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  • 1.
    Hellman, Eva
    et al.
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för hälsovetenskap.
    Sirviö Lager, Mirjam
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för hälsovetenskap.
    Wikberg, Marlene
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för hälsovetenskap.
    Den stora utmaningen: anestesisjksköterskors erfarenheter av barninduktion2011Independent thesis Advanced level (degree of Master (One Year)), 10 poäng / 15 hpOppgave
    Abstract [sv]

    Bakgrund: Anestesisjuksköterskor i Sverige har en unik roll i och med att de har ett eget yrkesansvar som ger behörighet att utföra anestesiarbetet självständigt. Det finns många utmaningar som en anestesisjuksköterska ställs inför vid sövning av barn, både ur fysiologisk och psykologisk synvinkel. Få studier finns gjorda kring anestesisjuksköterskors erfarenheter av barninduktion.

    Syfte: Studiens syfte var att belysa anestesisjuksköterskors erfarenheter vid barninduktion.

    Metod: Studien genomfördes på ett sjukhus i mellersta Sverige under våren 2011. En kvalitativ intervjumetod användes med innehållsanalys av materialet. Sammanlagt intervjuades 14 anestesisjuksköterskor med varierande yrkeserfarenhet.

    Resultat: Alla studiedeltagare ansåg att det är en utmaning att söva barn. Med ökad erfarenhet upplevde anestesisjuksköterskorna att de blev tryggare i sin yrkesroll och att de lättare kunde hantera de små marginaler som barns fysiologi innebär. De betonade vikten av en god kommunikation med barnet och dess familj. Ibland uppkom situationer som ställde anestesisjuksköterskan inför etiska dilemman.

    Diskussion: I studien framkom hur anestesisjuksköterskor utvecklas från att vara noviser till att bli experter på sitt område. En tydlig känsla av yrkesstolthet kunde utläsas av intervjuerna. Anestesisjuksköterskorna befann sig på ett kontinuum mellan att vara uppgifts- eller relationsfokuserad.

     

    Nyckelord: Anestesisjuksköterskor, barninduktion, erfarenheter, omvårdnad, samspel

     

  • 2.
    Schandl, Anna
    et al.
    Department of Anesthesiology, Surgical Services and Intensive Care Medicine, Karolinska University Hospital Solna, 171 76 Stockholm, Sweden .
    Bottai, Matteo
    Unit of Biostatistics, Department of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden .
    Hellgren, Elisabeth
    Department of Anesthesiology, Surgical Services and Intensive Care Medicine, Karolinska University Hospital Solna, 171 76 Stockholm, Sweden .
    Sundin, Örjan
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för psykologi.
    Sackey, Peter V.
    Department of Anesthesiology, Surgical Services and Intensive Care Medicine, Karolinska University Hospital Solna, 171 76 Stockholm, Sweden .
    Developing an early screening instrument for predicting psychological morbidity after critical illness2013Inngår i: Critical Care, ISSN 1364-8535, E-ISSN 1466-609X, Vol. 17, nr 5, s. Art. no. R210-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction: Guidelines recommend follow-up for patients after an intensive care unit (ICU) stay. Methods for identifying patients with psychological problems after intensive care would be of value, to optimize treatment and to improve adequate resource allocation in ICU follow-up of ICU survivors. The aim of the study was to develop a predictive screening instrument, for use at ICU discharge, to identify patients at risk for post-traumatic stress, anxiety or depression. Methods: Twenty-one potential risk factors for psychological problems - patient characteristics and ICU-related variables - were prospectively collected at ICU discharge. Two months after ICU discharge 252 ICU survivors received the questionnaires Post-Traumatic Stress Symptom scale -10 (PTSS-10) and Hospital Anxiety and Depression Scale (HADS) to estimate the degree of post-traumatic stress, anxiety and depression. Results: Of the 150 responders, 46 patients (31%) had adverse psychological outcome, defined as PTSS-10 >35 and/or HADS subscales >= 8. After analysis, six predictors were included in the screening instrument: major pre-existing disease, being a parent to children younger than 18 years of age, previous psychological problems, in-ICU agitation, being unemployed or on sick-leave at ICU admission and appearing depressed in the ICU. The total risk score was related to the probability for adverse psychological outcome in the individual patient. The predictive accuracy of the screening instrument, as assessed with area under the receiver operating characteristic curve, was 0.77. When categorizing patients in three risk probability groups - low (0 to 29%), moderate (30 to 59%) high risk (60 to 100%), the actual prevalence of adverse psychological outcome in respective groups was 12%, 50% and 63%. Conclusion: The screening instrument developed in this study may aid ICU clinicians in identifying patients at risk for adverse psychological outcome two months after critical illness. Prior to wider clinical use, external validation is needed.

  • 3.
    Sjöling, Mats
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för hälsovetenskap.
    Experiences of abandonment and anonymity among arthroplastic surgery patients in the perioperative period: Some issues concerning communication, pain and suffering2005Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    The overall objective of the thesis is to describe and illustrate the experience of being an arthroplastic surgery patient during the perioperative period with regard to the issues of communication, pain,suffering and satisfaction with care. While waiting for surgery, the participants in this thesis experience suffering in different ways and mainly experience health care as being unavailable and negative in a faceless system (I). Obtaining information related to their illness is difficult, as it is hard to establish contact with health care providers. The responsibility for establishing contact and obtaining information rests solely with the patients (II). In Paper I, due to poor communication, the respondents express feelings of abandonment, anonymity and being disparaged by the health care system. During the participants' journey through the health care system, the negative experience acquires a more positive nature, as personal contacts are established with health care representatives (I-IV). The findings in the different papers (I-IV) are interpreted in the light of Katie Eriksson and Lennart Fredriksson’s descriptions of suffering and the caring conversation. There are participants in this thesis who have been able to reach a personal understanding of themselves and have found reconciliation in suffering. In this way, they have been able to maintain or obtain meaning in their lifeworld. Through their own power, or with the help of family and friends, individuals may be able to attain confirmation of their suffering, have the time and space to suffer and find reconciliation. However, as long as health care is experienced as a faceless system, there are individuals in this study who are unable to face their suffering. During the patients’ journey through the system, it becomes obvious that the system obtains a face when the individuals are able to establish trustful contact with an actual person within the system. The system does not obtain a face as long as the individuals perceive themselves as being poorly treated by health care representatives. In these cases, the system is actually the cause of additional suffering. In the terms defined by Fredriksson, the system obtains a face when a turning point occurs in the form of a caring conversation. During the waiting time, there are few opportunities for a caring conversation. An opportunity is more likely to occur when the individual is admitted to hospital. This is reflected in the extensive degree of satisfaction with care as expressed in Papers II-IV. High levels of satisfaction are reported, although the participants report having experienced high levels of postoperative pain. In Paper III, 68% (n=40) and, in Paper IV, 83.5% (n=50) of the patients experienced pain of = 4 on the Visual Analogue Scale (VAS). When they have been admitted to hospital, the individuals sense that they are confirmed by and visible in the system. This visibility is mutual, as the individual becomes an actual person to health care representatives. In a caring conversation, a sense of trust is established and, as this occurs, the individual and the care provider dare to communicate in an open way, where both are present in the situation.

  • 4.
    Sjöling, Mats
    et al.
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för hälsovetenskap.
    Westman, Anton
    Umeå University.
    Saveman, Britt-Inger
    Umeå University.
    Skydiving culture and its relation to injury risks and injury reporting2010Konferansepaper (Fagfellevurdert)
    Abstract [en]

    This article explores some aspects of the Swedish skydiving culture and its relation to injury risks and injury reporting. The reference frame emerging from the analyses encompasses experiences of joy, passion and playfulness; and of injury, suffering and death. For the individual the risk of injury is viewed as an integrated element of the recreational activity, counterbalanced by its recreational value. From the findings we suggest that Swedish skydiving culture on an organisational level is carried by the local club; not the national association. Though the association has far-reaching powers over the clubs, skydiving culture at the local drop zone and formal and informal hierarchical structures among skydivers are what really decide how rules are enforced, and if incidents and injuries are reported.

  • 5.
    Åberg, Viktor
    et al.
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för hälsovetenskap.
    Jeffrey, Wall
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för hälsovetenskap.
    Oavsiktlig vakenhet under operation - Hur kan riskerna minskas?2013Independent thesis Advanced level (degree of Master (One Year)), 10 poäng / 15 hpOppgave
    Abstract [sv]

    Bakgrund:

    Awareness definieras som när en patient i generell anestesi i efterhand kan minnas händelser eller ha förnimmelser från en operation då han eller hon borde varit medvetslös. Det är en allvarlig anestesiologisk komplikation som kan leda till posttraumatiskt stressyndrom. Av de patienter som genomgår kirurgiska ingrepp i generell anestesi drabbas cirka 0,1 - 0,2 %. Den vanligaste orsaken till awareness är ytlig anestesi, vilket hos särskilda riskpatienter ibland kan vara svårt att förebygga med endast traditionell övervakning. Det finns därför ytterligare metoder att tillgå. Syfte: Denna litteraturstudie syftade till att undersöka om man med vissa läkemedel, mätmetoder eller andra interventioner kan minska risken för intraoperativ awareness. Metod: Studien genomfördes via artikelsökningar i databaserna PubMed, Cinahl och SveMED+. Efter kvalitetsbedömning och analys inkluderades 20 artiklar i studien. Resultat: Inkluderade artiklar delades in i fyra kategorier för en bättre översikt. Dessa var läkemedels- och anestesiformsrelaterade metoder, EEG-metoder, EEG-metoder kontra traditionell övervakning samt övriga metoder. Resultatet visade att det fanns många metoder att tillgå och att det råder delade meningar om dess effektivitet. Slutsats: De metoder som används har en viss felmarginal och ingen av dem är så effektiv att de kan användas som enda hjälpmedel för att förebygga awareness. EEG-mätningar kan dock vara ett effektivt tillägg till den traditionella övervakningen.

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