Bakgrund: Enligt forskning har en majoritet av personer med demens någon form av obehandlad smärta. Bristande kommunikation mellan sjuksköterska och patient beskrivs som en orsak till svårigheten för sjuksköterskan att undersöka, bedöma och behandla denna smärta. En fungerande kommunikation och förståelse för patientens livsvärld i kombination med kunskaper om smärtbedömning, kunskap om hur personer med demens upplever smärta samt lämpliga omsorgssåtgärder är nödvändiga för att lindra patientens smärta.  Syfte: Studiens syfte var att beskriva hur sjuksköterskan kan bedöma och lindra smärta hos personer med demens.  Metod: Litteraturöversikt baserad på 15 vetenskapliga artiklar varav elva med kvalitativ ansats och fyra med kvantitativ ansats. Datasamling genomfördes via databaserna CINAHL och PubMed.  Resultat: Det är en stor utmaning för sjuksköterskan att genomföra smärtbedömning på person med medelsvår eller svår demens i form av kognitiv svikt. Bedömningsinstrument är grunden för att sjuksköterskan ska kunna genomföra smärtbedömningen på ett adekvat, säkert, systematiskt och tidseffektivt sätt. Sjuksköterskan kan använda observationsinstrument och självrapporterade bedömningsskalor vid smärtbedömning utifrån observation respektive patientens egen smärtskattning. Fungerande omvårdnadsåtgärder för att lindra smärta är, utöver en fungerande kommunikation med patienten, musik, massage, värmebehandling och användning av rogivande robotdjur.  Slutsats: Smärtbedömning och omsorg av personer med demenssjukdom är en komplex process på grund av patientens nedsatta kommunikationsförmåga. Sjuksköterskan behöver därför fördjupad kännedom om lämpliga bedömningsinstrument för att framgångsrikt bedöma smärta. Utifrån ett personcentrerat helhetsperspektiv behöver sjuksköterskan även förstå patientens livsvärld samt kommunicera med närstående för att framgångsrikt ge smärtreducerande omsorg. / Background: According to research, the majority of people with dementia have some form of untreated pain. Lack of communication between nurse and patient is described as a reason for the difficulty for nurses to examine, assess and treat this pain. A functioning communication and understanding of the patient's perceptions in combination with knowledge of pain assessment, knowledge of how individuals with dementia experience pain and appropriate care measures are necessary to relieve the patient's pain. Aim: The purpose of the study was to describe the nurse's nursing measures to assess and alleviate pain in people with dementia. Method: A literature review based on 15 scientific articles, 11 of which have a qualitative approach and four with a quantitative approach. The data collection was carried out in the databases CINAHL and PubMed.  Results: It is a major challenge for the nurse to make a pain assessment for a patient with moderate and severe cognitive failure. Assessment instruments are the basis for the nurse to be able to perform the pain assessment in an adequate, safe, systematic and time-efficient manner in this patient group. There are observational instruments and self-reported assessment scales that nurses can use in pain assessment based on the nurse's observation and interpretation and the patient's own pain assessment. The nursing measures that the nurse can take in order to alleviate the pain of the patient include music, massage, heat treatment and use of robotic animals. Conclusion: Pain assessment and care of people with dementia is a complex process due to the patient's impaired communication skills. The nurse therefore needs indepth knowledge of appropriate assessment instruments to successfully assess pain. From a person-centered holistic perspective, the nurse also needs to understand the patient's world of life viewpoints and communicate with relatives to successfully provide pain-reducing care.

Sammanfattning   Bakgrund: Andelen personer som är 65 år eller äldre fortsätter att öka globalt. Åldrandet medför fysiska och neurologiska förändringar, funktionsnedsättningar samt ökad risk för sjukdomar, vilket i sin tur ökar risken att drabbas av negativa konsekvenser såsom fallskador, trycksår, undernäring och oral ohälsa. Negativa konsekvenser kan ofta förebyggas eller mildras genom att arbeta vårdpreventivt på ett samordnat, genomtänkt och effektivt sätt i hela sjukvårdssystemet. Sjuksköterskor kan med hjälp av validerade riskbedömningsinstrument tidigt identifiera risker gällande fall, trycksår, undernäring och oral ohälsa vilket minskar risken för att äldre personer ska drabbas av onödigt lidande.   Syfte: Syftet var att beskriva sjuksköterskors erfarenheter av att använda riskbedömningsinstrument för fall, trycksår, undernäring och oral ohälsa inom kommunal vård och omsorg för äldre personer. Metod: En kvalitativ intervjustudie med induktiv ansats genomfördes med åtta sjuksköterskor inom kommunal vård och omsorg. Resultat: Under analysprocessen framkom två huvudkategorier: riskbedömningar prioriteras bort med underkategorierna tidsbrist, brist på stöd, brist på kunskap och förståelse för riskbedömningsinstrumentens vinster, samt riskbedömningar bidrar till en säkrare vård och bättre hälsa för de äldre med underkategorierna riskbedömning bidrar till ett strukturerat arbetssätt och möjliggör identifiering av risker.     Slutsats: Tidsbrist, brist på stöd samt brist på kunskap om fördelar och vinster med användandet av bedömningsinstrumenten var orsaker till att arbetet med riskbedömningar prioriterades bort av sjuksköterskorna. De sjuksköterskor som hade kunskap om skillnaden mellan riskbedömningsinstrument jämfört med andra instrument som skattar ett pågående symtom ansåg att användandet av riskbedömningsinstrument ökade möjligheten att tidigt identifiera risker.   Nyckelord: Preventiv vård, riskbedömningsinstrument, sjuksköterskor, äldre personer / Summary   Background: The proportion of people aged 65 or older continues to increase globally. Aging leads to physical and neurological changes, disabilities, and an increased risk of disease, which in turn increases the risk of suffering negative consequences such as falls, pressure ulcers, malnutrition, and oral ill-health. Negative consequences can often be prevented or mitigated by working in preventive care in a coordinated, well-thought-out, and effective manner throughout the healthcare system. With the help of validated risk assessment instruments, nurses can identify risks at an early stage regarding falls, pressure ulcers, malnutrition, and oral ill-health, which reduces the risk of elderly people suffering from unnecessary suffering.   Purpose: The aim was to describe nurses' experiences of using risk assessment instruments for falls, pressure ulcers, malnutrition, and oral ill-health in municipal care and care for the elderly.   Method: A qualitative interview study with an inductive approach was conducted with 8 nurses in municipal care and nursing.   Results: During the analysis process, two main categories emerged: risk assessments are prioritized away with the subcategories lack of time, lack of support, lack of knowledge and understanding of the benefits of risk assessment instruments, and risk assessments contribute to safer care and health for the elderly with subcategories risk assessment contributes to a structured approach. of risks.   Conclusion: Lack of time, lack of support, and lack of knowledge about the benefits and gains with the use of the assessment instruments were reasons why the work with risk assessments was prioritized away by the nurses. The nurses who had knowledge of the difference between risk assessment instruments compared to other instruments that estimate an ongoing symptom considered that the use of risk assessment instruments increased the ability to identify risks early.    Keywords: Preventive care, risk assessment instruments, Nurses, older people

No description available.

Patient education is an important component of quality cancer care. However, there remains much debate about its effects, merits and limitations. The primary objective of this thesis was to identify outcomes of importance for patient education interventions in breast cancer. Through the process of this inquiry, a systematic review of all patient education assessment instruments, a literature review of patient education studies in chronic diseases and cancer, and ultimately a qualitative study using interpretive description was conducted. The systematic review of assessment instruments revealed a lack of psychometrically sound instruments developed to assess quality and efficacy of patient education materials. There was also a lack of consensus as to what aspects of materials should be appraised to constitute good quality. The review of patient education intervention studies in both chronic diseases and cancer identified a general lack of consensus on the intended effects of educational interventions. Multiple outcomes were used without consistency and in differing combinations in the literature making it difficult to compare relative efficacy of interventions. To discover what key stakeholders in the process of patient education in breast cancer (patients, physicians and nurses) would identify as outcomes of importance, a generic qualitative study using interpretive description was conducted. Five common themes to all groups with respect to outcomes of importance were discovered: improving knowledge, improving coping ability, providing an orientation to the cancer system, enabling shared decision making and impacting behaviour during cancer treatment. Despite the surprising variability and inconsistency of outcomes discovered in the patient education literature, this qualitative study demonstrated that patients, physicians and nurses generally agree on what constitute important outcomes and serves as a first step in the process of developing validated outcomes for patient education interventions in cancer. / Thesis / Master of Science (MSc) / This thesis explores what are considered important outcomes of patient education in breast cancer. Firstly, a systematic review of all instruments created to judge patient education materials was completed and showed a lack of valid instruments for use in judging quality or outcomes in patient education. Secondly, a review of patient education studies in chronic conditions and cancer revealed a paucity of consistent or recommended outcomes for patient education. Lastly, the major focus of this thesis was a qualitative study that used focus groups to discover what breast cancer patients, physicians and nurses identify as important outcomes of patient education interventions at the Juravinski Cancer Centre. It identified that patients, physicians and nurse have five common beliefs about important outcomes of education interventions: improving knowledge, improving coping ability, providing an orientation to the cancer system, enabling shared decision making and helping to direct behaviour during cancer treatment.

Titel: Intensivvårdssjuksköterskans upplevelser av att vårda patienter med delirium. En kvalitativ intervjustudie. Bakgrund: Delirium uppkommer som akuta förändringar i mental status, slutenhet, medvetandepåverkan, konfusion och agitation. Vid tecken på delirium är det viktigt att snabbt göra bedömning för att identifiera delirium och minimera farmakologiska och fysiologiska riskfaktorer samt minska riskfaktorer i patientens miljö som stress. Det är viktigt att visa förståelse och ge stöd, samt förklara patientens upplevelser. Forskning visar att delirium oftast diagnostiseras med den subjektiva kliniska blicken på patienten istället för att använda screeningverktyget CAM-ICU. Syfte: Syftet var att belysa vad intensivvårdssjuksköterskan hade för upplevelser av att vårda patienter med delirium. Metod: Studien genomfördes med en kvalitativ design med individuella semistrukturerade intervjuer där elva intensivvårdssjuksköterskor deltog. Nio av deltagarna var kvinnor och två var män. Data analyserades genom en kvalitativ innehållsanalys. Resultat: Intensivvårdssjuksköterskornas upplevelser av att vårda patienter med delirium belyser en frustration över svårigheter med att identifiera patienter med delirium, att en god kommunikation både med patient, anhöriga och personal är en viktig del i vårdandet, samt att läkemedelsbehandling, aktivering och fysisk stimulans ger positiva effekter för patienten. Slutsats: Det framkom i studien att intensivvårdssjuksköterskorna upplever frustration och svårigheter med att identifiera patienter med delirium. På grund av insikt om kunskapsbrister i CAM-ICU är det viktigt att vårdpersonalen får utbildning i hur bedömningsinstrumentet ska användas eftersom det är ett tillförlitligt instrument. / Title: Intensive care nurse's experiences of caring for patients with delirium. A qualitative interview. Background: Delirium occurs as acute mental status changes, introversion, impaired consciousness, confusion and agitation. If signs of delirium, it is important to make quick assessment to identify delirium and minimize the pharmacological and physiological risk factors and reduce risk factors in the patient's environment such as stress. It is important to show understanding and support, and explain the patient´s experiences. Research shows that delirium is usually diagnosed with the subjective clinical gaze on the patient instead of using the screening tool CAM-ICU.Aim: The aim was to illustrate intensive care nurses experiences of caring patients with delirium. Method: The study was conducted with a qualitative design with individual semi-structured interviews where eleven critical care nurses participated. Nine of the participants were women and two were men. The data was analyzed by qualitative content analysis. Results: Intensive care nurses' experiences of caring for patients with delirium illustrates the frustration over difficulties in identifying patients with delirium and that a good communication both with patients, relatives and staff is an important part of caring. Also pharmacological treatment and activation and physical stimulation produces positive effects for the patient. Conclusion: It was revealed in the study of intensive care nurses´ experience that they experienced frustration and difficulties in identifying patients with delirium. Due to the realization of the knowledge gaps in the CAM-ICU, it is important that the staff is trained in how the assessment instrument should be used because it is a reliable instrument.

The purpose of this pilot investigation was to assess the inter-rater reliability of an expert-validated pediatric feeding assessment, designed for clinician use with children who have severe disabilities. The tool would ideally allow for standardization of the clinical mealtime assessment process. A comprehensive review of available feeding instruments revealed that there is a need for an assessment tool for children with motor and developmentally based feeding problems.In response to this need, a new clinician administered instrument called the Mealtime Assessment Tool for Children (MATCH) was developed in order to guide the assessment of a child during a clinical meal. The items on the MATCH were selected based on expert validation of normal and abnormal feeding patterns that remain constant across the feeding assessments found in the literature. The tool includes a rating scale that allows for gradation of the severity of the problem. Child participants were taped while eating, and clips were rated by four SLPs using the MATCH. The resulting data was analyzed quantitatively, and it was found that across items there was a strong percentage agreement.

För att språket ska fungera normalt krävs ett samspel mellan uttrycksförmåga och förståelse av språk. Afasi är en språkstörning som kommer sig av en skada i de delar av hjärnan som påverkar språket. Att få afasi kan innebära en stor omställning i livet och ofta uppstår ett behov av anpassning av kommunikationen både för personen som fått afasi och personer i dess omgivning. Detta inkluderar även den vårdpersonal som arbetar nära personen med afasi. För att nå förståelse och kunna ge vård och omsorg av god kvalitet, måste tillräcklig kunskap om afasi finnas hos vårdpersonalen. Tidigare forskning visar att det finns brister hos vårdpersonal i deras kunskap om afasi. Utifrån detta kan det anses viktigt att kunna mäta vårdpersonals kunskap om afasi. Denna studies syfte har varit att ta fram relevanta frågor (items) som kan mäta kunskapsnivån hos vårdpersonal. För att besvara frågeställningarna användes kvalitativ metod för materialinsamling. För att samla erfarenheter av hur vårdpersonalens kunskap om afasi upplevs vara idag, genomfördes intervjuer med tre separata grupper: fem personer med afasi, fem anhöriga till personer med afasi och tre logopeder med erfarenhet av arbete med personer med afasi. Intervjuerna analyserades med hjälp av kvalitativ innehållsanalys. Resultatet visade att informanternas erfarenheter var att det hos vårdpersonal existerar kunskapsbrister om afasi, varför studien ansågs vara motiverad. Utifrån det analyserade materialet togs 32 items fram, med syfte att mäta vårdpersonals kunskap om afasi. Som alltid vid kvalitativ forskning finns det risker att olika faktorer, exempelvis forskarnas förförståelse, påverkar informanterna. Största möjliga hänsyn har tagits till detta. Framtida nytta med studien är att de framtagna items kan användas i ett bedömningsinstrument för att mäta vårdpersonals kunskap om afasi. Därmed ges nya möjligheter att kvalitetssäkra vård av personer med afasi, att motivera utbildning för vårdpersonal och att exempelvis mäta vårdpersonals kunskap i relation till rehabilitering.   Nyckelord: afasi, kunskap, vårdpersonal, items, bedömningsinstrument, kommunikation / In order for the language to function normally, the expression- and comprehension of language must work together. Aphasia is a language impairment caused by damage to the language areas of the brain. Getting aphasia can mean a big change in life and often requires adaptation regarding communication both for the person with aphasia and the persons around them. Adaptation regarding communication also includes healthcare staff working close to the person with aphasia. In order to reach understanding and to give care of good quality, knowledge about aphasia is necessary.  Previous research shows that health care staff lacks efficient understanding about aphasia. Considering that, a tool for measuring knowledge about aphasia would be desirable. This study's aim has been to produce questions (items) which can measure the level of knowledge in healthcare personnel. Qualitative research method was used in order to find material for the production of items. In order to gather experiences of how the health care staff's understanding of  aphasia are experienced by interested people today, interviews with three separate groups were performed: five persons with aphasia, five relatives to persons with aphasia and three speech and language pathologists with experience of working with persons with aphasia. The interviews were analyzed through qualitative content analysis. The result showed that all the participants' had various experiences of knowledge deficiencies regarding aphasia within the healthcare staff. The analyzed material resulted in 32 items, with the purpose of measuring the understanding of aphasia in healthcare staff. Since the material indicated that a deficiency in knowledge of aphasia exists in healthcare staff, the study was considered to be justified. Within qualitative research method, there are always risks that different elements, for example the researcher´s viewpoint, can affect the participants. Maximum consideration regarding this issue has been considered. Future benefits of this study could be an assessment instrument containing the items produced in this study. The purpose of an assessment instrument could be to measure health care staff´s knowledge about aphasia. Thereby, new opportunities are given to assure the quality of care for persons with aphasia, to justify education for healthcare staff and to evaluate the health care staff´s understanding in relation to the results of rehabilitation.   Keywords: aphasia, knowledge, understanding, healthcare staff, items, assessment instruments, communication, healthcare personnel

The overall aim of the present thesis was to explore and compare professional co-operation in child welfare investigations, explore the psychometric properties, and describe the clinical utility from different perspectives of a translated Swedish version of the standardized assessment instrument the Home Observation for Measurement of the Environment (the HOME Inventory). Social workers in Sweden, Denmark, Britain, Germany, and Texas (USA) co-operated with different professionals around a fictitious child welfare case. Differences were found between and within country-based samples, indicating an unsystematic work procedure in the social work agencies studied. The psychometric properties of the translated Early Childhood version (EC-HOME) and Middle Childhood version (MC-HOME) of the HOME Inventory were explored in terms of inter-observer reliability and by Rasch analysis. The samples were authentic Swedish child welfare cases recruited from a field setting. Inter-observer reliability was satisfactory. Results were ambiguous regarding measurement construction of the two versions studied. Because of the differentiating ability of the EC-HOME and MC-HOME, total scores could provide an indication of inadequate home environments. Experiences of social work practitioners of the clinical utility of the HOME Inventory suggested that they considered the instrument to be comprehensive and have explicit potential benefits, i.e. to be clinically useful. Correspondingly, caregivers’ overall perceptions of the HOME Inventory were positive, determining the content relevant and the format acceptable. However, certain flaws have to be rectified before the HOME Inventory is to be implemented and used successfully. Further, education and the possibility to practice administering the instrument seemed to be essential conditions for future use according to social workers. When social workers and teachers’ apprehensions about support and stimulation provided by caregivers to children in their home environments were compared, preschool teachers’ apprehensions correlated poorly with the social workers’ assessment. These results suggest that the HOME Inventory is promising but cultural adaptation and further studies of psychometric properties are necessary. Different forms of support to practitioners and agencies for successful implementation are required. Awareness of the type of information provided by different sources is important when co-operating in child welfare.

Att identifiera problemet är avgörande i behandlingen av ungdomar med normbrytande beteende, men för många av de bedömningsinstrument som används saknas utvärdering. När det gäller beteendeobservationer under en längre behandlingsperiod, tycks det vara särskilt ont om kvalitetssäkrade instrument. Det övergripande syftet för denna uppsats är att undersöka beteendeobservationer som utvecklats inom en longitudinell studie (Behandlings- och resultatuppföljning, BRU) vid SiS’ ungdomshem Stigby, och om dessa lämpar sig för att bedöma de inskrivna elevernas relevanta risk- och skyddsfaktorer och hur dessa förändras under vårdtiden. Undersökningen inkluderar 40 pojkar på Stigby i åldrarna 16-20 år. Resultatet består av två delstudier, där del ett undersöker instrumentets psykometriska egenskaper. De första analyserna av beteendeobservationerna visar att 21 av de 24 områdena är lämpliga för att mäta förändring över tid. Del två i resultatet undersöker förändring över tid under behandlingen på Stigby. På samtliga områden noteras att bedömningarna av problemets allvarlighetsgrad har minskat. Den föreliggande studien visar att beteendeobservationerna bör kunna ligga till grund för de utfallsmätningar som planeras i den longitudinella studien två och fem år efter avslutad behandling. / Identifying the problem is crucial in the treatment of adolescents with rule-breaking behavior, but many of the instruments used has not been evaluated. In the case of behavioral observations over an extended treatmentperiod, there seem to be especially short on quality assured instruments. The overall aim of this paper is to investigate the behavioral observations that have been developed in a longitudinal study (Treatment and monitoring performance, BRU) at SiS’ institution Stigby, and if these are suitable for measuring the clients relevant risk and protective factors and how they change during the treatmentperiod. The survey includes 40 boys in Stigby aged 16-20 years. The result consists of two sub-studies, where part one examines the instrument's psychometric properties. The first analysis of behavioral observations show that 21 of 24 areas are suitable for measuring change over time. Part two of the results examines changes over time during treatment at Stigby. In all these areas it is noted that the assessments of problem severity has decreased. This study shows that behavioral observations should form the basis of the outcome measures that is a part of the longitudinal study two and five years after treatment.

Fundação Carlos Chagas Filho de Amparo a Pesquisa do Estado do Rio de Janeiro / Conselho Nacional de Desenvolvimento Científico e Tecnológico / A síndrome de fragilidade pode ser definida como um estado de vulnerabilidade a agentes estressores, um resultado de declínios orgânicos observados em múltiplos sistemas, comprometendo a habilidade do indivíduo em manter a homeostase. O objetivo deste estudo transversal foi avaliar a prevalência desta condição através da Escala de Fragilidade proposta pelo Cardiovascular Health Study em uma população de idosos, clientes de uma operadora de saúde, que vivem na zona norte da cidade do Rio de Janeiro, além de observar o comportamento deste instrumento em uma amostra brasileira. 754 indivíduos foram avaliados quanto aos cinco critérios da escala além de variáveis sociodemográficas, capacidade funcional, quedas, perfil cognitivo e comorbidades relatadas. Foram considerados Frágeis aqueles que apresentaram três ou mais dos seguintes critérios: a) lentificação da velocidade da marcha; b) reduzida força de preensão palmar; c) sensação de exaustão; d) baixa atividade física; e) perda de peso. Os resultados apontam que, dentre os avaliados, 9,2% eram Frágeis. Estes eram mais idosos, com pior status socioeconômico, com pior desempenho cognitivo e maior comprometimento funcional (p< 0,05). Entre os 9,2% de Frágeis, 87% apresentaram alteração da velocidade da marcha, 79,7% da força de preensão palmar, 66,8% baixa atividade física, 52,2% relato de sensação de exaustão e 36,2% relato de perda de peso. A distribuição de suas frequências quando comparado ao estudo original foi bastante semelhante. Vários estudos partem do postulado que a fragilidade pode ser identificada através de medidas clínicas. Através de sua identificação precoce, é possível reconhecer uma entidade potencialmente reversível, reduzindo morbidade e mortalidade na população idosa, no entanto é fundamental um estudo acurado sobre como esta entidade será mensurada e quais serão os critérios adotados para defini-la. Maiores estudos são necessários para realizar, no Brasil, uma análise mais aprofundada desta pertinente questão. / The Frailty Syndrome can be defined as a state of vulnerability to stress agents, an organic result of declines observed in multiple systems, compromising the ability of individuals to maintain homeostasis. The aim of this survey was to assess the prevalence of this condition through the range proposed by the Cardiovascular Health Study in an elderly population, clients of a private health care, living in the northern city of Rio de Janeiro, in addition to observing the behavior of this instrument in a Brazilian sample. 754 individuals were evaluated for five criteria of the instrument beyond socio-demographic variables, functional capacity, falls, cognitive profile and comorbidities reported. Those who reported three or more of the following criteria, slowing the speed of gait, reduced grip strength, feelings of exhaustion, low physical activity and weight loss were considered frail. The results indicate that among the subjects, 9.2% were frail. These were older, with poorer socio-economic status, with poorer cognitive performance and greater functional impairment (p <0.05). Fragile showed 87% of the change in gait velocity, 79.7% of grip strength, low physical activity 66.8, 52.2% reported feeling of exhaustion and 36.2% reported weight loss. New cutoff points were established for walking speed, energy expenditure and grip strength. The distribution of their frequencies when compared to the original study was quite similar. It is postulated that the weakness can be identified by clinical measures. Through early identification, it is possible to recognize an entity potentially reversible, reducing morbidity and mortality in the elderly population, however it is essential to accurate study on this entity will be measured and what are the criteria used to define it. Further studies are required to perform in Brazil, a deeper analysis of the proposed instrument.