Breathing is one of the basic life functions and for its proper functioning it is necessary to have the airways free and clear. One way to maintain free and open airways is the tracheostomy. Tracheostomy may be performed either by surgical or puncture method. Nursing care and its quality in patients with tracheostomy are important factors that can significantly affect postoperative complications, their course and overall clinical outcome of treatment of patients. Sufficiently qualified, knowledgeable and experienced nurse applies her knowledge in practice with a holistic view of the patient and his needs. The theoretical part of the thesis introduces us to the anatomy of the respiratory tract, the history of tracheostomy, individual methods of tracheostomy - surgical versus puncture and nursing care for adult patients with tracheostomy for intensive care. Methods: In the empirical part, the data obtained on the basis of a quantitative survey in the form of a questionnaire will be evaluated. The sample of respondents will be nurses working in the intensive care department for more than 1 year with experience in nursing care for tracheostomy. Aim of the work: Analysis of nurses awareness about different tracheostomy methods - surgical versus puncture, role of nurse in these methods, their experience...

Introduction: Oropharyngeal tumours belong to the most common malignancies situated in the head and neck area. In the past, their incidence has been associated with classical risk factors (smoking and alcohol use). In the recent years, the increase of oropharyngeal carcinomas resulting from HPV (human papilloma virus) infection incidence has been observed. The change of their aetiology also implies a number of clinical differences, the most important being a significantly better survival prognosis in patients with HPV+ carcinomas. Aims: The main goal of this thesis was to characterize correctly patients with oropharyngeal carcinomas and to identify different specifics of nursing intensive care for these patients. Methods: The quantitative prospective study involved 30 patients following their surgical treatment of oropharyngeal carcinoma, hospitalised in an intensive care unit. The patients were divided into 3 groups: HPV+ non-smokers, HPV+ smokers, HPV- smokers. Results: The study confirmed the demographic differences between individual patient groups. The HPV+ non-smokers group is characterized by a lower age in average, which is significantly reflected in a reduced duration of hospital stay. In addition, opioid administration rate, infection rates and postoperative complications incidences are...

<p>The welfare of the elderly population is one of the most important goals of the public health services. At macro level the Swedish National Board of Health and Welfare state that the premier goal is for elderly people to have dignified and comfortable lives. They should have a life with a sense of value and feel confident. These ethical values which are expressed on macro level or as normative ethics are expected to prevail at micro level. In our study the micro level is the caring encounter between the elderly patient, next of kin and nurses. Ethical values and morals are important aspects that influence the quality of care, videlicet in empiric ethics.</p><p>The aim of study (I) was to identify and describe the ethical values experienced by the older person in the daily interaction with nurses in a ward for older people during caring encounters. In study (II) the aim was to identify and describe the governing ethical values that next of kin experience in interaction with nurses who care for elderly patients at a geriatric clinic. Study (I) which was an empirical observational study included follow-up interviews. Twenty-two older people participated voluntarily. In study (II) interviews with fourteen next of kin were conducted. In both studies Constant comparative analysis, the core foundation of grounded theory was used.</p><p>Five categories; Being addressed, receiving respect, desiring to participate, increasing self-determination and gaining self-confidence formed the basis for the core category in study (I): Approaching. Approaching concerns the way people become closer to each other in a physical space .It also includes how people become closer to each other in a dialogue, which involves verbal or bodily communication. Approaching indicates the ethical values that guide nurses in their caring encounters with older people. This ethical value is noted by the older person and has an individual value, as well as leading to improved quality of their care. The older person will be confident and satisfied with the caring encounter if the desired components in the nurse’s approaching are exhibited.</p><p>Four categories were identified in study (II): Receiving, showing respect, facilitating participation and showing professionalism. These categories formed the basis of the core category: “Being amenable”, a concept identified in the next of kin’s description of the ethical values that they and the elderly patients perceive in the caring encounter. Being amenable means that the nurses are guided by ethical values; taking into account the elderly patient and next of kin. Nurses who focus on elderly patients’ well-being as a final principle will affect next of kin and their experience of this fundamental situation.</p>

<p><strong>Bakgrund:</strong> Människan tillbringar en tredjedel av sitt liv i sömn det är ett behov vilket hon inte kan vara utan. Patienter som vårdas på IVA drabbas frekvent av sömnstörningar och därmed sömnbrist. Tidigare gjorda studier tyder på att IVA patienter upplever sömnstörningar som ett stort problem.<strong> Syfte:</strong> Att beskriva sömnförändringar, sömnpåverkande faktorer och sömnförbättrande omvårdnadsåtgärder för IVA-patienter.<strong> Metod:</strong> Databassökning gjordes och nyckelord har identifierats. Studier som inkluderar vuxna patienter som vårdats på en IVA har valts för denna beskrivande litteraturstudie.<strong> Resultat:</strong> IVA-patienter drabbas av fragmenterad sömn uppdelad i korta abnorma perioder. Sömnen påverkas av mänsklig intervention, diagnostiska tester samt miljöbetingad ljus och ljud. Minskning av ljud- och ljusnivån samt sammanhängande vilotid utan intervention var de främst undersökta sömnfrämjande omvårdnadsåtgärder i de granskande artiklarna.<strong> Slutsats: </strong>Alla IVA-patienter upplevde störd sömnrytm. I vilken utsträckning sömnrytm stördes berodde på ålder, sjukdom, erfarenhet av IVA-vård och respiratorvård. Omvårdnadsåtgärder som planerad vilotid, sänkningar av ljud och ljus förbättrade sömnmönstret och skapade möjlighet till förbättrad sömn.</p>

Many patients with an aneurysmal subarachnoid haemorrhage (SAH) exhibit difficulties in rehabilitation, even in cases of a good prognosis. The present project investigates this using qualitative methods and standardised outcome measures. Patients with SAH treated at Uppsala University Hospital between 2002 and 2005 with an expected good prognosis were consecutively included. In addition, nurses working with such patients were interviewed. Outcome was assessed in terms of perception of care, psychiatric health, coping and health related quality of life (HRQoL). Qualitative content analyses revealed eight categories, which were divided into two patterns, Confident or Pessimistic perception of recovery, largely on the basis of the presence or absence of depression. Eighty-three patients were assessed by The Structured Clinical Interview for DSM-IV, Axis I (SCID-I). Forty-one percent fulfilled criteria for any psychiatric disorder seven months after SAH and 45 % presented with a history of lifetime psychiatric morbidity. Logistic regressions indicated that a psychiatric history was related to a higher risk of psychiatric problems seven months after SAH, as well as a lower return to work. SAH patients had lower HRQoL than the general Swedish population; almost entirely in the subgroup with a psychiatric history prior to the SAH. Those with a psychiatric history used more evasive, fatalistic, emotive and palliative coping strategies associated with inability to handle illness. Multiple regressions revealed that a psychiatric history and use of coping were independently associated with HRQoL, albeit more in the mental than the physical domains. Qualitative content analyses revealed that nurses viewed patients’ support needs as a process ranging from technological to emotional care. Shortcomings in the communication between nurses in acute and rehabilitation settings on the subject of support were acknowledged. The results underline the importance of early diagnosis of coexisting psychiatric illness and the need for an intact health care chain.

Older people should have a life with a sense of value and should feel confident. These ethical values, which are expressed in normative ethics, are expected to prevail in empirical ethics. Central components of nursing are the ethical issues of autonomy, beneficence, non-maleficence and the principles of justice. The general aim of this thesis is to identify and describe the ethical values that are apparent in the caring encounter and their influence on the people involved. This is done from the perspective of the older person in study (I), next of kin in study (II) and nurses in study (III). In study (IV) the aim was to synthesize the concepts from empirical studies (I- III) and analyze, compare and interrelate them with normative ethics. Studies (I, III) were empirical observational studies including follow-up interviews. Twenty-two older people participated voluntarily in study (I), and in study (III) 20 nurses participated voluntarily. In study (II) fourteen next of kin were interviewed. In studies (I- III) constant comparative analysis, the core foundation of grounded theory, was used. Five concepts were used in the analysis in study (IV); three from the grounded theory studies (I- III) and two from the theoretical framework on normative ethics i.e. the ICN code and SFS law. Five categories; being addressed, receiving respect, desiring to participate, increasing self-determination and gaining self-confidence formed the basis for the core category ‚Approaching‛ in study (I). ‘Approaching’ indicates the ethical values that guide nurses in their caring encounters with older people. These ethical values are noted by the older people and are greatly appreciated by them, and also lead to improved quality of care. Four categories were identified in study (II): Receiving, showing respect, facilitating participation and showing professionalism. These categories formed the basis of the core category ‚Being amenable‛, a concept identified in the next of kin’s description of the ethical values that they and the older patients perceive in the caring encounter. In study (III), three categories were identified: showing consideration, connecting, and caring for. These categories formed the basis of the core category ‚Corroborating‛. Corroborating deals with support and interaction. Empirical ethics and normative ethics are intertwined, according to the findings of this study (IV). Normative ethics influence the nurse’s practical performance and could have a greater influence in supporting nurses as professionals. Criteria of good ethical care according to this thesis are: showing respect, invitation to participation, allowing self-determination, and providing safe and secure care. These criteria are elements of the concept of being professional. Professionalism of nurses is shown by: the approach nurses adapt to the performance of their duties, and their competence and knowledge, but also how they apply laws and professional codes

The welfare of the elderly population is one of the most important goals of the public health services. At macro level the Swedish National Board of Health and Welfare state that the premier goal is for elderly people to have dignified and comfortable lives. They should have a life with a sense of value and feel confident. These ethical values which are expressed on macro level or as normative ethics are expected to prevail at micro level. In our study the micro level is the caring encounter between the elderly patient, next of kin and nurses. Ethical values and morals are important aspects that influence the quality of care, videlicet in empiric ethics. The aim of study (I) was to identify and describe the ethical values experienced by the older person in the daily interaction with nurses in a ward for older people during caring encounters. In study (II) the aim was to identify and describe the governing ethical values that next of kin experience in interaction with nurses who care for elderly patients at a geriatric clinic. Study (I) which was an empirical observational study included follow-up interviews. Twenty-two older people participated voluntarily. In study (II) interviews with fourteen next of kin were conducted. In both studies Constant comparative analysis, the core foundation of grounded theory was used. Five categories; Being addressed, receiving respect, desiring to participate, increasing self-determination and gaining self-confidence formed the basis for the core category in study (I): Approaching. Approaching concerns the way people become closer to each other in a physical space .It also includes how people become closer to each other in a dialogue, which involves verbal or bodily communication. Approaching indicates the ethical values that guide nurses in their caring encounters with older people. This ethical value is noted by the older person and has an individual value, as well as leading to improved quality of their care. The older person will be confident and satisfied with the caring encounter if the desired components in the nurse’s approaching are exhibited. Four categories were identified in study (II): Receiving, showing respect, facilitating participation and showing professionalism. These categories formed the basis of the core category: “Being amenable”, a concept identified in the next of kin’s description of the ethical values that they and the elderly patients perceive in the caring encounter. Being amenable means that the nurses are guided by ethical values; taking into account the elderly patient and next of kin. Nurses who focus on elderly patients’ well-being as a final principle will affect next of kin and their experience of this fundamental situation.

Bakgrund: Bröstcancer är den vanligaste cancerformen bland kvinnor. Många av de drabbade reagerar med starka känslor på diagnosen och behandlingen är tung och ofta obehaglig att ta sig igenom. Kvinnorna behöver stöd från anhöriga, vårdpersonal och andra kvinnor som har eller har haft bröstcancer. Anhöriga utgör den största källan till stöd, men stödet från vårdpersonalen är också av stor betydelse. Stöd kan delas in i emotionellt, materiellt och informativt stöd. Syfte: Att beskriva bröstcancerdiagnostiserade kvinnors upplevelse av emotionellt stöd från vårdpersonal. Metod: En litteraturöversikt enligt Friberg utfördes. Nio kvalitativa studier har valts ut och analyserats. Resultat: Resultatet visar att det var många olika faktorer som påverkade om kvinnorna upplevde att de fick emotionellt stöd eller inte. Åtta kategorier bildades under analysen: vårdrelationen, kontinuitet, trygghet och tillit, respekt och individualitet, närvaro, känslighet, tid samt personliga egenskaper. Diskussion: Resultatet jämförs med Joyce Travelbees teori som berör mycket av det som framkommit i resultatet, exempelvis att det är viktigt att se patienten som en individuell individ. I disskussionen betonas bland annat vikten av att uppfatta patienten som mångdimensionell samt hur och vårdpersonalens stress och tidsbrist påverkar möjligheten av att kunna ge emotionellt stöd. Sökord: bröstcancer, emotionellt stöd, kvinnor, omvårdnad, stöd, upplevelse. / Introduction: Breast cancer is the most common type of cancer among women. Many of the affected women react to the diagnosis with strong feelings and the treatment is tough and often unpleasant getting through. The women need support from relatives, health-care personnel and other women with or who have had breast cancer. The relatives are a big source for support, but the support from health care personnel is also of great importance. Support can be divided into emotional, material and informational support. Aim: To describe breast cancer diagnosed women’s experience of emotional support from caring personnel. Method: A literature review was performed according to Friberg. Nine studies with a qualitative approach were collected and analysed. Findings: The result shows that there were many different factors who affected if the women experienced getting emotional support or not. Eight categories emerged in the analysis: the caring relation, continuity, confidence and trust, respect and individuality, presence, sensitibity, time and personal characteristics. Discussion: The result is compared to Joyce Travelbee’s theory that is connected to much of what was found in the result, for example the importance of recognizing the patient as an individual. The discussion highlights amongst other things the matter of seeing the many different dimensions of the patient and how the pressure and lack of time affects the health caring staff’s ability to give emotional support. Keywords: breast cancer, emotional support, experience, nursing care, support, women.

Hur patienter och sjuksköterskor upplever delaktighet i vården är en viktig aspekt för att kunna vidareutveckla och främja patientens delaktighet i vården. Syftet med studien var att undersöka upplevelser av patientens delaktighet ur ett patient- och sjuksköterskeperspektiv. Studien genomfördes som en systematisk litteraturstudie och grundar sig på 14 vetenskapliga artiklar. Resultaten visade att patienters upplevelser av patientdelaktighet innefattade att bli sedd och respekterad som en egen individ. Ett inbjudande klimat där sjuksköterskan var lyhörd och där relationen mellan parterna var jämlik upplevdes viktigt. Sjuksköterskor upplevde att det var viktigt med ett empatiskt förhållningssätt där etablerandet av en fungerande relation var grundläggande. Detta innebar ett respektfullt bemötande där patienter uppmuntrades och värdesattes. En bra kommunikation och ett givande och tagande mellan båda parter samt individanpassad och tillräcklig information var viktigt. Både patienter och sjuksköterskor upplevde att det fanns hinder för delaktighet vilka bland annat var tidsbrist, brist på kontinuitet och begränsade val. Det är viktigt att lyfta patientens delaktighet i sjuksköterskeutbildningen. I vårdverksamheten kan daglig reflektion vara ett sätt för sjuksköterskor att bibehålla medvetenhet om vikten av patientens delaktighet. Det vore önskvärt med vidare forskning som förklarar varför det finns brister i patientens delaktighet och vinsterna med patientens delaktighet. / How patients and nurses experience participation in care is an important aspect to advance and improve the patient’s participation in care. The aim with the study was to investigate experiences of the patient’s participation from a patient and nurse perspective. The study was performed as a systematic literature study and is based on 14 scientific articles. The results showed that patients’ experiences of patient participation included to be seen and respected as an own individual. An inviting environment where the nurse was sensitive and where the relation was equal between the parts was experienced as important. Nurses experienced that it was important to have an empathic approach where establishing of a functional relation was essential. This meant a respectful manner where patients were encouraged and recognized. A good communication, a giving and taking between the parts and individual and adequate information was important. Both patients and nurses experienced lack of time, lack of continuity and limited choices as hindrances for participation. It is important to raise patient participation in nurse education. Daily reflection in nursing care can be one way for nurses to maintain awareness of the importance of patient participation. It would be desirable with further research which can explain why there are shortages with patient participation and the benefits with patient participation.

Bakgrund: Människan tillbringar en tredjedel av sitt liv i sömn det är ett behov vilket hon inte kan vara utan. Patienter som vårdas på IVA drabbas frekvent av sömnstörningar och därmed sömnbrist. Tidigare gjorda studier tyder på att IVA patienter upplever sömnstörningar som ett stort problem. Syfte: Att beskriva sömnförändringar, sömnpåverkande faktorer och sömnförbättrande omvårdnadsåtgärder för IVA-patienter. Metod: Databassökning gjordes och nyckelord har identifierats. Studier som inkluderar vuxna patienter som vårdats på en IVA har valts för denna beskrivande litteraturstudie. Resultat: IVA-patienter drabbas av fragmenterad sömn uppdelad i korta abnorma perioder. Sömnen påverkas av mänsklig intervention, diagnostiska tester samt miljöbetingad ljus och ljud. Minskning av ljud- och ljusnivån samt sammanhängande vilotid utan intervention var de främst undersökta sömnfrämjande omvårdnadsåtgärder i de granskande artiklarna. Slutsats: Alla IVA-patienter upplevde störd sömnrytm. I vilken utsträckning sömnrytm stördes berodde på ålder, sjukdom, erfarenhet av IVA-vård och respiratorvård. Omvårdnadsåtgärder som planerad vilotid, sänkningar av ljud och ljus förbättrade sömnmönstret och skapade möjlighet till förbättrad sömn.