Hjärtsvikt är ett mycket vanligt tillstånd och kan innebära nedsatt livskvalitet, frekventa sjukhusinläggningar och hög dödlighet. En viktig del i behandlingen vid hjärtsvikt är utförandet av egenvård, vilket innebär att vidta åtgärder för att upprätthålla hälsa. På senare tid har utvecklingen och användningen av digitala verktyg som stöd till egenvård ökat. Genom olika digitala mobilapplikationer och fjärrövervakningssystem kan personer med hjärtsvikt stödjas i utförandet av egenvård, vilket kan leda till förbättrat hälsotillstånd och minskat antal sjukhusinläggningar.  Syftet var att beskriva upplevelser av att använda digitala verktyg som stöd till egenvård hos personer med hjärtsvikt.  Metoden var en litteraturöversikt med systematisk sökstrategi och genomfördes i enlighet med Polit och Beck´s niostegsmodell. Utifrån databassökningar i CINAHL och PubMed inkluderades 18 artiklar med kvalitativ metod eller mixad metod. Artiklarna kvalitetsgranskades och analyserades sedan genom en integrerad analys.  Resultatet baseras på 18 artiklar som bedömts ha god kvalitet eller mycket god kvalitet. I resultatet framkom att deltagarna upplevde att de digitala vertygen kunde öka deras kunskap och förståelse för egenvård, öka deras motivation till egenvård och stärka deras egenmakt. De använde de digitala verktygen som stöd för att övervaka tecken och symtom på försämring och som stöd för att vidta egenvårdsåtgärder. De digitala verktygen upplevdes av många som användbara och enkla att använda, men det framkom också svårigheter med användningen som exempelvis fysiska begränsningar, bristande digital kompetens och tekniska problem.  Slutsatsen är att de digitala verktygen upplevdes användbara för att upprätthålla egenvårdsbeteenden, övervaka tecken och symtom som kan tyda på försämring och som stöd vid beslut om egenvårdsåtgärder. Deltagare beskrev dock även en del svårigheter med användningen. / Heart failure is a very common condition and can involve reduced quality of life, frequent hospitalizations and high mortality. An important part of the treatment for heart failure is the performance of self-care, which means taking measures to maintain health. Recently, the development and use of digital tools as support for self-care has increased. Through various digital mobile applications and remote monitoring systems, people with heart failure can be supported in self-care, which can lead to improved health status and reduced hospital admissions. The aim was to describe experiences of using digital tools as support for self-care in people with heart failure. The method was a literature review with a systematic search strategy and was carried out in accordance with Polit and Beck's nine-step model. Based on database searches in CINAHL and PubMed, 18 articles with a qualitative method or mixed method were included. All articles were quality checked and then analyzed through an integrated analysis. The result is based on 18 articles judged to have good quality or very good quality. The result showed that the participants felt that the digital tools could increase their knowledge and understanding of self-care, increase their motivation for self-care and strengthen their empowerment. They used the digital tools to support monitoring for signs and symptoms of deterioration and to support taking self-care measures. The digital tools were perceived by many as useful and easy to use, but there were also difficulties with their use. The perceived difficulties were mainly related to physical limitations, lack of digital skills and technical problems. The conclusion is that digital tools were found useful in maintaining self-care behaviors, monitoring signs and symptoms that may indicate deterioration, and supporting decisions about self-care measures. However, participants also described some difficulties with the use.

I denna studie undersöks framställningen och förmedlingen av kvinnliga ideal på sociala medier, med fokus på mediefenomenen “Self-Care” och “Clean-Girl”. I studien diskuteras det ökande inflytandet av sociala medier i unga kvinnors liv, där särskilt fokus ligger på TikTok som är en av de mest framträdande plattformar i den yngre generationen. Det uppmärksammas i studien hur sociala medier förmedlar och förstärker kvinnliga skönhetsideal genom att fokusera på fenomenen “Self-Care” och “Clean-Girl, vilka representerar två populära skönhetsideal som presenteras på sociala medier. Metoden som används är netnografisk, vilket möjliggör en djupgående undersökning av hur kvinnliga skönhetsideal konstrueras på sociala medier. Datainsamling sker genom en analys av medieinnehåll relaterade till fenomenen “Self- Care” och “Clean-Girl” på TikTok. Det insamlade medieinnehållet analyseras genom tillämpningen av det teoretiska ramverket, innehållande Erving Goffmans begrepp om främre och bakre region samt Leon Festingers teori om social jämförelse.  Under analysen identifierades det att unga kvinnor aktivt formar en idealiserad bild av sig själva i den främre regionen på sociala medier, i enlighet med normer och förväntningar från mediefenomenen. Denna framställning kan dock leda till en känsla av diskrepans mellan den offentliga och privata sidan av deras liv. Vidare diskuteras det hur unga kvinnor blir utsatta för en jämförelse med idealiserade standarder som presenteras på sociala medier, vilket kan påverka deras självbild och leda till känslor av otillräcklighet och press kring den egna kroppen och det egna utseendet. Resultatet och analysen betonar även ett motstånd mot ”Self-Care” och ”Clean-Girl”, där unga kvinnor aktivt väljer att ifrågasätta de traditionella skönhetsnormerna. Slutligen lyfts behovet av inkludering och representation av olika kvinnliga perspektiv på sociala medier. / This study examines the production and transmission of feminine ideals on social media, focusing on the media phenomena of “Self-Care” and “Clean-Girl”. In the study it is discussed the increasing influence of social media in the lives of young women, with particular focus on TikTok, which is one of the most prominent platforms among the younger generation. The study draws attention to how social media spreads and reinforces female beauty ideals by focuses on the phenomena of “Self-Care” and “Clean-Girl”, which represent two popular beauty ideals that appear on social media. The method used is netnographic, which enables an in-depth analysis of how female beauty ideals are constructed on social media. Data collection takes place through an analysis of media content related to the “Self-Care” and “Clean-Girl” phenomena of TikTok. The collected media content is analyzed through application of the theoretical framework, containing Erving Goffman ́s concept of frontstage and backstage and Leon Festinger ́s theory of social comparison.  The results and analysis make visible that young women actively form an idealized image of themselves in the frontstage on social media, in accordance with norms and expectations from the media phenomena. This representation can lead to a sense of dissonance between the public and private side of their lives. Furthermore, it is discussed how young women are exposed to a comparison with the idealized standard presented on social media, which can affect their self- image and lead to feelings of pressure regarding their own body and appearance. The results and the analysis also emphasize a resistance to “Self-Care” and “Clean-Girl, where young women actively choose to question the traditional beauty standards. Finally, the need for inclusion and representation of different female perspectives on social media is highlighted.

Bakgrund: Sjuksköterskeledda astma/KOL-mottagningar förekommer inom primärvården, men forskning kring effekten av dessa är bristfällig. Det är oklart om patienternas astmakontroll (symtomkontroll) förbättras om vårdcentralerna har en astma/KOL-mottagning. Syfte: Syftet är att belysa relationen mellan vuxna astmapatienters astmakontroll och förekomsten av astma/KOL-mottagningar i primärvården. Metod: En enkät skickades till alla vårdcentraler i landstinget Sörmland, för att kartlägga vårdresurser kring omhändertagandet av vuxna astmapatienter. Utifrån kartläggningen bildades två grupper av vårdcentraler baserat på hur mycket tid sjuksköterskan hade avsatt för astma/KOL-mottagningen. Patienter från båda grupperna fick besvara en enkät i vilken bl.a. astmakontrolltest (ACT) ingick. Resultat: 76 % av vårdcentralerna hade en sjuksköterskeledd astma/KOL-mottagning. I genomsnitt var den avsatta tiden för sjuksköterskan 0,9 timmar/vecka/1000 listade invånare per vårdcentral (1,5 h rekommenderas). Av patienterna i gruppen med vårdcentraler där sjuksköterskan hade mest tid avsatt för astma/KOL-mottagningen hade 58 % god astmakontroll, jämfört med 36% av patienterna i den andra gruppen (p<0,01). Slutsats: Få av astma/KOL-mottagningarna uppfyllde tidskriteriet för en godkänd astma/KOL-mottagning, vilket troligtvis kan vara en bidragande orsak till att astma/KOL-sjuksköterskorna inte hann med att utföra tillräckligt med omvårdnadsaktiviteter för att stärka patienternas egenvårdskapacitet. Vilket i sin tur kan bidra till en sämre astmakontroll. / Background: Nurse-led asthma/COPD-clinics in primary care is common, but there is insufficient research of the effects. The evidence of  the impact of patients asthma control is not sufficient.  Aim: The aim is to illustrate the relationship between adult asthma patients asthma control and the presence of asthma/COPD-clinics in primary care. Method: Every Primary Healthcare Center (PHC) in the region of Sörmland answered a questionnaire about the organization of care to adult asthma patients. Two groups of PHC was formed, based on how much time was allocated for the nurse at the asthma/COPD-clinic. Patients from each group answered a questionnaire. Asthma Control Test (ACT) was included. Findings: 76 % of the PHC´s had an nurse-led asthma/COPD-clinic. The average time for the nurse was 0,9 hours/week/1000 patients at the PHC (1,5 h is recommended). Of the patients in the group from PHC´s with most time allocated for the nurse at the asthma/COPD-clinic 58 % reached asthma control, compared to 36% of the patients in the other group (p<0,01). Conclusions: Only a few asthma/COPD-clinics fulfilled the recommended time  for an approved asthma/COPD-clinic. This can probably be a contributing factor to that the asthma/COPD-nurse did not manage to perform enough nursing activities to strengthen patients self-care capacity. This can in turn contribute to poor asthma control.

Bakgrund: Diabetes typ 2 är en endokrin sjukdom och ett globalt hälsoproblem, där antalet insjuknande personer ökar kraftigt. Behandlingen vid diabetes typ 2 utgörs till största del av egenvård vilket ställer stora krav på patienten och på sjukvården. En bristande följsamhet till råd om egenvård kan leda till sämre hälsa för patienten och ökade kostnader för samhället. Syfte: Syftet med denna litteraturöversikt var att beskriva vilka faktorer som påverkar följsamheten till råd om egenvård hos patienter med diabetes typ 2. Metod: En litteraturöversikt baserad på 15 vetenskapliga artiklar där både kvalitativa och kvantitativa artiklar har granskats. Databaserna CINAHL och PubMed har använts. Resultat: Faktorer som påverkade följsamheten till råd om egenvård identifierades och resulterade i fem huvudkategorier: Information; Kunskap; Socialt stöd; Teknologiskt stöd och Livssituation. Dessa faktorer framkom som viktiga för en god följsamhet till råd om egenvård. Slutsats: Det är av stor betydelse att försöka identifiera varje individs olika förutsättningar, för att på så sätt ha möjlighet att anpassa både information, utbildning och egenvårdsplanering utifrån individen. / Background: Type 2 diabetes is an endocrine disorder and a global health problem, with the number falling ill persons greatly increases. Treatment of type 2 diabetes consists mainly of self-care, which places great demands on the patient and the healthcare system. A lack of compliance to advice on self-care can lead to poorer health for the patient and increased costs for society. Aim: The purpose of this literature review was to describe the factors that influence compliance to advice on self-care in patients with type 2 diabetes. Method: A literature review based on 15 scientific articles, both qualitative and quantitative articles were reviewed. The databases CINAHL and PubMed were used. Results: Factors affecting compliance to advice on self-care were identified and resulted in five broad categories: Information; Knowledge; Social support; technological support and Life situation revealed as important factors for low compliance to advice on self-care. Conclusion: It is very important to try to identify each individual's different conditions, in order to thus be able to cu

This study involved designing an instrument to estimate self care knowledge levels of post myocardial infarction patients. The instrument subscales were diet, smoking, exercise, signs and symptoms of cardiac distress, medications, stress and high blood pressure. Twenty-six subjects were tested following hospital discharge and again two weeks later. Test-retest reliability was performed to establish stability of the instrument. The preset criterion level of.70 for the total scale was not met. The medication subscale did meet the.70 criterion level. Reliability estimates were conducted to establish internal consistency of the instrument. The preset criterion level of.70 was not met for the total scale; however, the stress subscale did meet the.70 criterion level on the retest. Concurrent validity was estimated by comparing subscale knowledge scores with self report behavior. Point biserial coefficients did not meet the preset.70 criterion levels. These results suggest that reliability and validity estimates in the post myocardial infarction patient population were not statistically significant. (Abstract shortened with permission of author.)

No abstract / Health Studies / D. Litt. et Phil. (Health Studies)

BACKGROUND: The relationship between patient expectations about a treatment and the treatment outcomes, particularly for Complementary and Alternative Medicine (CAM) therapies, is not well understood. Using qualitative data from a larger study to develop a valid expectancy questionnaire for use with participants starting new CAM therapies, we examined how participants' expectations of treatment changed over the course of a therapy. METHODS: We conducted semi-structured qualitative interviews with 64 participants initiating one of four CAM therapies (yoga, chiropractic, acupuncture, massage) for chronic low back pain. Participants just starting treatment were interviewed up to three times over a period of 3 months. Interviews were transcribed verbatim and analyzed using a qualitative mixed methods approach incorporating immersion/crystallization and matrix analysis for a decontexualization and recontextualization approach to understand changes in thematic emphasis over time. RESULTS: Pre-treatment expectations consisted of conjecture about whether or not the CAM therapy could relieve pain and improve participation in meaningful activities. Expectations tended to shift over the course of treatment to be more inclusive of broader lifestyle factors, the need for long-term pain management strategies and attention to long-term quality of life and wellness. Although a shift toward greater acceptance of chronic pain and the need for strategies to keep pain from flaring was observed across participants regardless of therapy, participants varied in their assessments of whether increased awareness of the need for ongoing self-care and maintenance strategies was considered a "positive outcome". Regardless of how participants evaluated the outcome of treatment, participants from all four therapies reported increased awareness, acceptance of the chronic nature of pain, and attention to the need to take responsibility for their own health. CONCLUSIONS: The shift in treatment expectations to greater acceptance of pain and the need for continued self-care suggests that future research should explore how CAM practitioners can capitalize on these shifts to encourage feelings of empowerment rather than disappointment surrounding realizations of the need for continued engagement with self-care.

Background: Attachment styles involve perceptions of the self and others and influence how individuals relate to other people. Insecure attachment styles have been strongly associated with the life experiences, criminal behaviour and mental health presentations common to patients in forensic settings. Therefore, challenging interactions associated with patients’ insecure attachment styles and contact with traumatising material are considered common for psychologists working within these settings. However, previous research has also indicated that a significant number of psychologists may also have insecure attachment styles. Forensic settings have been associated with stress and burnout amongst health care professionals. However, no previous research has explored how psychologists’ attachment styles may impact their levels of compassion fatigue and compassion satisfaction or influence their self-care in this setting. Aims: This is an exploratory study which addresses a gap in the literature. It aims to explore the attachment styles and prevalence of compassion fatigue (burnout and secondary traumatic stress) and compassion satisfaction amongst psychologists in forensic settings. It will also qualitatively explore how psychologists manage negative feelings that arise in relation to their work and their use of self-care strategies in a range of situations. Finally, it will explore differences in the self-care strategies used by psychologists with different attachment styles. Methodology: An online survey was used to gather data from 66 psychologists currently working in forensic settings in the United Kingdom. Quantitative measures of attachment style, compassion satisfaction and compassion fatigue were combined with qualitative questions regarding psychologists’ self-care strategies. This provided data which was analysed using a mixed methodology, including correlational statistical analysis and qualitative content analysis. Attachment style groups were identified from the quantitative data and qualitative content analysis was applied to explore group similarities and differences in psychologists’ self-care strategies. Results: The results indicated that participating psychologists had a range of attachment styles. Compassion fatigue was not found to be as prevalent as suggested by previous research. Positive correlations were found between attachment related anxiety and burnout, and attachment related avoidance and burnout. Compassion satisfaction was found to be common within the present sample. A negative correlation was found between attachment related avoidance and compassion satisfaction. Similarities and differences in psychologists’ self-care were highlighted between different attachment style groups. Implications: A potential vulnerability was identified for psychologists with insecure attachment styles, in relation to burnout and reduced compassion satisfaction. Furthermore, there appeared to be a lack of knowledge and understanding of attachment theory and how this applies to clinical work. Therefore, a key implication is the development of training for psychologists in relation to this topic. Use of multiple self-care strategies was common and self-care was perceived as important to clinical practice by the majority of the present sample. However, a training need for skills to be taught early in the psychologists’ career and a need for self-care to be more widely supported at an organisational level regardless of stage of career was identified. The study concludes with a review of methodological considerations and the limitations these may present to the current findings.

Sammanfattning   Bakgrund: Övervikt och fetma har blivit en hälsofarlig nödsituation i västvärlden, i synnerhet bukfetma som är en av de viktigaste riskfaktorerna för kardiovaskulära sjukdomar. Den västerländska dieten domineras av högt förädlade livsmedel till låg kostnad vilket snabbt har utvecklat övervikt och överviktsrelaterade sjukdomar. Det finns olika behandlingsmetoder för att minska övervikt och fetma, där kost är en viktig komponent. Lågkolhydratkost kommer alltmer i fokus, som ett alternativ till de rådande näringsrekommendationerna. För att stödja och motivera personer med övervikt och fetma kan sjuksköterskan förmedla en personcentrerad egenvård enligt Orem. Sjuksköterskan skall enligt lag arbeta evidensbaserat och det krävs ständig uppdatering av forskningsläget. Syfte: Syftet var att studera effekten av lågkolhydratkost hos personer med övervikt och fetma. Metod: Litteraturöversikten är av kvantitativ metod och innehåller 15 vetenskapliga artiklar. Analysmodellen som användes var Fribergs analys. Resultat: Effekter av lågkolhydratkost visar signifikanta förbättringar i framförallt viktnedgång men även i blodtryck, blodfetter och blodsocker. De största effekterna av de olika variablerna sågs efter sex månader. Dessa effekter gav ofta en minskad användning av antidiabetika som följd. Slutsats: Då lågkolhydratkost har gynnsamma effekter på viktnedgång, blodfetter och blodsocker är behovet stort av långtidsstudier. Sjuksköterskan har en viktig roll att stödja och motivera personer med övervikt och fetma till livsstilsförändringar. Nyckelord: Viktnedgång, ketogen kost, lågkolhydratkost, egenvård / Summary Low-carbohydrate diets for overweight and obesity - A literature review   Background: Overweight and obesity has become a health hazard emergency in the western world, especially abdominal obesity which is one of the major risk factors for cardiovascular diseases. The Western diet is dominated by highly processed food at low cost, which has rapidly developed obesity and obesity related diseases. There are various treatment methods to reduce overweight and obesity by diet which is an important component. Low-carbohydrate diet comes increasingly into focus, as an alternative to the current nutritional recommendations. To support and motivate people with overweight and obesity, the nurse can convey a person-centered self-care according to Orem. The nurse should, by law, set their work based on evidence and that requires a continuous update of available research. Objective: The objective was to study the effect of low-carbohydrate diet in people with overweight and obesity. Method: The literature review is the quantitative method and contains 15 scientific articles. The analysis model used was Friberg analysis. an important role to support and motivate people with overweight Result: Effects of low-carbohydrate show significant improvements especially in weight loss but also in blood pressure, blood fats and blood sugar. The main effects of the different variables were observed after six months. These effects often gave a reduced use of antidiabetic drugs as a result. Conclusion: Since low-carbohydrate proven to have beneficial effects on weight loss, blood fat and blood sugar there is a great need for long-term studies. The nurse has and obesity to lifestyle changes. Keywords: Weight loss, ketogenic diet, low-carbohydrate diet, self-care

Bakgrund: Diabetes mellitus typ 2 (DMT2) ökar i världen och kan leda till allvarliga fotkomplikationer. Det har påvisats brister i den förbyggande vården för att undvika fotkomplikationer. Sjuksköterskan ansvarar för att stötta personer med DMT2 och målet är att få dem att känna sig självständiga och delaktiga i sin egenvård. Syfte: Syftet med studien var att belysa omvårdnadsåtgärder och egenvård som förebygger fotkomplikationer för personer med DMT2 Metod: En litteraturstudie som utgår ifrån 20 vetenskapliga artiklar med kvantitativ uppbyggnad. Sökningarna av Artiklarna är sökta i databaserna Cinahl och Pubmed. Samtliga artiklar är kvalitetsgranskade. Resultat: Identifiering av risker är en viktig faktor i förebyggandet av fotkomplikationer. Dagliga inspektioner och undersökningar av fötterna är viktiga egenvårdsråd som sjuksköterskan bör tilldela genom individuell undervisning. Sjuksköterskan skall efter bästa förmåga stötta och motivera personer med DMT2 till god egenvård. Slutsats: Sjuksköterskan bör undervisa och ge personer med DMT2 tillräcklig kunskap, för att självständigt kunna utföra förebyggande egenvård. / Background: Diabetes mellitus type 2 (DMT2) increases in the world and can lead to serious foot complications. It has been demonstrated deficiencies in preventive care to avoid foot complications. The nurse is responsible for supporting people with DMT2 and the goal is to get them to feel independent and involved in their self-care. Aim: The aim of the study was to highlight nursing care and self-care to prevent foot complications for people with DMT2 Method: A literature review based on 20 scientific articles by quantitative structure. Articles are searched in the databases Cinahl and Pubmed. All items are quality controlled. Results: Risk identification is a key factor in the prevention of foot complications. Important self-care measures as to inspect and examine their feet daily are substances as the nurse should provide individual instruction in. The nurse shall endeavor to support and motivate people with DMT2 until good self-care. Conclusion: The nurse should teach and give people with DMT2 sufficient knowledge, to independently carry out preventive self-care.