Thesis--University of Minnesota. / Photocopy of typescript. Ann Arbor, Mich. : University Microfilms International, 1977. -- 21 cm. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves [119]-125).

Thesis (Ph. D.)--University of Washington, 2003. / Vita. Includes bibliographical references (leaves 223-231).

SAMMANFATTNING Bakgrund Malnutrition är ett globalt problem i både industri- och utvecklingsländer. Svenska studier genomförda under 2000-talet har påvisat att drygt var fjärde patient i slutenvården är malnutrierad. Vårdgivare är ansvariga att identifiera malnutrierade patienter och de som löper risk för malnutrition. Punktprevalensmätningen Dagen nutrition utförs årligen på Akademiska sjukhuset. Under ett dygn registreras inneliggande patienters nutritionsstatus för att utvärdera uppsatta nutritionsmål. År 2013 samt 2014 registrerades data på ca 60 % av patienterna. Orsaken till att registreringar inte genomfördes på alla aktuella patienter är inte kartlagt.   Syfte Att få fördjupad kunskap om involverad personals syn på varför alla aktuella patienter inte deltog i punktprevalensmätningen Dagen nutrition åren 2013 och 2014. Syftet var även att belysa förutsättningar som kan bidra till att öka patientdeltagandet i framtiden.   Design Kvalitativ metod. En deskriptiv studie med induktiv ansats. Datainsamlingen skedde genom semistrukturerade intervjuer.   Resultat Orsaker till att patienter inte deltog eller att resultatet från Dagen nutrition uteslöts var bristfälligt ifyllda registreringslistor, samt bristande kunskap och engagemang hos personalen. Respondenterna ansåg att delat ansvar, väl genomfört förarbete, personalengagemang samt avsatt tid skulle kunna öka patientdeltagandet. De belyste även vikten av utbildning och information. Det skriftliga informationsmaterialet ansågs vara svårtillgängligt. Respondenterna föredrog muntlig information framför webbaserad utbildning. De efterfrågade även återkoppling av resultatet från Dagen nutrition samt förbättringsförslag till avdelningarna.   Slutsats Ofullständiga registreringslistor samt bristande kunskap och engagemang hos personalen orsakade att alla aktuella patienter inte deltog eller uteslöts från Dagen nutrition. Respondenterna ansåg att det kan vara möjligt att öka patientdeltagandet om föreslagna åtgärder vidtas. / ABSTRACT   Background Malnutrition is a global health problem occurring in both industrialized and developing countries. Swedish studies conducted in the 21st century show that more than one in four inpatients are malnourished. Caregivers are responsible to identify the malnourished patients, and those at risk of malnutrition. The point prevalence survey Dagen nutrition, is performed annually at Uppsala university hospital. During one day inpatients' nutritional status is recorded in order to evaluate the set goals regarding nutrition. In 2013 and 2014 data was recorded on approximately 60 % of the patients. The reason why data wasn’t registered among all viable patients was not investigated.   Aim To gain in-depth knowledge in involved personnel´s views on why all viable patients did not participate in the point prevalence survey Dagen nutrition in the years 2013 and 2014. An additional aim was to highlight conditions which may contribute to increase patient participation in the future.   Design A qualitative design. A descriptive study with an inductive approach. Data was collected through semi-structured interviews.   Findings The reasons why patients did not participate or that the results from Dagen nutrition were excluded was inadequately completed forms and that the personnel lacked knowledge and engagement. According to the respondents a shared responsibility, well performed prepar-atory work, personnel engagement and dedicated time could improve the potential to increase patient participation. Moreover the respondents emphasised the importance of education and information. The written information was experienced as hard to understand. The respondents preferred oral information rather than web-based training. They also requested feedback on the results from Dagen nutrition along with suggestions for improvement to pass on to the wards.   Conclusions Inadequate filled out register forms and lack of knowledge and engagement among the personnel caused lack of participation and exclusion in Dagen nutrition among the viable patients. The respondents thought that it is possible to increase patient participation through suggested active measures.

One challenge in the Western world is the risk of functional impairmentand chronic disease accompanying older age. In Norway it is expected thatmost chronically ill older persons will continue to live at home and receivehelp from home nursing care. The inner strength of the oldest old, as seenin relation to the help that is given, and whether the help has contributed tostrengthen the will to live has been explored only to a limited extent.Meaning in life and daily routines can be related to the will to live,understood as enjoying life and having the courage to live. The aim of thisstudy is to develop knowledge in regard to chronically ill oldest olderpersons and the possibilities and limitations in their will to live when theyreceive help from home nursing care.This study uses the quantitative method (n=120, Article 1 and Article 2) todescribe the characteristics of inner strength using the questionnairesResilience Scale, Sense of Coherence Scale, Purpose in Life Test, and Self-Transcendence Scale. Inner strength was seen in relation to mental andphysical health using the questionnaire SF-36. The qualitative method wasused to illuminate how the oldest older persons experienced living at homewith chronic illness (n=13, Article 3) and receiving help from home nursingcare (n=11, Article 4). The participants in this study were 80 years old orolder, living at home with chronic illnesses, and receiving help from homenursing care. All participants were determined to have the mental capacityto take part in this study.The analysis showed in Article 1 that the oldest old had an inner strengthexpressed as ”sense of coherence” and ”purpose in life.” Their innerstrength was accompanied by the ability for self-transcendence. Mentalhealth was predicted by self-transcendence (p < 0.001) for the total sampleand for women. Physical health was predicted by self-transcendence (p <0.01) for the total sample. Low resilience contributed to vulnerability for theparticipants. They were vulnerable in terms of limited perseverance, selfreliance,and existential aloneness (Article 2). On the contrary, theyexperienced equanimity and meaning. Meaning in daily life (Article 3)sometimes meant feelings of insufficiency and dependency. In contrast,they also experienced joy in life, gratitude for living at home, and aneagerness to participate in activities that made them feel alive. Theyexperienced both good and bad days, which depended on their illness butwas also based on how their needs for help and support were met. InviiArticle 4, receiving help indicated different experiences. Being ill anddependent on help led to days with illness, treatment, and receiving care. Italso indicated they were in need of professional help. Receiving help couldmean being at the mercy of helpers, which could imply unworthy help, asthey had no influence on the help they got from incompetent nurses whofocused only on tasks, with limited flexibility in their work, using theirhomes as a working place. This situation of receiving help from busynurses caused the old person to feel inferior as a human being. Other timesit meant receiving help from nurses who took care with respect to the oldperson and confirmed him or her as a human being. The older personswanted to be seen, met, and supported to strengthen their courage to meetthe challenges of being old and ill.According to the ethics of caring, human beings are vulnerable andmutually dependent on each other. This influences the possibilities andlimitations of ”the other” in experiencing a will to live. ”Receiving theother” can contribute to the will to live, influenced by the help received inan asymmetric dependency in which the nurses are caught in the tensionbetween suffering and the will to live for the oldest older person in need ofhelp. In this tension, the will to live is dependent on help that is given in arelationship characterized by caring and responsibility for the other.

The quality of care in nursing homes has generally improved since the implementation of the OBRA-1987; however reports of serious problems such as inadequate pain management, pressure sores, malnutrition, and urinary incontinence persist. While the primary concern remains lack of staffing, investigators have found that even the highest staffed nursing homes are deficient in some care processes. It has been suggested that a lack of effective management structure may be a contributing factor. There is theoretical and empirical evidence to suggest that effective management structure is best guided by the complexity of work performed by the organization. The purpose of this study was to develop a reliable and valid instrument to measure nursing care complexity in nursing homes. Items were developed based on a comprehensive review of the literature and the adaptation of items from existing instruments to make them relevant to the nursing home setting. Content validity was evaluated by nurse experts with extensive knowledge of the theory and/or nursing home care. One hundred sixty-eight direct care providers from seven nursing homes located in central and southern Arizona participated in the study.Reliability was estimated using Cronbach's alpha. Reliabilities using individual level data were generally acceptable for a new scale, however, the alpha for the client technology subscale was low (total scale = .78, client technology = .65, operations technology = .78, and knowledge technology = .79). Exploratory factor analysis demonstrated three domains of nursing care complexity as conceptualized. Explained variance for the 3 factors was 36.19%. There was a very modest correlation of the instrument with an established instrument of work unit technology and a modified magnitude estimate of nursing care complexity. One subscale (knowledge technology) discriminated between nursing subunits in the nursing home.The instrument demonstrated modest psychometric properties in measuring nursing care complexity in nursing homes. The strength of the instrument is its ability to measure domains of work complexity based on theory from organizational and nursing science. Further investigation is needed to strengthen the psychometric properties of the instrument and to determine its usefulness in measuring nursing care complexity in nursing homes.

Statistik visar att av alla kvinnor i Sverige som föder barn, har minst 21 % också genomgått missfall. Ett missfall väcker många olika känslor hos de par som berörs, såsom förlust, sorg, skuld, oro och existentiella funderingar. Missfall kan innebära en traumatisk upplevelse för alla berörda och sjuksköterskans roll att stödja och tillgodose parets behov är central för att säkra såväl fysisk som psykisk återhämtning. Sjuksköterskorna behöver identifiera det individuella behovet och vidta lämpliga omvårdnadsåtgärder för att hjälpa paret under denna tid. Litteraturstudiens syfte var att belysa sjuksköterskors omvårdnadsåtgärder i samband med missfall. I denna litteraturstudie av 13 vetenskapliga artiklar framkom följande begrepp enligt VIPS-modellen som kan användas: information/undervisning, stöd, skötsel, smärta/sinnesintryck, observation/övervakning, läkemedelshantering, psykosocialt och samordning. Ett annat bra redskap för sjuksköterskor är Swansons omvårdnadsteori, som ger insikt i optimala omvårdnadsåtgärder vid missfall och som kan integreras i VIPS-modellen. Sjuksköterskan behöver få ökad kunskap om missfall för att kunna möta parets behov av omvårdnad med ett holistiskt synsätt och säkra såväl fysisk som psykisk återhämtning.  Därför behövs vidare forskning för att utveckla sjuksköterskans omvårdnad vid missfall. / Statistics indicate that at least 21 % of all women in Sweden who give birth to a child also have experienced a miscarriage. A miscarriage evokes many different emotions for affected couples such as loss, grief, guilt, anxiety and existential reflections. Miscarriage can be a traumatic experience for all parties involved and the role of nurses in supporting these needs is pivotal in ensuring a physical and psychological recovery. Nurses are required to identify the needs of individuals and apply the appropriate nursing intervention to support families during this time. The purpose of the literature review was to illustrate the nursing interventions provided by nurses when women suffering of miscarriages. This literature review on 13 scientific articles illustrated the following concepts used in the VIPS-model to source appropriate information, referrals or assistance: information/education, support, care, pain/sensory impression, observation/supervision, medical management, psychosocial and coordination. Another useful tool for nurses is Swanson’s theory of caring which offers insight on optimal nursing practices during the event of a miscarriage which may be integrated in the VIPS-model. The nurses need to gain increased knowledge of miscarriage to be able to take a holistic approach to the care required to ensure recovery both physically and psychologically. Therefore more research is needed to develop nursing care when women suffering of miscarriage.

Bakgrund: En stomi är en konstgjord öppning på buken som tillåter kroppsvätskor att tömmas ut. De vanligaste orsakerna till stomioperationer är tumörsjukdomar, inflammatoriska sjukdomar och medfödda missbildningar. Att bli stomiopererad innebär en stor händelse i en patients liv. Psykiska påfrestningar, förlust av kroppsfunktion, förändringar i personlig hygien och avsmak för stomin är affekter som kan uppstå till följd av stomioperationen.  Syfte: Syftet med denna litteraturstudie var att belysa patienters upplevelser av att leva med stomi. Metod: I litteraturstudien har elva kvalitativa studier sammanställts och analyserats utifrån metoden innehållsanalys. Sökningar av artiklar utfördes i databaserna CINAHL, PubMed och PsycINFO.   Resultat: Under analysen identifierades tre huvudkategorier med totalt elva underkategorier.  Huvudkategorin ”Anpassning och acceptans” innehåller underkategorierna ”Svårigheter till acceptans”, ”Lättnad för att ha överlevt”, ”Minskade symtom av sjukdom” och ”Det nya livet”.  Den andra huvudkategorin ”Stöd och information” inrymmer underkategorierna ”Att möta andra personer med stomi”, ”Familj och närstående” och ”God och bristande information”. ”Självbild och intimitet” som utgör den tredje huvudkategorin innehåller ”Sänkt självkänsla”, ”Kroppen förändrad”, ”Sex och närhet” och ”Påverkan på relationer”.   Konklusion: Litteraturstudiens resultat visar att patienters upplevelser av att leva med stomi innebar olika former av anpassning. För att förbättra omvårdnaden av dessa patienter krävs det att sjuksköterskan praktiserar personcentrerad vård för att uppmärksamma deras individuella behov och upplevelser av sin unika situation. / Background: A stoma is an artificial opening in the abdomen which allows body fluids to be discharged. The most common reasons for ostomy surgeries are tumor diseases, inflammatory diseases and congenital malformations. Ostomy surgery is a critical moment in a patient’s life. Psychological stress, loss of bodily function, changes in personal hygiene and a feeling of disgust towards the stoma are affections which may arise as a result of ostomy surgery.     Aim: The purpose of this study was to highlight patients’ experiences of living with a stoma.  Methods: In this literature study eleven studies were compiled and analysed based on the content analysis method. Articles were searched for in the CINAHL, PubMed and PsycINFO databases.  Results: Three main categories and eleven subcategories were identified through analysis. The main category “Adaptation and acceptance” contains the subcategories “Difficulties to acceptance”, “Relief for survival”, “Reduced symptoms of disease” and “The new life”. The other main category “Support and information” includes the subcategories “Meeting others with a stoma”, “Family and relatives” and “Good and poor information”. The third main category “Self-image and intimacy” contains “Lowered self-esteem”, “The changed body”, “Sex and intimacy” and “Impact on relationships”.  Conclusion: The results of the literature study show that patients’ experiences of living with a stoma imply different forms of adjustment. In order to improve the nursing care of these patients, person centred care is required from the nurse to highlight the individual needs and experiences of the patients’ unique situation

Bakgrund: MRSA är i dagens samhälle ett globalt problem. Denna bakterie producerar ett enzym, vilket gör en del antibiotiska läkemedel verkningslösa. Flertalet MRSA-infekterade patienter upplever negativa känslor till följd av infektionen. Dessa tros orsakas av bristande kunskap hos både sjuksköterskor och patienter.Syfte: Syftet med denna litteraturstudie var att belysa patienters upplevelser och erfarenheter av att vara MRSA-infekterad.Metod: I litteraturstudiens resultat har 9 artiklar med kvalitativ ansats sammanställts. Dessa har analyserats med inspiration från det beskrivande metasyntestänkandet. Databaserna Cinahl, Medline, Pubmed och Scopus användes vid sökning av artiklar.Resultat: Patienternas upplevelser vid en MRSA-infektion var komplexa. Känslor av skuld, stigmatisering och att vara smittsam återkom upprepade gånger. Varierande kunskapsnivåer beträffande MRSA påvisades också hos patienterna. Anpassningen till infektionen upplevdes ofördelaktigt påverka möjligheten till ett normalt liv. Information erhållen från vården ansågs otillräcklig och vårdpersonalen upplevdes även agera oprofessionellt i vissa situationer. Konklusion: Ökad kunskap och förståelse för MRSA-infekterade patienter kan bidra till att en god omvårdnad möjliggörs. För att understödja en mer personcentrerad omvårdnad bör eventuellt upplevda skillnader i relation till genus och ålder beforskas. / Background: MRSA is a global problem in today's society. This bacterium produces an enzyme, making some antibiotic drugs ineffective. Most patients infected with MRSA experience negative emotions as a result of the infection. The lack of knowledge of both nurses and patients are believed to be causing these emotions. Aim: The purpose of this literature review was to illuminate patients' perceptions and experiences of being infected with MRSA. Method: 9 articles with a qualitative approach have been compiled in this review. These have been analyzed with inspiration from descriptive meta-synthesis method. The search for articles was performed in the databases of Cinahl, Medline, PubMed and Scopus. Results: The result shows that patients' perceived the MRSA infection as complex. Feelings of guilt, stigma and being contagious recurred repeatedly. Varying levels of knowledge regarding MRSA were also detected. Adaptation to the infection was perceived as an unfavorably affect to the possibility of a normal life. Information obtained from the care was considered inadequate and nursing staff were experienced to act unprofessional.Conclusion: Increased knowledge and understanding of patients' infected with MRSA can make a good healthcare possible. Any perceived differences in relation to gender and age should be further studied in order to contribute a more person-centered healthcare.

Burns are common in low- and middle income countrie ssuch asTarzania and firerelated deaths are numerous in Africa compared to high income countries in Europe. The nurse's primary professional responsibility is to require nursing care to people. Nursing care for burned patients is important and demands knowledge. Nurses in Tanzania experience difficulties in their daily work in terms of heavy workload and lack of material. Transcultural nursing aims to see care, health and illness from a cultural perspective and the goal is to provide competent care to people in different cultures. The purpose of the study was to illuminate how nurses in Tanzania take care of patients with burns.The study was implemented at the hospital Kilimanjaro Christian Medical Centre in Moshi,Tanzania. A qualitative method was used;participating observations of nine nurses were carried out. The field notes were analyzed by content analysis and gradually two themes appeared; preventing infections and meeting the patient.The conclusion was that nursing care meant collaboration with the relatives, a calm and low stress atmosphere and concems about the patients' integrity. Difficulties experienced in the nurse's daily work were lack of time and material, but despite this the nurses wanted to improve the care of the burned patients in order to reduce the risk of infection. An interesting finding was that normally no contact was created between the nurse and the patient. Overall the lasting impression was that nursing care must be seen and understood in the cultural context. / <p>Röda Korsets sjuksköterskeförening stipendium 2010</p>

Background: Pressure ulcers are related to reduced quality of life for patients and high costs for health care. Guidelines for pressure ulcer prevention have been available for many years but the problem remains. Aim: The overall aim of this thesis was to investigate hospital setting factors that are important to the performance of pressure ulcer prevention and to evaluate an intervention focused on implementing evidence-based pressure ulcer prevention. Methods: Four studies with a qualitative and quantitative approach were conducted.  Registered nurses’ performance of pressure ulcer prevention for patients at risk was investigated. Factors related to pressure ulcer prevention at different levels in hospital organizations were examined (hospital and ward type, workload, and nurse staffing) in two hospitals. A quasi-experimental study evaluated the effects of an intervention focusing on pressure ulcer prevention and a descriptive study with interviews examined nurses and first-line managers’ experiences of this intervention. Results: All of the studies show that quality improvement was needed for patients at risk of pressure ulcer. Registered nurses attention to pressure ulcer prevention was low and the caring culture of the wards ranged from organized work to unorganized work. Factors related to pressure ulcer prevention were patients’ age (risk and skin assessment) and patients’ risk (skin assessment, pressure reducing mattresses and planned repositioning), type of hospital (university and general), and ward (geriatric, medical, and surgical). Nurse staffing and workload played a minor role. Significantly more patients received pressure ulcer prevention after the intervention. Important factors for improvement were the support nurses and managers received by external and internal facilitators. Another important factor was interpersonal communication on the care provided by the nurses and first-line managers. Conclusion: Quality improvement regarding evidence-based pressure ulcer prevention was needed. Factors associated with pressure ulcer prevention were related to all levels in the hospital settings. A comprehensive intervention showed statistically significant improvement in the care. Interpersonal communication among the staff based on quality measurements was the key factor. Managers from the micro- to the macro-level have to know the conditions for pressure ulcer prevention and, given their position, ensure that the necessary prerequisites are in place.