Diploma project, the issue of informal care for a close person with Parkinson's disease from the perspective of caregivers is focused on the intensity of care and access to services that could help informal caregivers in the care of their loved ones.In the theoretical section of Parkinson's disease I am describing, its development and changes that the disease brings along. Then I followed with the care of relatives person and support from the social system - the state. In the practical part I have chosen for my research a survey, which was attended by only a small part of respondents from informal carers. Care of long-term sick family member is very difficult. Caregivers feel tired and exhausted, they report that their own health becomes wors. Care also affects cares professional life and there leisure time. Although half of the respondents are still able to find time for their hobbies. Some carers have no idea about the possibilities of helping services and just minimum of them use these services.

Multipel skleros är en autoimmun sjukdom som genom en inflammatorisk process bryter ner myelinet runt nerverna i centrala nervsystemet och leder till ärrbildning på nerverna. Sjukdomen utvecklas under många år och leder till olika grad av funktionsnedsättningar. Den drabbar kvinnor oftare än män och är vanligare i Nordamerika och norra Europa än i världen övrigt. Syftet med litteraturstudien var att studera hur personer med multipel skleros upplever att sjukdomen påverkar livskvaliteten. Metoden för litteraturstudien inspirerades av Goodmans sju steg för litteratursökning. Sökningen efter artiklar gjordes i Pubmed och Cinahl. Trettioen artiklar granskades och detta ledde till att tio artiklar inkluderades i resultatet. Av de tio artiklar som inkluderades i studien var åtta av kvantitativ art och två av kvalitativ. Resultatet visar att livskvaliteten påverkas av symtom relaterade till multipel skleros, av inre och yttre hinder samt av bekymmer till följd av olika symtom på sjukdomen. Slutsatser Personer med multipel skleros upplever att sjukdomen påverkar de fysiska, psykiska, sociala och existentiella aspekterna av deras livskvalitet. För att kunna hjälpa denna patientgrupp till bättre upplevd livskvalitet måste sjuksköterskan skapa en relation med personen och verkligen förstå hur denne upplever att livskvaliteten påverkas av sjukdomen. För att bättre kunna förstå hur denna patientgrupp upplever att deras sjukdom påverkar livskvaliteten behövs mera kvalitativ forskning på detta område. / Multiple sclerosis is autoimmune disease that which, through an inflammatory process, breaks down the myelin surrounding the nerves in the central nervous system leading to the buildup of scar tissue around the nerves. This disease develops over many years and leads to different types of disabilities. It effects women more often than men and is more common in North America and Northern Europe than in the rest of the world. The aim of this study was to examine how people with multiple sclerosis experience that the disease affects their quality of life. The method for this study was inspired by Goodman’s seven steps for literature search. The search for the articles was done in Pubmed and Cinahl. Thirty one articles were examined and this led to ten articles being included in the result. Of these ten articles that were included in the result eight were quantitative and two were qualitative. The results show that the quality of life is affected by symptoms relating to multiple sclerosis, by inner and outer barriers and by worries that are caused by different symptoms of the disease. Conclusions People with multiple sclerosis experience that the disease affects the physical, psychological, social and existential aspects of their quality of life. To be able to help this group of patients experience better quality of life the nurse must form a relationship with the person and truly understand how their quality of life is affected by the disease. To be able to better understand how this patient group experiences how the disease affects their quality of life there is a need for more qualitative research in this field.

Bakgrund: Sjuksköterskor har delade attityder till psykisk ohälsa. Mest förekommande var attityder gällande rädsla och behandling, samt auktoritära attityder. Majoriteten av patienterna erhöll negativa upplevelser av sjuksköterskors attityder, inkluderat stigmatisering, nedvärdering och sedering. Syfte: Denna litteraturöversikt syftade till att skapa en översikt över sjuksköterskestudenters attityder gentemot psykisk ohälsa. Metod: Tillämpad metod var en allmän litteraturöversikt där 16 artiklar analyserades. Resultat: Sjuksköterskestudenterna hade delade attityder till psykisk ohälsa. Vanligt förekommande attityder delades in i kategorierna; ”synen gentemot personer med psykisk ohälsa”, ”upplevelser i mötet med personer med psykisk ohälsa” samt ”närvaro, eller frånvaro, av kunskap och förståelse”. Många sjuksköterskestudenter ansåg personer med psykisk ohälsa som farliga, våldsbenägna och att symtomen inte var äkta. Sjuksköterskestudenterna ansåg även att patienten bär ansvaret till sin sjukdom. Sjuksköterskestudenter såg även psykisk sjuka personer som någon utanför den egna gruppen. Dock visade en stor del av sjuksköterskestudenterna inkluderade attityder och mod till att vårda en psykisk sjuk och en förståelse för patientens symtom och sjukdomsbild. Slutsats: Rädsla och segregerande attityder riktade mot personer med psykisk ohälsa är vanligt förekommande bland sjuksköterskestudenter. En stor del sjuksköterskestudenter tar inte heller patienters symtom på allvar och det finns en bristande förståelse gällande psykisk ohälsa. / Background: Nurses held divided attitudes towards mental illness. Most commonly emerged attitudes were those related to different forms of fear, authoritarian attitudes and treatment. Patients experiences of nurses’ attitudes towards mental illness were for the most part negative, including being stigmatized, the staff being degrading towards the patient, as well as sedation. Aim: The aim of this study was to create an overview of nursing students’ attitudes toward mental illness. Method: The method used were a general literature review containing 16 articles which were analyzed. Results: Nurse students held divided attitudes towards mental illness. Commonly emerged attitudes were categorized into “the view on persons with mental illness”, “experiences and feelings of contact with mentally ill persons” and “the presence, or absence, of knowledge and understanding”. Many nursing students viewed the mentally ill as dangerous and more prone to violence, that the patients’ symptoms were not real and that the individual is responsible for becoming mentally ill. Nursing students also viewed the mentally ill as someone outside of the own group. However, many nursing students also showed including attitudes and courage regarding caring for a mentally ill patient, as well as showing an understanding for the patients’ symptoms and diagnosis. Conclusion: Fear and segregated attitudes aimed towards mentally ill persons commonly emerge amongst nursing students. A large number of nursing students does not take patient’s symptoms seriously, and there is a short understanding regarding mental illness.

Funktionella neurologiska symtom är vanliga och funktionsnedsättande symtom som ofta anses svårbehandlade. En vanlig förklaringsmodell har varit att den drabbade varit med om något stressande och traumatiskt som lett till kroppsliga symtom. Denna förklaringsmodell leder till frågan om psykologisk behandling med fokus på trauma kan påverka funktionella neurologiska symtom. En systematisk litteraturöversikt, i enlighet med riktlinjer från Statens beredning för medicinsk och social utvärdering, har genomförts för att undersöka om psykologisk traumabehandling med kognitiv beteendeterapi och Eye Movement Desensitization and Reprocessing Therapy kan minska funktionella neurologiska symtom vid symtom på komorbid posttraumatiskt stressyndrom. Resultaten av litteraturöversikten består av totalt 10 artiklar, merparten fallstudier. Slutsatsen av litteraturöversikten tyder på att den forskning som gjorts visar på minskning av funktionella neurologiska symtom efter behandling av symtom på posttraumatiskt stressyndrom. Detta forskningsområde är dock väldigt litet och består främst av fallstudier med något bristande kvalitet. Trots detta anser vi att det finns underlag för att rekommendera att det bör finnas ett fokus på erfarenheter av trauma vid bedömning av funktionella neurologiska symtom.

<p>The present thesis follows an intensive care unit during four year of hard work and demanding organisational changes (1998-2001). The changes were mainly initiated by diminishing resources and a legislative claim to pay regard to the quality aspect of health care service. The process of implementing a quality system was the main focus for the thesis. Triangulation was used aiming at explore the process from different views. Two interviews studies were conducted one with the staff and another with the leadership. Both interviews were analysed thematically combined with a phenomenographic technique (e.g. using the how, and what aspect). A longitudinal quasi experimental time-series study was also accomplished. The correlation between staff variables and workload were measured once a year. The result show a 20 % increase in workload per staff and year. The staff judged the organisational climate for innovativeness stable over the period. Sick leave increased, and more so, than the general trend in the society. In spite of this increase the prevalence of stress related symptoms was the same. Two different systems emerged, a complex adaptive system and a mechanical system. The two systems exist and functions intertwined. Because of the construction of the patient register it is possible to see that the situation around a patients being admitted ≥ 5 days functions according to the complex systems character while the situation around the acute patients functions according to a mechanical system. Sick leave correlated with number of patient admitted ≥ 5 days (P=,000). It seemed the problem found had its root in the unawareness of the existing of a complex system. The result has implications for a need of increased awareness about how to manage the situation when the ICU is functioning according to the complex adaptive system.</p>

The present thesis follows an intensive care unit during four year of hard work and demanding organisational changes (1998-2001). The changes were mainly initiated by diminishing resources and a legislative claim to pay regard to the quality aspect of health care service. The process of implementing a quality system was the main focus for the thesis. Triangulation was used aiming at explore the process from different views. Two interviews studies were conducted one with the staff and another with the leadership. Both interviews were analysed thematically combined with a phenomenographic technique (e.g. using the how, and what aspect). A longitudinal quasi experimental time-series study was also accomplished. The correlation between staff variables and workload were measured once a year. The result show a 20 % increase in workload per staff and year. The staff judged the organisational climate for innovativeness stable over the period. Sick leave increased, and more so, than the general trend in the society. In spite of this increase the prevalence of stress related symptoms was the same. Two different systems emerged, a complex adaptive system and a mechanical system. The two systems exist and functions intertwined. Because of the construction of the patient register it is possible to see that the situation around a patients being admitted ≥ 5 days functions according to the complex systems character while the situation around the acute patients functions according to a mechanical system. Sick leave correlated with number of patient admitted ≥ 5 days (P=,000). It seemed the problem found had its root in the unawareness of the existing of a complex system. The result has implications for a need of increased awareness about how to manage the situation when the ICU is functioning according to the complex adaptive system.

Made available in DSpace on 2014-12-17T14:47:04Z (GMT). No. of bitstreams: 1 MariaICDF_DISSERT.pdf: 1911495 bytes, checksum: b33fd53ec7c7e2b2d0bd96f5e0ea12e9 (MD5) Previous issue date: 2014-01-27 / Trasnversal study, with the objective of evaluating the accuracy of clinical indicators of nursing diagnosis excessive fluid volume in patients undergoing hemodialysis. The study occurred in two stages, the first consisted of the evaluation of the diagnostic indicators in study; and the second, the diagnostic inference conducted by nurse diagnosticians. The first stage occurred from december 2012 to april 2013, in a University Hospital and a Hemodialysis Clinic in Northeastern of Brazil, with a sample of 100 chronic renal failure patients on hemodialysis. The data were selected through an interview form and a physical examination, organized into spreadsheets and analyzed as to the presence or absence of the indicators of diagnosis excessive fluid volume. In the second step, the spreadsheets were sent to three nurses diagnosticians, who judged the presence or absence of diagnosis in the clientele searched. This step was conducted from july to september 2013. For analysis of the data, we used descriptive and inferential statistics. In the descriptive analysis, we used measures of central tendency and dispersion. In inferential analysis, we used the tests Chi- square, Fisher and prevalence ratios. The accuracy of the clinical indicators pertaining to the diagnosis were measured as to the specificity, sensitivity, predictive values, likelihood ratios and Diagnostic Odds Ratio. Also developed a logistic regression. The results were organized in tables and discussed with literature. This study was approved by the Ethics Committee in Research of the Federal University of Rio Grande do Norte, with Presentation Certificate for Ethics Appreciation n? 08696212.7.0000.5537. The results revealed that the diagnosis studied was present in 82% of patients. The characteristics with prevalence above 50 % that stood out were: azotemia, decreased hematocrit, electrolyte imbalance, intake exceeds output, anxiety, edema, decreased hemoglobin, oliguria and blood pressure changes. Eight defining characteristics were presented statistically significant association with the nursing diagnosis investigated: pulmonary congestion, intake exceeds output, electrolytes imbalance, jugular vein distension, edema, weight gain over short period of time, agitation and adventitious breath sounds. Among these, the 10 characteristics which showed higher prevalence ratios were: edema and weight gain over short period of time. The features with the highest sensitivity were edema, electrolytes imbalance and intake exceeds output and the standing out with greater specificity were: anasarca, weight gain over short period of time, change in respiratory pattern, adventitious breath sounds, pulmonary congestion, agitation and jugular vein distension. The indicators jugular vein distension, electrolytes imbalance, intake exceeds output, increased central venous pressure and edema, together, were identified in the logistic regression model as the most significant predictors. It is concluded that the identification of accurate clinical indicators allow a good prediction of the nursing diagnosis of excessive fluid volume in patients undergoing hemodialysis in order to assist the nurse in the inference process, which will contribute to the success of patient care. In addition, nurses will consider for diagnostic inference not only his clinical experience, but also scientific evidence of the occurrence of excessive fluid volume, contributing to the control of volemia in these patients / Estudo transversal, com o objetivo de avaliar a acur?cia dos indicadores cl?nicos do diagn?stico de enfermagem Volume de l?quidos excessivo em pacientes submetidos ? hemodi?lise. Ocorreu em duas etapas, a primeira composta pela avalia??o dos indicadores do diagn?stico em estudo; e a segunda, pela infer?ncia diagn?stica realizada por enfermeiros diagnosticadores. A primeira etapa aconteceu nos meses de dezembro de 2012 a abril de 2013, em um Hospital Universit?rio e em uma Cl?nica de Hemodi?lise do Nordeste do Brasil, com uma amostra de 100 pacientes renais cr?nicos submetidos ? hemodi?lise. Os dados foram obtidos mediante formul?rio de entrevista e exame f?sico, organizados em planilhas eletr?nicas e analisados quanto ? presen?a ou aus?ncia dos indicadores do diagn?stico Volume de l?quidos excessivo. Na segunda etapa, as planilhas foram encaminhadas a tr?s diagnosticadores, que julgaram a presen?a ou aus?ncia do diagn?stico na clientela pesquisada. Essa etapa desenvolveu-se nos meses de julho a setembro de 2013. Para a an?lise dos dados, utilizou-se a estat?stica descritiva e inferencial. Na an?lise descritiva, utilizaram-se medidas de tend?ncia central e de dispers?o. Na inferencial, utilizaram-se os testes de Qui-quadrado, Fisher e as raz?es de preval?ncia. Mensurou-se a acur?cia dos indicadores cl?nicos do diagn?stico estudado por meio da especificidade, da sensibilidade, dos valores preditivos, das raz?es de verossimilhan?a e da Odds Ratio Diagn?stica. Desenvolveu-se tamb?m uma regress?o log?stica. Os resultados foram organizados em tabelas e discutidos com literatura pertinente. O estudo foi aprovado pelo Comit? de ?tica da Universidade Federal do Rio Grande do Norte, com Certificado de Apresenta??o para Aprecia??o ?tica n? 08696212.7.0000.5537. Os resultados revelaram que o diagn?stico de enfermagem estudado esteve presente em 82% dos pacientes. Dentre as caracter?sticas com preval?ncia acima de 50% destacaram-se: azotemia, hemat?crito diminu?do, eletr?litos alterados, ingest?o maior que o d?bito, ansiedade, edema, hemoglobina diminu?da, olig?ria e mudan?a na press?o arterial. 8 Apresentaram associa??o estatisticamente significativa com o diagn?stico de enfermagem investigado oito caracter?sticas definidoras: congest?o pulmonar, ingesta maior que o d?bito, eletr?litos alterados, distens?o da jugular, edema, ganho de peso em um curto per?odo de tempo, agita??o e ru?dos advent?cios. Dentre estas, as que apresentaram maiores raz?es de preval?ncia foram edema e ganho de peso em um curto per?odo de tempo. A caracter?stica com maior sensibilidade foi o edema e sobressa?ram-se com maior especificidade ru?dos advent?cios, congest?o pulmonar e agita??o. Os indicadores distens?o da jugular, eletr?litos alterados, ingesta maior que o d?bito, press?o venosa central aumentada e edema, em conjunto, foram identificados no modelo da regress?o como as caracter?sticas preditoras mais significantes. Conclui-se que a identifica??o de indicadores cl?nicos acurados permite uma boa predi??o do diagn?stico de enfermagem Volume de l?quidos excessivo em pacientes submetidos ? hemodi?lise, de modo a auxiliar no processo de infer?ncia do enfermeiro, o que contribuir? no sucesso do cuidado prestado ao paciente. Al?m disso, os enfermeiros considerar?o para a infer?ncia diagn?stica n?o apenas sua experi?ncia cl?nica, mas tamb?m evid?ncias cient?ficas da ocorr?ncia do Volume de l?quidos excessivo, contribuindo para o controle da volemia nesses pacientes