving vulnerable non-poor instead of taking consideration of all categories of poor. It revealed from the study that MFIs could gain long term success by serving specific market segment but it should not be only focus of MFIs, their initiative should be to include all poor in their clients profile with a priority to a specific market segment. This could help them to become sustainable and to minimize risks by spreading it in different market segments. The study found that ASA considered FGDs as an effective tool for collecting clients’ information as their staffs and managers were familiar with this tool, moreover it was cost effective for them. It observed that they seldom followed Tool Selection Process and it was the top management that decided over the tools, the decision might influence by internal and external interest groups and the competition. MFIs should organize client information in a way so that they could be able to manipulate the specific client information to serve client better and to take effective decision, although it is imperative to argue that they may like to serve the wealthier clients. This research paper is also presenting some important findings from existing literature of microfinance and a number of recommendations based on the study experience and scholars opinions from existing microfinance study that may help MFIs to prepare themselves to adopt client-oriented approach by utilizing client assessment tools to fulfill the needs of financial services of their clients that may hopefully include all poor irrespective of their categories.

Assessment of the level of the pupils´ knowledge and understanding are important parts of teaching. There are diverse ways to do this and many different tools to use. The purpose of this study is to explore, through qualitative interviews, how five teachers work with assessment. The focus lies on both how they work with assessment in general and how they use the assessment tools called »LUS» and »Nya språket lyfter!». The pupils´ participation in their own education is an important part of the Swedish curriculum, which is why the study also focuses on how the informants work to enable the pupils´ participation in the assessment and in their education. The informants all think that both assessment and the pupils´ participation in the assessment are important, since teaching is easier when the pupils are aware of what they need to know and learn. Many of the informants express that time is an issue when it comes to making the assessment trustworthy. They need to have time to discuss assessment and the interpretation of the curriculum with colleagues, which is not always possible. In spite of this hurdle most of them think that they enable their pupils´ participation and that an assessment tool is an important aid that both furthers this and makes assessment easier and more trustworthy.

Bakgrund Sjuksköterskor ansvarar för att bedöma om en patient har smärta, vilket kan vara utmanande om patienten har svårt att kommunicera. För att bidra med mer kunskap kring detta uppfattades ett behov av att undersöka vad sjuksköterskor inom olika verksamheter har för erfarenheter kring att bedöma smärta hos dessa patienter och deras tankar kring smärtskattning som omvårdnadsåtgärd. Syfte Syftet med studien var att belysa sjuksköterskors erfarenheter kring smärtskattning av patienter med nedsatt förmåga att kommunicera. Metod Semistrukturerade intervjuer genomfördes med sjuksköterskor inom olika verksamheter i Umeå och analyserades med kvalitativ innehållsanalys. Resultat Vi identifierade erfarenheter som sammanställdes inom åtta olika kategorier fördelade på fyra domäner. Centrala iakttagelser är att smärtskattning bör ske med välfungerande metoder och att smidiga rutiner för deras användning är viktiga. Det behövs mer kunskap om smärtskattning för att kunna komplettera de erfarenheter som finns. För att förbättra kvaliteten bör likaså hänsyn tas till nackdelar med alltför stela arbetssätt för att inte den personliga kunskapen och viljan ska gå förlorad. Likaledes behöver verktygen förbättras. Slutsats Smärtskattning är ett komplext ämne. Sjuksköterskorna som idag utför smärtskattning på olika sätt anser att välfungerande, enkla verktyg tillsammans med fungerande lokala rutiner kring deras användning skulle kunna förbättra omvårdnaden i många fall. / Background Nurses are responsible for pain assessment in patients, a challenging task if the patient has a communicative impairment. To contribute to more knowledge regarding the present situation we identified a need to study nurses’ experiences regarding assessment of pain among these patients, and their thoughts around pain assessment as a nursing method. Aim The aim of the study was to illuminate nurses’ experiences of pain assessment in patients with impaired ability to communicate. Method Semi-structural interviews were conducted with nurses within different health care settings in Umeå. They were interpreted using a qualitative content analysis. Results The analysis identified experiences within eight categories in four domains. A central observation is that assessment needs to be conducted with good quality methods and that smooth routines regarding there use is crucial. Deeper knowledge about pain assessment need to complement the nurses’ experiences to improve quality, as well as recognising disadvantages with too strict routines need to be taken into consideration. The assessment tools also need further development. Conclusion Pain assessment is a complex issue. Nurses that are practicing this today reflects the view that well functioning tools together with functional routines regarding their use could help improve nursing in many cases.

Bakgrund: Inom de närmaste åren och i många länder kommer demenssjukdom att fördubblas, vilket betyder att sjuksköterskans kompetens när det gäller smärtbedömning hos personer med demenssjukdom måste öka. Därför är det av stor vikt att sjuksköterskan vet vilka bedömningsinstrument som fungerar att använda hos personer med demenssjukdom och vilka uttryck som är viktigt att uppmärksamma, för att kunna minska lidandet och öka livskvalitén för patienten. Syfte: Studiens syfte var att sammanställa forskningsbaserad kunskap om hur sjuksköterskan kan identifiera smärta hos individer med demenssjukdom. Metod: Studien är en litteraturöversikt där 15 vetenskapliga artiklar inkluderades. Studien har kvalitativa-, kvantitativa- och mixade artiklar. Artiklarna söktes i databaserna PubMed, Web of Science och CINAHL. Resultat: Resultatet visar att det finns många olika smärtskattningsinstrument och smärtuttryck som sjuksköterskan kan använda och observera för att identifiera smärta hos personer med demenssjukdom. Några mätinstrument som visade sig vara användbara var observationsskalorna Doloplus-2, ePAT, PAINAD, PACSLAC och MOBID-2. De smärtuttryck som observerades mest var ansiktsuttryck, kroppsspråk och beteendeförändringar. Slutsats: Det är lättare att se beteendeförändringar hos patienten om sjuksköterskan känner patienten sedan tidigare. Det är viktigt att sjuksköterskan har en god kunskap om vad demenssjukdom är och innebär för att lättare kunna identifiera smärta hos personer med demenssjukdom. / Background: Within the next few years and in many countries, dementia will double, which means that the nurse's competence in assessing pain on people with dementia will increase. Therefore, it is of great importance that the nurse knows which assessment tools are useful for people with dementia and what expressions are important to pay attention to in order to reduce suffering and increase the quality of life for the patient. Aim: The aim of this study was to compile research-based knowledge about how the nurse can identify pain in individuals with dementia. Method: The study is a literature review of which 15 scientific articles were included. The study included qualitative, quantitative and mixed articles. The articles were searched in the PubMed, Web of Science and CINAHL databases. Results: The results show that there are many different pain assessment tools and pain expressions that the nurse can use and observe to identify pain in people with dementia. Some measuring instruments that proved useful for people with dementia were Doloplus-2, ePAT, PAINAD, PACSLAC and MOBID-2. The most painful expressions were facial expressions, body language and behavioral changes. Conclusion: It is easier to see behavioral changes on the patient if the nurse is aware of the patient earlier. It is important that the nurse has a good knowledge of what dementia is and means to more easily identify pain in people with dementia.