Background: Patients with diagnosis of schizophrenia experienced a reduced life expectancy of up to 25 years as compared to people in general. Health promotion interventions concern behavior affecting interventions intended to improve the living habits of patients with diagnosis of schizophrenia. In this work, the psychiatric nurse had an important role in taking into consideration the resources of the patient. The literature indicated a difference between men and women what regarded nursing. Aim: To investigate health promotion interventions between genders for patients with diagnosis of schizophrenia. In addition, to identify predicting factors for the achievement of health promotion interventions. Method: The study design was retrospective cross-sectional. Data registered 2014 and 2015 in the national quality registry for psychosis care were analyzed statistically. The sample had a size of 5554 individuals. Results: Logistic regression analysis indicated that to be a man, have systolic hypertension and lack occupation were statistically significant variables that together affected whether or not patients had received health promotion interventions during the last twelve months, chi-squared test indicated no difference between men and women. However, chisquared test indicated that to be below 55 years of age, to have high school education and occupation were predicting factors for health promotion interventions. Conclusion: Being a man seemed to predict health promotion interventions, however systolic hypertension and lack of occupation were predicting factors together with being a man. Gender specific advice could be of help to the psychiatric nurse in the initial valuation of the needs of the patient.

Bakgrund: Patienter inlagda på sjukhus behöver näringstillförsel för att kunna återhämta sig. Enteral nutrition är troligen att föredra framför parenteral nutrition, och bör sättas in så tidigt som möjligt. Enteral nutrition kan administreras på olika sätt. Den kan ges intermittent och innehålla nattvila, eller ges kontinuerligt för att undvika plötsliga sänkningar i blodsockernivåer. En oönskad komplikation är lösa avföringar hos patienten. Frågan är om administrationsformen av enteral nutrition kan påverka frekvensen av diarré. Syfte: Att med hjälp av en registerstudie jämföra antal lösa avföringar per dygn mellan två olika administrationsformer av enteral nutrition: intermittent med nattvila jämfört med kontinuerlig tillförsel över hela dygnet. Metod: En kvantitativ retrospektiv registerstudie har genomförts på totalt 50 intensivvårdspatienter med traumatisk skallskada vid Norrlands Universitetssjukhus. Journaler från 2007 till 2012 har använts i studien. Resultat: Ingen signifikant skillnad kunde påvisas mellan grupperna i antal lösa avföringar per dygn, p=0.5. Däremot visade denna studie att de patienter som fick intermittent enteral nutrition fick signifikant större mängd enteral nutrition (699±249 ml) per dygn jämfört med patienter som fick sin enterala nutrition kontinuerligt (505±278 ml/dygn), p = 0.008. Slutsats: Resultatet från studien visar att antalet lösa avföringar inte verkar bero på administreringsformen av enteral nutrition. Mängden tillförd enteral nutrition skiljer sig dock statistiskt signifikant varav betydelsen av det borde studeras vidare för att avgöra vilken administreringsform som är att föredra. / Background: Patients admitted to hospital need nutrition to recover. Enteral nutrition is probably preferable to parenteral nutrition should be initiated as early as possible. Enteral nutrition may be administered in various ways, it can be intermittent and include night rest, or given continuously to avoid abrupt reductions in blood sugar levels. An unwanted complication is loose stools of the patient. The question is whether the form of administration of enteral nutrition can affect the frequency of diarrhea. Aim: With the help of a retrospective registry study comparing number of loose stools per day between two different forms of administration of enteral nutrition: intermittent with night sleep compared with continuous supply throughout the day. Method: A quantitative retrospective registry study has been carried out on a total of 50 ICU patients with traumatic head injury at Norrlands University Hospital. Records from 2007 to 2012 were used in the study. Results: No significant difference was detected between the groups in the number of diarrhea per day, p = 0.5. However, this study demonstrated that patients receiving intermittent enteral nutrition was significantly greater amount of enteral nutrition (699 ± 249 ml) per day compared with patients who received their enteral nutrition continuously (505 ± 278 mL / day), p = 0008. Conclusion: The results from the study show that the number of loose stools do not seem to depend on the form of administration of enteral nutrition. Quantities of enteral nutrition differ statistically significantly significance of which it should be further studied to determine which form of administration is preferred.

Background: Chronic pain, defined as non-malignant pain emanating from the musculoskeletal system, may limit everyday activities, social functioning and the quality of social and working life for individuals, creating disability as well as incurring high economic and public costs for society. Controlled studies show that cognitive-behavioural interdisciplinary rehabilitation has a positive effect on functioning in patients who have been disabled by chronic non-malignant pain conditions. Positive outcomes described include lower pain intensity, less preoccupation with pain, greater independence and lower consumption of healthcare. On the other hand, the return to work rate varies. To facilitate comparisons on the national level and to enable audit spirals for single programmes as part of the ongoing quality assurance in healthcare the Swedish Quality Registry for Pain Rehabilitation (SQRP) has aggregated data since 1998 on all patients referred to the majority of Swedish rehabilitation units. The aim of this dissertation was to improve the knowledge base of pain rehabilitation in Sweden using the validated self-reported instruments of pain and its consequences included in the SQRP. Methods: The SQRP data were collected before, at the end and 1 year after the intervention for all individuals included, and concerns self-reported demographic variables, pain intensity, activities, thought patterns, impact of pain on daily life and life satisfaction. Individual sick leave data were collected from the Swedish Social Insurance after 1 year. Data collected from 19833 patients (6002 men and 13831 women) of which 7289 participate in work ability improving programmes, were used. Results: The results of four studies included in this thesis showed that the SQRP provided a basis for scientific works since it use the validated self-report instruments of pain and its consequences and contain a large amount of patient’s data. However, a lack of follow-up data from some units influenced the opportunity of to analyse long-term outcomes. Nevertheless, the SQRP was a useful tool to audit and evaluate as well as to propose optimising of pain rehabilitation. It seemed that contextual factors such as patients’ own beliefs and expectations, education, gender, actual sick leave and employment situation had more importance for the effect of rehabilitation programme than pain characteristics, depression or activity limitation. The Multidimensional Pain Inventory (MPI) scale scores and MPI coping profiles might be used for assessing the outcomes of treatment interventions. A reduction of MPI scale scores for Pain severity and Interference decreased the risk of being on full-time sick leave. On the other hand, the MPI coping profiles Dysfunctional, among both men and women, and Interpersonally distressed, among women, were associated with higher odds of being on full-time sick leave. Conclusions: Attending cognitive-behavioural interdisciplinary pain rehabilitation programmes in Sweden resulted in improvements of the MPI scales after completing a pain rehabilitation programme and this improvement was sustained after 1 year. Moreover, these programmes decreased the levels of full-time sick leave 1 year after completed programme. The findings suggest also the need to tailor rehabilitative strategies differently for men and women as well as for different pain coping profiles.

Bakgrund: Globalt inom hälso- och sjukvården skadas årligen tusentals patienter, somliga med dödligt utfall. Majoriteten av dessa skador sker inom den perioperativa vården där operationssjuksköterskan har ett ansvar att minimera risken för att en vårdskada ska uppkomma. En viktig del inom patientsäkerhets- och förbättringsarbetet är avvikelserapportering och detta är således ett viktigt ämne för vidare forskning. Syfte: Studiens syfte var att kartlägga inrapporterade avvikelser inom operationssjukvård samt att undersöka eventuellt samband mellan tidpunkt och avvikelseområde. Metod: Kvantitativ retrospektiv registerstudie. Studien innefattar Centraloperation i Skellefteå och Umeå universitetssjukhus samtliga operationsavdelningar. Avvikelserna samlades in via databasen Platina och materialet behandlades med hjälp av SPSS Statistics version 23. Resultat: Resultatet visade på en signifikant skillnad (p=,000) mellan för- och eftermiddag där förmiddag var vanligast förekommande tidsintervall för inrapportering av avvikelser. De tre vanligaste avvikelseområdena representerades av: Vård och rehabilitering, kommunikation och medicinsk teknik-produkt. Av de totalt 1621 inrapporterade avvikelserna så visade inte resultatet på något signifikant samband mellan tidsintervall och avvikelseområde. Ortopedoperation i Umeå var den klinik där de flesta avvikelser var inrapporterade samt den mest avvikelsefrekventa dagen var onsdag. Slutsats: En signifikant skillnad förelåg mellan antalet inrapporterade avvikelser under för- och eftermiddagar, med förmiddagar som mest frekvent. Inget signifikant samband kunde påvisas mellan tidsintervall och avvikelseområde, dock belyser båda resultaten trender i verksamheten som ur ett patientsäkerhetsperspektiv är av värde för vidare forskning. / Background: Globally within the health care system thousands of patients get injured annually, some with a deadly outcome. The majority of these injuries occur in the perioperative care, where the theatre nurse plays an important role in patient safety. An important part within patient safety and work enhancement is adverse event (AE) reporting and therefore makes it an important topic for further research. Objective: The aim of the study was to map reported AE’s in surgical care and to examine possible correlations between time and AE area. Method: Quantitative retrospective registry study. The study includes Central Operation in Skellefteå and Umeå University Hospital’s all surgical departments. The AE’s were collected through the database Platina and the material was processed with the help of SPSS Statistics version 23. Findings: The results showed a significant difference (p=,000) between morning and afternoon where morning was the most frequent. The three most common areas of AE's were represented by: Care and rehabilitation, communications and medical technology-product. Out of the total 1621 reported AE's the result showed no significant correlation between time interval and AE area. Orthopaedic surgery in Umeå was the clinic were the most AE’s was reported and the most AE frequent day was Wednesday. Conclusion: A significant difference between the numbers of reported AE's during mornings and afternoons was present, with mornings being the most frequent. No significant correlation could be found between the time interval and the AE area, both results however highlight trends in the business which from a patient safety perspective is of valuable for further research.

Bakgrund: Det finns ett ökat behov av närstående, som vårdar den palliativa patienten i hemmet. Antalet vårdplatser inom slutenvården har minskat och andelen äldre ökar i befolkningen. Det palliativa teamet är av betydelse som stöd till närstående i hemmet i vården av den palliativa patienten. Syfte: Att kartlägga närståendes beskrivning av det stöd de fått från palliativa teamet under den tid de vårdade den palliativa patienten i hemmet och vilka förslag till förbättringar anger närstående, som skulle kunna stärka stödet från det palliativa teamet.Metod: En kvantitativ och kvalitativ registerstudie. Data hämtades från Svenska palliativregistrets (SPR) närståendeenkät, bearbetad av SPRs registerhållare och översänts till författaren i Microsoft Exelfil. Deskriptiv analys med frekvensberäkningar, procent samt medelvärde, standardavvikelse och variationsvidd. Kvalitativ data med närståendes kommentarer analyserades med summativ innehållsanalys. Nyckelord räknades och därefter genererades fem koder. Samtliga närståendes kommentarer i citat har redovisats med följande fem koder; informationsbehov, kommunikation och dialog, stödinsatser, närståendes ansvar och anpassad vårdnivå. Resultat: Majoriteten av närstående var nöjda med stödet de fått från palliativa teamet och med information om efterlevandesamtalet, var de skulle vända sig i en akutsituation, närståendepenningdagar, vem som är den patientansvarige läkaren under den palliativa patientens sista dagar i livet och hur få tag på denne vid behov och förväntat dödsfall. De förslag på förbättringar som närstående redovisade var; förbättringar om ett ökat informationsbehov, bättre kommunikation och dialog, stödinsatser, närståendes ansvar och vårdnivå för den palliativa patienten. Konklusion: Majoriteten av närstående var nöjda med det stöd de fått från palliativa teamet under tiden de vårdade den palliativa patienten i hemmet. De förslag på förbättringar, som närstående angav omfattade behov för ökad information, bättre kommunikation, stödbehov och anpassad vårdnivå för den palliativa patienten. / Background: There is an increased need for caregivers to provide in home care for the palliative patient. The number of hospital beds have decreased and the proportion of elderly in the population is expected to increase. The palliative team has an important role in providing support for the palliative patient and their caregivers during in home care. Purpose: Compilation of caregivers’ perception of the support from the palliative team during in home care for the palliative patient and their suggestions for improvements in support from the palliative team.Method: A quantitative and qualitative registry study. Data received from the Swedish Palliative Registry caregiver survey, summarized by the registry technician, was sent via a Microsoft Word file to the author. Descriptive analysis by calculations of frequency, percent, standard deviation and variation width. In the qualitative section all suggestions from caregivers’ were analyzed with summative content analysis. Keywords counted and divided into five codes; information needs, communication and dialogue, support interventions and level of care for the palliative patient. Result: A majority of the caregivers’ were satisfied the support received from the palliative team and information received regarding the follow-up interview after the passing of the palliative patient, knowledge of who was the primary care physician during the palliative patient’s last week of life and how to contact him/her, where to turn in an acute situation and the expected death of the palliative patient. Caregivers’ suggestions for an improvement in support included needs for increased information, better communication and dialogue, actions for support and level of care for the palliative patient. Conclusion: A majority of the caregivers were satisfied with the support received from the palliative team during the time they cared for the palliative patient at home. Caregivers’ suggestions included needs for increased information, better communication and dialogue, actions for support and level of care for the palliative patient.