Landspítali University Hospital Research Archive
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Family caregivers' experiences of end-of-life care in the acute hospital setting. A qualitative study.
Get PDFTo access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadBackground: Acute hospital settings are generally not considered adequate places for end-of-life care, but terminally ill patients will continue to die in acute medical wards in the unforeseeable future.
Aim: The aim of this study was to investigate family caregivers' experiences of end-of-life care in an acute community hospital in Iceland.
Methods: Fifteen in-depth qualitative semi-structured interviews were conducted with participants who had been primary caregivers. The transcribed interviews were analysed using thematic content analysis.
Findings: Findings indicated that the acute hospital setting is not a suitable environment for end-of-life care. Effective communication and management of symptoms characterised by warmth and security give a sense of resilience. Three main themes emerged: (1) Environmental influences on quality of care; (2) Communication in end-of-life care; (3) The dying process. Each of the themes encompassed a variety of subthemes.
Conclusions: Findings suggest that effective communication is the cornerstone of quality of care in the acute hospital environment and essential for establishing a sense of security. The severity of symptoms can deeply affect family caregivers' well-being. Acknowledging and appreciating the meaning of respect and dignity at the end-of-life from family caregivers' perspective is vital.
Keywords: acute hospital settings; bereavement; communication; end-of-life care; environment; family caregivers; grief; palliative care.Science Fund of the University of Akureyri, Icelan
Plasma interferon-alpha is associated with double-positivity for autoantibodies but is not a predictor of remission in early rheumatoid arthritis-a spin-off study of the NORD-STAR randomized clinical trial.
Get PDFTo access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadBackground: The type I interferon (IFN) gene signature is present in a subgroup of patients with early rheumatoid arthritis (RA). Protein levels of IFNα have not been measured in RA and it is unknown whether they associate with clinical characteristics or treatment effect.
Methods: Patients with early untreated RA (n = 347) were randomized to methotrexate combined with prednisone, certolizumab-pegol, abatacept, or tocilizumab. Plasma IFNα protein levels were determined by single molecular array (Simoa) before and 24 weeks after treatment initiation and were related to demographic and clinical factors including clinical disease activity index, disease activity score in 28 joints, swollen and tender joint counts, and patient global assessment.
Results: IFNα protein positivity was found in 26% of the patients, and of these, 92% were double-positive for rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPA). IFNα protein levels were reduced 24 weeks after treatment initiation, and the absolute change was similar irrespective of treatment. IFNα protein positivity was associated neither with disease activity nor with achievement of CDAI remission 24 weeks after randomization.
Conclusion: IFNα protein positivity is present in a subgroup of patients with early RA and associates with double-positivity for autoantibodies but not with disease activity. Pre-treatment IFNα positivity did not predict remission in any of the treatment arms, suggesting that the IFNα system is distinct from the pathways of TNF, IL-6, and T-cell activation in early RA. A spin-off study of the NORD-STAR randomized clinical trial, NCT01491815 (ClinicalTrials), registered 12/08/2011, https://clinicaltrials.gov/ct2/show/NCT01491815 .Swedish Research Council
European Commission
Swedish government
country council
Health related quality of life in patients having total knee replacement and associations with symptoms, recovery, and patient education: A six month follow up study.
No full textTo access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadAim: To describe the symptoms, recovery, patient education, and health related quality of life (HRQOL) of patients having total knee replacements at three time points and to detect experiences and situations that predict HRQOL six weeks and six months post-surgery.
Method: A prospective exploratory two-site study assessing 123 patients, while in hospital (T1), at six weeks (T2), and at six months (T3) post-discharge. HRQOL was measured using the SF-36v2 and symptoms were measured with the Hospital and Anxiety Scale. Two questions considered pain and two considered movement and tiredness while two questions addressed recovery and patient education. Linear regression models were used to calculate predictors of mental and physical HRQOL at T2 and T3.
Results: HRQOL improved from T1 to T3. The main predictors of higher physical scores at T2 were; being older, fewer symptoms of depression and little distress related to movement. At T3 the main predictors were; having resumed work, finding patient education very useful, experiencing no pain in the last 24 h and fewer symptoms of depression. The main predictors of higher mental scores at T2 were fewer symptoms of anxiety and depression and little distress related to movement while at T3 these were fewer symptoms of anxiety and depression and experiencing no pain last 24 h.
Conclusion: Apart from pain, function and resumption of activities, the symptoms of anxiety and depression influence HRQOL. These symptoms should be assessed during the hospital stay.
Keywords: HRQOL; Recovery; Total knee replacement.University of Iceland Science Fund
Landspitali University Hospital Science Fund
Icelandic Nurses Association Science Fun
Þrýstingssár: Greining og meðferð með aðstoð Bradenkvarða og RAI-mats
Get PDFTo access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadMeðalaldur íbúa hjúkrunarheimila á Íslandi er 87 ár. Margir
eru fjölveikir, veikburða, á mörgum lyfjum og eiga á hættu
að fá þrýstingssár. Þeir sem eru vannærðir og með skerta
hreyfifærni eru í sérstakri hættu.
Þrýstingssár eru of algeng meðal mikið veikra sjúklinga á
heilbrigðisstofnunum. Þau skerða lífsgæði, hægja á bata,
valda þjáningu og eru kostnaðarsöm.
Mælt er með notkun kerfisbundinna aðferða til að greina þá
sem eiga á hættu að fá þrýstingssár. Auk þess sem klínískt
innsæi er notað við áhættumat sjúklings (Landspítali, 2008).
Gæðateymi til varnar sárum á Sóltúni var stofnað árið
2007. Þá voru ábendingar um að hægt væri að gera
betur. Stuðst er við viðurkenndar, gagnreyndar aðferðir
í gæðaumbótastarfi. Gæðateymið setti fram gæðastaðal
um forvarnir gegn sárum. Gæðastaðallinn er rýndur og
endurbættur reglulega af gæðateymi.
Ársfjórðungslega er farið yfir niðurstöður RAI-mælinga og
skoðuð nánar þau óheppilegu atvik sem upp hafa komið.
Gæðateymið fer yfir samspil heilsufars, lyfjagjafar, notkunar
hjálpartækja, virkni og umhverfis, auk þess að veita ráðgjöf
og stuðning eftir þörfum.
Almenna orsökin fyrir myndun þrýstingssára er langvarandi
þrýstingur á húð sem veldur staðbundinni blóðþurrð. Aðrir
þættir geta aukið hættuna á slíkri blóðþurrð. Þar má nefna
æðasjúkdóma, skert blóðflæði, sykursýki, vannæringu,
þurrk og skerta skyntilfinningu o.fl. (Allen, 1997; Blom,
1985).
Sár á húð geta myndast fljótt og er góð hjúkrun, sem felst
í forvörnum, mikilvæg til að koma í veg fyrir myndun
þeirra. Florence Nightingale (1969) skrifaði árið 1860 að
þrýstingssár stöfuðu ekki af sjúkdómum manna heldur
hjúkruninni sem veitt væri eða skorti á veittri þjónustu. Það
er mikið til í því.
Í samtíma okkar er því þannig háttað að veikustu
sjúklingarnir á öllum aldri liggja inni á stofnunum. Það
er því langvarandi verkefni hjúkrunar að koma í veg fyrir
þrýstingssár. Talið er að um 4% útgjalda stofnana í Bretlandi
megi rekja til kostnaðar við að græða þrýstingssár (Bennett
o.fl., 2004). Í rannsókn, sem gerð var á Landspítala árið 2008,
reyndust 21,5% sjúklinga vera með þrýstingssár (Guðrún
Sigurjónsdóttir o.fl., 2011). Í annarri rannsókn, sem gerð var
í Noregi árið 2012, voru 18,2% sjúklinga með þrýstingssár
(Bredesen o.fl., 2015).
Samanburður rannsókna á algengi legusára er erfiður
vegna þess að skilgreining og flokkun er mismunandi og
samsetning úrtaks einnig
How do we sense pain? The Nobel Prize in Physiology or Medicine 2021
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How can we get out of COVID-19?
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Thrown into the deep end of the pool - Newly graduated nurses’ challenges, wellbeing and coping skills
No full textTo access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadMarkmið: Nýútskrifaðir hjúkrunarfræðingar mæta ýmsum áskorunum þegar þeir hefja starfsferil sinn. Hjúkrunarstarfið krefst mikillar þekkingar, færni og öryggis sem þróast samhliða aukinnireynslu
í starfi. Námið, eitt og sér, virðist ekki alltaf duga til að undirbúa
hjúkrunarfræðinga fyrir allt sem starfið felur í sér og oftar en ekki
finnst nýútskrifuðum hjúkrunarfræðingum að þeim sé hent út í
djúpu laugina þegar þeir hefja störf. Markmið þessarar rannsóknar
var að öðlast innsýn í hvaða áskoranir mæta nýútskrifuðum hjúkrunarfræðingum fyrsta árið í starfi, hversu tilbúnir þeir telja sig vera
til að takast á við þær og hvaða bjargráð þeir nýta sér til að vinna úr
þessum áskorunum til að stuðla að góðri líðan í starfi. Með því að
átta sig á þeim áskorunum sem nýútskrifaðir hjúkrunarfræðingar
mæta daglega í störfum sínum er hægt að styðja við þá í starfi og
stuðla þar með að aukinni starfsánægju og sporna gegn kulnun í
starfi og brottfalli úr stéttinni.
Aðferð: Stuðst var við eigindlega rannsóknaraðferð þar sem sett voru
þau skilyrði að þátttakendur hefðu brautskráðst frá hjúkrunarfræðideild Háskólans á Akureyri á árunum 2013–2017. Einnig voru
sett þau skilyrði að þátttakendur væru starfandi á legudeildum
sjúkrahúsa og hefðu unnið samfellt á sama vinnustað í a.m.k. þrjá
mánuði.
Niðurstöður: Niðurstöður sýndu að hjúkrunarfræðinámið undirbjó
þátttakendur vel fyrir hjúkrunarstarfið og þær áskoranir sem mættu
þeim þegar þeir hófu störf sem hjúkrunarfræðingar og töldu þeir að
einstaklingsmiðuð aðlögun væri lykilatriði. Allir þátttakendur voru
sammála um nauðsyn þess að tileinka sér jákvæð bjargráð í starfi og
stuðla þannig að aukinni starfsánægju. Jákvætt viðhorf til starfsins
var einkennandi meðal viðmælenda en samkvæmt þeim er það einn
af þeim mikilvægu þáttum sem geta dregið úr líkum á kulnun ásamt
brottfalli úr faginu.
Ályktanir: Þrátt fyrir að hjúkrunarfræðingar nýti sér jákvæð bjargráð
og séu meðvitaðir um streitutengda þætti starfsins er ekki síður
mikilvægt að þeir njóti stuðnings vinnufélaga og stjórnunin sé góð.
Lykilorð: Hjúkrunarfræðingur, nýútskrifaður, áskoranir og bjargráð,
innihaldsgreiningAim: Newly graduated nurses face many challenges as they start
their careers. Nursing demands a great deal of knowledge, skills
and sense of precaution, which grows and evolves with added experience. An education in the field of nursing does not always
seem to be enough to prepare new nurses for everything that the
job requiers. The experience of newly graduated nurses has often
been compared to learning to swim by being thrown into the deep
end of the pool. The aim of this study was to provide insight into
the kinds of challenges newly registered nurses experience during
their first years of nursing.
Method: A qualitative research method with the following two criteriawas applied.Allstudy participants had to have graduated in the
years 2013–2017 from theUniversity ofAkureyri andworked consec -
utively at the same in-patient hospitalward for at least three months.
Results: The results suggest that the participants’ education in
nursing prepared them well for their work as a registered nurse.
However, individualized ways of adjusting to the challenges these
registered nurses face are needed in order to overcome them. The
participants in the study all agreed that it was necessary to find
positive coping strategies to ensure a positive work experience.
The participants all had a positive attitude toward their work
which is, according to them, very important in the prevention of
career burnout and their leaving nursing.
Conclusions: The study shows that even though registered nurses
use positive coping strategies and are aware of the stress inducing
aspects in their work, a supportive work environment and good
management are equally important.
Keywords: registered nurse, newly graduated,challenges and coping
strategies, content analysi
CP í norðri - Hvernig farnast einstaklingum með Cerebral Palsy á Norðurlöndunum? Kynning á samnorrænu 4ra ára rannsóknarverkefni
Get PDFTo access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadIn CP-North a highly qualified team of researchers
from the Nordic countries will address a number
of societal challenges associated with living with,
or being a parent of a child with CP in Norden by
merging data from national registers with unique
health data from quality registers. Cerebral palsy
(CP) is rare, but still the most common
musculoskeletal childhood disability. How
persons with CP fare in life in terms of health,
quality of life, education, employment, and
income is virtually unknown. Also, very little is
known about how parents of children with CP −
both young and grown-up− fare, in terms of
health, stress, employment, and income. Although
the Nordic countries have strong welfare systems
it is unknown to what extent the added burden
related to disability are actually compensated for. With CP-North,
the world’s largest dataset of persons with CP, their parents, and
controls from the general population will be created. The
knowledge gain is expected to influence how the social support
systems in the Nordic countries are constructed and how healthcare
is organized for this population. Findings will also be of interest
to the international community as the size, richness, and
generalizability of the data set will allow investigation of questions
that cannot be studied elsewhere. Comparison between the Nordic
countries, with identification of successful and unsuccessful
policies for the group, allows the countries to learn and benefit
from each other
Mat á endurhæfingarþörf einstaklinga sem greinst hafa með krabbamein
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Severe volcanic SO exposure and respiratory morbidity in the Icelandic population - a register study.
Get PDFTo access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadBackground: The Holuhraun volcanic eruption September 2014 to February 2015 emitted large amounts of sulfur dioxide (SO2). The aim of this study was to determine the association between volcanic SO2 gases on general population respiratory health some 250 km from the eruption site, in the Icelandic capital area.
Methods: Respiratory health outcomes were: asthma medication dispensing (AMD) from the Icelandic Medicines Register, medical doctor consultations in primary care (PCMD) and hospital emergency department visits (HED) in Reykjavík (population: 215000) for respiratory disease from 1 January 2010 to 31 December 2014. The associations between daily counts of health events and daily mean SO2 concentration and high SO2 levels (24-h mean SO2 > 125 μg/m3) were analysed using generalized additive models.
Results: After the eruption began, AMD was higher than before (129.4 vs. 158.4 individuals per day, p < 0.05). For PCMD and HED, there were no significant differences between the number of daily events before and after the eruption (142.2 vs 144.8 and 18.3 vs 17.5, respectively). In regression analysis adjusted for other pollutants, SO2 was associated with estimated increases in AMD by 0.99% (95% CI 0.39-1.58%) per 10 μg/m3 at lag 0-2, in PCMD for respiratory causes 1.26% (95% CI 0.72-1.80%) per 10 μg/m3 SO2 at lag 0-2, and in HED by 1.02% (95% CI 0.02-2.03%) per 10 μg/m3 SO2 at lag 0-2. For days over the health limit, the estimated increases were 10.9% (95% CI 2.1-19.6%), 17.2% (95% CI 10.0-24.4%) for AMD and PCMD. Dispensing of short-acting medication increased significantly by 1.09% (95% CI 0.49-1.70%), and PCMD for respiratory infections and asthma and COPD diagnoses and increased significantly by 1.12% (95% CI 0.54-1.71%) and 2.08% (1.13-3.04%).
Conclusion: High levels of volcanic SO2 are associated with increases in dispensing of AMD, and health care utilization in primary and tertiary care. Individuals with prevalent respiratory disease may be particularly susceptible.
Keywords: Atmospheric transport; Epidemiology; Public health; Respiratory disease; Volcanic eruption.Icelandic Ministry of Healt