Andningsbesvär är en av de vanligaste sökorsakerna på Sveriges akutmottagningar. Det är ett komplext tillstånd som består i både fysiska och psykiska faktorer och kräver såväl farmakologisk som icke-farmakologisk vård. Okunskap inom den icke-farmakologiska vården leder till utebliven behandling, förlängt patientlidande och stor risk för vårdskador. Syftet med detta arbete var att belysa akutsjuksköterskans interventioner för att underlätta och förbättra tillståndet för patienter med andningsbesvär inom akutsjukvård. Studiedesignen som tillämpats var en litteraturöversikt med systematisk metod. Vetenskapliga artiklar som behandlat icke-farmakologisk behandlingsstrategi av all form av andningsbesvär som presentationssymtom eller huvudsymtom inom akutsjukvård har inkluderats. Totalt 15 vetenskapliga artiklar uppfyllde kriterierna för studien och genomgick kvalitetsgranskning samt integrerad analys. Resultaten visade att interventionerna kan delas in i fysiska (aktiv motståndsträning, bukläge och kontrollerad andning), såväl som psykologiska (trygg närvaro, kommunikation och utbildning samt vårdrelation). Motståndsträning kan göras med såväl sammandragna läppar som med apparat med god effekt. Bukläge visade sig effektivt på vakna patienter med omfattande andningsbesvär och syrgasbehov. Riktad och strukturerad kommunikation och patientutbildning ledde inte bara till signifikant förbättrade symtom utan även till att patienterna tolererade interventionerna bättre. Även en god vårdrelation med sjuksköterskan visade på lättare acceptans till givna behandlingar. Den slutsats som drogs var att akutsjuksköterskan har en stor roll i att förbättra tillståndet för patienter med andningsbesvär. Akutsjuksköterska kan ge lättillgängliga, men värdefulla ickefarmakologiska insatser för både de fysiska och psykologiska aspekterna av andningsbesvären. De kan även bidra med kunskap och utbildning för patienterna som resulterar i minskad ångest, förbättrad livskvalitet och minskade sjukhusbesök. De undersökta interventionerna kan troligen med fördel implementeras inom sluten- såväl som öppenvård för att förbättra tillståndet hos patienter med andningsbesvär. / Breathlessness is one of the most frequent causes of visit in Swedish emergency departments. It is a complex condition consisting of both physical and psychological factors, requiring both pharmacological and non-pharmacological treatment approaches. Inexperience in nonpharmacological treatment causes missed treatment, prolonged patient suffering and increased risk of care related injuries. The aim of this study was to illustrate the interventions of the emergency care nurse in facilitating and improving the condition for patients with breathlessness in emergency healthcare. The study design applied was a literature review with a systematic method. Scientific articles covering non-pharmacological treatment approaches of any breathlessness as presenting or main symptom within emergency healthcare was included. 15 articles in total met the criteria for the study and underwent a quality control and integrated analysis. The results indicated that the interventions could be divided into physical (active resistance training, prone position and controlled breathing techniques) and psychological (assuring presence, communication and education and care relationship). Resistance training can be achieved either through pursed lips or specific devices with good results. Prone position proved effective in patients with severe breathlessness requiring oxygen therapy. Aimed and structured communication and patient education did not only result in improved symptoms but enabled the patients to better endure the interventions. A good care relationship too facilitated better acceptance to given treatment. The conclusion drawn was that the emergency care nurse played an immense role in improving the condition of patients presenting with breathlessness. The emergency care nurse could provide easily available, although valuable non-pharmacological contributions to both the physical and psychological aspects of breathlessness. Furthermore, they could contribute with knowledge and education for the patients resulting in relieved anxiety, improved quality of life and reduced hospital visits. The analyzed interventions could presumably be successfully implemented within both inpatient and outpatient care improving conditions for patients suffering from breathlessness.

The impact of the diagnosis and the reality of being hearing impaired could trigger uncomfortable feelings at different times in the client's life. With the cochlear implant, these feelings will still be a reality, as the implant does not heal the hearing impairment. Psychological interventions could assist the client during this healing process. The process of cochlear implants could also bring other challenges into the client's life. Expectations of quick healing play a major role and should be addressed throughout the process of implantation and rehabilitation. This is another opportunity for the psychologist to intervene. This research shows that the role of the psychologist could be expanded not only to evaluate but also to bring about change. The treatment model gives a logical and workable explanation of how and where the psychologist may intervene in the process of cochlear implantation. This model was tested and adapted by the cochlear implant team at the University of Pretoria over a period of ten years. The model may be used as a template for new teams. Intervening as described in the model presents the opportunity to address various different needs as they occur. The qualitative research design proved to be a fitting method to explore the experiences of the participants from their own viewpoints. The qualitative research is also congruent with a systemic perspective and emphasises social context, multiple perspectives, complexity, recursion and holism. This study aims to develop a complementary psychological treatment programme and create awareness within professionals working with hearing impairment of the complexity of systems. The study shows that one can only understand the behaviour of any given system by tracking changes that occur within that system and its subsystems and by tracking changes between that system and the larger whole. In this study three different therapeutic interventions are used on three different case studies, two children from different age groups and an adult, to accommodate the multiple realities of the different systems. The aim of the study with cochlear implantees and their families is to stimulate new leads and avenues of enquiry that may be used as a basis for further research. / Psychology / Thesis (D.Litt. et Phil. (Psychology))

The impact of the diagnosis and the reality of being hearing impaired could trigger uncomfortable feelings at different times in the client's life. With the cochlear implant, these feelings will still be a reality, as the implant does not heal the hearing impairment. Psychological interventions could assist the client during this healing process. The process of cochlear implants could also bring other challenges into the client's life. Expectations of quick healing play a major role and should be addressed throughout the process of implantation and rehabilitation. This is another opportunity for the psychologist to intervene. This research shows that the role of the psychologist could be expanded not only to evaluate but also to bring about change. The treatment model gives a logical and workable explanation of how and where the psychologist may intervene in the process of cochlear implantation. This model was tested and adapted by the cochlear implant team at the University of Pretoria over a period of ten years. The model may be used as a template for new teams. Intervening as described in the model presents the opportunity to address various different needs as they occur. The qualitative research design proved to be a fitting method to explore the experiences of the participants from their own viewpoints. The qualitative research is also congruent with a systemic perspective and emphasises social context, multiple perspectives, complexity, recursion and holism. This study aims to develop a complementary psychological treatment programme and create awareness within professionals working with hearing impairment of the complexity of systems. The study shows that one can only understand the behaviour of any given system by tracking changes that occur within that system and its subsystems and by tracking changes between that system and the larger whole. In this study three different therapeutic interventions are used on three different case studies, two children from different age groups and an adult, to accommodate the multiple realities of the different systems. The aim of the study with cochlear implantees and their families is to stimulate new leads and avenues of enquiry that may be used as a basis for further research. / Psychology / Thesis (D.Litt. et Phil. (Psychology))

This study explored the impact of three psychological interventions over seven weeks - goal setting (GS), GS and imagery (IM), and GS and mindful self-compassion (MSC) - on 20 athletes' (Mage = 16.75 years) pain, cognitive appraisal, depression reinjury anxiety, psychological readiness to return to sport, and range of motion (ROM). IM and GS interventions have demonstrated initial effectiveness; however, no study has examined MSC in relation to post-ACL recovery. All athletes experienced significant decrease in pain (F(2) = 97.30, p = .000) from Week 1 to Week 7 and a significant increase in ROM from Week 2 to Week 7 (F(1) = 77.93, p = .000). All athletes experienced significantly higher depression at Week 1 compared to both Week 2 and Week 7 (F(2) = 9.01, p = .001), and significantly higher difficulty coping with their injury at Weeks 1 and 2 compared to Week 7 (F(2) = 6.32, p = .005). There were no statistically significant effects found between the intervention groups at Weeks 1, 2, and 7. However there were moderate effect sizes between interventions which suggest MSC and IM could help athletes cope with their injury during the first few weeks after surgery, and GS may contribute towards less depression at seven weeks post-surgery. Limitations include small sample size, low power, and use of self-report measures. Results have implications for orthopedic surgeons, physical therapists, and health professionals working with athletes recovering from serious sport injury.