Thesis (Msc.(Med.)(Pharmacy))--University of Limpopo, 2010 / Background Information regarding disease epidemiology, treatment options and emerging infections and resistance constantly challenge the knowledge of the health care practitioner. Antibiotic prescribing patterns was identified by the Dr George Mukhari hospital antibiotics committee as an area of concern. Due to this concern it was decided to investigate the prescribing patterns in adult patients with meningitis admitted to the internal medicine wards at Dr George Mukhari hospital. Objectives To determine the current antimicrobial prescribing patterns in adult patients diagnosed with meningitis, to record the causative organisms and sensitivity patterns, to record the outcom e, cost and length of treatment. Method Patient and prescriptions data were recorded prospectively on specially designed data sheets from five internal medicine wards for four months (May to August 2008). Patients were followed until discharged. Results Sixty-six patients were enrolled; 41 recovered, 22 died, 2 refused treatment and 1 absconded. Ceftriaxone was prescribed the most frequently and was administered to 58 patients; four patients with confirmed cryptococcal meningitis received amphotericin B IVI, three patients were started on iv Rifafour® for suspected tuberculosis meningitis and one was started on cefuroxime. Specimens from only 22 patients were sent for culture and sensitivity tests; ten were positive for yeast-like organisms, three for S pneumoniae and one for N meningitides and tuberculosis respectively. The average duration of treatment of patients with meningitis was 9.2days. The total cost of antiinfectives used for treatment of meningitis amounted to R111, 292.53 and the average cost per patient was R1 686.25. The cost of all medicines prescribed for the 66 patients amounted to R116, 490.43. Conclusion Ceftriaxone was used frequently as empiric therapy. Specimens for culture and sensitivity were not sent routinely. Therefore it was difficult to monitor and observe any resistance patterns and to contain cost of treatment.

Clinical neuropsychologists assess the cognitive functioning of individuals with a wide range of psychiatric and neurological disorders. They provide feedback to patients that include both conclusions about their diagnosis and prognosis, as well as specific recommendations related to improving their everyday functioning. Despite the importance of this part of the assessment, there has been limited research on the types of recommendations that are provided to patients. The study surveyed 309 clinical neuropsychologists who work with adult patients to address this open question. The results from this research can be used to improve the lives of patients and their family members by informing best practices for what recommendations clinical neuropsychologists should give to patients with specific concerns.

The cornerstone in the fight against HIV/AIDS is prevention followed by the access to and use of highly active antiretroviral treatment (HAART). Adherence is the greatest patient- enabled predictor of treatment outcome for the patients on HAART, as good adherence leads to a decrease in disease progression and death. There is no ‘gold standard’ in the measurement of adherence. Also, factors that influence adherence and hence the prevalence of adherence differ across different settings making it necessary to determine local adherence prevalence as well as factors that might impact on it. This was a cross sectional study which assessed the prevalence of one- week adherence to antiretroviral therapy at St Rita’s hospital through an abridged version of the questionnaire developed by the Adult Aids Clinical Trials Group in the United States. Results from the questionnaires were compared to the results from a decrease in plasma viral load to undetectable limits within six months. The study found out that the prevalence of one- week adherence by self-report was 96.8% (95% CI: 93.2 – 98.9%). Using a decrease in viral load to undetectable limits within six months of initiating treatment as a tool to assess adherence, the prevalence in this study was 96%. A combined prevalence of 94% was found for this study. These results were identical to a few results locally but it was much higher than most local studies. The explanation for this apparent higher adherence rate might be that the study site has not reached its maximum capacity for the delivery of service as it is still operating at just below the staff/patient ratio recommended by the Department of health. The study also found out that being a member of an AIDS support group was a facilitator to adherence while lack of adherence counselling and monitoring is a barrier. Based on these findings it is therefore recommended that measures should be put in place to ensure improving existing adherence counselling and monitoring, encouraging patients to belong to at least one AIDS support group, more decentralization of antiretroviral therapy roll out to the districts that are yet to roll out and providing financial assistance through improved access to disability grants for those who qualify and income generating activities for the unemployed that do not qualify for disability grant.

Mental capacity is the ability to understand, reason, and exercise choice by making informed decisions. Acute and/or critical illness may impact upon the decision making abilities of hospitalised adult patients. Assessment of patients for reduced, fluctuating or absent capacity gives the healthcare team the legal authority to assess best interests and to make treatment decisions without consent under this justification. Qualified nurses are the everpresent professional group in acute and critical care settings. They may initiate assessments of mental capacity which may be influential in the ways that the decision making of patients is facilitated or substituted. There are, however, few studies that focus on processes employed by them in this area in fast-moving clinical settings, although it is recognised that physical illness may have a significant impact upon capacity status.

Background: Depression is one of the most common illnesses in the world, which today affects 280 million people globally. Depression occurs at all ages and is the largest group of mental illnesses linked to suicide. Women and the elderly are the most prone to depression. Depression is considered a public disease and is a complex disease with many aspects that influence its course and onset. The research indicates that the care of depressive patients can be deficient and lead to patient suffering and mistrust of the healthcare system. Furthermore, previous research shows that there is a lack of patients' perceived experiences of depression. In order to improve patients' treatment results, it is important to gain more understanding of depressive patients by allowing their point of view to take a greater place. Aim: The aim was to describe adult patients' experiences of living with depression. Method: A structured literature study with a focus on qualitative research containing seventeen scientific articles that were analyzed thematically in accordance with Braun and Clarke's content analysis. Results: Two main themes and five subthemes were identified. The first main theme was Malaise with the subtheme Emotional experience and the subtheme Experiences of physical discomfort. The second main theme were Social aspects with the subtheme The social self-image, the subtheme Experiences of coping strategies and the subtheme Experiences of healthcare. Conclusion: Depression has a significant impact on the life of the sufferer. The disease entails a wide range of emotional and physical ailments that cause the depressive patient to feel unwell. The disease entails a changed self-image that causes suffering and affects social aspects in the patient's life. Coping strategies affect everyday life and have an effect on the patient in social contexts. Experiences with healthcare affected patients' depression. Specialist nurses have a central role in care and, with the help of nurturing communication, they can instill vitality and hope in the depressive patient. By gainingan increased understanding of the patient's malaise and social aspects surrounding the depressed patient, specialist nurses can identify symptoms of depression in good time and provide more empathetic care.

Bakgrund: Diabetes typ 2 (DMT2) står för majoriteten av all diabetes i Sverige som internationellt, vilket har satts i samband med vår moderna livsstil, minskad fysisk aktivitet och en tilltagande ökning av kroppsvikt. Orsaken kan t.ex. relateras till patientens ärftliga betingad eller individens levnadsvanor. Egenvård är viktig för att förebygga eller minska senkomplikationer. Syftet: Syftet med det föreliggandeexamensarbetetvar attbeskriva vuxna patienters erfarenheter av egenvård vid DMT2samt granska datainsamlingsmetoder och urvalsgrupp använts i artiklarna.  Metod: Litteraturstudieutfördes med en beskrivande design där sammanfattas 12 kvalitativa artiklar. Huvudresultat:Patienter hade positiv inställning livsstilsförändringar och började ta ansvar för sin egenvård. En del patienter hade svårigheter att ta till sig kunskaper och tillämpa dessa i sin egenvård, arbetssituation påverkad, låg inkomst och en känsla av utanförskap både från hemmet och omgivningen. En del av patienter upplevde socialt stöd från familj och närstående samt hade god kontakt med vården.  Slutsats:Föreliggande examenarbetevisade att patientens levnadssituation, relation till sin omgivning måste sättas i centrum. Patienten möjlighet att få en vårdkontakt förbättras, med syfte att ge individanpassad kunskap, motivera och ge mer tid. Vidare forskning bör undersöka familjens förhållningssätt till personen som har DMT2 för att få en djupare förståelse om vad familjen kan göra för att skapa en holistisk syn.  Nyckelord: DMT2, Egenvård, Erfarenhet, Vuxna patienter / Background:Diabetes type 2 (DMT2) accounts for the majority of all diabetes in Sweden as well as global, which has been associated with our modern lifestyles, reduced physical activities and an increase in body weight. Causes can be, for example, related to the patient's hereditary condition or the individual's living habits. Self-care is important to prevent or reduces the late complications. Aim: The aim of the present thesis was to describe adult patients’ experiences of self-care with DMT2 and examine the data collection methods and sample group used of the articles. Methods: A literature study was conducted with a descriptive design summarizing 12 qualitative articles. Main result: Patients had positive attitude to lifestyle changes and began taking responsibility for their self-care. Some patients had difficulty in acquiring knowledge and applying them for their own care, affected in work situation, weak income and a sense of alienation both at home and surrounding. Some of patients experienced social support from family and close relatives and had good contact with healthcare. Conclusion: The present study shows that the patient's living situation, relationship with his surrounding, must be placed at the center. The patient possibilities for care contact should be improved in order to give him individualized knowledge, motivate and give more time.  Further research should investigate the family's approach to the person with DMT2 to gain a deeper understanding of what the family can do to create holistic view. Keyword: Adult patients,DMT2, Experience, Self-care,

Bakgrund: Inom den svenska vuxenpsykiatriska vården vårdas en del av patienterna under tvång. För att förbättra tvångsvården krävs en förståelse för patienternas upplevelser under vårdtiden. Syfte: Syftet med denna litteraturstudie var att beskriva hur patienter inom psykiatrisk slutenvård upplever och påverkas av tvångsvård. Metod: En litteraturöversikt med kvalitativa originalartiklar. Efter sökningar i databaserna PubMed, Cochrane och Cinahl har 10 artiklar valts ut för analys. Teoretisk referensram var Katie Erikssons omvårdnadsteori. Resultat: Sammanställningen av resultatet visade på gemensamma nämnare i samtliga artiklars resultat. En positiv upplevelse av tvångsvård kräver kompetent och ödmjuk personal som håller patienten informerad under hela vårdtiden samtidigt som personalen är ett stöd för patienten genom att visa respekt och förståelse. Patienter som har vårdats under tvång har samtliga resultat mer eller mindre upplevt någon form av negativ känsla kring vården. Upplevelser av kränkning av patientens integritet eller människovärde som i sin tur leder till ett försämrat mående gick att se i majoriteten av resultaten. Slutsats: Hur man som patient upplever och påverkas av tvångsvård i Sverige är individuellt och både upplevelsen och resultatet av vården är unikt för varje patient. Samma typ av vård kan ibland ge motsägelsefulla resultat mellan olika patienter. Oavsett upplevelse och resultat, finns dock vissa gemensamma nämnare som kan vara avgörande för patienternas upplevelser. Som sjuksköterska har man stora möjligheter och ett ansvar att påverka patientens vård till det positiva, bland annat genom att ge personcentrerad vård, vara lyhörd, engagerad och göra patienten delaktig i sin vård. / Introduction: In the Swedish psychiatric care for adults, some patients are treated under coercion. To improve the coercive care, there is a need for understanding the patients’ experiences during treatment. Aim: The aim of this literature review was to describe how patients in the Swedish psychiatric coercion care experienced their care and how they were affected by it. Methods: A literature review with qualitative original articles. After searches on the databases PubMed, Cochrane and Cinahl, 10 articles have been chosen for analysis. Framework of reference was Katie Erikssons theory of nursing. Results: The compilation of the results showed several similarities in all the articles’ results. A positive experience of coercion care requires qualified and humble staff that keep the patients informed during the entire treatment and at the same time supports the patient by showing respect and understanding. Patients who have been admitted to coercion care has in all the results more or less experienced some form of negative feelings about the care. Experiences of violation of patient privacy or dignity, which in turn leads to deterioration in health could be seen in the majority of the results. Conclusions: How the patient perceives and is affected by coercion care in Sweden is individual and both the experience and outcome of care is unique to each patient. The same type of care can sometimes provide contradictory results between different patients. Regardless of the experience and the results, however, some common denominators can be crucial to patients’ experiences. As a practicing nurse, there is great opportunity and responsibility to influence the patients’ care to be positive, for example by providing person-centred care, being responsive, committed and make the patient involved in their own care.

abstract: Greater than half of older adults who are admitted to an acute care setting experience delirium with an estimated cost between four to twenty billion dollars annually in the United States. As a strategy to address the gap between research and practice, this feasibility study used the Roy Adaptation Model to provide a theoretical perspective for intervention design and evaluation, with a focus on modifying contextual stimuli in a Trauma Intensive Care and a Trauma Orthopedic Unit setting. The study sample included older hospitalized patients in a Trauma Intensive Care and a Trauma Orthopedic setting where there is a greater incidence for delirium. Study participants included two groups, with one group assigned to receive either a music intervention or usual care. The music intervention included pre-recorded music, delivered using an iPod player with soft headsets, with music self-selected from a collection of music compositions with musical elements of slow tempo and simple repetitive rhythm that influence delirium prevention. For the proposed study a music intervention dose included intervention delivery for 60 minutes, twice a day, over a three day period following admission. Physiologic variables measured included systolic blood pressure, diastolic blood pressure, heart rate, and respiratory rate, which were electronically monitored every four hours for the study. The Confusion Assessment Method was used as a screening tool to identify delirium in the admitted patients. Specific aims of this feasibility study were to (a) examine the feasibility of a music intervention designed to prevent delirium among older adults, and (b) evaluate the effects of a music intervention designed to prevent delirium among older adults. Findings indicate there was a significant music group by time interaction effect which suggests that change over time was different for the music and usual care group. / Dissertation/Thesis / Doctoral Dissertation Nursing and Healthcare Innovation 2015

Bakgrund: Sömn är ett grundläggande behov som bidrar till fysisk och psykisk återhämtning. Miljömässiga och emotionella faktorer, som ofta återfinns i sjukhusmiljö, kan bidra till negativ inverkan på sömnen. Påverkad sömn kan leda till komplikationer vilket är ett problem då patienter är i större behov av sömn relaterat till ohälsa. Sjuksköterskan har en betydande roll i att främja sömnen för patienter. Syfte: Att beskriva omvårdnadsåtgärder vid sömnbesvär hos vuxna patienter på vårdavdelning i sjukhusmiljö. Metod: En litteraturstudie baserad på 15 vetenskapliga artiklar. Resultat: Tre huvudkategorier och tolv subkategorier av omvårdnadsåtgärder framkom. Huvudkategorierna var miljöanpassning, avslappning samt sömnfrämjande rutiner. Slutsats: Sömn är betydelsefullt, framförallt för patienter. Flertalet omvårdnadsåtgärder kan tillämpas för att främja sömn. / Background: Sleep is essential to humans regarding physical and psychological recovery. Environmental and emotional factors can disrupt sleep and these factors are common in hospital environment. Disrupted sleep can result in complications to the patient which is a problem because patients are in greater need of sleep due to their illness. Nurses have an important role to enhance the patients’ sleep. Aim: To describe nursing interventions on sleep disruption among adult inpatients. Method: A Literature review based on 15 science articles. Results: Three major categories and twelve subcategories of nursing interventions were identified. The major categories were; adjustment of the environment, relaxation and sleep promoting routines. Conclusion: Sleep is essential, especially to patients. Several nursing interventions could be applied to enhance sleep.

Bakgrund: Fetma är ett växande problem världen över, som ger en ökad risk för bland annat hjärt-kärlsjukdomar och diabetes typ 2. Fetmans uppkomst påverkas av olika faktorer som miljö, genetik och livsstil. Sjuksköterskans uppgift är att ge en jämlik vård med respekt för människors lika värde. Studier visar att personer med fetma undviker vården på grund av rädsla för ett dåligt bemötande.  Syfte: Syftet var att undersöka sjuksköterskors attityder till vuxna personer med fetma.  Metod: Allmän litteraturöversikt med nio kvantitativa och en kvalitativ artikel, vilka hittades genom databassökningar i PubMed, Cinahl complete och PsychInfo. Dataanalysen utfördes i fyra steg enligt Fribergs metod.  Resultat: Fem teman växte fram ur resultatet: Fördomar och stereotypa föreställningar, kunskap om fetmans uppkomst och viktkontroll, attityder relaterade till demografiska faktorer, sjuksköterskornas egen vikt och kroppsuppfattning, attityder i omvårdnadsarbetet.  Sammanfattning: Fetma är en komplex sjukdom som påverkas av en rad faktorer. En förenklad bild av sjukdomens uppkomst leder till mer fördomar. Att medvetandegöra samhällets normer om hälsa och kroppar kan sjuksköterskor upptäcka egna fördomar. Fortbildning kan ge sjuksköterskor en bättre kunskap vilket kan påverka deras attityder. En etisk diskussion rörande individens kontra samhällets ansvar samt påverkbara faktorer är av vikt så att sjuksköterskor sätter upp rimliga mål för patienterna. / Background: Obesity is a growing problem worldwide, which increases the risk of, among other things, cardiovascular disease and type 2 diabetes. The onset of obesity is affected by various factors such as the environment, genetics and lifestyle. The nurse's task is to provide equal care with respect for the equal value of human beings. Studies show that people with obesity avoid care due to fear of poor treatment. Aim: The aim was to describe nurses' attitudes towards adult patients with obesity. Method: General literature review with nine quantitative and one qualitative article, which were found through database searches in PubMed, Cinahl complete and PsychInfo. The data analysis was performed in four steps according to Friberg's method. Results: Five themes emerged from the results: prejudices and stereotypical perceptions, knowledge about factors, causation and weight control of obesity, attitudes related to demographic factors, nurses' own weight and body perception, attitudes in nursing care. Summary: Obesity is a complex disease that is affected by a number of factors. A simplified explanation of the etiology of obesity leads to more prejudice. Awareness about society's norms about health and body images, may help nurses to discover their own prejudices. Education can give nurses more knowledge, which may affect their attitudes. An ethical discussion whether responsibility and controllability is placed on individuals or society is important so that nurses sets reasonable goals for the patients.