The overall aim of this thesis was to develop, test and use a simple, clinically useful instrument for the nutritional screening of older patients. Four studies were performed, with a quantitative approach, in a geriatric rehabilitation ward in western Sweden. The number of patients who par-ticipated was: 56 (I), 114 (II), 147 (III) and 144 (IV) older patients. A nutritional screening instrument, the Nutritional Form For the Elderly (NUFFE), was constructed (I) and tested regarding reliability and validity (I, II). NUFFE was used in a screening, and the screening results were related to the patients’ perceived health and compared to the nurses’ nutritional notes in the nursing documentation (III). The screened patients’ self-care ability and sense of coherence (SOC) were investigated and the patients’ perceived health was related to selfcare ability and SOC (IV). The collection of data was done through interviews with the instruments NUFFE (I-IV), the Selfcare Ability Scale for the Elderly (SASE) (IV), Antonovsky’s SOC scale (IV), a question about perceived health, healthrelated ques-tions (III, IV) and background variables (I-IV). Weight and height were measured (I-III). The nurses’ nutritional notes in the nursing documentation were collected (III). The screening instrument contains 15 threepoint items on ordinal level. The total score ranges between zero and 30 and a higher score indicates higher risk for undernutrition. Evidence of reliability and validity was shown (I, II). The determined cut-off points of NUFFE for identification of patients at low, medium and high risk for undernutrition were set to scores of <6, ≥6 and ≥13 (III). The screening results showed that 31% of the patients were identified to be at low risk for undernutrition, 55% at medium risk and 14% at high risk. When the screening results were compared to nurses’ nutritional notes in the nursing documentation, it was shown that important nutritional issues were absent in many patient records (III). The patients at high risk were more likely to perceive ill health than were those at low risk for undernutrition (p=0.03) (III). Those at medium or high risk were more likely to perceive ill health (p=0.014) and to have lower self-care ability (p<0.001) and weaker SOC (p=0.007) than were those at low risk for undernutrition. To perceive good health was associated with higher self-care ability (p<0.001) and stronger SOC (p<0.001). Lower self-care ability, being single and having been admitted from another hospital ward were three obtained predictors for being at medium or high risk for undernutrition (IV). In conclusion, NUFFE is a simple, useful screening instrument for identification of older nutritional at-risk patients. The instrument has sufficient evidence of reliability and validity. Using NUFFE in a screening of older patients, the prevalence of patients at medium or high risk for undernutrition was found to be high. Nurses’ nutritional notes showed deficiencies, indicating that all medium or high risk patients were not identified. Using NUFFE, associations were found between older patients’ nutritional risk and their perceived health, and their self-care ability and SOC, respectively. These associations indicate that being at low risk for undernutrition is concomitant with perceived good health, higher self-care ability and stronger SOC. Conversely, being at medium or high risk for undernutrition is concomitant with perceived ill health, lower self-care ability and weaker SOC.

In today’s health care it’s most common to treat an illness with a kind of pharmaceutical preparation. But lack of resources, given information and bad communication and collaboration between the patient and the nursing staff can lead to a patient unwilling to follow the doctor’s prescription. This does not just affect the individual patient’s health but it can also result in consequences for other people and the whole society. The purpose of this study was to analyse studies about the concepts compliance and concordance in order to illustrate why patients with chronic illnesses fail to follow their prescriptions. Our method has been to read and analyse the methods and results of articles out of the perspective similarities and differences of the concepts compliance and concordance. It was hard to keep the concepts separated because of their similar meanings. Our result shows that the method used was interviews with questionnaires which has been analysed on the basis of the qualitative studies’ themes and categories. The quantitative articles’ data were displayed statistically. Our analyse showed that patients often lack knowledge about their medical treatment which affects their attitudes and can lead to bad compliance and concordance. As a nurse it’s therefore important to identify the cause that affects the patient. The nursing staff’s goal ought thus to be to get the patient involved as much as possible in their self-care. If the patient is involved in hers/his treatment, it’s more likely that they feel a responsibility towards themselves and therefore gets a better quality of life.

Background: There currently exists a vast amount of literature concerning chronic illness self-management, however the developmental patterns and sustainability of self-management over time remain largely unknown. This paper aims to describe the patterns by which different chronic illness self-management behaviors develop and are maintained over time. Method: Twenty-one individuals newly diagnosed with chronic illnesses (e.g., diabetes, rheumatism, ischemic heart disease, multiple sclerosis, chronic renal disease, inflammatory bowel disease) were repeatedly interviewed over two-and-a-half years. The interviews were conducted in Sweden from 2006 to 2008. A total of 81 narrative interviews were analyzed with an interpretive description approach. Results: The participants’ self-management behaviors could be described in four different developmental patterns: consistent, episodic, on demand, and transitional. The developmental patterns were related to specific self-management behaviors. Most participants took long-term medications in a consistent pattern, whereas exercise was often performed according to an episodic pattern. Participants managed health crises (e.g., angina, pain episodes) according to an on demand pattern and everyday changes due to illness (e.g., adaptation of work and household activities) according to a transitional pattern. All of the participants used more than one self-management pattern. Conclusion: The findings show that self-management does not develop as one uniform pattern. Instead different self-management behaviors are enacted in different patterns. Therefore, it is likely that self-management activities require support strategies tailored to each behavior’s developmental pattern. / Exploring individuals’ conceptions as a way to understand self-management among people living with long term medical conditions

This thesis presents a study to develop and explore the use of a computerized system that provided automated prompts to children with ASD during the completion of a self-care activity (handwashing). A Wizard-of-Oz experiment was implemented using an A-B experimental design. During the baseline phase (A) the child’s caregiver was asked to guide the child through handwashing, in the intervention phase (B) the system guided the child. The results showed that the system was not very successful to guide the child. He tended to get distracted very easily presenting off-task behaviour, which resulted in needing assistance from the caregiver. The data obtained showed that during the intervention phase the assistance from the caregiver consisted mostly of verbal instructions versus the hand over hand guidance observed during B phase. From the data analyses and reviewed literature some improvements and redesigns were suggested which could help develop a more automatic prompting system.

This thesis presents a study to develop and explore the use of a computerized system that provided automated prompts to children with ASD during the completion of a self-care activity (handwashing). A Wizard-of-Oz experiment was implemented using an A-B experimental design. During the baseline phase (A) the child’s caregiver was asked to guide the child through handwashing, in the intervention phase (B) the system guided the child. The results showed that the system was not very successful to guide the child. He tended to get distracted very easily presenting off-task behaviour, which resulted in needing assistance from the caregiver. The data obtained showed that during the intervention phase the assistance from the caregiver consisted mostly of verbal instructions versus the hand over hand guidance observed during B phase. From the data analyses and reviewed literature some improvements and redesigns were suggested which could help develop a more automatic prompting system.

No description available.

Sleep problems affect a considerable number (49-86%) of patients undergoing peritoneal dialysis (PD) treatment. Insomnia i.e. difficulties to initiate and/or maintain sleep or too early wakening, combined with daytime symptoms, seems to be the dominating problem. Despite these facts there is a lack of research in PD-patients, especially studies with objective data on the sleep-wake cycle and evaluation of sleep promoting non-pharmacological  interventions. The overall aim of this thesis was to describe sleep problems from different perspectives, and how these problems affect daily life and health in patients treated with PD at home. The aim was also to evaluate an individualised non-pharmacological intervention for improvement of sleep quality outcomes. Four studies were conducted during eight years, starting in 2002. Patients from six hospitals in the south-east of Sweden were invited to participate. In addition, data from a reference group with Coronary Artery Disease and a population group were used for comparisons with PD-patients in one of the studies. Data was collected by self-reported questionnaires, actigraphy registrations and interviews. Sleep was evaluated in a 17-week single-case study with an intervention focusing on sleep hygiene advice. Data from a total of 700 sleep-wake cycles was collected in the patients’ homes. The main findings clearly demonstrated that PD-patients have seriously fragmented sleep compared to the CAD- and population group, and that the PD-patients have a high prevalence of insomnia. The sleep was mainly disturbed by pruritus and Restless Legs Syndrome (RLS). Daytime impairments and a frequent napping behaviour were detected. The prevalence of fatigue was also reported to be extremely high. The patients described that an ever-present tiredness and poor sleep had consequences in their everyday life both physically, mentally, socially and existentially. The nurse-led intervention demonstrated that individual, non-pharmacological sleep interventions can improve sleep and daytime activities in PD-patients. This thesis elucidates that deteriorated sleep with serious fragmentation leads to a variety of daytime impairments and fatigue. By adopting “renal supportive care” in clinical work a more elaborate assessment and individualised non-pharmacological treatment of sleep problems may improve sleep quality and activity in frail patients undergoing peritoneal dialysis at home.

Introduction Approximately 1-2% of the adult population in developed countries suffer from heart failure (HF), with the prevalence rising to more than 10% among patients 80 years of age or older. The HF syndrome is associated with elevated mortality and morbidity, and decreased quality of life. Cognitive dysfunction has been reported in patients suffering from a variety of cardiovascular disorders. However, few studies have systematically assessed cognitive performance in HF patients, its prevalence and other factors influencing cognition in HF patients. Further, it is of great interest to understand the relationship between self-care in HF and cognition. It may be important to screen for cognitive dysfunction as it may influence HF patients’ ability to perform self-care, e.g. make lifestyle changes, adhere to medical treatment and monitor, evaluate and treat symptoms of deterioration. Aim The overall aim of this thesis was to explore cognitive function in elderly patients with chronic heart failure with focus on prevalence, risk factors, sleep and self-care. Design and method This thesis is based on four quantitative studies. The data from study I and II were collected in a prospective longitudinal design, including Swedish same-sex twin pairs born in 1913 or earlier in Sweden. The study was conducted 1991-2002 and a total of 702 individuals aged 80 and older were included. Study III and IV had a cross- sectional design and included stable HF patients, median 72 years of age, living in the community in the south of Sweden. Data were collected between 2009 and 2012. Study III included a total of 137 patients and Study IV included 142 patients. Results Study I found that  octogenarians with HF had significantly poorer spatial performance and episodic memory, and that the episodic memory declined more over time compared to a non-HF population of the same ages. Study II showed that octogenarians with HF had a significantly higher prevalence of vascular dementia, 16% vs. 6%, and all types of dementia, 40% vs. 30%, than those not diagnosed with HF. Factors related to dementia in individuals with HF were depression, hypertension and increased levels of homocysteine. Diabetes was associated with an increased risk for vascular dementia. In study III we found that  HF patients with sleep disordered breathing (SDB) (apnoea-hypopnoea index >15) had significantly higher saturation time < 90%, more difficulties maintaining sleep and lower levels of daytime sleepiness compared to those in the non-SDB group. Cognitive function did not differ between the SDB and the non-SDB-group. Only insomnia was associated with a decreased global cognititive function measured with the Mini Mental State Examination instrument. Finally, in study IV, the relationship between self-care and different dimensions of cognitive function was explored. Psycho- and visuomotor function (speed and attention) was the only dimension of cognitive function associated with self-care. Conclusion Octogenarians suffering from HF have a decreased performance in spatial and episodic memory and they also have a higher risk for developing dementia. Cognitive dysfunction as well as higher prevalence of dementia can contribute to decreased adherence to prescribed therapy and self-care management, and lead to other socio-behavioural problems.   Self-care was found to be associated with psychomotor speed. This may influence sustained attention negatively and the ability to carry out more than one task at the same time. This may lead to decreased attention for receiving and understanding information on self-care. / Thesis

Inadequate, expensive health care services for the chronically ill, confront the lay person as one of the major forces in the social movement toward self-care. The purpose of this predictive correlational study was to investigate within a theoretical framework derived from Orem's conceptual model of nursing relationships among family as a social support system, exercise of self-care agency, and health status for the person with a chronic illness. The sample group was 51 chronically ill adults diagnosed with diabetes mellitus who attended diabetic instructions from one of the Central Indiana Hospitals. Findings indicated a weak positive correlation between self-care and cohesion and weak negative correlation between health status and cohesion. Findings also revealed significant differences between male and female for the variables self-care and conflict.Conclusions were that this study supported certain relationships proposed by Orem's conceptual model in nursing. Results can guide diabetics in providing optimal daily self-care. Professionals in the health care arena can utilize the results for educational development and encouragement of self-care agency in the adult diabetic. The family members can also clarify roles in supporting the diabetic adult. / School of Nursing

Bakgrund: Astma är en folksjukdom som ökar kraftigt bland den svenska befolkningen. Sjukdomens svårighetsgrad kan påverka livskvalitet och arbetsförmågan.För att kunna hantera sjukdomen och minska besvären kan sjuksköterskan lära ut handlingar för egenvård. Syfte: Att belysa hur sjuksköterskor undervisar vuxna patienter med astma bronkiale. Metod: Litteraturstudien grundade sig på tidigare forskning och användes 10 vetenskapliga artiklar från Cinahl, PubMed och Psykinfodatabas. Artiklarna har varit både kvalitativa och kvantitativa. Resultat: Litteraturstudie visade sig på tre olika huvudkategorier. Sjuksköterskan förmedlar kunskap om egenvård genom att göra patienten delaktig, utforma individuellt anpassad utbildning och involvera anhöriga. Att upprätta handlingsplan görs tillsammans med patienten med hjälp av sjuksköterskan. Att kommunicera och ge stöd är en viktig komponent i patientens behandling. Slutsats: Inom vården kan man utgå från Orems och Suzie Kims domäner för en god egenvård. Egenvård bör utföras så gott som möjligt för att främja patientens välbefinnande. / Background: Asthma is a widespread disease that is increasing dramatically among the Swedish population. Diseases severity may affect quality of live and working ability. Inorder to cope with the disease and improve health nurse can teach acts of self-care. Aim: To illuminate how nurses teach adult patients with asthma bronchial. Method:The literature review is based on previous research and used 10 scientific articles from database, Cinahl, PubMed and PsycInfo. The review has encompassed both qualitative and quantitative reference. Results: The analysis of the articles revealed three different main categories. The nurse conveys knowledge about self-care by making patient involvement, develop individualized education and involve relatives. The preparation of action plan with the patient is positive for the treatment. To communicate and provide support is an important component of patient treatment. Conclusion: In healthcare it can be assumed Orems and Suzie Kims domains for a good self-care. Self-care should be performed as best as possible to promote patient comfort.