https://www.mdu.se/

Background: Patients who receive palliative care experience that they lose their independence through the disease and are frustrated that their body is not functioning as before. They also experience that their situation make them change their attitudes towards life. Several patients appreciate when healthcare professionals show genuine interest and the same patients have confidence in the healthcare system. Some patients experience that the healthcare professionals have no time and that their knowledge regarding their psychosocial problems is inadequate. Aim: The purpose is to describe nurses experience of nursing in palliative care. Method: Qualitative literature study with descriptive synthesis. Ten qualitative articles have been analyzed and is presented in the result. Results: After analysis, two themes were disclosed; Becoming enriched and Being challenged who described nurse’s experiences presented under five subthemes. Conclusion: Nurses perceived, among other things, that they were strengthened as a person and that they learned to re-prioritize and appreciate life. They also experienced grief over the fate of patients and it was common to take work home. Several of the nurses perceived that doctors did not give them support, others felt that their lack of experience contributed to the care worsening.

Equity in access to primary health care services is a central objective of the Swedish health care system. Yet, several reports have illustrated that disparities still exist in the primary health sector, and have increased since the beginning of the 1990s. This commentary analyzes and explains the reasons for continuing inequality in access to and utilization of primary health care services in a welfare system. Social and structural factors, communication, macro-sociological aspects and health care providers’ attitudes and perceptions are discussed as substantial contributors to inequality in access to and utilization of primary health care services. In conclusion, some intervention strategies for promoting more equitable primary health care are suggested.

Background: Participation, caring relation and communication are three key concepts in

health care. These are three factors that can affect the patients’ health process and their need

to feel safe. Aim: To show nurse’s opportunities and obstacles to creating participation in the

care relationship with patients when the same verbal language is not spoken. Method: The

study was based on a qualitative analysis by Evans (2002) literature study that reflects the

nurse's perspective. Result: What was considered to be presumptions for participation could

be interpreter’s presence for the creation of participation in the caring relation. As a nurse to

have knowledge of different cultures could be an advantage for participation in caring

relation. What was considered to be obstacles to participation could be overcome by the use

of nurses or relatives as interpreters. Language barrier and the lack of understanding of

different cultures could make it difficult to create an individualized care. Conclusion: When

a care relationship consists of good communication and interaction between nurses and

patients it creates the conditions for participation. It is therefore important to access the

resources that are necessary and enforce appropriate strategies.

Hjärtsvikt är en sjukdom som är vanlig idag i Sverige och prevalens siffrorna stider. Syftet med denna stuide var att studera om hjärtsviktspatienter önskar ett team runt sig med ansats på olika egenvårds och omvårdnadsåtgärder och på vilket sätt de önskar få hjälp av teamet för att förbättra sin livskvalitet. På vilket sätt uppfattar de att ett vårdteam kan öka deras livskvalitet efterdiagnos. Åtta patienter födda mellan 1922-1942 deltog, fyra kvinnor och fyra män. Resultatet visar att informanterna har symtom som de tror beror på hög ålder, de anpassar sina aktiviteter efter vad de orkar göra, att det upplevs svårt att komma in i värdsvängen men när man väl är inne, är upplevelsen att man får bra vård. För att behöva ett team i sin vård innebär att man snart ska dö vilket är inte överensstämmande med nationella riktlinjer som säger att uppföljning ska ske genom ett teambaserat arbetssätt

Background: As a nurse, meeting relatives of deceased patients is a complex task. Possessing the knowledge required to be able to deal with everyone in an individualized way is a prerequisite for being able to provide good care to grieving relatives. Relatives express multiple needs and wishes after a death. Among other things the need for a person–centered approach with straightforward and clear communication. Eriksson's theory of care science is the basis for this work, where caring, playing, teaching and compassion is described as a strength in a nurse profession. It also brings up how the nurse practice the rules, laws and regulatory documents. Aim: Is to describe nurses' experiences of treatment towards relatives at the patient's death. Method: The work is done with a general literature review where tencare science articles have been analyzed, of which two were quantitative and seven were qualitative and one were mixed method. Results: The analysis led us to four themes, where the themes were to be present in difficult times, to communicate with relatives, to make room for grief and to be inadequate. Conclusion: As nurses, facing death in their daily work contributes to emotional expressions and at the same time responding to sad, desperate and angry relatives makes the work difficult and emotionally demanding, then it is important that the nurse has the conditions to provide good care.

Background: Pressure ulcers are a common injury and are classified as healthcare injuries, pressure ulcers have a relatively high prevalence in healthcare. The occurrence of pressure ulcers is due to insufficient nursing measures that lead to the development of pressure ulcers for patients who are at risk of suffering from this. Therefore, it is of great importance to take pressure ulcer prevention measures and efforts to reduce the occurrence of pressure ulcers. This is to promote the patient's health and prevent ill health for patients who have or are at risk of pressure ulcers. Aim: The purpose is to describe nurses' experiences of preventive nursing work against pressure ulcers. Method: Analysis of 11 qualitative studies through systematic literature review with descriptive analysis according to Evans. Results: The results revealed various factors that positively and negatively affect nurses' pressure ulcer prevention work. This included various organizational factors such as experiences of lack of time, the importance of guidelines and attitudes and values. Also, the responsibility of the individual, which were individual competence development, involving patients and communication in care. Conclusion: Pressure ulcers can be prevented in most cases if the right measures are taken. Nurses have a responsibility to absorb knowledge and develop competence in pressure ulcer prevention work. Also absorb all information about patients' experiences to be able to adapt care individually. 

Keywords: Communication, competence development, guidelines, lack of time, participation.

Purpose: Psychopathic traits are associated with multiple negative outcomes. The present prospective, longitudinal study identified associations of childhood factors with adult psychopathy scores.

 Methods: 311 men, aged, on average, 33 years, were assessed using the Psychopathy Checklist-Revised (PCL-R). Predictors included neighbourhood deprivation, parents' characteristics, teacher ratings of behaviour at ages 6, 10 and 12, and academic performance at age 12. Hierarchical linear regression models were computed to identify predictors at different ages of PCL-R total and facet scores. 

Results: Age 33 PCL-R total and facet scores were significantly, and independently, associated with father's and mother's criminality and mother's age at participant's birth when teacher ratings of childhood behaviours and mathematics marks were included in the models. Anxiety was negatively associated with facet 1 scores at age 6. At age 12, 22% of the variance in facet 2 scores was predicted by father's violent convictions, mother's age and criminal charges, and reactive aggression. Facet 3 scores were associated with mother's age (marginally), inattention, and reactive aggression. Facet 4 scores were associated with father's violent criminality, mother's age, conduct probleins, inattention, and reactive aggression. 

Conclusion: Etiological research and prevention programs should focus on antecedents of psychopathic traits present in early childhood.

Bakgrund: Den äldre befolkningen ökar ständigt och antalet äldre personer överstiger redan två miljoner i Sverige, vilket innebär ökat vårdbehov. Att flytta till särskilt boende kan vara svår att acceptera för den äldre personen, även för anhöriga som oftast känner osäkerhet för vem som bär ansvaret för deras närstående. Sjuksköterskor upplever att det kan göras mer för att förbättra omvårdnaden av den äldre personen. På grund av tidsbrist är det svårare att skapa en vårdande relation. Problem: Det finns ett bristande engagemang från sjuksköterskor till att utföra en personcentrerad omvårdnad samt en tidsbrist för att beakta den äldre personens unika behov. Syfte: Beskriva äldre personers erfarenheter i samband med flytt till särskilt boende. Metod: En systematisk litteraturstudie med beskrivande syntes. Resultat: Anpassning till ny boendemiljö kunde vara svårt för den äldre personen. Vad som underlättade för trivsel var när de fick ta beslutet att flytta själva. Trots det fanns det omkringgivande aspekter som försvårade för den äldre personens trivsel på boendet, bland annat ökat vårdbehov. Slutsats: För att förbättra äldre personernas erfarenheter kan resurser sättas in före flytten för att säkra att deras synpunkter och behov tas hänsyn till.

BACKGROUND: Access to pre-hospital trauma care can help minimize many of traffic related mortality and morbidity in low- and middle-income countries with high rate of traffic deaths such as Iran. The aim of this study was to assess if the distribution of pre-hospital trauma care facilities reflect the burden of road traffic injury and mortality in different provinces in Iran. METHODS: This national cross-sectional study is based on ecological data on road traffic mortality (RTM), road traffic injuries (RTIs) and pre-hospital trauma facilities for all 30 provinces in Iran in 2006. Lorenz curves and Gini coefficients were used to describe the distributions of RTM/RTIs and pre-hospital trauma care facilities across provinces. Spearman rank-order correlation was performed to assess the relationship between RTM/RTI and pre-hospital trauma care facilities. RESULTS: RTM and RTIs as well as pre-hospital trauma care facilities were distributed unequally between different provinces. There was no significant association between the rate of RTM and RTIs and the number of pre-hospital trauma care facilities across the country. CONCLUSIONS: The distribution of pre-hospital trauma care facilities does not reflect the needs in terms of RTM and RTIs for different provinces. These results suggest that traffic related mortality and morbidity could be reduced if the needs in terms of RTM and RTIs were taken into consideration when distributing pre-hospital trauma care facilities between the provinces.

Background: Patient safety is of the utmost importance in health care. The patient safety culture in an institution has great impact on patient safety. To enhance patient safety and to design strategies to reduce medical injuries, there is a current focus on measuring the patient safety culture. The aim of the present study was to describe the patient safety culture in an ED at two different hospitals before and after a Quality improvement (QI) project that was aimed to enhance patient safety. Methods: A repeated cross-sectional design, using the Hospital Survey On Patient Safety Culture questionnaire before and after a quality improvement project in two emergency departments at a county hospital and a university hospital. The questionnaire was developed to obtain a better understanding of the patient safety culture of an entire hospital or of specific departments. The Swedish version has 51 questions and 15 dimensions. Results: At the county hospital, a difference between baseline and follow-up was observed in three dimensions. For two of these dimensions, Team-work within hospital and Communication openness, a higher score was measured at the follow-up. At the university hospital, a higher score was measured at follow-up for the two dimensions Team-work across hospital units and Team-work within hospital. Conclusion: The result showed changes in the self-estimated patient safety culture, mainly regarding team-work and communication openness. Most of the improvements at follow-up were seen by physicians, and mainly at the county hospital.

Innovationsbehovet blir allt starkare i en komplex värld och allt större krav ställs på kompetens och entreprenöriell förmåga. En av universitetens utmaningar är att koppla samman kunskap och entreprenöriella förmågor så att studenternas kunskap sätts i arbete. Hur arbetar vi med dessa frågor i samverkan?

Bakgrund: Kvinnliga idrottare drabbas i hög grad av främre korsbandsskador och under efterföljande rehabilitering har fysioterapeuten en viktig roll. En stor skillnad mellan kvinnor och män är menstruationscykeln. Den kvinnliga idrottaren påverkas av menstruationscykelns olika faser och intag av preventivmedel. Genom ett biopsykosocialt helhetsperspektiv kan en fysioterapeut ta hänsyn till flera olika faktorers påverkan på ett beteende. Detta kan möjliggöra vad som eventuellt kan påverka en elitidrottande kvinna kopplat till menstruationscykel under en pågående främre korsbandsrehabilitering.Syfte: Studiens syfte var att undersöka kvinnors upplevda motivation, self-efficacy och träningskvalité kopplat till menstruationscykeln under pågående främre korsbandsrehabilitering.Metod: Beskrivande fallstudier med deskriptiv och visuell analys. Sju kvinnliga elitidrottare som genomgick främre korsbandsrehabilitering rekryterades, varav en exkluderades. Datainsamlingen genomfördes med hjälp av ett frågeformulär och en dagbok. Datainsamlingen pågick i 33 dagar.Resultat: Resultatet visar att var och en av deltagarna upplevde variation i sina skattningar inom varje frågeställning under studiens gång. En deltagares variation kan eventuellt ha påverkats av menstruationscykeln och dess fluktuationer av hormoner.Slutsats: Uppsatsens resultat visar på variation av skattningar under menstruationscykeln hos samtliga deltagare. Denna studie kan dock inte påvisa om den påverkade faktorn är menstruationscykelns olika faser och intag av preventivmedel.Nyckelord: Främre korsbandsskada, fysioterapi, kvinnliga elitidrottare, rehabilitering, socialkognitiv teori

Objectives: To explore users’ experiences of a tailored, interactive web application that supports behaviour change in stress management and to identify if and in that case what in the web-based programme that needed further development or adjustment to be feasible in a randomised controlled trial.

Method: The design of this study was explorative with a qualitative approach. Nine individuals were recruited among the staff at a university. Semi-structured individual interviews were conducted and analysed using qualitative content analysis, after the participants had completed the web-based stress management programme.

Results: One theme was identified, Struggling with what I need when stress management is about me, describing the paradox in having a programme that is perceived as supporting stress management while also being perceived as extensive and time consuming. The theme was divided in two categories: Defining the needs, where the users expressed what they needed from the programme and their everyday environment, to be able to use the programme, and It is about me, where the programme was described as helping the users understand their own stress.

Conclusion: The participants expressed acceptance of using a web-based programme for stress related problems. The perceived extensiveness of the programme must be considered in further development.

Background: Stress is one of the most common reasons for sick leave. Web-based interventions have the potential to reach an unlimited number of users at a low cost and have been shown to be effective in addressing several health-related problems. Handling stress on an individual level is related to behavior change. To support behavioral changes in stress management, My Stress Control (MSC) was developed. The development of MSC was based on several health psychology theories and models; however, central in the development were Social Cognitive Theory, Theory of Reasoned Action, Theory of Planned Behavior, Transactional Theory of Stress and Coping, and the Transtheoretical Model and Stages of Change. MSC is a fully automated program. The program is tailored to the user’s specific needs for stress management and behavior change.

Objective: In this study, we aim to conduct a randomized controlled trial to evaluate the extent to which MSC affects perceived stress in persons experiencing work-related stress.

Methods: This was a randomized controlled trial with 2 arms. Study participants were recruited by visiting the worksites and workplace meetings. Participants were assigned to the intervention or wait-list group. Web-based questionnaires were used before and after the intervention to collect data. Perceived stress measured using the Perceived Stress Scale-14 was the primary outcome measurement. Analyses were conducted for both between-group and within-group changes.

Results: A total of 92 participants were included in this study: 48 (52%) in the intervention group and 44 (48%) in the wait-list group. Overall, 25% (12/48) of participants in the intervention group and 43% (19/44) of participants in the wait-list group completed the postintervention assessment. There were no significant effects on perceived stress between the intervention and wait-list groups or within the groups. A small effect size (Cohen d=0.25) was found when comparing mean change over time on the primary outcome measure between the intervention and wait-list groups. In addition, a small effect size was found between pre- and postintervention assessments within the intervention group (Cohen d=0.38) as well as within the wait-list group (Cohen d=0.25).

Conclusions: The effect of MSC on perceived stress remains uncertain. As adherence was low in the intervention group, elements or features that facilitate adherence and engagement must be further developed before firmer conclusions regarding the effect of MSC can be made.

The proportion of older people in the general population has increased and will continue to increase during the coming decade. Therefore, a positive attitude towards older people is important. The aim of the study was to gain knowledge about attitudes towards older people among health care students and health care staff in Swedish elder care settings. The study includes a convenience sample of 928 respondents comprised of health care students and three groups of professional caregivers [registered nurses (RNs) with university degrees, certified nursing assistants (CNAs), nurses] in a variety of health care settings in Sweden. The participants completed the Kogan’s Old People (KOPS) Scale with 17 positive (OP+) and 17 negative (OP–) statements. The statements score ranged from 17 to 85 respectively. A significant (P<0.05) difference in both positive and negative scores was observed among the three professional caregiver groups. RNs had the highest positive score (OP+:64) as well as the lowest negative score (OP–:36). Health care students in semester one had the most unfavourable attitude toward older people (OP–:41) while students in semester two had the most favourable attitude toward older people (OP+:62). RNs reported both a higher positive score as well as lower negative score compared to nurses without an academic degree and CNAs. In addition, we found that progression in one’s health care education contributes to reduce unfavourable attitudes toward older people. Health care professionals need to have the right skills to manage a more demanding role in the future in order to offer effective services for older people. A skilled workforce of health professionals is therefore very necessary.

In this study the authors describe parents' experiences of support over a 2-year period after a stillbirth and its effect on parental grief. Data was collected by questionnaire from 33 mothers and 22 fathers at 3 months, 1 year, and 2 years after a stillbirth. Midwives, physicians, counselors, and priests--at the hospital where the stillbirth occurred--are those on the front line providing professional support. The support from family and friends was seen to be important 2 years after the stillbirth. The need for professional support after stillbirth can differ, depending on the support provided by family, friends, and social networks. They may not fully realize the value of their support and how to be supportive. Printed educational materials given to individuals in the social network or family might therefore be helpful.

While sensory and motor systems have attracted most of the research effort in the field neuroprosthetics, little attention has been devoted to higher order cortical processes. Here, we propose a first step in the direction of applying neural decoding to the study and manipulation of visuospatial attention, an endogenous process at the interface between sensory and motor functions. To this aim, we investigate whether the offline activity of apopulation of non-human primate frontal eye field neurons (FEF) in response to an endogenous cue can be readout on a trial by trial basis to providea precise description of the cue's attributes, namely, its location and identity, but also the allocation of attention following its interpretation. Using alinear decoder, we reach up to 86% correct predictions for the different decoded variables, including the spatial allocation of endogenous attention. We show that the decoding performance drops on incorrect trials, indicating that cue encoding participates to the animal's behavioral performance. Last, we show that the temporal resolution of the decoding influences readout performance. These results are a strong indication of the feasibility of the readout of endogenous variables by standard decoding algorithms, on a suboptimal dataset. However, its validity remains to be proved in a real-time situation.

Test cases that only observe the system under test can improve parallelism and detection of faults occurring due to unanticipated feature interactions. Traditionally, such passive test cases have been challenging to express, partly due to the use of complex mathematical notations. The T-EARS (Timed Easy Approach to Requirements Syntax) language prototype was introduced to respond to this and has received positive feedback from practitioners. However, the prototype suffered from few deficiencies, such as allowing non-intuitive combinations of expressions and usage of temporal specifiers that quickly got difficult to understand. This paper builds on the T-EARS prototype and input from experienced testers on a previous iteration of the language. The collected experience was applied to a new prototype using a structured update process, including a set of system-level requirements from a vehicular software system. The results include a new, improved grammar for the T-EARS language and a description of the evaluation semantics.

Objective: The Nordic countries have published joint dietary recommendations, the Nordic Nutrition Recommendations (NNR), since 1980. We evaluated adherence to the NNR as a measure of a healthy diet and its potential association with self-reported upper respiratory tract infection (URTI). Design: A prospective, population-based study with a follow-up period of 4 months. Dietary intake was assessed using a semi-quantitative FFQ with ninety-six items, along with other lifestyle factors, at baseline. URTI was assessed every three weeks. A Poisson regression model was used to control for age, sex and other confounding factors. Setting: A middle-sized county in northern Sweden. Subjects: Swedish men and women (n 1509) aged 20-60 years. Results: The NNR include recommendations on macronutrient proportions, physical activity and intake of micronutrients, sodium, fibre and alcohol. We found that overall adherence to the NNR was moderately good. In addition, we found that high adherence to the NNR (>5.5 adherence points) was not associated with a lower risk of URTI (incidence rate ratio (IRR) 0.89, 95% CI 0.73, 1.08) compared with low adherence (<4.5 adherence points). When investigating individual components of the NNR, only high physical activity was associated with lower URTI risk (IRR=0.82, 95% CI 0.69, 0.97) whereas none of the dietary components were associated with risk of URTI. Conclusions: Overall adherence to the NNR was moderately good. Overall adherence to the NNR was not associated with URTI risk in our study. However, when investigating individual components of the NNR, we found that high physical activity was associated with lower URTI risk.

Endast 60 procent av vårdpersonalen inom vård och omsorg har adekvat utbildning, samtidigt gör nedskärningarna att de äldre som får vård blir allt sjukare.

Kompetensutveckling är en viktig drivkraft för att höja vårdens kvalitet men också för att öka arbetstillfredsställelsen och arbetsglädjen inom demensvården. Ett stort problem idag är att få tid och pengar att räcka till kompetensutveckling till den personal som är närmast patienten. I denna artikel presenteras Silviahemmet och dess utbildning av Silviasystrar.

This study explored the possible beneficial effects of singing on well-being during a singing lesson. Eight amateur (2m, 6f, age 28-53 yrs) and eight professional (4m, 4f, age 26-49 yrs) singers who had been attending singing lessons for at least six months were included. Continuous ECG was recorded and computerized spectral analysis was performed. Serum concentrations of TNF-alpha, prolactin, cortisol, and oxytocin were measured before and 30 min after the lesson. Five visual analogue scales (VAS, sad-joyful, anxious-calm, worried-elated, listless-energetic, and tense-relaxed) were scored before and after the lesson. In addition, a semi-structured interview was performed. Heart rate variability analyses showed significant changes over time in the two groups for total power, and low and high frequency power. Power increased during singing in professionals, whereas there were no changes in amateurs. This indicates an ability to retain more "heart-brain connection," i.e., more cardio-physiological fitness for singing in professional singers, compared to amateur singers. Serum concentration of TNF-alpha increased in professionals after the singing lesson, whereas the concentration in amateurs decreased. Serum concentrations of prolactin and cortisol increased after the lesson in the group of men and vice versa for women. Oxytocin concentrations increased significantly in both groups after the singing lesson. Amateurs reported increasing joy and elatedness (VAS), whereas professionals did not. However, both groups felt more energetic and relaxed after the singing lesson. The interviews showed that the professionals were clearly achievement-oriented, with focus on singing technique, vocal apparatus and body during the lesson. The amateurs used the singing lessons as a means of self-actualization and self-expression as a way to release emotional tensions. In summary, in this study, singing during a singing lesson seemed to promote more well-being and less arousal for amateurs compared to professional singers, who seemed to experience less well-being and more arousal.