152 research outputs found
Konsensusbegrepp som epistemologiska begrepp
No full textTeoretiska kunskaper är en bas för makt och vetenskapliga discipliners autonomi, men indirekt också för yrkesutövares autonomi. Därför är en begrepps- och teoriutveckling viktig, eftersom teorier och teoretiska resonemang bygger på ett begreppsliggörande av den verklighet som vårdandet är. Kommunikation och intradisciplinära diskussioner och debatter är viktiga för att ständigt utveckla disciplinens "eget språk". Det behöver inte betyda att det språk eller begrepp som används inte kan förstås av andra utanför disciplinen. Innehållet i något artikuleras genom begrepp, vilket betyder att om vårdandet skall kunna beskrivas måste begreppen innehålla det som vårdandet består av
Falls in somatic and dementia wards at Community Care Units
No full textINTRODUCTION: Falls and fall injuries are common problems for patients at nursing homes in Sweden. Impaired cognitive function, a poor sense of orientation and a high intake of medicine, can lead to an increase in falls among older people. AIM: The objective of this study was to investigate the associations between falls and: fall risks, fractures, the use of physical restraints and the use of certain medications in somatic and dementia wards, respectively. METHOD: The study design is ecological, and aggregated data regarding falls, fall risk assessments, fractures, the use of physical restraints and medication were collected between 2000 and 2003. The Pearson correlation analysis and regression analyses were used to investigate associations between fall risks, medication, fractures, wheelchair-bound situations, bed rails and falls. RESULTS: The total number of reported fall incidents was 2651; of these, 737 incidents were registered in dementia wards and 1914 in somatic wards. Dementia wards and somatic wards differed regarding falls and fractures, as it was only in dementia wards that falls were associated with fractures. There was also a significant correlation between falls and assessed risk of falling, the use of certain medication, and physical restraints such as wheelchairs and bed rails in dementia wards. Falls at somatic wards were associated with the use of sleeping pills with benzodiazepines. CONCLUSION: For dementia wards there were associations between falls and fractures, physical restraints and the use of certain medications. Fractures were associated with the use of neuroleptics, sleeping pills and sleeping pills with benzodiazepines. At somatic wards, falls correlated with the use of sleeping pills with benzodiazepines, and with the use of wheelchairs and bed rails
Family visits to patients treated in an intensive care unit.
No full textAim: The overall objective of the present thesis was to describe and assess the importance and impact of visits by the patients’ families in an ICU, from patient and family perspectives, and to develop, from a hermeneutic perspective, a research method to study the interplay between patient and family during the visit.
Method: The comprehensive methodology of the thesis was hermeneutic. Qualitative as well as quantitative methods were applied to elucidate the issues at stake. In paper I, 198 patients were consecutively included, and data were statistically analysed to establish patient mortality and length of stay at the hospital, in relation to visits of families in the ICU. In paper II, ten patients and 24 visitors were observed during visits. In paper III, seven patients and five relatives were interviewed about their memories of the visits in the ICU. Field notes from the observations, and the interviews with patients and relatives, were interpreted and analysed inspired by Gadamer’s hermeneutic philosophy. Paper IV represents a theoretical discourse, and presents methodological aspects of the hermeneutic interpretation of data from the observations.
Results: There were no significant differences between the patients having visitors and those who did not. The patient group with no visits comprised 25 %; they were older, and lived in single households, which contrasted to the patient group having visitors. Analyses of the three clinical studies revealed four themes. The themes relate to the meaning of visiting for patients and their relatives, and are as follows: the visit means to see and realize, to guard and watch, to meet, and to sacrifice. The caring entails that you witness and see with your own eyes, and that you feel a communion with the sick. From the patient perspective, the visit signifies that you are confirmed, empowering you to fight to get back to life. Communion and availability in conjunction enable an individual to achieve a thorough involvement with another being. The results of study IV disclosed that what you observe is depending on your theoretical view. If you see from your heart, you interpret from your heart.
Conclusions: The conclusions drawn from the studies of the present thesis are that opportunities to create a presence in the community - a communion - between patients, relatives, and carers, are at want. The present fundamental view of caring in intensive care units is in need of change, in order to create optimal conditions for a communion. Visits need to be regarded as an essential part of caring, and relatives’ visits ought to be facilitated and encouraged. Furthermore, visits are important both for patients and their relatives, as sharing the event of critical illness, in the sense of sharing the suffering, the healing, and the restoration of health, is considered a precondition for their recovery. Care should be organized around the patients and their families. Families and patients bring their fellow stories of life, including values and beliefs, thereby increasing the probability of dignified individualized care
Bokrecensioner
No full textRecenserade böcker:PAUL MOXNES: Ångest och ArbetsmiljöWILLIAM H MASTERS OCH YIRGINIA E JOHNSON: Ny syn på homosexualitet (orig. Homosexuality in perspec tive).INGEGERD BERGBOM ENGBERG &BIRGITTA HALLENBERG: Respiratorvård - patientupplevelser Tre rapporter från Institutet för Gerontologi, Jönköping
 
Visual arts and drawings to communicate and explore authentic life situations, a data collection method in caring science – a hermeneutic perspective
No full textThis methodological article aims to describe three methodological strategies for using drawings as a part of qualitative data collection methods in caring research based on hermeneutics. In some research interview situations, participants may have difficulties to express their experiences and feelings in words. The consequences may be that the descriptions in research reports will become superficial and not authentic, meaning, "telling it as it is". Drawn pictures may facilitate and support reflection related to the deepening of experiences and thoughts, and communicate and express more than words can do. It may also reveal thoughts and feelings the person drawing the picture was not aware of. Three methodological strategies are described: (1) Drawing a picture as an introduction or starting point for an interview, (2) During an ongoing interview, encouraging the participant to draw a picture when further explanation or description is needed for deepening the communication and (3) Drawing something in a pre-existing picture. The theoretical foundation of Gadamer's hermeneutic philosophy is discussed in relation to what a drawing is representing and presents. The interpretation of the drawn picture depends primarily on the creator of the picture, but at the same time the interpretation and understanding is a movement between the interviewer's and the participant's horizons, and thus is open for preunderstanding and new understanding. In contrast to an ordinary interview between two parties, an interview involving a drawing adds something specific to the conversation as it becomes a "trialogue" and not only a dialog. The drawn picture stands on its own. Using the participant's drawing can, therefore, be understood as an ongoing process with three parties involved: (1) the participant, (2) the researcher and (3) the drawing
Being conscious during mechanical ventilator treatment- Patients' and relatives' experiences
No full textIn recent years, light or no sedation has become a common approach in patients who require mechanical ventilation (MV) when cared for in an intensive care unit (ICU). This new approach has resulted in medical advantages as well as a shorter time on MV and in the ICU.
Aim: The overall objective of the thesis was to describe, illuminate and interpret patients’ and relatives’ experiences of caring and communication in connection with MV while the patient is conscious.
Methods: The data collection methods were inductive and included interviews and observations, both audiotaped and video-recorded. The study group consisted of patients and relatives; fourteen patients in paper I,
twelve in paper II and nineteen in paper III as well as ten relatives in paper IV. In paper I, the video-recorded interviews were analysed using content analysis and hermeneutics. The text in paper II was analysed using the phenomenological-hermeneutic method inspired by Ricoeur. The observations in paper III were analysed by means of a hermeneutic approach based on Gadamer’s philosophy. In paper IV, relatives were interviewed on two occasions. The text from these interviews was also analysed using a hermeneutic method inspired by Gadamer.
Results: The patients experienced an overall sense of being breathless. While conscious, they were aware of the mechanical ventilator as a life saver. Besides being breathless, being voiceless was considered the worst aspect. Communication was difficult and awkward as it demanded all their will power. Patients’ communication patterns
varied but there were commonalities; they also developed an individual style of communication. Being subjected to someone else’s will and direction meant being painfully aware of one’s dependency. Despite this, the patients struggled for independence in various ways as part of the recovery process. Being conscious while receiving MV demands caring communication, which in turn requires proximity, presence and constant attention by a nurse who is “standing by” and prepared to take care of the patient whatever happens. The patients’ non-verbal
communication through their gaze and facial expression was interpreted as sadness and sorrow, understood as expressions of unuttered suffering. The overall struggle and primary existential aim of relatives in the ICU is to
be in contact with the patient, a need which overshadows everything else.
Conclusion: Being conscious during MV means being painfully aware of one’s dependency while voiceless and helpless. It is possible to endure this situation when the caregivers are “standing by”, attentive to the patients’ expressions, prepared to act to make sure that the patients are feeling better and do not leave them unattended. Caring for a conscious patient on MV presupposes nurses’ ability to understand and be able to “standing by”. If this approach is not possible, consciousness might be too painful and sedation should be considered
Livskvalitet och hälsa - Patienters upplevelser i samband med Abdominellt Aorta Aneurysm
No full textThis thesis is based on four studies where the overall aim was to explore and describe experiences of being diagnosed with Abdominal Aortic Aneurysm (AAA), and if experiences of care and treatment, affect quality of life and health. Two of the studies were qualitative, where a phenomenological hermeneutic and a hermeneutic method of interpretation and analysis were used. In another two studies a quantitative method including two health related quality of life instruments, and an instrument measuring sense of coherence and sexual function were applied.
Abdominal Aortic Aneurysms do not usually give any symptoms before rupture. It is usually discovered in connection with a medical examination for other physical conditions. Three treatment regimens are available; Open Repair (OR), EndoVascular Aneurysm Repair (EVAR) and conservative treatment. An aneurysm >55mm is usually excluded with an intervention since the risk for rupture increases at this size. When the aneurysm is less than 55 mm, the patients visit the clinic for annual follow-ups.
In paper I, ten patients were invited to participate in an interview. They were all living at home but had been diagnosed with an AAA and were attending follow-ups at a university hospital in Sweden. A phenomenological – hermeneutic approach inspired by Ricoeur and developed for nursing science by Lindseth&Norberg was used for interpreting and analysing the interview text. In paper II twenty patients were consecutive invited to participate in the study. Ten of these patients underwent OR and ten underwent EVAR. Gadamer´s philosophical hermeneutics was chosen as an appropriate methodology in relation to the aim. In paper III and IV, 76 patients were consecutive included from two University hospitals between February 2003 and December 2004. The mean age was 72.5 with a range between 52 to 85 years. Data were statistically analyzed to investigate HRQoL and sexual function.
The results of the studies showed that the meaning of living with an AAA is to live with the awareness of having an invisible and threatening disease, and a feeling of being subject to suffering. The discovery of the aneurysm meant conviction of being blessed and saved. This was connected to feelings of gratitude. In the short perspective quality of life was worse for patients in the OR group than for patients in the EVAR group, but in the long term perspective (one and two years) improvements beyond preoperative status could only be seen for patients in the OR group. Patients in the EVAR group reported a significant impairment in their sexual functions such as quality of erection and ability to achieve ejaculation from their preoperative state to one year after the treatment. No significant differences were found for patients in the OR group. The knowledge from this research can form the basis for development of a long-term caring program including annual follow ups, pre- and postoperative nursing care including the recovery period for patients with Abdominal Aortic Aneurysm
Screenwriting, authorship and gender in Swedish cinema of the 1940s: Dagmar Edqvist’s ‘The Ingegerd Bremssen case’
No full textThrough a case study analysis, this article suggests that women’s screen-writing in Sweden in the 1940s eluci-dates important aspects of cinematic authorship in relation to cultural hierarchies and gender. The analysis consists of a contextualized reading of the 1942 film Fallet Ingegerd Bremssen (‘The Ingegerd Bremssen case’), based on Dagmar Edqvist’s psychological novel about a rape and its after-effects, with a screenplay writ-ten by the author herself. A textual adaptation analysis – focusing on the screenwriting style and how the woman’s perspective and experience in the novel is transformed in the adaptation – is contextualized against the historical backdrop of the changes in screenwriting practices during this period as well as of the critical reception of the film. </p
Att vaka en begreppsanalytisk studie To watch a study of the concept
No full textTo watch over a sick or dying person is a common phrase and phenomenon used both by relatives and hospital staff. The aim of this study was to analyse the concept of watch and it's meaning for caring in the context of intensive care. The study was conducted in two steps. First an etymological and semantic analysis was conducted, in the second step, 35 persons, including 19 registered nurses undergoing a specialist training program in critical care and 16 persons representing the public were asked to write down their personal opinions about the meaning of the concept. A synthesis of the semantic analysis and the empirical study was made and finally a tentative meaning of the concept was formulated. To watch (over someone) is to be present by a person's side with attention, in the purpose of protecting the loved one from danger and to assist and help in presence of illness and/or dying. The person who watches can do it day or night and be a next of kin or a nurse. To watch means to be emotionally involved and your own needs are put aside in favour of the concern and care for the ill or dying person. This abstract was translated into English by the publisher or author
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