Thesis (M.S.)--University of Michigan, 1993.

SAMMANFATTNING  Bakgrund: Hälso- och sjukvården belastas av många akuta återinläggningar. Omvårdnaden av patienter med cancer sker kontinuerligt under hela deras sjukdomstid.  Syfte: Syftet med studien är att undersöka orsakerna bakom de akuta inläggningarna av patienter med cancer på två onkologiska slutenvårdsavdelningar för att se om det finns några skillnader mellan patienter med olika cancerdiagnoser och olika behandlingsmål. Syftet med studien är även för att se hur länge den akuta inläggningen varade samt undersöka faktorer som kan vara av betydelse för vårdlängden.  Metod: Metoden som används är en kvantitativ undersökning med en retrospektiv och deskriptiv design. I studien ingår 100 patienter med en cancerdiagnos. Data inhämtades med hjälp av journalgranskning.  Resultat: I både Uppsala och Stockholm var 78 % av de akuta inläggningarna patienter med ett palliativt behandlingsmål. De vanligaste orsakerna bakom de akuta inläggningarna i Uppsala var illamående och kräkningar samt behandlingsbiverkningar för patienter med ett kurativt behandlingsmål medan de patienter med ett palliativt behandlingsmål lades in akut på grund av ileus/förstoppningsproblematik och smärta. I Stockholm var det behandlingsbiverkningar, där infektioner stod för den vanligaste orsaken till akut inläggning följt av nedsatt allmäntillstånd. De vanligaste diagnosgrupperna var gastrointestinal cancer, urogenital cancer och bröstcancer.  Slutsats: Studiens resultat visar på att patienter med ett palliativt behandlingsmål upptar en stor del av den akuta verksamheten inom den onkologiska slutenvården. Sjuksköterskan har en viktig ansvarsroll i planeringen och identifieringen av en cancerpatients vårdbehov och har möjlighet att förebygga många akuta återinläggningar. / ABSTRACT Background: Health care is burdened by many unnecessary emergency readmissions. Nursing care of patients with cancer occurs continuously throughout the patients illness. Aim: The aim of the study is to examine the reasons behind the emergency admissions of patients with cancer in inpatient care to see if there are any differences between patients with different cancer diagnoses and different treatment goals. The aim of the study is also to see how long the admission lasted and examine factors that may be important for length of the admission.  Method: The method used is a quantitative survey with a retrospective and descriptive design. The study included 100 patients with a diagnosis of cancer in Uppsala and Stockholm. Data were collected by reviewing medical records.  Results: In both Uppsala and Stockholm, 78% of emergency admissions were of patients with palliative treatment goals. The most common causes of acute admissions in Uppsala were nausea and vomiting and treatment of side effects for patients with a curative treatment goal, while patients with a palliative treatment goal were admitted acutely because of ileus/constipation or pain. In Stockholm, the treatment side effects such as infection accounted for the most common cause of acute admission followed by poor general condition. The most common diagnostic groups were gastrointestinal cancer, genitourinary cancer and breast cancer.  Conclusion: The study results show that patients with a palliative treatment goal occupy a large part of the emergency admissions of the oncology inpatient care. The nurse has an important role in the planning and identification of a cancer patient's care needs and are able to prevent many acute readmissions.

This study examined the difference among 3 patient education intervention strategies and compliance in the hypertensive elderly. The strategies were verbal instructions, written instructions and both verbal and written instructions. An ex post facto descriptive design was implemented based on a Cognitive Information Processing Theory of Learning. Forty subjects were recruited and interviewed. Data analysis revealed that compliance did not differ significantly with the type of educational strategy.

Bakgrund: Överviktsoperationer ökar i snabb takt runt om i världen i samband med en eskalerande fetmaepidemi. En överviktsoperation innebär stora förändringar i livet och ställer krav på att sjukvårdspersonal är kunniga om dessa förändringar ur patientens perspektiv. Syfte: Syftet med litteraturstudien var att belysa patienters upplevelser före och efter överviktskirurgi. Metod: 13 vetenskapliga artiklar granskades och analyserades. Sammanställningen resulterade i ett tema och fem presenterade underkategorier. Resultat: Överviktskirurgi blev en sista chans till ett bättre liv för patienterna. De hade förväntningar på ett förändrat liv, som i många fall till stor besvikelse inte blev bättre. Patienterna upplevde att den mentala hälsan blev åsidosatt vid överviktskirurgi, varav de önskade att vårdpersonalen la mer fokus på just detta. Slutsats: Då överviktskirurgi är en livsomvälvande process är det viktigt att sjuksköterskan har förståelse för patientens hela upplevelse, även den känslomässiga. / Background: The number of bariatric surgeries performed globally is increasing in relation to an escalating obesity epidemic. Bariatric surgery leads to life-changing processes and put demands on health care staff to have knowledge about these changes from the patients’ perspective. Purpose: The purpose of the literature review was to illuminate patients’ experiences before and after bariatric surgery. Method: Thirteen scientific articles were reviewed and analysed. The combination resulted in a theme and five presented subcategories. Results: Bariatric surgery became the last chance to a better life for the patients. They had expectations of a changed life, which in many cases to great disappointment didn’t became better. The patients experienced that the mental health was disacknowledged while going through bariatric surgery and was something they wished that the health care staff had focused more on. Conclusion: Bariatric surgery is a life-changing process, why it’s important for the nurse to understand the experiences of the patient, even the emotional experience.

No description available.

Bakgrund: Cancer är ett hälsoproblem som är stort över hela världen och mer än var tredje person riskerar att bli drabbad under sin livstid. Varje år ökar antalet människor som drabbas av cancer, men även överlevnaden ökar. Syfte: Att beskriva hur vuxna personer med obotlig cancersjukdom hanterar sin livssituation med hjälp av coping strategier vid livets slutskede samt metodologiskt granska hur undersökningsgrupp och urvalsmetod är beskrivet i granskade artiklar. Metod: En litteraturstudie med deskriptiv design som baserades på 10 artiklar med både kvalitativ och kvantitativ ansats. Artiklarna hittades i databasen Pubmed. Huvudresultat: Familj, vänner och trosuppfattning var viktiga källor för att personer med obotlig cancer sjukdom skulle kunna hantera faktumet att livets slut var nära. Socialt stöd och religiös tro var nyckelkomponenterna för att personer som levde sin sista tid i livet skulle klara av att hantera sin livssituation, antingen genom att finna en mening i den pågående situationen eller genom stöd från sina nära och kära. Resultatet baserades på fyra kvantitativa artiklar och sex kvalitativa artiklar. I granskningen av de ingående artiklarnas datainsamlingsmetod framkom både urvalsmetod och undersökningsgrupp. I studierna förekommer semistrukturerade intervjuer, strukturerade intervjuer och enkäter. Slutsats: Coping strategier i form av socialt stöd och religiöst stöd var nyckelkomponenter för att personer med obotlig cancersjukdom skulle klara av att hantera sin sista tid i livet. Personerna såg olika på komponenterna, vilka coping strategier de använde och vilka som fungerade, men även vilket stöd som var av betydelse. De flesta personerna upplevde att stöd från familj och anhöriga var viktigt för att kunna hantera livets slutskede, men likaså stödet från en religiös bakgrund. / Background: Cancer is a major health problem worldwide and more than every third person has got the risk to get cancer during their lifetime. The number of people getting diagnosed with cancer is increasing, but the survival rate is increasing as well. Aim: To describe how adults with incurable cancer manage their lives with the help of coping strategies at the end of life as well as methodologically review how the selection of the study group and the selection method in the reviewed articles were described. Method: A literature study with a descriptive design based on ten articles with both qualitative and quantitative approach. The articles were found in the database PubMed. Findings: Family, friends and religious beliefs were important sources for people with terminally ill cancer to cope with the fact that life was about to come to an end. Social support and religious beliefs were the main important facts for the people who were facing end of life to be able to cope with their situation, either trying to find meaning in the current situation or through support from loved ones. The findings were based on four quantitave articles and six qualitative articles. The selection of the study group and the selection method in the reviewed articles were described in each article. The data collection methods that the included articles used were semistructed interwievs, unstructed interwievs and surveys. Conclusion: Coping strategies as in social support and religious support were the main facts for people to cope with end of life. People had different views on both of the facts, which coping strategies they used and which ones that worked, but also what kind of support that was more important. Most of the people felt that support from family and friends were important to have so that they could cope with the end of life, but religious support was just as much important.

M.Sc. (Med.), Dept. of Pharmacy and Pharmacology, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, 2011

Adult literature has shown that quality of patient-physician relationships is associated with better patient adherence to treatment recommendations across chronic illnesses. However, few studies have examined this in youth with type 1 diabetes, particularly those of Hispanic origin. Evidence indicates that minority youth with type 1 diabetes are at higher risk for poorer metabolic control and experience less satisfaction in patient-provider relationships compared to their white, non-Hispanic counterparts. This study examined the association between satisfaction with the physician-patient relationship and regimen adherence and glycemic control in 120 Hispanic youth with type 1 diabetes. Most caregivers who participated were mothers (82.5%) and youths were primarily female (51.7%). Children ranged in age from 10 to 17 (M age = 13.63 ± 2.18 years). Mean duration of diabetes was 6.26 ± 3.72 years. Most caregivers were married (64.7%). Mothers? highest level of education included 35.3% who had a high school education or less, 34.5% who had some college, and 30.2% who completed college. Mean HbA1c level on recruitment date was 7.68 ± 3.56. Adolescents and their parents independently completed an adapted version of the Medical Interview Satisfaction Scale (MISS-21) (Meakin & Weinman, 2002), which assessed their personal satisfaction with their endocrinologist?s consultation, and the Diabetes Self Management Profile (DSMP) (Harris et al., 2000), which measures adherence over the past 3 months across multiple self-care domains. Spanish translations of both forms were used when appropriate in obtaining caregiver report. Also, physicians rated their patients? regimen adherence using an average of eight items concerning patient adherence. Youth and parents shared similar perceptions concerning youth regimen adherence, as measured by the DSMP (r=.68, p<.001). Youth and parent report of their relationship with their endocrinologist was modestly correlated (r=.27, p<.01). Due to high concordance between parent and child adherence scores, further analyses used a combined DSMP score, while separate scores were used for parent and child reports of satisfaction. Age, mother?s education, and single parent status were used as control variables and were correlated with parent and child satisfaction and a combined DSMP score. Including control variables, parent and child satisfaction did not significantly predict glycemic control (R2∆=.02, p<.10). Parent and child satisfaction also did not significantly predict adherence (R2∆=.02, p=.06). Due to these unexpected findings, further exploratory analyses were conducted. Parent and child satisfaction did not predict physician report of adherence. Interestingly, parent and child report of satisfaction with communication comfort with the physician predicted physician report of adherence (R2∆=.05, p<.01). More specifically, child report of communication comfort predicted physician report of adherence (ß=.26, p<.01), while parent report did not. No subscales of the satisfaction measure (MISS) or the adherence measure (DSMP) predicted glycemic control. Findings suggested that more positive patient-physician relationships are associated with better physician-reported regimen adherence, but not with family report of adherence. However, it is unclear whether better patient-physician relationships enhance adherence or whether more adherent patients are likely to be satisfied with their provider. Further studies are needed to prospectively examine the directionality of these relationships, as well as examine methods to improve the quality of physician-patient relationships in order to increase positive health outcomes.

Ronden på en kirurgisk akutvårdsavdelning är en central del i vårdprocessen för patient och personal. Ronden sker dagligen och mötet mellan patient, läkare, sjuksköterska och undersköterska sker på kort tid och det sker snabba beslut. Syftet var att undersöka patientens upplevelse av ronden på en kirurgisk akut vårdsavdelning. Med utgångspunkt från detta så valdes det en kvalitativ metod med fenomenologisk ansats och intervjuer som datainsamlings metod. Efter analys av totalt 11 patienters upplevelser av ronden kom det fram tre kategorier med tillhörande underkategorier i resultatet. Kategorin tid och rum har underkategorierna mångfaldens, tidens och placeringens betydelse, kategorin interaktion har bemötandets, rummets och erfarenhetens betydelse och kategorin delaktighet har informationens betydelse, självbestämmande och känsla av stöd. Informanternas upplevelser av ronden betonade att det var många deltagare, att mötet var kort och snabbt, deltagarnas placering på rummet och delgivande av information hade en betydelse. Dock ett bra bemötande från personalen, att känna sig delaktig, att känna ett stöd från sjuksköterskan, känsla av förtroende och tidigare negativa upplevelser gav en positiv upplevelse av ronden. / Round on a surgical emergency ward is a central part of the care process for patients and staff. Round take place daily and the meeting between patient, doctors and other staff take place briefly and decisions are taken rapidly. The purpose was to examine the patient's experience of rounds on a surgical emergency ward. A qualitative and the phenomenon illogical approach were chosen with the interviews. After the analysis of the 11 patients' experiences of rounds show three categories and related subcategories which are labelled as time and room such as diversity, time and posting importance. Further more interaction such as importance of treatment, the space and experience and also participation such as the importance of information, self-determination and sense of support. The results show that the participants thought that there were various participants involved in the rounds, the meetings were short and brief, and the participants' presence in the room and the given information affected their experiences. However, a good treatment from the staff, sense of participation, a sense of support, a sense of confidence and previous experience gave participants positive experiences.

This study examined client-reported changes in the therapeutic relationship across 29 sessions, spanning ten cases of short-term, Process-Experiential psychotherapy. Cases and sessions were empirically identified, based on clients' end-of-session ratings on the Working Alliance Inventory (WAI). This empirical selection strategy was intentionally broad and atheoretical, to encompass a variety of change scenarios. Therapist and client behaviors and interactions during selected sessions were explored using the Structural Analysis of Social Behavior (SASB) and the Hill Counselor and Client Verbal Response Modes (VRM) Systems. Both frequency and sequential analysis of category codes were conducted, followed by a session-by-session review of the ten cases. Observed therapist and client behaviors clearly reflected the Process-Experiential therapy model as well as therapist efforts to establish and maintain empathic attunement. No significant differences were found in the frequencies of SASB or VRM codes between strongest and weakest alliance sessions or between rupture and post-rupture sessions. This raises questions about the ability of these measures to differentiate between subtle in-session processes. The case reviews underscored the clients' independent and often-overlooked contributions to the formation and repair of the therapeutic relationship.