Bakgrund: Stroke ses som en av världens vanligaste folksjukdomar med ofta många och långa komplikationer i efterförloppet. Oavsett vart i vårdkedjan vårdpersonal är verksam i, är det stor sannolikhet att möta på patienter som någon gång kan ha drabbats av stroke. Syfte: Litteraturstudiens syfte var att belysa vårdpersonalens erfarenheter av att vårda patienter som drabbats av en stroke. Metod: En kvalitativ litteraturstudie utfördes där 6 artiklar analyserades genom Fribergs femstegsmodell. Vid sökningen av kvalitativa artiklar tillämpades databaserna Cinahl och Pubmed. Resultat: Analysen genererade 4 huvudkategorier och 9 subkategorier. Huvudkategorierna var: omvårdnad och rehabilitering, teamarbete, kommunikation och information samt arbetssituationen. Konklusion: Vårdpersonal har många positiva erfarenheter av att vårda patienter som drabbats av stroke, där en strävan finns efter att arbeta utifrån ett personcentrerat förhållningssätt. Det behövs dock fortsatt forskning, kunskap och utbildning utifrån vårdpersonalens perspektiv för att därmed kunna utföra en optimal omvårdnad och rehabilitering. / Background: Stroke is seen as one of the world's most common public diseases with often many and long complications in the aftermath. Regardless of where in the care chain healthcare staff are active in, there is a great chance of meeting patients who may have suffered a stroke at some point. Aim: The purpose of the literature study was to shed light on the care staff's experiences of caring for patients affected by a stroke. Methods: A qualitative literature study was performed where 8 articles where analyzed through Friberg's five-step model. When searching for qualitative articles, the databases Cinahl and Pudmed were applied. Results: The analysis genereted 4 main categories and 9 subcategories. The main categories where: nursing and rehabilitation, teamwork, communication and information, and the work situation. Conclusion: Nursing staff have many positive experiences of caring for patients affected by stroke, where there is an effort to work from a person-centered approach. However, continued research, knowledge and education from the care staff's perspective are needed to be able to perform optimal nursing and rehabilitation.

Among elderly persons living in nursing homes in Sweden, 42 percent have poor oral health. Poor oral health is a suffering for the elderly person and can affect the person's ability to speak, chew and smile but can also lead to poor self-esteem and depression and in worst case critical illness. Therefore, oral health is an area of nursing that must be updated and prioritized. Nurses hold a key position to be able to promote good oral health for older people and could identify oral health problems at an early stage. Therefore, nursing staff need to get knowledge about oral health related to general health. The purpose of the literature review is to shed light on how care staff can improve the oral health of people in nursing homes. The method chosen was a literature review, based on four qualitative, four quantitative and two mixed method studies. Two main categories and six subcategories were created. The two main categories were barriers to good oral health and factors for good oral health and the subcategories describe lack of knowledge among care staff, priorities and attitudes, dislike to oral care as well as interprofessional collaboration, progressive strategies and organizational support. Oral health is neglected due to barriers such as lack of time, high workload, and priorities in nursing homes. For oral health to be improved among people in nursing homes, increased knowledge and cooperation between care staff and dental staff is required.

Magister Curationis - MCur / Background: Absenteeism is a worldwide problem in health care facilities. Absenteeism results in low standard of care and in the dissatisfaction of clients as routine care activities tend to be disrupted due to the shortage of staff. Nurses are perceived to be under continued stress due to increased pressure at the workplace, which results in dissatisfaction, conflicts and absenteeism. Although the topic has been researched, very little information is available about nurse absenteeism in care facilities for intellectually disabled persons. Absenteeism often occurs because of low commitment by the staff members, illnesses, and job dissatisfaction. Nurse absenteeism impacts negatively on the activities of the facilities because the work becomes disorganized and schedules are delayed and patient care may be compromised. Aims and objectives: The aim of this study was to investigate self-reported reasons for absenteeism amongst nurses working in a facility for intellectually disabled persons in the Western Cape. The objectives were to describe the safety and security reasons, physical conditions, and work relations that contributed to absenteeism of nurses in this facility. Research design and method: A quantitative descriptive approach was utilised, using a self-completed questionnaire. Study setting and population: The study was conducted in a facility for intellectually disabled persons in Western Cape. The study population comprised all the permanently employed nurses working in a facility for intellectually disabled persons in the Western Cape in 2017. The population of nurses in this facility was N=191. Ten nurses (3 RNs, 3 ENs and 4 ENAs) who were not part of the actual study, participated in a pilot study, another ten nurses were nurse managers who were not included. Twenty nurses were on leave, therefore the study population for this study was 151 nurses (n=151). All inclusive sampling was used. Data analysis: Data was managed and analysed using SPSS version 24. Data is presented in tables, graphs and charts. Results: The majority of participants 76% reported that the physical environment contributed to their absenteeism. 54.6% of the respondents were concerned about physical injuries that they often sustain whilst caring for their clients. 56.6% of respondents reported that the psychosocial environment was also perceived to be unconducive. Absenteeism was also influenced by the lack of equitable access to training opportunities. Other factors reported included heavy workloads which lead to burnout (62%n=67). Conclusions and recommendations: There is a need for the improvement of the infrastructure in the institution, the introduction of wellness programmes in the workplace and support of nurses to limit burnout. Equitable access to training and opportunities for and career development should be encouraged by nurse managers.

Bakgrund: Sexualitet är en viktig del av att vara människa genom hela livet, trots detta ses sällan den äldre vuxna som en sexuell varelse. Forskning visar att sexualitet fortfarande är betydelsefullt hos äldre vuxna, trots detta så sjunker den sexuella aktiviteten med åldern. Det kan bero på kroppsliga hinder till sexuell hälsa där sjukvården kan hjälpa till. Att vårda den sexuella hälsan fungerar inte om det inte finns förståelse för begreppet sexualitet. Syfte: Att beskriva vårdpersonalens attityder och erfarenheter kring sexualitet hos äldre vuxna som vårdas på särskilt boende (SÄBO). Metod: Studien är en litteraturöversikt som analyserat tio artiklar av kvalitativ design. Resultat: Analysen gav ett resultat med två kategorier med två respektive tre underkategorier. Vårdpersonalens inre faktorer med underkategorierna; Fördomar som leder till obekväma känslor och Empati och öppenhet som bygger en stödjande roll. Vårdpersonalens yttre faktorer med underkategorierna; Familjen eller patienten, Den sjuka kroppens effekt och Boendestruktur, riktlinjer och ledning. Konklusion: För att beakta äldre vuxnas sexualitet krävs en personal som reflekterat över sin egna förförståelse av sexualitet för att eliminera fördomar. Det krävs också en ledning som stöttar och en verksamhet med tydliga riktlinjer. Detta bygger en miljö som är öppen och tillåtande, där sexuella frågor kan diskuteras. / Background: Sexuality is an important part of being human, through all ages. However, the older adult is rarely seen as a sexual being. Research shows that sexuality is still an important part of the older adult’s life, even if sexual activity drops with age. This can be related to problems with the ageing body, which healthcare can help with. To care for sexual health isn’t possible if there isn’t an understanding for the concept sexuality. Aim: To describe nursing staff’s experiences and attitudes towards sexuality in older adults in long term care. Method: The study is a literature review that analyzed ten articles with a qualitative design. Findings: The result contains two categories with two/three subcategories. Nursing staff’s inner factors with the subcategories; Prejudice that leads to uncomfortable feelings and Empathy and candidness that builds a supporting role. Nursing staff’s external factors with the subcategories; Family or patient, The effects of a sick body and Residential structure, guidelines and management. Conclusion: It takes a nursing staff that has reflected over their pre-understanding of sexuality to eliminate prejudice and be able to care för the older adult’s sexual health. It also requires a supportive management with clear guidelines. This will enable the topic of sexuality to be discussed.

Changes in reimbursement make it imperative for nurse managers to develop tools and methods to assist them to stay within budget. Disparity between planned staffing and required staffing often requires supplemental staffing and overtime. In addition, many states are now mandating staffing committees to demonstrate effective staff planning. This retrospective quantitative study developed an empirical method for building nursing unit staffing plans through the incorporation of patient acuity and patient turnover as adjustments towards planning nursing workload. The theoretical framework used to guide this study was structural contingency theory (SCT). Patient turnover was measured by Unit Activity Index (UAI). Patient acuity was measured using case mix index (CMI). Nursing workload was measured as hours per patient day (HPPD). The adjustment to HPPD was made through the derivation of a weight factor based on UAI and CMI. The study consisted of fourteen medical, surgical, and mixed medical-surgical units within a large academic healthcare center. Data from 3 fiscal years were used. This study found that there were significant, but generally weak correlations between UAI and CMI and HPPD. The method of deriving a weight factor for adjusting HPPD was not as important as the decision-making relative to when to adjust planned HPPD. In addition, the measure of unit activity index was simplified which will assist researchers to more easily calculate patient turnover. As a result of this study, nurse managers and will be better able to adjust and predict HPPD in cases where benchmarking has been problematic. Data-driven adjustments to HPPD based on UAI and CMI will assist the nurse manager to plan and budget resources more effectively.

Bakgrund Trycksår är en komplikation som kan uppstå när hud förskjuts mot underliggande vävnad i kombination med tryck. Anledningen tros bero på kunskapsbrist samt hög arbetsbelastning vilket kan resultera i ett lidande hos patienter som blir långliggande inom slutenvården. Syfte Syftet var att belysa åtgärder för att förebygga trycksår inom slutenvården. Metod Examensarbetet skrevs som en litteraturöversikt baserat på 20 vetenskapliga originalartiklar. Artiklarna inhämtades från databaserna PubMed och CINAHL och var publicerade mellan 2017–2022. Artiklarna har granskats med stöd av granskningsmallar för kvalitativa och kvantitativa studier. Fribergs analysmodell användes vid tolkning och analysering av resultatet för litteraturöversikten. Resultat Det finns olika typer av trycksårförebyggande åtgärder för att förebygga trycksår. Några exempel är; riskbedömning, trycksårsförebyggande material, hudbarriär och kontextuella faktorer. För att åtgärderna ska utföras på ett adekvat sätt bör sjuksköterskor ha uppdaterad kunskap och utbildning inom området trycksårsförebyggande åtgärder. Slutsats Att göra riskbedömningar och använda SEM-skannern i tidigt skede hos patienter inom slutenvården kan ses som grunden för att tillämpa rätt trycksårsförebyggande åtgärd till varje unik patient. / Background Pressure ulcers is a medical complication which appears when skin shifts against underlying tissue whilst under pressure. The origin of pressure ulcers seems to be lack of knowledge and high workload in healthcare personnel. The result of which leads to suffering to patients in institutional care. Aim The purpose is to highlight measures for preventing pressure ulcers applicable in inpatientcare. Method This thesis was written as an literature review based off 20 scientific publications. The articles was obtained from databases PubMed and CINAHL and was published between 2017–2022. The publications has been reviewed using templates for qualitative and quantitative studies. Fribergs analyzing model was used when interpreting and analyzing the result. Results There are different types of measures to prevent pressure ulcers in institutional care. Some of them are; risk assessment, pressure relieving material, skin barriers but also contextual factors. To ensure the adequate of the preventive measurements the caregivers should have updated knowledge and education in the subject. Conclusions The use of risk assessments and SEM-scanning of patients in institutional care in an early stage is the foundation for choosing the right preventing measurements and treatment to each and every patient.

Bakgrund I Sverige lever idag cirka 160 000 personer med demenssjukdom och i hela världen cirka 50 miljoner. Att leva med demenssjukdom medför kognitiva, funktionella, sociala och yrkesmässiga nedsättningar vilket ställer ökat krav på hälso- och sjukvården för att kunna tillämpa god och säker vård. För att kunna tillämpa en personcentrerad vård är det av vikt att ha kunskap och förståelse för kommunikationens betydelse. Syfte Syftet med denna litteraturöversikt är att beskriva kommunikationens betydelse för personcentrerad vård vid demenssjukdom. Metod Denna studie har genomförts som en litteraturöversikt och baserades på 17 vetenskapliga artiklar publicerade mellan år 2012-2022. Sökningarna utfördes i databasen CINAHL. De valda artiklarna analyserades där likheter och skillnader har jämfördes. Resultat Resultat visar att flera olika typer av kommunikation har betydelse för personcentrerad vård vid demenssjukdom. Kommunikation kan vara både verbal, icke verbal, skriftlig och även innefatta sång och musik. I resultatdelen framkom tre kategorier; Förståelse för den unika personen, God och öppen kommunikation samt Anhörigas upplevelse av kommunikation. Slutsats Kommunikation stärker personens identitet samt främjar värdighet och respekt. Anpassad kommunikation skapar förtroende och känsla av välbefinnande. Utebliven kommunikation minskar upplevelsen av delaktighet. / Background In Sweden there are 160,000 persons diagnosed with dementia and in the rest of the world the total is 50 millions. Dementia is characterized by several symptoms caused by braindamage. Dementia leads to cognitive decline which interferes with the person´s functional and social abilities as well as their professional life, which places increased demands on health care in order to be able to apply good and safe care. In order to be able to apply person-centered care, it is important to have knowledge and understanding of the importance of communication. Aim The purpose of this literature review is to describe the impact on communication for person-centred care in dementia. Method A literature study was conducted to create an overview of existing research of the selected topic. The result is based on 17 scientific articles. The selected articles were analyzed where similarities and differences has been compared. Results The results show that communication is important for person-centred care in dementia. Communication can be both verbal, non-verbal, written or include song and music. Three sub-headings appeared in the results section; Understanding of the unique person, Good and open communication and Relatives' experience of communication. Conclusions Communication strengthens the person's identity and promotes dignity and respect. Adapted communication creates trust and a sense of well-being. Failure to communicate reduces the experience of participation.

Bakgrund: Suicid är en av de vanligaste dödsorsakerna i världen hos personer i åldrarna 15-44 år. I Sverige förekommer det tio gånger så många suicidförsök som fullbordade suicid. Att vårda suicidala patienter handlar om att rädda liv och denna patientgrupp förekommer på många olika vårdavdelningar. Syfte: Studiens syfte var att undersöka vårdpersonalens upplevelser av att vårda suicidala patienter. Metod: En litteraturstudie med kvalitativ ansats där tio artiklar inkluderades. Resultat: Analysen resulterade i tre kategorier med sammanlagt sju underkategorier. Kategorierna var: Att nå och förstå suicidala patienter, Att orka vårda suicidala patienter och Känslor av att möta suicidala patienter. Underkategorierna döptes till: Förståelse och respekt, En vårdande relation, Behov av stöd, Copingstrategier, Att känna ansvar, Att inte räcka till, Maktlöshet och frustration. Slutsats: Resultatet genomsyrades av behovet av bättre och mer stöd från kollegor och fördjupad kunskap om att vårda suicidala patienter. Det uttrycktes även en frustration över att inte räcka till och en hopplöshet över att inte nå fram till patienterna. Klinisk betydelse: Denna studie kommer förhoppningsvis att vara vägledande för vårdpersonal att förstå sig själv och varandra i mötet med suicidala patienter. / Background: Suicide is one of the most common reasons of death worldwide, among persons aged 15-44. In Sweden, the numbers of suicidal attempts are ten times higher than the number of completed suicides. According to the nursing staff the care of suicidal patients are all about saving lives, and this group of patients is represented in many different wards. Aim: The aim of this study was to examine the nursing staffs’ experiences of suicidal patients. Method: A qualitative literature study with ten studies included. Results: The analysis resulted in three categories, with a total of seven subcategories. The categories were: To reach and understand suicidal patients, To endure the nursing of suicidal patients and The feelings of meeting suicidal patients. The subcategories were called: Understanding and respect, A caring relationship, Need of support, Copingstategies, To feel responsibility, To not be sufficient as a caregiver, Powerlessness and frustration. Conclusion: The result was imbued by the need of a greater quantity and quality in the support provided by colleagues, and a deeper knowledge in how to treat suicidal patients. A frustration was expressed with not being sufficient and feelings of hopelessness for not being able to reach the patients. Clinical significance: Hopefully, this study will become a guideline to nursing staff to better understand oneself, and each other, in the interaction with suicidal patients.

Falls and complications from falls are a common problem among adults aged 65 years and older. About 60% of older adults fall every year, causing injuries, hospitalization, nursing home placement, and even death. Most studies on falls among skilled nursing facility (SNF) residents focus on fall preventive measures that fail to include staffing variables such as nursing hours. Although researchers have examined the relationship between nursing staff and patient outcomes in hospital settings, similar studies have not occurred in long-term care facilities. The purpose of this retrospective longitudinal study was to determine whether a correlation exists between nursing staff hours per shift and rate of falls. The secondary data included Minimum Data Set 3.0, Certification and Survey Provider Enhanced Reporting, and residents' event reports from four skilled nursing facilities over 6 months. Statistical analysis of Latent Growth Curve Model of SPSS informed this retrospective longitudinal study. The theoretical framework of Donabedian's model of structure, process, and outcome provided the background for this study. The findings suggested that there is no correlation between higher nursing staff ratios and decreased fall rates. However, there were more falls during the day shift, with a higher nursing staff ratio. The study findings have implications for social change. The dissemination of study findings could assist Medicare and Medicaid services to improve SNF staff rating systems. Additionally, findings could inform and influence SNF administrators, policymakers, and health care providers in the development and implementation of policies and intervention programs that assist in fall prevention measures.

Bakgrund: Stroke är ett vanligt förekommande fenomen både nationellt och internationellt. Patienters beskriver ett missnöje över vissa delar av omvårdnaden när det kommer till problematik efter en stroke. Lagar och styrdokument förtydligar vårdpersonalens ansvar och skyldigheter vid omvårdnad och patienters egenvård betonas. Syfte: Att beskriva vårdpersonalens perspektiv på omvårdnaden gällande patienter som genomgått en stroke. Metod: En allmän litteraturöversikt där både kvalitativa och kvantitativa artiklar har analyserats och presenterats. Resultat: Vårdpersonalen menade att relationen till patienter var viktig för att ge patienter möjlighet till god omvårdnad. Vårdpersonalen beskrev också att andra förutsättningar behövs för god omvårdnad samt att det förekommer svårigheter i omvårdnaden. Det är viktigt att ta hänsyn till patienters unika svårigheter och problem efter stroke och anpassa omvårdnaden efter det. Omvårdnaden strävar efter att patienter i möjligaste mån ska bli självständig. Slutsats: Vårdpersonalen bör se den unika patienter med unika besvär för att anpassa omvårdnaden och för att omvårdnaden ska leda till främjandet av patienters självständighet. / Background: Stroke is a common phenomenon worldwide. Patients describes dissatisfaction when it comes to nursing after stroke related to specified problems. Laws and guidelines define healthcare staff’s responsibility and obligations related to nursing and the patient’s self-care is prioritized. Aim: To describe nursing related to patients after stroke from a nursing staff perspective. Method: A general literature review including analysis and presentation of both qualitative research and quantitative research. Result: Healthcare staff concluded that the relationship to the patient established the possibility to give the patient meaningful nursing care. Healthcare staff also described other important aspects to succeed in nursing and some difficulties in nursing. It’s important to be aware of the patients special and unique needs and adopt the nursing care after those aspects. The patient will receive nursing care to support the patient to independence which the nursing care also strives for. Conclusion: Healthcare staff must include the unique patient and be aware of the unique circumstances to be able to adjust nursing care and encourage the patient’s way to independency.