The aim of this thesis was to evaluate the benefits and complications of surgical treatment of refractory epilepsy. The criterion for the selection of patients was undergoing preoperative long-term monitoring. Information were obtained from six patients after 2-3 years r of surgery using the narrative interview and questionnaire QOLIE 89, which evaluates the quality of life. The interview was analyzed using grounded theory while the information obtained from questionnaire were used only as supplement and comparison of the results. Overall evaluation of questionnaire QOLIE 89 was in standard in five of six patients which is against the results obtained in interviews. Comparing risks and complications with benefits of surgical treatment of refractory epilepsy in the observed group was evaluate as problematic. Patients expected more positive benefit of the treatment and improving the quality of life. Keyword: epilepsy, surgical treatment, nursing care, quality of live

Syfte: Syftet med denna studie var att beskriva distriktssköterskors strategier vid behandling av venösa bensår.Bakgrund: Svårläkta sår är ett stort problem som orsakar försämrad livskvalitet för de som drabbas. Svårläkta sår innefattar venösa bensår som distriktssköterskan har ett stort eget ansvar för i primärvårdens verksamhet. Behandlingen är dock komplex och kan vara frustrerande både för patienter och personal då läkning uteblir. Viktiga delar i behandlingen är kontinuitet, helhetsperspektiv, utredning och förståelse för orsaken bakom såret.Design: Kvalitativ design med semistrukturerade intervjuer.Metod: Kvalitativ innehållsanalys med induktiv ansats. Data insamlades september-oktober 2015.Resultat: Resultatet visar på att distriktssköterskorna använder strategier som liknar omvårdnadsprocessen. Fem kategorier identifierades, anamnes, bedömning, åtgärder, dokumentation och uppföljning. Vissa strategier är genomgående hos alla distriktssköterskor medan andra varierar. Deltagarna lade mer tyngdpunkt på vissa delar i omvårdnadsprocessen, där de fokuserade mycket på bedömning och åtgärder och mindre på anamnes och uppföljning.Slutsats: Distriktssköterskan utför självständigt behandlingen av patienter med venösa bensår men behöver ibland konsultera kollegor, allmänläkare och specialistsjukvården. Avsaknaden av skriftliga rutiner och behandlingsriktlinjer kan bidra till skillnader i behandlingen då den i nuläget baseras på beprövad erfarenhet. Det framträdde att alla distriktssköterskor har en strategi vid behandling av venösa bensår som liknar omvårdnadsprocessen.

The general aim of this thesis was to examine the effect of interventions on the usage of inappropriate and hazardous multi-medication in the elderly ≥75 years with ≥5 drugs. Methods: Paper I describes a cluster randomization of nursing homes, the outcomes were; number of drugs, health status and evaluations. A randomized controlled trial concerning elderly in ordinary homes was performed in paper II and the outcomes were; EQ-5D index, EQ VAS and prescription quality. In paper III a cohort study was carried out and the outcomes were; medication appropriateness index, EQ-5D index and EQ VAS. In paper IV, registered nurses from the nursing homes study were interviewed in a descriptive study with a qualitative approach. Results:There was a significant reduction of number of drugs used per patient at the intervention nursing homes (p<0.05). Monitoring and evaluation of medications were significantly more frequent at the intervention homes (p<0.01). The registered nurses at the nursing homes described a self-made role in their profession and the leadership was not at sight. Drug treatment seems to be a passive process without own reflection. Extreme polypharmacy was persistent in all three groups of elderly living in ordinary homes and there was an unchanged frequency of drug-risk indicators. In the cohort study a lower medication quality was shown to be associated with a lower quality of life. EQ-5D index was statistically significantly different among the groups as was EQ VAS. Conclusion: The nursing home study showed an extreme shortage of monitoring of health status and surveillance of the effects of drugs in the elderly. More attention must be focused on the complexity of the nursing process; medication management must be promoted in teamwork with the physician. The resistance to change prescriptions in accordance with the intervention underlines the need of new strategies for improving prescription quality. Since medication quality is related to the patients’ quality of life, there is immense reason to continuously evaluate every prescription and treatment in shared decision with the patient.

Telephone nursing (TpN) care is delivered in a wide range of settings and provides a variety of services to individuals and populations across the age span. Although a viable specialty practice, there is little evidence regarding how the process of care delivery contributes to successful outcomes. To study the effects of TpN care, and to develop appropriate clinical and education interventions, a solid understanding of the process is needed. This study utilized grounded theory method to identify and describe the core concepts of the TpN process, the relationships among these concepts, and the factors influencing the process. Study findings were validated through peer and participant review. Based on interviews with ten telephone nurses from four sites, the following components were identified and organized into a conceptual model of the TpN process. The process generally proceeds through three phases, gathering information to cognitive processing to output. Throughout these phases, the nurse engages in a goal oriented parallel process focusing on both explicit (e.g., verbal, physical) and implicit (non-verbal, contextual) dimensions. Inherent to this parallel process is a two-way interpreting process in which information from the caller is translated into health care language for processing and then health care information is translated back into the language of the caller to identify and meet their needs. Factors influencing the process include prioritization and the level of complexity of the call, resources of the nurse and the organization, and the nurse's desire for validation of the service and the appropriateness of the output. The model highlights the need for research further delineating how implicit information is gathered and processed and how it influences output. Research is also needed on the value of implicit output and on the effects of feedback regarding output on nurse performance and satisfaction. The model suggests that more nursing education should be focused on the sub-processes within the three phases, the interpreting process, and implicit aspects of the process. Finally, the model suggests that formal feedback regarding the quality of call output should be provided and the value of implicit nursing output should be recognized.

Enligt Patientdatalagen (SFS 2008:355), 3 kap, 1 § har fastställts att sjuksköterskan är skyldig att föra journal. I varje patientjournal ska upprättas en omvårdnadsplan vilken ska vara utformad enligt omvårdnadsprocessens fem faser: bedömning, diagnos, mål, planering, genomförande och utvärdering. Omvårdnadsdokumentationen har som syfte att beskriva den vård som patienten erhållit genom att den beskriver vilka beslut som tagits, vilka åtgärder som gjorts samt vilka resultat som uppnåtts. Patienter som genomgår allogen stamcellstransplantation (SCT) upplever ofta en hög psykologisk påfrestning och själva transplantationstillfället är i sig komplext med många behandlingsrelaterade biverkningar som påverkar hela den transplanterades tillvaro både fysiskt och psykiskt. Syftet med uppsatsen var att undersöka sjuksköterskans  omvårdnadsdokumentation avseende omvårdnadsprocessen gällande patienters emotionella hälsa (EH) från utskrivningsdatum för SCT och ett år framåt. Totalt granskades 40 patientjournaler på en hematologmottagning, vilket är en mottagning som har ansvar för uppföljning och eftervård av de patienter som genomgått allogen SCT. Av dessa 40 patienter hade 73% minst en journalanteckning dokumenterad av en sjuksköterska som handlade om EH. 81% av det som var dokumenterat handlade om negativa upplevelser. Ingen patient hade upprättad omvårdnadsplan byggd enligt omvårdnadsprocessen gällande sin EH och patientens EH beskrevs i 86% under sökordet välbefinnande. Utifrån dessa resultat är författarens upplevelse att sjuksköterskorna på den här mottagningen i stor utsträckning dokumenterar patienters EH någonstans i omvårdnadsjournalen men att det saknas en planering av patientens EH som följer omvårdnadsprocessen i dess helhet. Med utgångspunkt av detta anser författaren till uppsatsen att alla sjuksköterskor borde ges möjlighet till kontinuerlig utbildning i omvårdnadsdokumentation för att upprätthålla och bättra på sin kunskap. / According to the Patient Act (SFS 2008:355), Chapter 3, § 1 has been determined that the nurse is required to keep records. Each health record shall contain a care plan which will be designed according to nursing process, five phases: assessment, diagnosis, goals, planning, implementation and evaluation. Nursing documentation is intended to describe the given care, what decisions and actions that have been taken and the results achieved. Patients undergoing allogeneic stem cell transplantation (SCT) often experience a high psychological distress and the time of transplantation is in itself complex, with many treatment- related side effects, both physically and mentally. The aim of the study was to investigate the nurse´s nursing documentation on nursing process to patient emotional health (EH) from the discharge date for SCT and one year ahead. 40 patient records were reviewed at a haematological reception, which is the reception which has responsibility for monitoring and follow-up care of patients undergoing allogeneic SCT. 73% of these 40 patients had at least one entry recorded in the journal about EH. 81% of documented records is about negative experiences. No patient had an established care plan, built according to nursing process known their EH and EH patients were described in 86% over the keyword welfare. Based on these results the author´s experience that the nurses at this clinic extensively documenting patients´ EH somewhere in the nursing journal, but that there is no planning of patient EH arising nursing process as a whole. Based on the result in the study, the author´s view is that all nurses should be given the opportunity to get training in nursing documentation in order to maintain and improve their knowledge.

This study examines nursing students' adoption of inferential sets in a clinical situation. The investigation determines (1) the particular inferential set(s) nursing students adopt toward a patient in a clinical situation; (2) the particular inferential set(s) adopted by sophomore and senior nursing students in a clinical situation; and (3) whether or not inferential sets adopted by the sophomore and senior nursing students differ. Sophomore and senior nursing students at a woman's university in Texas were asked to complete a research tool designed to determine inferential set adoption.

Introduktion: Operationssjuksköterskan ansvarar för en god och patientsäker perioperativ omvårdnad. Preoperativ personcentrerad information är en förutsättning för att kunna tillgodose patientens unika behov och främja kontinuitet i vården. Patientens individuella riskfaktorer är väsentligt för operationssjuksköterskan att känna till för att kunna förebygga vårdskador och genomföra en patientsäker perioperativ vård. Syfte: Syftet var att beskriva operationssjuksköterskors erfarenheter av att inhämta information för att skapa patientkännedom i den perioperativa vården. Metod: En kvalitativ studiedesign med en induktiv ansats tillämpades. Tio operationssjuksköterskor på ett länssjukhus i Sverige intervjuades. Intervjuerna spelades in och transkriberades i sin helhet. Innehållsanalys valdes som metod för dataanalys. Resultat: Två generiska kategorier framkom: Ta del av skriftlig information om patienten och Det preoperativa mötet med patienten. Dessa bildar tillsammans den övergripande huvudkategorin Förutsättning för personcentrerad och patientsäker perioperativ vård. Till den generiska kategorin Ta del av skriftlig information om patienten hör subkategorierna Att inhämta grundläggande kunskap och Att prioritera och ta vara på möjligheter. Till den generiska kategorin Det preoperativa mötet med patienten hör subkategorierna Att träffa och tala med patienten och Att skapa förutsättningar för samtal. Konklusion: Resultatet bidrar med fördjupade kunskaper kring vad som är väsentligt att veta om patienten i den perioperativa vården och varför det är viktig information, utifrån operationssjuksköterskans perspektiv. Både skriftlig information och ett preoperativt möte med patienten behövs för att skapa förutsättning för personcentrerad och patientsäker perioperativ vård. Resultatet tyder på att det behövs ett förändrat arbetssätt för att möjliggöra skapandet av god kännedom om varje enskild patient och på så sätt öka patientsäkerheten. / Introduction: The operating room nurse is responsible for a good and safe perioperative care. Preoperative person-centered information is a prerequisite to meet the patient´s unique needs and promote continuity of care. The patient´s individual risk factors are essential for the operating room nurse to know in order to prevent hospital acquired injuries and to accomplish safe perioperative care. Aim: The aim was to describe operating room nurses´ experiences of obtaining information to create knowledge of the patient in perioperative care. Method: A qualitative study with an inductive approach was conducted. Ten operating room nurses at a hospital in Sweden were interviewed. The interviews were recorded and transcribed. Content analysis was chosen as the method of data analysis. Result: Two generic categories emerged: Read written information about the patient and The preoperative meeting with the patient. These generic categories together form the main category Prerequisite for person-centered and safe perioperative care. The generic category Read written information about the patient includes the subcategories To acquire basic knowledge and To prioritize and to seize opportunities. The generic category The preoperative meeting with the patient includes the subcategories To meet and talk with the patient and To create conditions for conversation. Conclusion: The findings contribute to a deeper knowledge of what is essential to know about the patient in perioperative care and why this is important information, from the operating room nurse´s perspective. Both written information and a preoperative meeting with the patient are required to create prerequisite for person-centered and safe perioperative care. The results indicate a need of change in the way of working to enable good knowledge of each patient, and thereby increase patient safety in perioperative care.

Este estudo objetivou identificar os diagnósticos que as enfermeiras reconhecem como: 1) mais freqüentes em sua prática clínica; 2) mais difíceis de serem formulados; 3) mais difíceis para propor intervenções e 4) verificar as associações entre a freqüência de diagnósticos, a dificuldade para formular diagnósticos e a dificuldade para propor intervenções. Os 155 diagnósticos de enfermagem (DE) estudados foram divididos, compondo três questionários. A estimativa de freqüência, a dificuldade de formulação, e a dificuldade para propor intervenções para cada diagnóstico foram indicadas em escala tipo Likert de 5 pontos. O alfa de Chronbach variou de 0,90 a 097 entre os 3 tipos de questionários. Cada tipo de questionário foi respondido por 49 enfermeiras do Hospital Universitário da Universidade de São Paulo, totalizando 147 enfermeiras (97% = sexo feminino, idade média=35,1±8,3 anos; tempo médio de formadas=11,1 ±7,8 anos). Considerando os totais de DE em cada tipo de questionário, os escores médios de freqüência variaram de 2,2 a 2,3, os de dificuldade para formular variaram de 2,5 a 2,6, e os de dificuldade para propor intervenções de 2,9 a 3,0. Considerando cada diagnóstico, escores médios =3 foram definidos como altos para as três variáveis do estudo: freqüência, dificuldade para formular e dificuldade para propor intervenções. Entre as enfermeiras que cuidam predominantemente de adultos, 40 DE foram de alta freqüência, 59 foram de alta dificuldade para formular e 90 de alta dificuldade para a proposição de intervenções. Entre as enfermeiras que cuidam de pacientes pediátricos e de obstetrícia, 22 DE foram de alta freqüência, 67 de alta dificuldade de formulação e 82 de alta dificuldade para propor intervenções. Houve correlações significativas entre as variáveis dificuldade para formular os diagnósticos e dificuldade para propor intervenções de enfermagem nos 3 questionários (Pearson, coeficientes entre 0,75 e 0,83, p=0,000). / This study aimed to identify which diagnoses nurses estimate as: 1) the most frequent in their clinical practice; 2) the most difficult to formulate; 3) the most difficulty to propose interventions for and 4) to verify the associations among the nursing diagnoses (ND) frequency, the difficulty to state ND, and the difficulty to propose interventions The 155 nursing diagnoses (ND) studied were divided to compound 3 questionnaires. Frequency, difficulty to state, and difficulty to propose interventions for each ND were indicated in 5-point Likert scales. The Chronbach\'s alpha varied from 0.90 to 0.97 among the 3 questionnaires. Each questionnaire was answered by 49 nurses of the University Hospital of the University of São Paulo, totaling 147 nurses (97% female; mean age=35.1±8.3 years; mean years after bachelor´s degree=1.1±7.8). Considering the total of ND in each questionnaire, the mean scores of frequency varied from 2.2 to 2.3; the mean scores of difficulty to state ND, between 2.5 and 2.6; and the mean scores of difficulty to propose interventions, between 2,9 and 3.0. Considering each diagnosis, mean scores =3 were defined as high ones for the three variables: frequency, difficulty to state, and difficulty to propose interventions. Forty ND were high frequency ND among nurses who care of adult patients; 59 were ND of high difficulty to state; and 90 were ND of high difficulty to propose interventions for. For nurses caring of pediatrics and obstetrics\' patients, there were 22 high frequency ND, 67 ND of high difficulty to state; and 82 of high difficulty to propose interventions for. There were significant positive correlations between the variables: difficulty to state ND and difficulty to propose interventions for the 3 questionnaires (Pearson test, coefficients between 0.75 and 0.83, p=0.000).

O desenvolvimento de software pode contribuir com a padronização dos registros de enfermagem e facilitar a avaliação dos custos das ações desses profissionais nos serviços de saúde. Acresça-se a possibilidade de contribuir com a tomada de decisão para melhorar a qualidade da assistência nos diferentes pontos da Rede de Atenção à Saúde. Pesquisa teve como objetivo geral: Desenvolver um software para apoio à tomada de decisão na seleção de diagnósticos e intervenções de enfermagem a partir da nomenclatura de diagnósticos resultados e intervenções de enfermagem de um Hospital Universitário da Paraíba. Pesquisa metodológica do tipo aplicada, a qual seguiu os passos da engenharia de software proposto por Pressman, nas seguintes fases: construção do fluxograma; Conversão dos instrumentos de coleta de dados, diagnósticos e intervenções em telas (elaboração do protótipo); Inserção dos diagnósticos de enfermagem ao software (desenvolvimento de mapas conceituais e expressões funcionais) e a fase desenvolvimento técnico do sistema. O processo de desenvolvimento do software e implantação no servidor de rede ocorreu entre os meses de março de 2012 e janeiro de 2014. O fluxograma foi elaborado na Linguagem Unificada de Modelagem (UML -Unified Modeling Language), com auxílio do JUDE System Design Tool. Para o protótipo foram estruturadas, inicialmente, as telas de interface do software e para permitir a interação humano/sistema o protótipo foi estruturado utilizando o Programa Axure ®. A elaboração de mapas conceituais permitiu a visualização dos links para apresentação dos diagnósticos de enfermagem. O agrupamento dos indicadores conduziu a 28 mapas de diagnósticos de enfermagem para crianças 0- 5 anos e 29 mapas de diagnósticos para os adolescentes. Para inserção dos diagnósticos de enfermagem (DE) na programação foram elaboradas duas expressões funcionais para DE identificados nos dois grupos, resultando em 112 expressões para as crianças 0-5 anos e 124 para os adolescentes. Para o desenvolvimento do sistema foram utilizados os seguintes softwares de acesso livre (open source): Eclipse, um IDE (Integrated Development Environment), o Zend (conectividade com banco de dados e conectividade com Java). O MySQL workbench foi a ferramenta visual utilizada na arquitetura do banco de dados. O sistema foi desenvolvido com a linguagem PHP (hypertext preprocessor) + MySQL um sistema gerenciador de banco de dados que utiliza a linguagem SQL (Structured Query Language - Linguagem Estruturada para Consulta), juntamente com a linguagem P4A (php for application). Foram utilizados os software WampServer para instalar os softwares PHP 4.3.x/4.4.x/5.x.x, Apache 1.3.x/2.0.x e o MySQL e as configurações necessárias para os arquivos P4A. Após finalização para os testes em ambiente de simulação o software foi hospedado num servidor no endereço: http://143.107.193.26/sisped/applications/sica/. Para garantir a segurança das informações, o servidor dispõe de um módulo que utiliza a camada SSL (Secure Sockets Layers - camada de sockets protegida). A utilização de Tecnologia da Informação6 para auxiliar as ações de cuidado pode permitir aos profissionais de enfermagem realizar uma assistência baseada em conhecimentos validados contribuindo com a qualidade desse cuidado, o que pode levar a redução de erros e de custos, aumentando a eficiência da informação, a melhoria na continuidade e a segurança da informação / Software development can contribute to the standardization of nursing records and facilitate the cost assessment of the professionals\' actions in the health services. Also should add the possibility to contribute to the decision making to improve the quality of care in different points of the Health Care Network. The research had as general aim: Develop software to support decision making in the selection of nursing diagnoses and interventions from the nomenclature of nursing diagnoses, results and interventions from a University Hospital of Paraíba. Methodological research type, following the software engineering phases proposed by Pressman: flowchart construction; Conversion screens of instruments for data collection (prototype building); Insertion of nursing diagnoses to the software (development of concept maps and functional expressions) and technical development phase of the system. The software development process and implementation on the network server occurred between the months of March 2012 and January 2014. The flowchart was drafted in Unified Modeling Language (UML), with the aid of JUDE System Design Tool. For the prototype were structured at first the software interface screens and to allow human / system interaction the prototype was structured using Axure® Program. The development of concept maps allowed the visualization of links to display the nursing diagnoses. The grouping of indicators led to 29 maps of nursing diagnoses for children 0-5 years and 29 maps of nursing diagnoses for teens. To insert the nursing diagnoses in the system two functional programming expressions were prepared for nursing diagnoses identified in the two groups, resulting in 112 phrases for children 0-5 years and 124 for teens. To develop the system the following open source software were used: Eclipse, an IDE (Integrated Development Environment), Zend (database connectivity and connectivity with Java). The MySQL workbench was visual tool used in the database architecture. The system was developed with PHP (hypertext preprocessor) language and MySQL a database system manager that uses SQL (Structured Query Language) along with P4A (php for application) language. It was used the software WampServer to install the software PHP 4.3.x/4.4.x/5.x.x, Apache 1.3.x/2.0.x, MySQL and the required settings for the files P4A. After finishing the tests in simulation environment the software was hosted on a server at the address: http://143.107.193.26/sisped/applications/sica/. To ensure the information security, the server has a module that uses the layer SSL (Secure Sockets Layers). The use of information technology to help care actions can enable the nursing professionals perform a care based on validated knowledge, contributing to the care quality, to reduce errors and costs, information efficiency, improving continuity and security of information

A emergência psiquiátrica é uma unidade complexa devido à demanda de pacientes com várias patologias psiquiátricas e clínicas associadas e distintas, com alta rotatividade. O objetivo deste trabalho foi analisar a percepção da equipe de enfermagem quanto à Sistematização da Assistência de Enfermagem em um serviço de emergência psiquiátrica, enfatizando os aspectos relacionados à sua implementação. O estudo foi desenvolvido utilizando o método qualitativa e a coleta de dados se deu através de entrevistas e grupo focal com os diferentes profissionais envolvidos no cuidado de enfermagem da Unidade de Emergência do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto. Os resultados apontaram que a equipe percebe as contribuições da Sistematização da Assistência de Enfermagem (SAE) para o trabalho da equipe de enfermagem, no entanto uma série de dificuldades em relação à consolidação da Sistematização da Assistência de Enfermagem nesta unidade foram apontados, bem como propostas de melhorias e elementos essenciais que contribuiriam para a efetiva implementação da SAE na referida Unidade. Adequações nos instrumentos, treinamentos mais focados e estratégias participativas são descritos como elementos-chave para este processo / Psychiatric emergency is a complex unit due to the demand of patients with various psychiatric and medical conditions associated and distinct, with high turnover. The objective of this study was to analyze the perception of the nursing team about the systematization of nursing care in a psychiatric emergency service, emphasizing the aspects related to its implementation. The study was conducted using qualitative method and the data collection was carried out through interviews and focus groups with the different professionals involved in nursing care of the Emergency Unit of the Hospital of the Ribeirão Preto Medical School. The results showed that the team realizes the contributions of the Systematization Of Nursing Assistance (SNA) for the work of the nursing staff, however a number of difficulties in relation to the consolidation of systematization of nursing care in this unit were appointed and proposals improvements and essential elements that contribute to the effective implementation of SNA in that unit. Adjustments in the instruments, more focused training and participatory strategies are described as key elements to this process