Trata-se de um estudo de natureza descritiva, com o objetivo de caracterizar o processo de trabalho dos auxiliares e técnicos de enfermagem quanto aos seguintes aspectos da Sistematização da Assistência de Enfermagem (SAE): informação sobre essa metodologia durante sua formação profissional; informação sobre a SAE no setor de trabalho; informação quanto à aprovação legal para participar da SAE; a percepção desses profissionais sobre a sua participação nas fases da SAE; a contribuição da SAE na organização do seu serviço, conhecer as atividades realizadas por estes profissionais vinculadas às fases da SAE e a freqüência das mesmas. A população foi composta de 70 auxiliares e 07 técnicos de enfermagem. Um questionário com perguntas estruturadas e uma escala do tipo Likert foram utilizados como intrumento de coleta de dados. Os principais resultados revelaram: a) 93,5% dos sujeitos reconhecem autilização dessa metodologia no setor onde trabalha. b) 74,0% receberam treinamento para seu uso, destes, 67,7% afirmaram ter sido após a formação profissional. c) 46,8% referiram saber quais são as fases da SAE, destes, 33,3% citaram a coleta de dados, 33,3% a avaliação, 25,0% o diagnóstico de enfermagem, 25,0% a implementação, 27,7% o planejamento de enfermagem, 52,7% responderam de forma incorreta. d) 67,5% consideram que participam da SAE. e) 75,0% não identificam em quais fases participam da SAE. f) 33,8% acreditam ter respaldo legal para participar, 3,9% que não tem autorização, 13,0% referiram não saber e 44,2% não responderam. g) 94,8% consideram que a SAE melhora a qualidade de sua assistência. Quanto às atividades desenvolvidas: a) 81,8% referem que fazem a admissão do paciente. b) 77,9% dos sujeitos solicitam informações sobre o problema de saúde atual; 70,0% sobre antecedentes pessoais; 66,2% sobre antecendentes alérgicos; 87,7% sobre o uso diário de medicamentos. b) quanto a coleta de dados, 93,5% observam a freqüência respiratória; 93,5% a presença de dispnéia; 92,2% a presença de tosse; 77,9% alterações na oxigenoterapia; 67,5% nunca realizam a ausculta pulmonar; 89,6% verificam a pressão arterial; 81,8% alterações na infusão venosa, 81,8% verificam freqüência de pulsos periféricos; 76,6% avaliam a presença de edema; 76,6% a perfusão periférica; 87,0% referem avaliar aterações no nivel de consciência e 81,8% a orientação no tempo e espaço; 98,7% verificam a temperatura; 90,9% observam a presença de lesões; 85,5% a freqüência e características da urina, 83,1% o tipo e aceitação da dieta; 80,5% o débito urinário; 76,6% a freqüência e características das fezes; 85,7% não auscultam o abdome. c) quanto ao diagnóstico de enfermagem, 85,7% referem nunca realizar esta atividade. d) quanto ao planejamento 87,0% referem nunca participar da prescrição; e) quanto a implementação: 97,4% executam a prescrição e 98,7% checam a prescrição; 98,8% informam alterações observadas durante o cuidado. e) quanto à alta hospitalar, 75,3% anotam condições de deambulação do paciente; 97,4% as condições de dreno. Concluimos que estes profissionais, embora sem saberem, têm uma importante participação nas fases do processo, executando atividades assistenciais previstas em lei, como admissão, observação, descrição e anotação de sinais e sintomas, execução do plano de cuidados e relatório de enfermagem. / It is a descriptive study, that has had as goal to characterize the nursing auxiliaries and nursing technicians working process related to the following aspects of the Nursing Assistance of Systhematization (NAS): information acquired during their professional formation; the use of the method at the working field; the knowledge of legal aspects and their perception on the participation at the phases of NAS; the contribution of it in the organization of their assistance service and the activities done by these professionals. The sample of population was composed by 70 nursing auxiliaries and 07 nursing technicians. A questionnaire with structured questions and a Likert scale were used as collecting data tool. The main results have revealed: a) 93,5% of the subjects recognize the use of this methodology at the working field; b) 74,0% received training to use it, and 67,7% of these have said that it happened after their professional formation; c) 46,8% have said that they knew what the phases of the NAS are, and 33,3% of them have mentioned the collecting data, 33,3% the test, 25,0% the nursing diagnostic, 25,0% the implementation, 27,7% the nursing planning, 52,7% have answered incorrectly and 5,5% haven?t answered; d) 67,5% considered that participate of NAS; e) 75,0% of the subjects can?t identify in which phases they participate of NAS; f) 33,8% of them believe to have a legal protection (approval from Coren ? Regional Nursing Council) in order to participate, 3,9% believe that they don?t have authorization, 13% have said that they don?t know and 44,2% of them haven?t answered the question; G) 94,8% have considered that NAS improves the quality of their nursing assistance. In relation to the developed activities: a) 81,8% have said that they do the patient?s admission; b) 77,9% of the subjects have solicited information on the current health problem; 70,0% on personal antecedents; 66,2% on the allergic antecedents; 87% on the medicine daily use; c) related to the data collection, 93,5% have observed the respiratory frequency; 93,5% the presence of dyspnea; 92,2% the cough presence; 77,9% alterations at the oxygen therapy; 67,5% have never done the pulmonary ausculation; 89,6% have verified the arterial pressure; 81,8% alterations in the venous infusion; 81,8% have verified frequency of peripherical pulses, 76,6% have evaluated the presence of edema; 76,6% the peripherical perfusion, 87,0% have evaluated alterations at the consciousness level and 81,8% the orientation at time and space; 98,7% have verified the temperature; 90,9% have noted the lesion presence; 85,5% the frequency and characteristics of urine, 83,1% the type and acceptance of the diet; 80,5% the urinary debit, 76,6% the frequency and characteristics of excrement; 85,7% haven?t done the abdomen ausculation; d) in relation to the planning 87,0% have said that they have never participated of institutional protocol prescription; e) in relation to the implementation 97,4% have done the nursing prescription and 98,7% have checked the prescription after putting in practice the care proceeding; 98,8% have said they inform alterations noted during the care; e) in relation to the hospital release 75,3% have noted conditions of digression; 97,4% the conditions of drain; 72,7% have oriented on the prescribed medicines. By this way we can conclude that these professionals, although without knowing that, have had an important participation at the phases of the process. Mainly at those phases that mirrors their attributions foreseen by law, as admission, observation, description and taking notes of signals and symptoms, execution of care plans and nursing report.

Background: Oral health is an integral part of the general health and quality of life. Yet oral health among older people requiring nursing care is often poor. Despite this group’s frequent contact with health care services, they tend to lose contact with dental care. In nursing care, nursing staff are tasked to assist with oral hygiene care, but this has become more demanding as many older people retain more teeth or have advanced prosthetic constructions. Previous research in the field emphasised the need of collaboration between dental- and nursing care to support the nursing staff in this task. However, there is a lack of evidence regarding the effects of these collaborations. Aim: The overall aim of the thesis is to examine two oral health programmes used within nursing care with different design regarding support from and collaboration with dental care. Methods: Quantitative research methods was used. The data in Study I comes from an oral health assessments guide (ROAG-J) performed by nursing staff in a national health register. Oral health, assessed at two occasions from older people with nursing care, were used. Study II was a controlled intervention study performed at a nursing home. The intervention involved individual coaching of nursing staff in oral hygiene care by dental hygienist for four hours per week at the ward for a period of three months. Oral assessments of older people were performed by dental hygienists and questionnaires to nursing home staff were used. Result: In Study I, 667 individuals aged 65 years or older, receiving nursing care services and assessed using ROAG-J between November 2011 and March 2014 were included. No statistically significant difference in any of the oral health variables was found between the first and subsequent assessments. At the first assessments, less than one third of participants had oral health problems. At the first assessment, status of the tongue differed in men and women (p < .01); at the subsequent assessment, gender differences were found in voice (p < .05), mucous membranes (p < .003), tongue (p < .01), and saliva (p < .006). In Study II, 33 nursing staff and 48 residents participated at the baseline measurement and 22 and 32 respectively at the 9-month follow-up. The nursing staff changed in knowledge and attitudes related to gum disease, approximal cleaning, usage of fluoride and the likelihood that older persons would express the need for oral health support. The most frequently reported oral health problems among the residents pertained to teeth and gums. The residents relatively high level of oral health was stable during the study period. Conclusions: The participants in the oral health programmes were able to maintain an acceptable level of oral health during the study periods although health was likely to decline. The nursing staff maintained a high level of knowledge and attitudes about oral health. However, there seems to be a discrepancy regarding the prevalence of oral health problems among older people. A collaboration between dental- and nursing care providers indicates a positive influence on providing oral hygiene care.

Many older couples face the dilemma of one of them developing an illness that results in their ability to cope with everyday living activities. The well spouse may struggle for many years with an increasing workload, both physical and mental. Ultimately, there may come a time, when nursing home placement becomes necessary. The aim of this research was to find out what the experience was like for the wife, with a husband who is ill and faces placement in a nursing home, and to determine whether nurses could do more to help them to cope with this difficult situation. Following ethics approval, nine wives were interviewed over a period of two years. Each of the experience was unique, but there were some common problems that many of the wives mentioned. Loneliness was considered by most of the wives as being extremely upsetting, even when they were living with other people, for example their children. The absence of their partner and long term confident was noticed particularly in the evening when, in the past, they had sat down together and watched television. Other reactions included guilt, grief, depression and a change in the husband/wife relationship. Many of the wives seemed to accept the situation, realising that they could no longer cope with their husband at home, they were also healthier than they had been when their husband was at home. This research has highlighted some important points when a wife finds herself in the situation of having to place her husband in a nursing home, although nurses are unable to assist with many of the effects on the wife of the placement, it is helpful to know that the friendliness of the staff, the care of the patient and the cleanliness and homeliness of the nursing home are helpful at this time / Master of Nursing (Hons)

<p><em><p>I Sverige finns minst 150 000 personer med demens och cirka 20 000 personer insjuknar årligen. Bemötandet av en demenssjuk person har visat sig vara helt avgörande för hur mycket den demenssjuke klarar av och en nära positiv relation mellan demenssjuka och vårdare kan få den sjuke att fungera bättre. Syftet med studien var att belysa vad omvårdnadspersonal på kommunala gruppboenden upplevde som förutsättningar och hinder för att skapa bra bemötande av demenssjuka. Data samlades in via intervjuer och bearbetades med kvalitativ innehållsanalys. De kategorier som framkom var: <em>Medvetenhet</em> <em>om kroppsspråkets betydelse</em> <em>för</em> k<em>ommunikation, Viljan till gott samarbete och flexibelt arbetssätt, Stabil personalgrupp, Inställd på den andres behov, Känsla av otillräcklighet </em>och <em>Resursbrist. </em>Resultatet visade att det som verkade underlättande för bemötandet var framförallt personalens egenskaper såsom att använda sitt kroppsspråk, vara klar och tydlig vid kommunikation. Ett bra samarbete i personalgruppen och liten personalomsättning, att personalen försökte finna den röda tråden och leva sig in i den sjukes verklighet. Faktorer som verkade hindrande var framförallt organisatoriska, såsom att personaltätheten minskade och att ett mindre antal personal skulle vårda allt sjukare människor men även att personalen inte alltid kunde hjälpa den sjuke ur oro och ångest.</p></em></p><p> </p><p> </p>

<p>Det pågår hela tiden stora förändringar och omstruktureringar inom hälso- och sjukvården, i och med organisationens uppbyggnad och komplexitet kan det vara en utmaning för den eller de personerna som vill genomföra förändringar oavsett om initiativet kommer uppifrån eller nerifrån. Ett systematiskt förändringsarbete är nödvändigt för att kvaliteten inom hälso- och sjukvården ska kunna säkras och där har sjuksköterskan en central roll. För att ett lyckat förändringsarbete ska kunna ske krävs att verksamheten har en hög kompetens och att fokus ligger på patienten. Syftet med studien var att belysa faktorer som inverkar på sjuksköterskans möjligheter att initiera, bedriva och påverka förändringsarbete inom hälso- och sjukvården. Studien genomfördes som en litteraturstudie där 18 vetenskapliga artiklar granskades. Resultatet visar att det finns ett antal faktorer som både hindrar och stödjer förändringsarbete inom hälso- och sjukvården. Ett gott ledarskap, en öppen kommunikation samt delaktighet från vårdpersonalen är viktiga faktorer för ett framgångsrikt förändringsarbete. Om dessa faktorer inte fungerar tillfredsställande kan det leda till en negativ utveckling av verksamheten och ett aktivt motstånd bland vårdpersonalen. Ämnet måste uppmärksammas i sjuksköterskeutbildningen eftersom det är en stor del av sjuksköterskans arbetsmiljö. Det behövs mer forskning med fokus på sjuksköterskans roll i förändringsarbete. Genom ökade kunskaper inom ämnet kan sjuksköterskans möjligheter att påverka och ställa krav på förändringsarbete underlättas vilket kan stärka professionen samt höja sjuksköterskans status.</p>

<p>Palliativ vård innebär att ge vård till en svårt sjuk patient när sjukdomen inte längre går att bota. Omvårdnadspersonalen som arbetar med palliativ vård måste kunna se och fånga upp olika behov hos den svårt sjuke. Ett starkt engagemang och lyhördhet från omvårdnadspersonalen behövs i arbetet med palliativ vård. Att kunna se döden som en naturlig del av livet är en förutsättning för omvårdnadspersonalen att ha med sig i sin yrkesroll. Enligt den personal som intervjuats är kommunikation ett viktigt redskap i arbetet med palliativ vård för att kunna bemöta de svåra situationer som kan uppstå i arbetet. <strong>Syftet</strong> med vår studie var att ta reda på hur omvårdnadspersonalen upplevde det att arbeta inom palliativ vård. <strong>Metoden</strong> som använts har varit kvalitativ och sökningar har gjorts i databaser på Örebro universitet för att kunna förstå och bearbeta våra frågeställningar och därmed försöka uppfylla studiens syfte. I <strong>resultatet</strong> framkommer omvårdnadspersonalens uppfattning av att arbeta med palliativ vård var att det upplevdes som ett mycket meningsfullt och givande arbete. I studien belyser också omvårdnadspersonalen ett antal faktorer som är av vikt vid mötet med den svårt sjuke och som bidrar till att kunna uppnå en god och värdig död.</p><p> </p> / <p>Palliative care involves providing care to a seriously ill patient when the disease is no longer curable. The nursing staff working in palliative care must be able to see and capture the needs of the seriously ill. A strong commitment and sensitivity of the nursing staff are needed in the work of palliative care. To view death as a natural part of life is a prerequisite for nursing staff and to carry in their professional role. According to the nursing staff, the ability to communicate verbal and also non - verbal is an important tool in the work of palliative care to enable responding to the difficult situations that may arise at work. <strong>The aim</strong> of our study was to find out how the nursing staffs experience of their work in palliative care. <strong>The method</strong> used was qualitative and searches have also been done in the databases at Örebro University to better understand the study's aim. Nursing staff’s perceptions of working with palliative care were that it was perceived as a very purposeful and rewarding work. <strong>The results </strong>are based on informant’s fruitful information that we have taken note of by the interviews. The study will support nursing staff to highlight a number of important factors that are important in meeting difficult situations in the care of patients in order to achieve a good and dignified death for the patients.</p>

<p><strong>Bakgrund:</strong> Studier visar att smärta är vanligt förekommande (80-88 %) hos äldre personer. Demenssjukdom är en neurologisk skada i hjärnan där den verbala och kroppsliga kommunikationen försämras. Detta bidrar till problem att känna igen smärta hos personer med demenssjukdom. <strong>Syftet: </strong>Syftet<strong> </strong>var att belysa hur vårdpersonal kan känna igen smärta hos personer med demenssjukdom. <strong>Metod: </strong>En systematisk litteraturstudie där datainsamlingen genomfördes i databaserna Cinahl, PsycINFO och PubMed. Texterna analyserades induktivt för att finna koder och deduktivt för att sammanställa resultatet. <strong>Resultat: </strong>Genom ömsesidigt förtroende byggdes en relation upp mellan vårdpersonal och person med demenssjukdom. Vårdpersonalen lärde känna personen med demenssjukdoms vanor och mönster vilket ledde till att det blev lättare att upptäcka avvikande beteende. Beteendeförändringar i form av social tillbakadragenhet, aggressivitet och förändringar i sov- och matvanor kunde indikera smärta. Smärta kunde även visa sig genom ansiktsuttryck, verbalt- och kroppsligtspråk samt genom fysiologiska tecken. Smärtuttrycken yttrade sig olika genom demenssjukdomens olika faser. <strong>Slutsats: </strong>Det går att känna igen smärta hos personer med demenssjukdom och även hos personer med svår demenssjukdom. En förutsättning är dock att personalen känner personen.</p> / <p><strong>Background:</strong> Research shows that pain is common (80-88%) among older adults. Dementia is a neurological disease which impairs the verbal communication and the body language. This contributes to the problem of recognizing pain in cognitively impaired elders. The <strong>Aim</strong> was to illustrate how nursing staff to cognitively impaired elders could recognize pain. <strong>Method:</strong> A review of literature has been conducted and the data was collected in Cinahl, PsycINFO and PubMed. Inductive and a deductive analysis were used. <strong>Findings:</strong> Relationship between nursing staff and the cognitively impaired elders is built through mutual trust. By knowing the habits of the cognitively impaired elder the nursing staff is able to detect changes in their behaviour. Behavioural changes like social withdrawal, aggression and changes in sleeping and eating habits could indicate pain. Pain could also be recognized by facial expression, verbal communication, body language and physiological symptoms. However people with different levels of cognitive impairment express pain in different ways. <strong>Conclusion:</strong> It is possible to recognize pain in cognitively impaired even when the person is suffering from a severe dementia disease. To do this, knowing the person seems necessary.</p>

<p>Syfte: Syftet var att beskriva äldre patienters upplevelse av sin sexualitet samt att beskriva utmaningar i kommunikationen mellan omvårdnadspersonal och äldre patienter kring sexuella problem. Metod: Det var en systematisk litteraturstudie. Resultat: Resultatet visade att sexualiteten enligt den äldre var mer än samlag, bland annat närhet och beröring var också en del av sexualiteten. Sexualiteten gav den äldre välbefinnande och den finns alltid kvar. Samtidigt kunde den sexuella lusten minska eller försvinna och det var mer hälsoproblem än åldern som gjorde att sexualitetens betydelse minskade. Ålderdomen blev av båda patient och omvårdnadspersonal upplevd som en barriär mot kommunikation om sexualitet. Äldre tyckte att sexualiteten var privat och inte skulle diskuteras samtidigt som sexuella problem gav upphov till en känsla av skam. Någon omvårdnadspersonal tyckte att det var normalt för äldre att inte ha ett sexualliv, andra tyckte att det var svårare att ta upp sexualitet med äldre än med yngre. I resultatdiskussionen kopplades Jean Watsons omvårdnadsmodell in. Hon beskrev att sexualiteten är ett grundbehov hos människan samt att omvårdnad bör utövas ur ett holistiskt synsätt.</p> / <p>Aim: The aim of the study was to describe elderly patient’s experience of their sexuality and to describe challenges in the communication between nursing staff and older patients about sexual issues. Method: It was a systematic literature review. Result:The result showed that sexuality according to the elderly was more than intercourse, amongst others nearness and touching was also included. Sexuality gave a sense of wellness and it was always remaining. At the same time there was an experience that the sexual urge was diminishing or disappearing and it was more health issues than age per se that lead the importance of sexuality to diminish. Old age was experienced by both patient and nursing staff as a barrier to communicating about sexuality. The elderly felt that sexuality was private and was not to be discussed, and sexual problems caused the elderly to feel shame. Some nursing staff felt that it was normal when elderly did not have a sexual life, others felt that it was harder to raise the issue of sexuality with elderly than with younger people. Jean Watson nursing model was in the result discussion linked to the result. She says that sexuality is a basic need for humans and that nursing should be practiced from a holistic point of view.</p>

<p>Background: Pain can be a constant problem in many older people's daily life, associated with particular physical and social disability, depression and poor quality of life. Dementia diseases are often associated with old age. Communication difficulties are one of the consequences of the disease, which clarifies the role of nursing staff in detecting and assessing pain. Objective: The aim was to compile knowledge about how nursing staff can identify pain in people with dementia. Method: A systematic literature review, where data were collected through manual and database searches. Databases Cinahl, Pubmed and electronic journal Health in the Nordic countries were used. Results: The results showed that pain-identification can be improved by knowing how the pain is reflected in different forms through physical and psychological reactions. Nursing staff knowledge and beliefs were essential for reliable pain assessment. It was also important to be able to see the relationship between cognitive function and pain perception, and to have access to pain assessment tools adapted to individual conditions. Conclusion: Living with constant pain can lead to unnecessary suffering and reduced quality of life. It’s important to be alert to changes in behaviours and habits of daily life. To provide good care, requires knowledge and engagement in caring for people with dementia.</p> / <p>Bakgrund: Smärta som kan vara ett ständigt problem i många äldres dagliga liv, förenad medbland annat fysiska och sociala handikapp, depression samt dålig livskvalitet.Demenssjukdom innefattar skador i hjärnan som ofta är förknippade med hög ålder.Kommunikationssvårighet är en av sjukdomens konsekvenser, vilket tydliggörvårdpersonalens roll i att upptäcka och bedöma smärta. Syfte: Syftet var att sammanställakunskap om hur vårdpersonalen kan identifiera smärta hos personer med demenssjukdom.Metod: En systematisk litteraturstudie, där datainsamling genomfördes via manuella ochdatabassökningar. Databaser Cinahl, Pubmed och elektronisk tidskriften Vård i Nordenanvändes. Resultat: Resultatet visade att smärtidentifiering kan förbättras genom att kännatill hur smärta speglar sig i olika uttryck genom fysiska och psykosociala reaktioner.Vårdpersonalens kunskap och förståelse var grundläggande förutsättningar för att uppnåadekvat bedömning och behandling av smärta. Viktigt var det också att kunna se sambandmellan kognitiv funktion och smärtupplevelse samt att ha tillgång tillsmärtskattningsinstrument som är anpassade efter individers behov och möjligheter.Slutsats: Att leva med ständig smärta kan leda till onödigt lidande och försämrad livskvalitet.Det är viktigt att vara uppmärksam på förändringar i beteende, vanor och mönster i detdagliga livet. För att kunna ge en god omvårdnad, krävs det kunskap samt engagemang ivårdande av personer med demenssjukdom.</p>

<p>Syftet med studien var att undersöka vårdpersonalens inställning till djur samt upplevelsen hos vårdpersonal av delaktighet och inflytande när djur introduceras på särskilda äldreboenden. Metoden var deskriptiv och komparativ studie med kvantitativ ansats med kvalitativa inslag. Enkätstudie besvarades av 102 vårdpersonal på elva särskilda äldreboenden. Resultat visade att 74 %vårdpersonalen ansåg att djur på särskilt äldreboende är mycket bra och om upplevelsen av sin hälsa i relation till djur på avdelningen beskrevs av ett fåtal som att hälsan har försämrats, majoriteten svarade att hälsan inte hade försämrats. Studien visar att förekomsten och frekvensen av besök av djur och längden på besöken är hög.  Nästan hälften (47 %) av vårdpersonalen har varit med om att djur introducerats under deras anställningstid och djuret / djuren sköts främst av vårdpersonalen. Upplevelsen av skötsel av djur är att det är trevligt och stimulerande. Om avdelningsbyte svarade 9 % av vårdpersonalen att de hade haft en kollega som bytt avdelning p g a djur och deras beskrivning av upplevelsen var att det var tråkigt, någon svarade att det var självvalt av den som bytte. Vid beslut om att införa djur i verksamheten upplevde de flesta att det var positivt.</p> / <p>The purpose of this study was to examine nursing staff´s attitudes towards pets and the experience of involvement and influence when animals are introduced at the homes for older people. It was a survey studie which was answered by 102 nursing assistents and nurses. The method was descriptive and comparative study with quantitative approach with qualitative elements. Results showed that 74% of the nursing staff felt that pets at homes for older people are very good and the experience of their health in relation to animals in the ward were described by a few as to health has deteriorated, the majority responded that health had not deteriorated. The study shows that the occurrence and frequency of visits by pets and length of visits is high. Almost half (47%) of nursing staff has experienced pets introduced during their employment period and the pet /pets are primarily looked after by the nursing staff. The experience of care of pets is that it's fun and stimulating. 9 % of the nursing staff that they had had a colleague who changed ward because of pets and their description of the experience was that it was boring, someone replied that it was the choice of the one who changed ward. In deciding whether to include pets in the home for older people experienced most of the staff that it was positive.</p>