Purpose: The purpose of this Qualitative Descriptive study was to describe the experience of hospitalized adults during the pandemic who did not have COVID-19. Specific Aims: The specific aims of the study were to: Describe the hospital experience, including but not limited to, interactions with hospital staff, visitation, isolation, physical and emotional stressors, and the environment. Identify perceived comfort needs during hospitalization and perceptions of the nurse’s role in providing comforting interventions. Examine the ability to achieve physical, psychospiritual, sociocultural, and environmental comfort during hospitalization despite the required infection control measures. Framework: This study was guided by Kolcaba’s Theory of Comfort (1994). Design: This was a qualitative descriptive study. Semi-structured interviews were conducted. Interview questions focused on the overall hospital experience, the nurse’s role in their experience, comfort needs, and the experience of having comfort needs met during the hospitalization. Results: Twenty participants took part in this study. Conventional content analysis revealed five main themes. The themes are: I don’t expect the hospital to be comfortable, I was always tense, Wanting human connection, Communication is important, and Nurses are busy. Conclusion: The findings identified a need for targeting education, research, and policy development to improve patient comfort (physical, psycho-spiritual, sociocultural, and environmental). This is important as we look toward improving the overall patient experience during hospitalization.

Bakgrund: Det är cirka 40 miljoner människor i världen som är i behov av palliativa vårdinsatser och i Sverige anses 70 000 – 75 000 personer vara i behov av det årligen. Vården baseras på holistisk vård som grundas på de fyra hörnstenarna, vilket sjuksköterskan bör förhålla sig till. Patienters åsikter anses värdefulla för en god palliativ vård. Syfte: Syftet med litteraturöversikten är att belysa vuxna patienters erfarenheter av palliativ vård.  Metod: Metoden som har används är en allmän litteraturöversikt. Tio kvalitativa vetenskapliga artiklar har bidragit till resultatet. Åtta artiklar är från PubMed och Cinahl Complete, två genom sekundärsökning. Artiklarna analyserades enligt rekommenderade analyssteg.  Resultat: Fyra huvudteman med tillhörande underteman framkom: (1) Holistisk vård med undertema Upplevelser av holistisk vård och Livskvalitet trots obotlig sjukdom, (2) Upplevelser av palliativa teamet med undertema Upplevelser av sjuksköterskor och Upplevelser av brister under vårdtiden, (3) Vikten av information och kunskap samt (4) Dialog vid livets slut med undertema Avsked av närstående och Önskningar vid livets slut. Sammanfattning: Palliativ vård upplevdes generellt positivt av patienter utifrån detta resultat. Värdig vård ansågs vara genom holistisk vård och tid. För att hantera och acceptera sin situation angav patienterna att information om tillstånd och behandling var viktigt, likaså samtal om livets slut. Palliativa vården och vårdteamet hade en viktig roll för patienter med obotlig sjukdom. / Background: There are about 40 million people in the world who are in need of palliative care and in Sweden 70,000 - 75,000 people are considered to be in need of it annually. The care is based on holistic care which is founded in the four cornerstones, which the nurse should relate to. Patients opinions are considered valuable for good palliative care.  Aim: The purpose of the literature review is to explain adult patients experiences of palliative care.  Method: The used method is for a general literature review. Ten qualitative articles have contributed to the result. Eight articles from PubMed and Cinahl Complete, two through a secondary search. The articles were analyzed according to recommended analysis steps. Results: Four main themes with associated sub-themes emerged. (1) Holistic care with the sub-theme Experiences of holistic care and Quality of life despite incurable disease, (2) Experiences of the palliative care team with the sub-theme Experiences of nurses and Experiences of deficiencies during the care period, (3) The importance of information and knowledge and (4) Dialogue at the end of life with subtheme Farewell to relatives and Wishes at the end of life. Summary: Experiences of palliative care were generally experienced positively by patients based on this result. Nurses' abilities to care holistically and provide time were perceived by patients as dignified care. To handle and accept their situation, the patients indicated that information about the condition and treatment was important, as well as conversations about the end of life. Palliative care and the care team also had an important role for patients living with an incurable disease.

Bakgrund: Smärta är ett vanligt förekommande symtom vid cancer. Trots tydliga riktlinjer för hur omvårdnad vid cancerrelaterad smärta ska bedrivas, är smärta fortfarande ett problem för många patienter med cancer. Sjuksköterskan är omvårdnadsansvarig för patienten och har en betydande roll i smärthanteringen. Genom att undersöka patientens uppfattning ökar förståelsen för vad som är av vikt i sjuksköterskans smärthantering. Syfte: Syftet var att beskriva patientens uppfattning om sjuksköterskans smärthantering vid cancerrelaterad smärta. Metod: Studien genomfördes som en allmän litteraturstudie med induktiv ansats. Resultat: I litteraturstudiens resultat framkom fyra kategorier; betydelsen av kunskap hos sjuksköterskan, vikten av god kommunikation, relationens betydelse i smärthanteringen och patientens behov av stöd. Resultatet visade att patientens uppfattning om sjuksköterskans smärthantering påverkades av de kunskaper sjuksköterskan hade om smärta, smärtanalys och smärtbehandling. Kommunikationen med sjuksköterskan påverkades av den information patienten fick, hur sjuksköterskans samverkade i team och att vården var individanpassad. Patientens relation till sjuksköterskan var beroende av sjuksköterskans attityd till patienten och smärtupplevelsen, att sjuksköterskan var omtänksam och att patienten kunde känna tillit till sjuksköterskan. Sjuksköterskans närvaro och förmåga att visa empati påverkade patientens uppfattning om sjuksköterskans stöd i smärthanteringen. Konklusion: Mer utbildning behövs för att sjuksköterskan ska få mer kunskap om smärta och smärthantering. På så sätt kan sjuksköterskan lindra patientens lidande och främja livskvalitet och välbefinnande. / Background: Pain is one of the most common symptoms of cancer. Despite clear guidelines for the treatment of cancer-related pain, pain still remain a problem for many patients with cancer. The nurse has a significant role in the management of the patient’s pain. By exploring the patient’s perception increases the understanding of what’s important in the nurse’s pain management. Aim: The aim of this study was to describe patient’s perception of nurses’ pain management in cancer-related pain. Method: The study was designed as a structured literature review with an inductive approach. Results: Main findings of the study results in four categories; the importance of the nurse’s knowledge, the importance of good communication, the importance of the relationship in pain management and the patient’s need for support. The results showed that patients’ perception of nurses’ pain management depended on the nurse’s knowledge of pain, pain assessment and pain management. Communication with the nurse was affected by the information the patient received, how the nurse cooperated with the healthcare team and that the care was individualized. The patient's relationship with the nurse depended on the nurse's attitude towards the patient and the pain experience, that the nurse was caring, and that the patient could have trust in the nurse. The nurse’s presence and ability to show empathy influenced the patient’s perception of the nurse’s support in pain management. Conclusion: The result demonstrated that more education is needed to evaluate the nurses’ knowledge about pain and pain management. Though education, the nurse has opportunity to relive patients’ suffering and promote quality of life and well-being.

Transitions of care is a model designed to ensure that patients have resources needed to assist them to care for themselves at home after hospital discharge, which helps to decrease preventable adverse events. For people with heart failure (HF) to transition home from the hospital successfully, specific education is needed that is individualized to the disease process, but most patients' educational needs after discharge are unmet. The purpose of this qualitative study, guided by the Meleis middle range theory of transition, was to explore the perspectives of people with HF about their educational needs in order to gather data that could inform better care practices for them once they are discharged from the hospital. Twelve participants with HF were interviewed post hospital discharge about their education experience at discharge and what they felt was needed for them to be successful in caring for themselves after discharge. Data were analyzed, and three themes emerged: discharge preparation, lifestyle changes, and transitions of care. Participants indicated that they had a positive experience with the education provided, that they had to make changes to their daily routines, and that the transition of care program was beneficial in helping them successfully care for themselves after discharge. Further studies should interview people of different ethnicities with HF, should include multiple sites in the study, and should extend the research to people with other illnesses to gain their perception of discharge education. Results contribute to positive social change because individuals with HF who know how to care for themselves at home will be able to improve their quality of life as they can effectively transition to home from the hospital setting.

No description available.

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2017-05-18T11:35:00Z No. of bitstreams: 2 Dissertação - Nara Lília Oliveira Arruda - 2017.pdf: 1415739 bytes, checksum: 48cd639b4a03f2c5f99a2ff058045ea3 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2017-05-18T11:35:52Z (GMT) No. of bitstreams: 2 Dissertação - Nara Lília Oliveira Arruda - 2017.pdf: 1415739 bytes, checksum: 48cd639b4a03f2c5f99a2ff058045ea3 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2017-05-18T11:35:52Z (GMT). No. of bitstreams: 2 Dissertação - Nara Lília Oliveira Arruda - 2017.pdf: 1415739 bytes, checksum: 48cd639b4a03f2c5f99a2ff058045ea3 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2016-12-19 / This study aimed at analyzing users' perception due to safeness of health care offered by professionals in an emergency and urgency unit of a university hospital in Midwest of Brazil. The population was composed of 100 patients who met pre – established criteria for research. This is a cross-sectional, descriptive, quanti-qualitative study. The data were collected from May 31 to August 30, 2015 through interviews, guided by a semi-structured adapted and tested tool. The quantitative data were entered in the Statistical Package for The Social Science (SPSS) version 20.0 and analyzed, descriptively, by means of simple and absolute frequencies. For qualitative analysis, Bardin content analysis was used. The results showed that 53.0% of the patients were females from 19 to 84 years, an average of 50.6 years. Regarding the care, 100% were of urgency for clinical treatment. 99% of the patients were satisfied with the care received, and 99% felt safe with professionals care; 96% had no problems during the period they remained in the emergency and urgency unit. As a safe conduit, they pointed out that 99% of the professionals confirmed the name before any procedure and 89% clearly explained the procedures; 86% were advised on possible complications; 93% reported that professionals showed skill in performing procedures; 69% that professionals always consulted the prescription before the procedure. Regarding the occurrence of errors, 97% would like to be informed about the occurrence of errors during the treatment, even if, it did not cause damage; 80% relied on the team and judged they were unable to anticipate the possible error in care. Patients' satisfaction with the care and rehabilitation of the emergency and urgency services was considered an important indicator of assistance quality in emergency and urgency units in the hospital. It is expected that this study contributes to the formulation and enhancement of educational actions as a strategic way to reach and / or strengthen patient satisfaction with care security, as well as, for the policies elaboration that subsidize the formation of a culture decreasing the risks of hospitalization and ensuring improvements in care quality in emergency and urgency units in local and national context. / Este estudo objetivou analisar a percepção dos usuários quanto a segurança no atendimento em saúde, oferecida pelos profissionais, em uma unidade de urgência e emergência de um hospital de ensino do centro-oeste brasileiro. A população foi composta por 100 pacientes que atenderam aos critérios pré-estabelecidos para a pesquisa. Trata-se de um estudo transversal descritivo, de natureza qualiquantitativa. Os dados foram coletados de 31 de maio a 30 de agosto de 2015 por meio de entrevistas, norteadas por um instrumento semi estruturado, adaptado e testado. Os dados quantitativos foram inseridos no Statistical Package For The Social Science (SPSS) versão 20.0 e analisados, descritivamente, por meio de frequências simples e absolutas. Para análise qualitativa, foi utilizada a análise de conteúdo de Bardin. Os resultados mostraram que 53,0% dos pacientes eram do sexo feminino com idade variável entre 19 e 84 anos, com média de 50,6 anos. Quanto ao atendimento, 100% foram de urgência para tratamento clinico. 99% dos pacientes demonstram-se satisfeitos com o atendimento recebido e, 99% sentiram-se seguros com o atendimento dos profissionais; 96% não tiveram problemas durante o período que permaneceram na unidade de urgência e emergência. Como condutas seguras, destacaram que 99% dos profissionais confirmam o nome antes de qualquer procedimento e 89% explicaram claramente os procedimentos; 86% foram orientados sobre possíveis complicações; 93% referiram que os profissionais mostraram habilidade na realização de procedimentos; 69% que os profissionais consultavam sempre a prescrição antes do procedimento. Quanto à ocorrência de erros, 97% gostariam de ser informados sobre a ocorrência de erros durante o tratamento, mesmo que, não causasse dano; 80% confiavam nos profissionais que prestavam cuidado e julgaram não ter condições para se antecipar ao possível erro durante o cuidado. A satisfação dos pacientes sobre o atendimento e cuidados recebidos no serviço de urgência e emergência foi considerada um importante indicador de resultado da qualidade da assistência nas unidades de urgência e emergência do hospital. Espera-se que este estudo contribua para a formulação e potencialização de ações educativas como um caminho estratégico para o alcance e/ou fortalecimento da satisfação do paciente com a segurança assistencial, bem como, para elaboração de políticas que, subsidiem a formação de uma cultura de segurança, minimizando os riscos da internação e garantindo melhorias na qualidade do cuidar nas unidades de urgência e emergência no contexto local e nacional.

ABSTRACT  Aim: Professionalism is an important and integrated part of dentistry and an essential characteristic in dentists. The aim of this study is to evaluate how patients perceive dental student’s professionalism and if their perception differs between male and female dental students at the Faculty of Odontology at Malmö University.  Material & method: By using definitions of professionalism, a cross-sectional survey with eight statements was created to evaluate the patients’ perceptions of the dental student’s professionalism. For each of the statements, patients responded through a five-point Likert scale. The results were analysed using IBM SPSS Statistics 25 programme and p ≤ 0,05 as a significant p-value.  Results: Majority of the 103 patients that participated in the survey had a positive response to all eight statement and only three patients responded negatively. Dental students in their final years generally received better reviews than students in their second or third year. 100% of the patients agreed completely that they felt respectfully treated by the students. Male dental student received slightly higher percentage in two statement that of them being more knowledge and able to care for the patient in the best way possible. No significant results, p ≤ 0,05, were obtained.  Conclusion: The patients generally perceived dental students to be professional and that the student’s professionalism increases as their education progresses. Male and female dental students were largely considered equally professional. More studies are necessary on professionalism in dental educations. / SAMMANFATTNING  Syfte: Professionalism är en viktig och integrerad del av tandvården och är ett nödvändigt karaktärsdrag hos tandläkare. Syftet med denna studie är att undersöka tandläkarstudenternas professionalism från patientens perspektiv samt att utvärdera om studenternas professionalism skiljer sig med hänsyn till kön på odontologiska fakulteten på Malmö Universitet.  Material & metod: En tvärsnittsundersökning med åtta påståenden om tandläkarstudents professionalism utformades för att undersöka patienternas uppfattning av tandläkarstudenternas professionalism. Patienternas respons registrerades på en fem-punkts Likert-skala. Resultatet analyserades med hjälp av kalkyleringsprogrammet IBM SPSS Statistics 25 och p ≤ 0,05 som ett signifikant p-värde.  Resultat: Majoriteten av 103 deltagande patienter gav positiva svar till alla åtta påståenden, och endast tre patienter svarade med negativa svarsalternativ. Tandläkarstudenter som går i de sista åren i tandläkarutbildningen fick generellt positivare respons än tandläkarstudenter som studerar i andra och tredje året av utbildningen. 100% av patienterna höll med helt att de kände sig respektfullt bemötta av studenterna. Manliga tandläkarstudenter fick något högre procentuella värden för två påståenden där patienterna ansåg att manliga studenter erhöll mer kunskap och var kapabla att ta hand om patienterna på bästa sätt. Inga signifikanta resultat där p ≤ 0,05 erhölls.  Konklusion: Patienterna uppfattade generellt tandläkarstudenterna som professionella och att studenternas professionalism ökade desto längre fram i utbildningen de befann sig. Manliga och kvinnliga tandläkarstudenter ansågs i stort vara likvärdigt professionella. Fler studier är nödvändiga för utvärdering av professionalism bland tandvårdsrelaterade utbildningar.

As lesões por esforços repetitivos (Ler) tem-se apresentado como um importante problema de Saúde Pública, tanto por sua alta e crescente incidência, como pela dificuldade de abordagem adequada nos 3 níveis de atenção: preventivo, curativo e reabilitador. O presente trabalho tem como objetivo as LER, descrevendo o significado da doença do ponto de vista do adoecido, investigando-se os possíveis aspectos relacionados à percepção, sentimento, crenças e conduta do paciente em relação a sua doença. Discute-se a importância de se definir o ponto de vista do adoecido como uma contribuição para aumentar a abrangência do conhecimento sobre a problemática das LER, uma vez que somente o adoecido é capaz de informar o que significa vivenciar a situação geradora da lesão, a doença em si e suas conseqüências. Para se atingir o objetivo desse trabalho, utilizou-se a metodologia qualitativa. A partir da coleta de 10 depoimentos de bancárias adoecidas, sua transcrição integral e analise temática, construiu-se o Discurso do Sujeito Coletivo (DSC) onde uma adoecida síntese descreve sua relação com a doença e suas diversas implicações. Vários aspectos presentes do DSC são dscutidos a partir do referencial teórico adotado. Aponta-se que o material produzido (DSC) pode ser utilizado no desenvolvimento de atividades educativas que colaborem para o esclarecimento dos diversos aspectos relacionados com a doença entre os atores sociais envolvidos na questão. Espera-se, assim, contribuir para a adoção de ações que levem em conta a complexidade do problema, possibilitando a transformação da situação atual / The Repetitive Trauma Disorders (RTD) has shown to be an important Public Health issue because of both its high and increasingly occurrence as well the difficulty to find the adequate approach for 3 health attention stages: preventing, curing and rehabilitating. This study has the RTD as subject and describes what is disease meaning from the ill person point of view. To achieve this purpose, it was assessed the possible aspects related to the patient perception, feeling, belief and behavior regarding the disease. The study discuss the importance of defining the ill person point of view which can contribute for enlarging the RTD problem knowledge, once that the ill person is the only one able to report precisely how it is to experience the situation which caused the injury, the disease itself as well the its consequences. A qualitative approach was used in order to reach the work objective. It was collected depositions from 10 ill bank workers. After the integral depositions transcription and its thematic analysis, it was built the Collective Subject Discourse (CSD), where a synthesis ill person describes its relationship with the disease and the consequent implications. Many aspects present in the CSD are discussed based on the theoretical referential adopted. It is indicated that the result of this study, the CSD, could be used as a guide line for developing educational activities to help clarifying many issues related to the disease among the social actors. Is is expected as a result a contribution for selecting actions that takes in account the problem complexity transforming the current situation.

As lesões por esforços repetitivos (Ler) tem-se apresentado como um importante problema de Saúde Pública, tanto por sua alta e crescente incidência, como pela dificuldade de abordagem adequada nos 3 níveis de atenção: preventivo, curativo e reabilitador. O presente trabalho tem como objetivo as LER, descrevendo o significado da doença do ponto de vista do adoecido, investigando-se os possíveis aspectos relacionados à percepção, sentimento, crenças e conduta do paciente em relação a sua doença. Discute-se a importância de se definir o ponto de vista do adoecido como uma contribuição para aumentar a abrangência do conhecimento sobre a problemática das LER, uma vez que somente o adoecido é capaz de informar o que significa vivenciar a situação geradora da lesão, a doença em si e suas conseqüências. Para se atingir o objetivo desse trabalho, utilizou-se a metodologia qualitativa. A partir da coleta de 10 depoimentos de bancárias adoecidas, sua transcrição integral e analise temática, construiu-se o Discurso do Sujeito Coletivo (DSC) onde uma adoecida síntese descreve sua relação com a doença e suas diversas implicações. Vários aspectos presentes do DSC são dscutidos a partir do referencial teórico adotado. Aponta-se que o material produzido (DSC) pode ser utilizado no desenvolvimento de atividades educativas que colaborem para o esclarecimento dos diversos aspectos relacionados com a doença entre os atores sociais envolvidos na questão. Espera-se, assim, contribuir para a adoção de ações que levem em conta a complexidade do problema, possibilitando a transformação da situação atual / The Repetitive Trauma Disorders (RTD) has shown to be an important Public Health issue because of both its high and increasingly occurrence as well the difficulty to find the adequate approach for 3 health attention stages: preventing, curing and rehabilitating. This study has the RTD as subject and describes what is disease meaning from the ill person point of view. To achieve this purpose, it was assessed the possible aspects related to the patient perception, feeling, belief and behavior regarding the disease. The study discuss the importance of defining the ill person point of view which can contribute for enlarging the RTD problem knowledge, once that the ill person is the only one able to report precisely how it is to experience the situation which caused the injury, the disease itself as well the its consequences. A qualitative approach was used in order to reach the work objective. It was collected depositions from 10 ill bank workers. After the integral depositions transcription and its thematic analysis, it was built the Collective Subject Discourse (CSD), where a synthesis ill person describes its relationship with the disease and the consequent implications. Many aspects present in the CSD are discussed based on the theoretical referential adopted. It is indicated that the result of this study, the CSD, could be used as a guide line for developing educational activities to help clarifying many issues related to the disease among the social actors. Is is expected as a result a contribution for selecting actions that takes in account the problem complexity transforming the current situation.

I performed two randomised controlled trials (RCTs) to determine the best treatments for enteric fever in Kathmandu, Nepal, an area with a high proportion of nalidixic acid resistant S. Typhi and S. Paratyphi A isolates. I recruited 844 patients with suspected enteric fever to compare chloramphenicol versus gatifloxacin. 352 patients were culture confirmed. 14/175 patients treated with chloramphenicol and 12/177 patients treated with gatifloxacin experienced treatment failure (HR=0.86 (95% CI 0.40 to 1.86), p=0.70). The median times to fever clearance were 3.95 and 3.90 days, respectively (HR=1.06 [CI 0.86 to 1.32], p=0.59). The second RCT compared ofloxacin versus gatifloxacin and recruited 627 patients. Of the 170 patients infected with nalidixic acid resistant strains, the number of patients with treatment failure was 6/83 in the ofloxacin group and 5/87 in the gatifloxacin group (Hazard Ratio, HR=0.81, 95% CI 0.25 to 2.65; p=0.73); the median times to fever clearance were 4.7 and 3.3 days respectively (HR=1.59 [CI 1.16 to 2.18], p=0.004). I compared conventional blood culture against an electricity free culture approach. 66 of 304 patients with suspected enteric fever were positive for S. Typhi or S. Paratyphi A, 55 (85%) isolates were identified by the conventional blood culture and 60 (92%) isolates were identified by the experimental method. The percentages of positive and negative agreement for diagnosis of enteric fever were 90.9% and 96.0%, respectively. This electricity free blood culture system may have utility in resource-limited settings or potentially in disaster relief and refugee camps. I performed a literature review of RCTs of enteric fever which showed that trial design varied greatly. I was interested in the perspective of patients and what they regarded as cure. 1,481 patients were interviewed at the start of treatment, 860 (58%) reported that the resolution of fever would mean cure to them. At the completion of treatment, 877/1,448 (60.6%) reported that they felt cured when fever was completely gone. We suggest that fever clearance time is the best surrogate for clinical cure in patients with enteric fever and should be used as the primary outcome in future RCTs for the treatment of enteric fever.