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.

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.

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.

Antalet vuxna som lever med fetma har enligt WHO fördubblats sedan 1980. Kirurgiskt ingrepp såsom gastric bypass är den metod som leder till hållbar viktminskning. Syftet med studien var att undersöka hur patienter som genomgått viktminskningskirurgi kan uppleva stödet före, under och efter operation. Studien har en narrativ fenomenologisk ansats, berättelserna har analyserats genom meningskoncentrering, strukturering och tolkning. Studien innefattar berättelser från fem informanter som valdes genom handplockat urval. Resultatet visar att de flesta informanter upplever ett fint stöd från omgivningen under processen. Missnöjet riktar sig mot sjukvården och det först efter operationen. Informanterna upplever sig som ensamma och saknar sjukvårdens förståelse. Den bristfälliga uppföljningen genererar i svårigheter för patienterna att med tiden följa de kostrekommendationer som angavs. En samtalskontakt som stöd för hållbar viktminskning och för undvikande av bristsjukdomar är att rekommendera.

Syfte: Att undersöka om kvinnor vidmakthöll fysisk aktivitet under graviditet. Metod: webbaserad enkätstudie med kvantitativ ansats. Totalt 80 enkäter samlades in via olika grupper på Facebook. Har analyserats med deskriptiv statistik. Resultat: Kvinnor som var fysiskt aktiva innan graviditeten minskade eller bibehöll mängden fysisk aktivitet under graviditet. Ingen av kvinnorna ökade den fysiska aktivitetsnivån. Under besöken på barnmorskemottagningen fick flertal kvinnor inte någon skriftlig information om fysisk aktivitet eller tillräcklig information från barnmorskan. En majoritet av kvinnorna använde sociala medier flertalet gånger per dag och följde konton som handlar om graviditet eller fysisk aktivitet. Kvinnorna uppgav dock att den fysiska aktivitetsnivån inte påverkades av innehållet på sociala medier. Slutsats: Majoriteten av kvinnor minskade mängden fysisk aktivitet under graviditet och ett fåtal bibehöll samma mängd fysisk aktivitet under. Majoriteten av kvinnorna upplevde att de inte fick tillfredsställande stöd från barnmorskan. Kliniska implikationer: Barnmorskan bör rekommendera den gravida kvinnan att vara fysiskt aktiv under graviditet och samtala med kvinnan och fysisk aktivitet. Det är även viktigt att samtala om innehåll på sociala medier, vilket inte alltid är evidensbaserad information.

Background: Health and welfare technologies (HWTs) are interventions that aim at maintaining or promoting health, well-being, quality of life, and increasing efficiency in the service delivery system of welfare, social, and health care services, while improving the working conditions of the staff. Health and social care must be evidence-based according to national policy, but there are indications that evidence for HWT effectiveness is lacking in related Swedish municipal work processes. Objective: This study aimed to investigate whether the evidence is used when Swedish municipalities procure, implement, and evaluate HWT, and if so, the kinds of evidence and the manner of their use. The study also aimed to identify if municipalities currently receive adequate support in using evidence for HWT, and if not, what support is desired. Methods: An explanatory sequential mixed methods design was used with quantitative surveys and subsequent semistructured interviews with officials in 5 nationally designated “model” municipalities regarding HWT implementation and use. Results: In the past 12 months, 4 of 5 municipalities had required some form of evidence during procurement processes, but the frequency of this varied and often consisted of references from other municipalities instead of other objective sources. Formulating requirements or requests for evidence during procurement was viewed as difficult, and gathered evidence was often only assessed by procurement administration personnel. In total, 2 of 5 municipalities used an established process for the implementation of HWT, and 3 of 5 had a plan for structured follow-up, but the use and dissemination of evidence within these were varying and often weakly integrated. Standardized processes for follow-up and evaluation across municipalities did not exist, and those processes used by individual municipalities were described as inadequate and difficult to follow. Most municipalities desired support for using evidence when procuring, establishing evaluation frameworks for, and following up effectiveness of HWT, while all municipalities suggested tools or methods for this kind of support. Conclusions: Structured use of evidence in procurement, implementation, and evaluation of HWT is inconsistent among municipalities, and internal and external dissemination of evidence for effectiveness is rare. This may establish a legacy of ineffective HWT in municipal settings. The results suggest that existing national agency guidance is not sufficient to meet current needs. New, more effective types of support to increase the use of evidence in critical phases of municipal procurement and implementation of HWT are recommended.

Bakgrund: Psykiska problem av varierande svårighetsgrad under graviditeten ökar.

Psykiska problem under graviditeten innebär bland annat en ökad risk för

minskad anknytning till barnet och tillväxthämning hos barnet. Barnmorskor är de

yrke som ansvarar för graviditetskontroller och har därmed ett ansvar att upptäcka tecken på

psykiska problem under graviditeten. Syfte: Att beskriva barnmorskors erfarenheter av

vård av gravida med psykiska problem inom mödravården. Metod: Webbaserat

undersökning, analyserad med kvalitativ manifest innehållsanalys med en induktiv ansats.

Resultat: Förutsättningar och möjlighet till vård gjorde att barnmorskorna hade en förtroendefull och

professionellt förhållningssätt som en del av att ha en stödjande och professionell roll samt att ha

tillgång till team och resurser för remiss och samarbete/samverkan vid behov. De

Resultatet visade också på utmaningar och hinder såsom brist på tid, brist på kunskap som

resulterat i att det inte räckte till och att det saknades stöd och resurser där det saknades eller

brist på resurser och samarbete/samverkan. Slutsats: Att barnmorskor har tillgång till

tid, kunskap, lagarbete och samarbete är nödvändigt för att identifiera och svara på

behov av stöd och insatser vid psykiska problem under graviditeten.

The overall aim of this thesis was to investigate the use of speech-generating device (SGD)-mediated interaction with children with anarthria, severe physical impairments and intellectual disabilities due to cerebral palsy with a focus on partner strategies and social practices.

Studies I and II were cross-sectional studies that used questionnaires, which were analyzed using descriptive statistics and directed content analysis. In Study I, speech and language pathologists’ (SLPs) practices and perceptions of communication partner training in SGD-mediated interaction were examined. In Study II, communication partners’ (i.e., caregivers’, teachers’, and assistants’) practices and perceptions of communication partner training in SGD-mediated interaction were examined.

Studies III and IV were qualitative observational studies that used video recordings, which were analyzed with ethnomethodological conversation analysis. Study III investigated how multiparty classroom interaction was organized when one of the students used an eye-gaze accessed SGD. Study IV explored the social actions that mobilized SGD-mediated responses when the child was a beginner user of the eye-gaze accessed SGD.

The findings suggest the following: all participants (i.e., SLPs, caregivers, teachers, and assistants) considered that SGD-mediated interaction was beneficial for the children. SLPs were important providers but they provided few training sessions and used mostly verbal instructions. Communication partners could benefit from more support from SLPs and SLPs should consider using additional instructional approaches such as feedback and role-play when coaching communication partners in SGD-mediated interaction. Children could interact with their eye-gaze accessed SGDs in multiparty classroom interactions provided that the turn-taking in Initiation-Response-Evaluation (IRE) sequences was applied and that the teacher or the assistant provided contingent on-screen gaze and deictic scaffolding actions. Communication partners to children who were beginner users of an eye-gaze accessed SGD may need to produce repeated turn transition relevance places and use contingent on-screen gaze and deictic practices to scaffold an SGD-mediated response.

This thesis brings new knowledge to the field of SGD-mediated interaction. Partner strategies that can enhance children’s linguistic skills were seldom used in multiparty classroom interaction, but other social practices were used, which facilitated social inclusion and participation.

Studien riktar sig mot upplevelser av hälsa och vårdande i klostermiljö i nutidens Sverige. Hermeneutisk tolkning av texter baserade på 6 intervju med människor som upplever psykiskt lidande visar att verklighet som de möter på kloster kan beskrivas med hjälp av ordpar som förenar motsägelsefulla, ibland paradoxala aspekter som Yttre lugn/Inre intensitet; Andlig/Kroppslig arbete; Ramar/Frihet; Tystnad/ Samtalskvalité; Kultur/Natur; Relationer/Avskildhet; Trygghet/Respekt; Bekräftelse/Krav; Tro/Sökande; Gemensamma/Personliga berättelsen. Även Närvaro av det Osynliga konstateras i beskrivningar av kloster. Vid tolkning med hjälp av tradition – vårdvetenskapliga teorier och studier – konstateras det att kloster uppfyller de flesta kriterier för vetenskaplig baserad vårdinrättning och människor som vistas där skiljer sig inte markant från vetenskapens bild av psykiatriska patienter. På en högre abstraktions nivå framkommer det även strukturella likheter av kloster som fenomen ursprungligen placerad mellan himlen och jord och en psykiskt lidande människa som finner sig låst i motsägelsefull förbindelse mellan den gemensamma verkligheten som bekräftas av andra och den personliga verkligheten som är i högsta grad verklig för henne själv men förkastas och sjukförklaras av andra. Studiens slutsats betonar att bekräftelse av psykiskt lidande människors avvikande verklighetsuppfattning har en vårdande verkan och därför förtjänar mer plats i den moderna vården samt i vårdvetenskapligt forskning.

The purpose of this study was to explore and describe older adults’opinions regarding actions to prevent falls and to analyze differences in theopinions of highly versus less physically active older adults. An open-endedquestion was answered by 262 individuals aged 75 to 98 years living in thecommunity. The answers were analyzed using qualitative content analysis,and differences in the categories were compared between highly and lessphysically active persons. Physical activity was measured according to afive-level scale. The content analysis resulted in eight categories: assistivedevices, avoiding hazards, behavioral adaptive strategies, being physicallyactive, healthy lifestyle, indoor modifications, outdoor modifications, andseeking assistance. Behavioral adaptive strategies were mentioned to agreater extent by highly active people, and indoor modifications were moreoften mentioned by less active older adults. Support for active self-directedbehavioral strategies might be important for fall prevention among lessphysically active older adults.

With the global population aging, the demand for technologies facilitating independent living, especially for those with cognitive impairments, is increasing. This paper addresses this need by conducting a comprehensive evaluation of the Rostock Kitchen Task Assessment dataset, a pivotal resource in kitchen task activity recognition. Our study begins with an in-depth introduction, emphasizing the increasing prevalence of neurodegenerative disorders and the crucial role of assistive technologies. Our contributions encompass a systematic literature review, design and implementation of a working prototype of our envisioned system, refinement of the Rostock Kitchen Task Assessment dataset, creation of a semantically annotated dataset, extraction of statistical features, comparative analysis, and rigorous model performance assessment. The core of our work is the thorough evaluation and benchmarking of different activity recognition approaches using the aforementioned Rostock Kitchen Task Assessment dataset. Our experimental results demonstrate that despite encountering an imbalance problem in the dataset, the fusion of the Hidden Markov Model and Random Forest leads to superior results, achieving a weighted-averaged F-1-score of 74.10% for all available activities and 81.40% for the most common actions in the Rostock Kitchen Task Assessment dataset. Moreover, through systematic analysis, we identify strengths and suggest potential refinements, thereby advancing the field of kitchen activity recognition. This offers valuable insights for researchers and practitioners in assistive and remote care technologies.