Publikationer från Röda Korsets Högskola
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Nursing approaches to prevent diabetic foot ulcers : A literature review
No full textBackground: Diabetes – one of the leading non-communicable diseases of our time is steadily increasing in prevalence with each year. The disease is linked to several complications that can have major consequences for both the individual and society at large. Diabetic foot ulcers are one of these complications. Aim: The aim of this study was to investigate preventive nursing measures that can be provided to patients at risk of diabetic foot ulcers. Method: This study was conducted as a literature review. The databases CINAHL and Medline were used to identify relevant articles. The database searches resulted in 11 articles that were included in the study and analyzed with the use of a thematic analysis approach. Results: Three overarching categories that nurses can work within to prevent diabetic foot ulcers were derived from the thematic analysis, namely: Care based on needs, Education and Importance of collaborations. Conclusion: Care based on needs, Education and Collaboration are areas in which the nurse can provide preventive care to patients with diabetes at risk of developing diabetic foot ulcers or to patients with already existing foot ulcers. Based on the studies key concepts, implications on the preventive areas relevance for nursing were drawn. Further studies are recommended to investigate how these nursing measures for preventing diabetic foot ulcers can be disseminated within the nursing profession. By spreading these nursing measures within the profession good conditions for minimizing the disease burden of diabetic foot ulcers can be established.Bakgrund: Diabetes – en av vår tids främsta icke-smittsamma sjukdomar ökar stadigt i prevalens för varje år som går. Sjukdomen är kopplad till en rad komplikationer, bland annat diabetesfotsår, som kan innebära konsekvenser för individen och samhället i stort. Syfte: Syftet med denna litteraturstudie var att belysa sjuksköterskans preventiva omvårdnadsåtgärder kring fotsår hos patienter med diabetes. Metod: Studien genomfördes som en litteraturstudie. Databaserna CINAHL och Medline användes för att identifiera relevanta artiklar. Sökningarna i databaserna resulterade i 11 artiklar som inkluderades och analyserades med en tematisk analysmetod. Resultat: Den tematiska analysen resulterade i tre övergripande kategorier inom vilka sjuksköterskor kan tillhandahålla preventiva omvårdnadsåtgärder till patienter med diabetes som har eller riskerar att utveckla diabetesfotsår. Slutsats: Vård utifrån behov, Utbildning och Vikten av samarbeten är områden inom vilka sjuksköterskan kan tillhandahålla preventiva omvårdnadsåtgärder till patienter med diabetes som riskerar eller har utvecklat diabetesfotsår. Sett ur de centrala begreppens perspektiv kan slutsatsen att de identifierade omvårdnadsåtgärderna är relevanta för omvårdnad dras. Studiens resultat är således relevanta för sjuksköterskeprofessionen och vidare studier rekommenderas undersöka hur omvårdnadsåtgärderna kan spridas inom professionen. Om omvårdnadsåtgärderna kan spridas inom professionen och tillhandahållas patientgruppen finns goda förutsättningar att förebygga samt lindra den sjukdomsbörda som diabetesfotsår kan leda till.
The Healthcare Staffs’ Perception of Parents’ Participation in Critical Incidents at the PICU, a Qualitative Study
No full textBackground: Internationally, there are very few guidelines regarding how near relations can be taken care of on a children’s intensive care unit. Despite knowledge about the positive effects of parental presence, staff frequently reject parents out of insecurity. This study aimed to investigate health professionals’ understanding of letting parents be present throughout critical situations. A qualitative method with semi-structured interviews was used to answer the aim of his study. Nine persons participated in the study, both physicians and nurses. The result showed that health professionals’ main view is that parents’ presence is positive. However, their presence often has lower priority than the medical focus of the child and the health professionals’ concern of failure. Conclusion: Health professionals have the power to decide if parents can be present in critical situations. Only when a parent demands to be present does that demand beat the decisions made by health professionals. Lack of resources within the team and fear of parents becoming a disturbance or a distraction are cited as the primary reasons not to let parents be present
Upplevelser av den sexuella hälsan hos personer med bukstomi : En litteraturöversikt
No full textBackground: Abdominal ostomy is an artificial opening in the abdomen that is done through a surgical procedure. This is due to cancer diagnosis and / or inflammatory diseases of the intestine. Intimacy and sexuality are important aspects of the quality of life of an individual that can be affected by different factors. It is the nurse's responsibility to promote health, and the nurse's role to convey knowledge of sexual health to patients. Aim: The purpose was to describe the experiences of sexual health in people with abdominal ostomy. Method: Literature review with a qualitative approach. Results: The results show that people with abdominal ostomy experienced a change in sexualhealth caused by various aspects. The results also show a need for increased healthcare guidance about sexual health, and support from relatives is an important component. Conclusion: Taboos about sexuality were discussed and need to be put in relation to where in the world one is. Sexual health is individual and looks different globally, because there are different societal and cultural norms and values. Strategies for healthcare professionals were discussed in order to be able to address sexual health and to support people with abdominal ostomy in the best possible wa
Patients' experiences of palliative care : A literature study
No full textBackground: Cancer is one of the most common diseases in Sweden. When illness can no longer be cured, the patient is transferred to palliative care. The majority of palliative care is performed in hospitals. The goal of palliative care is to alleviate suffering and promote quality of life. Research has shown clear insufficiency in palliative care. From a patient perspective, insufficiency is mostly common in pain relief, communication and care environments. Aim: The aim of the literature review was to describe patients' experiences of palliative care in hospitals in the event of cancer. Method: This general literature review was based on twelve original articles with a qualitative approach that were analyzed using thematic analysis. Results: Three themes were identified: The importance of being seen as a whole person, The importance of pain relief and The importance of a good care environment. The patients were generally satisfied with the palliative care in the hospital. The importance of good pain relief and a good care environment at the hospital as well as a functioning communication with the care staff was emphasized. Conclusions: The patients who were cared for in the palliative care ward had different nursing experiences. Through patient experiences of palliative care, the nurse can increase the understanding of the patient's care needs. The knowledge can be used to give the patient an improved quality of life and alleviate suffering.Bakgrund: Cancer är en av de vanligaste sjukdomarna i Sverige. När sjukdom inte längre går att bota övergår vården till att bli palliativ. En stor del av palliativ vård utförs på sjukhus. Målet med den palliativa vården är att lindra lidande och främja livskvaliteten. Forskning har påvisat tydliga brister inom den palliativa vården. Ur patientperspektiv är det framför allt brister inom smärtlindring, kommunikation och vårdmiljöns utformning. Syfte: Syftet med litteraturöversikten var att beskriva patienters upplevelser av palliativ vård på sjukhus vid cancersjukdom. Metod: En allmän litteraturöversikt baserad på tolv originalartiklar med kvalitativ ansats som analyserades med hjälp av tematisk analys. Resultat: Tre teman identifierades: Betydelsen av att bli sedd som en hel människa, Vikten av smärtlindring och Vikten av en god vårdmiljö. Patienterna var överlag nöjda med den palliativa vården på sjukhus. Vikten av en god smärtlindring och en bra vårdmiljö på sjukhuset samt en fungerande kommunikation med vårdpersonalen betonades. Slutsats: Patienterna som vårdades på palliativ vårdavdelning hade olika vårdupplevelser. Genom patientupplevelser av den palliativa vården kan sjuksköterskan öka förståelsen för patientens vårdbehov. Kunskapen kan användas för att ge patienten förbättrad livskvalité́ och lindra lidande
A mapping of patients per nursing staff and skill mix in Swedish medium-sized emergency departments
No full textBackground: The number of patients per nursing staff and skill mix (the percentage of registered nurse) among nursing staff have an impact on the working environment, effects quality of care and patient safety. Aim: The aim of this study was to map the number of patients per nursing staff during a 24-hour period and to describe skill mix among nursing staff at emergency departments in medium-sized hospitals in Sweden. Method: This study is a descriptive cross-sectional study with a quantitative approach. Thirty medium-sized Swedish emergency departments participated in this study. Result: The number of patients per registered nurse varied between 0,0-11,0 patients (mean=3,3) during a 24-hour period. The number of patients per licensed practical nurse varied between 0,0-17,2 (mean=4,7). The average skill mix was 58,1% registered nurses and 41,9% licensed practical nurses for 24 hours. Conclusion: The staffing of nurses does not follow the patient flow, which results in a higher number of patients per nursing staff between 11:00 am and 11:59 pm. Further studies are needed to optimize the staffing of nurses, which can lead to an improved working environment for nurses, an improved quality of care and an increased patient safety. Bakgrund: Antal patienter per omvårdnadspersonal och skill mix (andel sjuksköterskor i procent) bland omvårdnadspersonal har en inverkan på arbetsmiljö, vårdkvalitet samt patientsäkerhet. Syfte: Syftet med studien var att kartlägga antalet patienter per omvårdnadspersonal under en 24-timmarsperiod samt att beskriva skill mix bland omvårdnadspersonalen vid akutmottagningar på mellanstora sjukhus i Sverige. Metod: Studien är en deskriptiv tvärsnittsstudie med kvantitativ ansats. Trettio mellanstora svenska akutmottagningar deltog i studien. Resultat: Antalet patienter per sjuksköterska varierade mellan 0,0–11,0 patienter (medel= 3,3) under en 24-timmarsperiod. Antalet patienter per undersköterska varierade mellan 0,0–17,2 patienter (medel= 4,7). Skill mix var i genomsnitt 58,1% sjuksköterskor och 41,9% undersköterskor under 24 timmar. Slutsats: Bemanning av omvårdnadspersonal följer inte söktrycket/patientflödet, vilket resulterar i ett högre antal patienter per omvårdnadspersonal mellan klockan 11:00–23:59. Vidare studier behövs för att optimera bemanning av omvårdnadspersonal, vilket kan leda till förbättrad arbetsmiljö för omvårdnadspersonalen, en förbättrad vårdkvalité samt en ökad patientsäkerhet.
Can morality become a burden? : A literature review on causes of moral distress in nurses
No full textBackground: Ethical dilemmas are present in all areas of healthcare and arise particularly when working with patients. When a nurse has to act in contrast to what they consider to be morally correct they risk developing moral distress. Moral distress can lead to mental health problems, burnout or even a career change. The element of compassion is at the core of nursing and is present during ethical challenges and patient suffering. Aim: The aim of this study was to investigate what causes moral distress in nurses.Method: A qualitative literature-review based on 19 articles. Results: The result consists of one overall theme with three main categories and ten subcategories. The overall theme was patient suffering. Main categories were: Organizational causes, internal causes and relational causes. Conclusion: Moral distress in the nursing profession is a complex multi-factored problem. Both organizational and individual-focused solutions need to be implemented to reduce moral distress and there by reduce burnout and mental health problems in nurses. Future research in this area should focus on nurses and how they can better manage and cope with moral stress.Bakgrund: Etiska dilemman uppkommer inom alla områden inom hälso- och sjukvård, i synnerhet vid patientarbete. När sjuksköterskan måste agera mot sina egna moraliska värderingar riskerar hen att drabbas av moralisk stress. Moralisk stress kan leda till psykisk ohälsa, utmattningssyndrom och karriärbyte. Medkänsla är en grundpelare inom omvårdnad och är närvarande vid etiska utmaningar och vid lindrande av patientens lidande.Syfte: Syftet med studien var att undersöka orsaker till moralisk stress hos sjuksköterskor. Metod: En litteraturstudie med kvalitativ ansats utfördes. Studien baseras på 19 artiklar. Resultat: I resultatet framkom ett övergripande tema samt tre huvudkategorier med tio tillhörande underkategorier. Det övergripande temat var patientens lidande. Huvudkategorierna var: Organisatoriska orsaker, inre orsaker och relationella orsaker. Slutsats: Moralisk stress inom sjuksköterskeyrket är ett komplext och mångfacetterat problem. För att lösa problemet måste både organisatoriska och individbaserade lösningar implementeras, för att därigenom minska utbrändhet och psykisk ohälsa bland sjuksköterskor. Framtida forskning bör fokusera på sjuksköterskan och hur denne bättre kan hantera moralisk stress
When a child gets cancer : A litterature study on the experiences of next of kin
No full textBackground: Cancer is the most occurring reason for death of children in high-income countries. About 300 children are every year diagnosed with cancer in Sweden, approximately 80% survives their illness. When a child undergoes cancer treatment it is of importance to nclude the child along with their next of kin in the treatment and in conversations regarding treatment. While the sick child tends to be in focus, it is common for next of kins’ feelings to be overlooked. Aim: To describe the experiences of next of kin when a child has been diagnosed with cancer. Method: A literature study with a qualitative study design has been chosen for the implementation, based on ten scientific articles with a qualitative approach. A thematic analysis has been applied to formulate the study’s themes. Result: The results revealed four different themes, which have two sub-themes each. These themes are Information, Experiences, Impact on everyday life and Support. Conclusion: The importance of providing good support and having a good attitude and understanding for the child who has been diagnosed with cancer and their next of kin has been established. Anxiety and stress are emotions experienced by the next of kin during and after the child’s treatment.Bakgrund: Cancer är den mest förekommande orsaken till att barn dör i höginkomstländer. Omkring 300 barn diagnostiseras varje år med cancer i Sverige, ungefär 80% överlever sin sjukdom. När ett barn genomgår en cancerbehandling är det viktigt att inkludera barnet tillsammans med sina närstående i behandlingen samt i konversationer angående behandling. Medan det sjuka barnet tenderar att vara i fokus är det vanligt att närståendes känslor förbises. Syfte: Att beskriva närståendes erfarenheter när ett barn har diagnostiserats med cancer. Metod: En litteraturstudie som innehar en kvalitativ studiedesign har valts till genomförandet, baserad på tio vetenskapliga artiklar vilka använder en kvalitativ ansats. En tematisk analys har tillämpats för att utforma studiens teman. Resultat: I resultatet framkom fyra olika teman, vilka innehar två subteman vardera. Dessa teman är Information, Upplevelser, Påverkan på vardagen och Stöd. Slutsats: Vikten av att utdela ett bra stöd samt att ha ett bra bemötande och förståelse för barnet som fått diagnosen cancer och de närstående har konstaterats. Oro och stress är känslor som upplevs av de närstående under och efter barnets behandling
Cost-of-Illness Progression Before and After Diagnosis of Multiple Sclerosis : A Nationwide Register-Based Cohort Study in Sweden of People Newly Diagnosed with Multiple Sclerosis and a Population-Based Matched Reference Group
No full textBACKGROUND: Multiple sclerosis (MS) is a chronic disease associated with increased healthcare utilisation and productivity losses. OBJECTIVE: The objective of this study was to explore the progression of healthcare costs and productivity losses before and after diagnosis of MS in comparison to that of a population-based matched reference group. METHODS: We conducted a nationwide, Swedish register-based cohort study of working-aged people with MS diagnosed in 2010-12 (n = 1988) and population-based matched references without MS (n = 7981). Nine years of observation spanned from 4 years prior (Y-4) to 4 years (Y+4) after the year of diagnosis (Y0). Differences in annual all-cause healthcare costs (inpatient and specialised outpatient healthcare as well as pharmacy-dispensed prescribed drugs) and costs of productivity loss (days with sickness absence and disability pension) were estimated between the people with MS and references using t tests with 95% confidence intervals. The average excess costs of MS were estimated using generalised estimating equation models. RESULTS: People with multiple sclerosis had higher costs before the diagnosis of MS and also thereafter. The mean differences in healthcare costs and productivity losses between the people with MS and matched references in Y-4 were 216 EUR (95% confidence interval 58-374) and 1540 EUR (95% confidence interval 848-2233), with larger cost excesses observed in later study years. Summarising the 9 study years, people with MS had fivefold higher excess healthcare costs than references, and more than twice as high productivity losses. CONCLUSIONS: Excess healthcare costs and productivity losses occur already before the diagnosis of MS and increase with time. The excess costs findings before diagnosis could suggest that an earlier diagnosis might lead to reduced excess costs of MS over time.Funding: Biogen (Grant number 4-2803/2019)</p
Circumcised women’s experiences of antenatal – and maternity care : A literature study
No full textBackground: Female genital mutilation is a harmful cultural practice that is carried out in several places around the world, despite the fact that it is a violation of women’s human rights. Worldwide, around 200 million young girls and women live with the aftermath of genital mutilation. There are several motives for implementing the practice linked to social, cultural and esthetic aspects. Aim: To describe how women who have been circumcised experience antenatal–and maternity care. Method: The study was designed as a general literature study which included nine scientific articles with a qualitative approach. Qualitative content analysis was applied. Result: Two categories and four subcategories emerged. “A confidence-building approach” and “Feeling trust in a female caregiver” went under “Good care relationship” while “Lack of knowledge about female genital mutilation” and “The feeling of being different” belonged to “Lack of empathy”. Conclusion: A confidence–building approach can demonstrably form the basis for a good care relation between a woman who has been circumcised and a healthcare professional. However, women who have been circumcised deliberately chose not to disclosure their health problems when they felt that healthcare professionals lacked knowledge about female genital mutilation. To alleviate the suffering and promote well–being of women who have circumcised, the healthcare professionals need to show respect, consideration and also provide caring care. Bakgrund: Kvinnlig könsstympning är en skadlig kulturell sedvänja som utförs på flera håll runt om i världen trots att det är ett brott mot kvinnors mänskliga rättigheter. Globalt lever cirka 200 miljoner unga flickor och kvinnor i efterföljderna av könsstympning. Det finns flertal motiv till att genomföra kvinnlig könsstympning kopplad till sociala, kulturella samt estetiska aspekter. Syfte: Att beskriva hur kvinnor som blivit könsstympade upplever mödra–och förlossningsvården. Metod: Studien utformades som en allmän litteraturstudie med nio vetenskapliga artiklar med kvalitativ ansats. Kvalitativ innehållsanalys tillämpades. Resultat: Två kategorier och fyra subkategorier framkom. “Ett förtroendeingivande bemötande” och “Att känna tillit till en kvinnlig vårdgivare” gick under “God vårdrelation” medan “Bristande kunskaper kring kvinnlig könsstympning” och “Känslan att vara annorlunda” tillhörde “Brist på empati”. Slutsats: Ett förtroendeingivande bemötande kan bevisligen utgöra grunden för en god vårdrelation mellan kvinna som blivit könsstympad och sjukvårdspersonal. Dock valde kvinnor som blivit könsstympade avsiktligt att inte delge sina hälsoproblem när de ansåg sjukvårdspersonal sakna kunskaper om kvinnlig könsstympning. För att lindra lidandet och befrämja välbefinnandet hos kvinnor som blivit könsstympade skall hälso–och sjukvårdspersonal visa respekt, omtanke samt ge omsorgsfull vård
Treating alcohol use disorders in primary care - a qualitative evaluation of a new innovation : the 15-method
No full textOBJECTIVE: This study aims to explore how the characteristics of an innovation, the 15-method, a stepped care model for treatment of alcohol use disorders in primary care was perceived. METHODS/DESIGN/SETTING/SUBJECT: General practitioners and heads of primary care units (n = 10) that delivered the 15-method in a randomized controlled trial participated in individual interviews at two occasions in Stockholm, Sweden. Data were analyzed with theoretical thematic analysis, using Diffusion of Innovation Theory. RESULTS: The participants described that offering the 15-method met a need among their patients. Participants were positive towards the training and the manual for the method. They mentioned a previous lack of routines to work with alcohol use disorders. The 15-method was described as easy to use. It would however be more feasible to implement in a team of different professions, rather than among general practitioners only. Priorities made by regional health care managers were described as important for the implementation, as well as financial incentives. A barrier to implementation was that alcohol screening was perceived as difficult. While the 15-method was perceived as effective in reducing the patients' alcohol use and cost effective, participants expressed uncertainty about the long-term effects. CONCLUSIONS: The 15-method provides structure for treatment of alcohol use disorders and is described by general practitioners and heads as a promising approach. Being able to offer treatment for alcohol dependence may increase the uptake of alcohol interventions in primary care. KEY POINTS Little attention has been given to develop treatment models for alcohol use disorders that are adapted to primary care settings. This study describes how an innovation, the 15-method, a stepped care model for treatment of alcohol use disorders in primary care was perceived. The 15-method provides structure for treatment of alcohol use disorders in primary care and is described by general practitioners and heads as a promising approach. Being able to offer treatment for alcohol dependence may increase the uptake of alcohol interventions in primary care