Bakgrund: Personcentrerad omvårdnad (PCO) är när den vårdsökande personen är delaktig i sin vård och blir sedd som mer än sin sjukdom eller åkomma. Förhållningssättet PCO grundade sig först inom demensvården men har numera blivit ett förhållningssätt som de flesta vårdinstitutioner eftersträvar. För att uppnå den förbättrande vården som PCO kan medföra, behövs en välplanerad och tydlig implementeringsplan från ledningen.
Syfte: Att beskriva sjuksköterskors upplevelser av att implementera ett personcentrerat arbetssätt på en slutenvårdsavdelning.
Metod: En induktiv kvalitativ studie där elva intervjuer genomfördes. Därefter utfördes en innehållsanalys av åtta strategiskt utvalda intervjuer.
Resultat: Det finns förhoppningar hos deltagarna att implementeringen ska leda till en bättre och säkrare vård, men också farhågor om rädsla för förändring bland vårdpersonalen samt en ökad arbetsbelastning. Att arbeta personcentrerat upplevs av deltagarna kommer ställa högre krav på vårdteamet, framför allt sjuksköterskorna, när det gälller tid, kunskap och kommunikation.
Slutsats: För att kunna ge vårdsökande personen den bästa vården, behövs det engagerad och kompetent personal som har stöd och förståelse från ledningen. Trots de hinder som tycks finnas så lever en positiv anda bland sjuksköterskorna om implementeringen av PCO. Förhoppningarna är att ett personcentrerat arbetssätt bland annat ska öka delaktigheten som kan leda till kortare vårdtider samt minskar risken för återbesök tätt efter vårdtiden. Det i slutändan ger en bättre vård i helhet för den enskilda vårdsökande personen.
During the simulation, participants experience different degrees of stress and anxiety. It could be described as “Anxiety is like perpetually hearing the enemy music but never seeing the threat”. This study aimed to describe the Emergency Medical Services personnel's feelings of anxiety during simulation. The study had a qualitative design with interviews of 28 participants. The data were analyzed using content analysis. The result shows how the simulation could be perceived as a stage performance in the form of a theatre. The perceived acting was unpleasant and embarrassing due to unfamiliarity to perform. To be scrutinized meant having spectators reviewing ones' performance. It was considered more natural to care for actors than manikins. The interaction and connection with a human, even unconscious, were more natural. To care for a human did not require the imagination to empathize in the simulation.
A common feature of prehospital emergency care are short and fragmentary patient encounters with increased demands for efficient and rapid treatment. Crucial decisions are often made, based on the premise of the ambulance staff`s ability to capture the situation instantaneously. The assessment is, therefore, a pre-requisite for decisions about appropriate actions. However, a low exposure to severe trauma cases leads to vulnerability for the ambulance staff, which makes the assessment more difficult. Assessment of severe trauma patients at the scene of accident is difficult and complicated. No trauma scenarios are alike and practical skills, training, and feedback are therefore necessary.
Purpose – The purpose of this paper was to describe firefighters’ experiences of First Response Emergency Care.
Design/methodology/approach – An explorative descriptive design with a qualitative approach. Data was collected through group interviews of 35 firefighters and subjected to qualitative content analysis.
Findings – The results showed that the firefighters’ professional role and their uniform serve as protection against mentally strenuous situations. It is important to protect the dignity of the injured or dead, as well as to protect and safeguard colleagues from the experience of the tragedy of an accident. Having a solid and sterling medical education gives a sense of security when providing emergency care, as well as when caring for the relatives. Debriefing brings thoughts and feelings to the surface for processing and closure. The sense of sadness lingers for those they were unable to save, or the ones that had been dead on arrival or were forgotten.
Originality/value – A firefighter’s work situation is exposed and stressful. The firefighter’s uniform as a mental barrier, colleagues, time to mentally prepare and being allowed to show feelings are factors all needed to cope. It is therefore important to encourage, promote and strengthen the protective role of camaraderie for the firefighter, which can likely be emphasized for other uniform-wearing professions such as police, military and ambulance personell. Being acknowledged for their contribution to other peoples’ lives and wellbeing can confirm the firefighters’ importance.
Takotsubo can be detected as a kindred disease, predominantly affecting post-menopausal women. By correctly identifying these patients as having an acute heart failure syndrome, the outcome can be favorable.
Purpose
The purpose of this paper is to investigate the effects of the intervention of low-dose, high-frequency cardiopulmonary resuscitation (CPR) training with feedback for firefighters for one month.
Design/methodology/approach
The study had a quantitative approach. Data were collected through an intervention by means of simulation. The data collection consisted of a pre- and post-assessment of 38 firefighter’s CPR performance.
Findings
There was a statistically significant improvement from pre- to post-assessment regarding participants’ compression rates. Compression depth increased statistically significantly to average 2 mm too deep in the group. Recoil decreased in the group with an average of 1 mm for the better. There was a statistically significant improvement in participants’ ventilation volume from pre- to post-assessment.
Originality/value
Prehospital staff such as firefighters, police, and ambulance perform CPR under less than optimal circumstances. It is therefore of the utmost importance that these professionals are trained in the best possible way. The result of this study shows that low-dose, high-frequency CPR training with an average of six training sessions per month improves ventilation volume, compression depth, rate, and recoil. This study concludes that objective feedback during training enhances the firefighters’ CPR skills which in turn also could be applied to police and ambulance CPR training.
The aim of this study was to describe specialist ambulance nurse students’ experiences of ethical conflicts and dilemmas in prehospital emergency care. In the autumn of 2015, after participating in a mandatory lecture on ethics, 24 specialist ambulance nurse (SAN) students reported experiences and interpretations concerning conflicts and ethical dilemmas from prehospital emergency care. The text consisted of 24 written critical incidents which were interpreted using hermeneutic text interpretation. The text revealed three themes: Not safeguarding a patient’s body and identity; Not agreeing on the care actions; and Not treating the patient with dignity. The SANs experiences ethical dilemmas and conflict of values when they witness how others violate a patient’s dignity. Discussion and reflection is based on ethical conflicts and dilemmas experienced when students see how caregivers do not safeguard the patient’s body or identity. When caregivers have a conflicting will, it results in patients not being treated in an ethical manner. Also, seeing how caregivers put themselves in a power position over patients is described as an ethical dilemma that students experience when they choose not to intervene.
Introduction. We focus on trauma care conducted in the context of a simulated traumatic event. This is in this study defined as a four-meter fall onto a hard surface, resulting in severe injuries to extremities in the form of bilateral open femur fractures, an open tibia fracture, and a closed pelvic fracture, all fractures bleeding extensively.
Methods. The simulated trauma care competence of 63 ambulance nurses in prehospital emergency care was quantitatively evaluated along with their perception of their sufficiency. Data was collected by means of simulated trauma care and a questionnaire.
Results. Life-saving interventions were not consistently performed. Time to perform interventions could be considered long due to the life-threatening situation. In comparison, the ambulance nurses’ perception of the sufficiency of their theoretical and practical knowledge and skills for trauma care scored high. In contrast, the perception of having sufficient ethical training for trauma care scored low.
Discussion. This study suggests there is no guarantee that the ambulance nurses’ perception of theoretical and practical knowledge and skill level corresponds with their performed knowledge and skill. The ambulance nurses rated themselves having sufficient theoretical and practical knowledge and skills while the score of trauma care can be considered quite low.
Introduction. As a part of the emergency medical services, the Swedish fire brigade can increase the survival rate in out-of-hospital cardiac arrests.
Aim. To compare the quality of cardiopulmonary resuscitation (CPR) performed by firefighters at a routine CPR practice versus when involved in a simulated life-saving event.
Methods. In this study, 80 firefighters divided into two groups performed CPR according to guidelines: one group indoors during a routine training session; the other group outdoors during a smoke diving exercise wearing personal protective clothing and self-contained breathing apparatus. Descriptive and inferential statistics were used to analyze the data.
Results. The results showed a tendency for the outdoor group to perform CPR with better ventilation and compression quality, as compared to the indoor group. The ventilation of the manikin was not hampered by the firefighters wearing personal protective clothes and self-contained breathing apparatus, as the Swedish firefighters remove their facial mask and ventilate the patient with their mouth using a pocket mask.
Conclusions. Overall, the results in both groups showed a high quality of CPR which can be related to the fire brigade training and education traditions. CPR training is regularly performed, which in turn helps to maintain CPR skills.
Introduction
During military missions medical care is provided to military personnel as well as civilians. Although cardiopulmonary resuscitation (CPR) may not be a common task in a military field hospital, all personnel need to be trained to deal with cardiac arrest.
Methods
This study was a comparative simulation study. Participants (n=36) from the Swedish armed forces performed CPR for 2 minutes at one of three different locations: at ground level, a military bed, or a transportable military stretcher. Compression depth and rate after 2 minutes of CPR and at the time of the participants’ own request to be relieved were measured. Descriptive and inferential analysis was conducted.
Results
There is a direct correlation between compression depth and working level, concluding that the higher working level, the lower the compression depth. There is in total an overall low percentage of participants within limits for correctly conducted CPR regarding both compression depth and rate. Time to fatigue is related to working level, where increased level results in early fatigue.
Conclusion
The quality of CPR is affected by the level at which it is performed. The quality of CPR was satisfactory when working at ground level, but suboptimal when working at hospital bed level or military stretcher level. When working at raised levels, participants appeared to misjudge their own compression depth and rate. This may indicate that changes are needed when CPR is practised in the military hospital setting. Future studies regarding the use footstools are required due to the height of military beds and transportable stretchers.
Purpose: To evaluate military personnel’s self-rated perceptions of their knowledge, experience and training after high-fidelity battle injury simulation.
Design: 26 military medical personnel participated in this quantitative study. Data was collected using a questionnaire after a six-day exercise where participants self-rated 10 statements regarding having sufficient medical, practical and ethical knowledge, experience and training. Descriptive and inferential analyses were conducted to obtain the results.
Results: Nurses rated themselves statistically significantly higher than medics in having sufficient medical knowledge and experience, practical knowledge, experience and training, as well as ethical knowledge and experience. The nurses also rated themselves statistically significantly higher than physicians in having practical knowledge, experience and training. Physicians’ self-rated perception was low regarding sufficient knowledge, experience and training in practical skills. Physicians, nurses and medics all reported low ratings for sufficient training in ethical issues.
Discussion: Military medical personnel are required to have the knowledge and skills to work autonomously in challenging and threatening environments. For personnel that seldom see battlefield-like injuries, a clinical placement in a country with a high frequency of battlefield-like injuries would be advisable. A comparison between subjective and objective assessments may identify deficiencies in competence, which can negatively impact quality of care.
INTRODUCTION: Swedish firefighters are a part of the emergency medical services. Therefore, they perform prehospital cardiopulmonary resuscitation (CPR) on a regular basis. Training becomes crucial for maintaining the CPR skills and increasing the patients’ chances of survival. Training with visual feedback is for Swedish firefighters a new way of training CPR. The aim of this study was to evaluate firefighters’ perception of a CPR manikin with visual feedback.
METHOD: This study had a qualitative approach. Data were collected by interviews with 16 firefighters after performing CPR on a manikin with visual feedback. The data were analyzed with a manifest content analysis.
RESULTS: Visual feedback makes it easy to identify and maintain correct compression rate. There is a need for identifying too deep compressions. Uncertainty regarding the closeness to the stomach arises when using the whole hand during compressions instead of just the wrist. To accomplish an open airway requires a bit of adjustment of the manikins’ head.
DISCUSSION: To train and learn CPR is feasible with visual feedback. The firefighters can maintaing a correct compression rate and correct compression depth during the sessions. Ventilating a patient with bag-valvemask or pocket mask may require training with visual feedback to guarantee the firefighters being able to secure an open airway of the patient. All these skills are essential and improve the chance of survival for the patients.
OBJECTIVE: The aim of this study was to evaluate the simulated emergency care performed by firefighters and their perception of simulation as an educational method.
METHODS: This study had a mixed method with both a quantitative and a qualitative approach. Data were collected by simulation assessment, a questionnaire, and written comments. Descriptive analysis was conducted on the quantitative data whereas a qualitative content analysis was conducted on the qualitative data. Finally, a contingent analysis was used where a synthesis configured both the quantitative and the qualitative results into a narrative result.
RESULTS: The cognitive workload that firefighters face during simulated emergency care is crucial for learning. In this study, the severity and complexity of the scenarios provided were higher than expected by the firefighters. Clearly stated conditions for the simulation and constructive feedback were considered positive for learning. Patient actors induced realism in the scenario, increasing the experience of stress, in comparison to a manikin.
CONCLUSION: To simulate in a realistic on-scene environment increases firefighters' cognitive ability to critically analyze problems and manage emergency care. Simulation of emergency care developed the firefighters as professionals.
By educating laymen, survival after cardiac arrest can increase in society. It is difficult to reach the entire population with cardiopulmonary resuscitation (CPR) training. However, if 15% of the population knows how to perform CPR, an increase in short- and long-term survival in patients suffering a cardiac arrest could be seen. To educate youth is a way to reach parts of the population. This study aimed to investigate the effect of a 2-h CPR intervention for youth.
Simulation provides the opportunity to learn how to care for patients in complex situations, such as when patients are exposed to high-energy trauma such as motor vehicle accidents. The aim of the study was to describe nurses' perceptions of high-energy trauma care through simulation in prehospital emergency care. The study had a qualitative design. Interviews were conducted with 20 nurses after performing a simulated training series. Data were analyzed using a phenomenographic method. The result indicates that simulation establishes, corrects, and confirms knowledge and skills related to trauma care in prehosp ital emergency settings. Trauma knowledge is readily available in memory and can be quickly retrieved in a future trauma situation.
Well-educated ambulance staff is a prerequisite for high-quality prehospital trauma care. The aim of this study was to examine how nurses in the ambulance service experienced participation in trauma simulation. Sixty-one nurses, working in an emergency ambulance service, performed simulated trauma care on four different occasions and afterward rated three statements on a 5-point Likert scale. A descriptive and inferential analysis was conducted. There are statistically significant increases between the pre- and posttests regarding all three statements: I think simulation of severe trauma with manikins is realistic (0.23 or 6% increase), Simulation is a suitable method for learning severe trauma care (1.3 or 38% increase), and I am comfortable in the situation learning severe trauma care through simulation (0.74 or 19% increase). With the experience of realism in simulation, participants become more motivated to learn and prepare for future events. If the participants instead feel uncomfortable during simulation training, they focus on their own feelings instead of learning. In a realistic simulated environment, participants are prepared to understand and manage the emergency care situation in clinical work. Participants learn during simulation when they are outside their comfort zone but without being uncomfortable or experiencing anxiety.
Sammanfattning
Bakgrund: Antalet personer med diabetes Mellitus typ 2 växer snabbt i världen. Egenvård krävs för att bromsa progressionen av DMT2 och förhindra eller fördröja komplikationer. Många personer med DMT2 sköter emellertid inte sin egenvård enligt rekommendationer.
Syftet: Att beskriva erfarenheter av egenvård hos personer med DMT2.
Metod: Med hjälp av Fribergs femstegsmodell gjordes en litteraturöversikt av elva kvalitativa studier om erfarenheter av egenvård hos personer med DMT2.
Resultat: Att integrera egenvården i vardagen är en utmaning. Familjen och vårdpersonalen har en nyckelroll och kan utgöra såväl ett hinder som ett stöd för egenvården. Andra personer med diabetes upplevs som ett entydigt positivt stöd. Att acceptera sjukdomen är en förutsättning för att kunna bedriva egenvården. Brist på förståelse och okunskap kring DMT2 utgör ett hinder mot egenvård. Personliga mål och feedback är avgörande för motivationen.
Slutsatser: Socialt stöd, acceptans av sjukdomen, positiv feedback och individualiserad information upplevs underlätta egenvård.
Bakgrund: Diabetes typ-1 är en autoimmun sjukdom och en av de vanligaste kroniska sjukdomarna i Sverige. Diabetes typ-1 kan utvecklas i alla åldrar men bryter vanligen ut under barn- och ungdomsåren. Att leva med sjukdomen innebär även att individen ansvarar för sin egenvård.
Syftet: Syftet med studien var att beskriva unga vuxnas upplevelser av att leva med diabetes typ-1 utifrån Orem’s egenvårdsteori.
Metod: Denna studie är en kvalitativ studie med en deduktiv ansats. Studien är baserad på tre bloggar. I denna studie användes Orem’s egenvårdsteori.
Resultat: Gemenskapen med familj och andra diabetiker upplevs vara ett stort stöd och kan fungera som en hjälp i egenvården. Egenvården kan vara svår att lyckas med och ibland upplevs planering och struktur vara förgäves. Det upplevs som viktigt att inte låta sjukdomen begränsa det sociala livet. Det finns en stor okunskap i samhället om diabetes typ-1 vilket leder till otrygghet och brist på förtroende. Individerna med diabetes typ-1 upplever ensamhet trots en omgivning av stöttande personer.
Slutsats: En förståelse för upplevelsen av att leva med diabetes typ-1 är viktig för sjuksköterskan. Förståelsen kan minska konflikter mellan sjuksköterskan och patienten samt förbättra förutsättningarna för en god egenvård.
Bakgrund: Bröstcancer är den vanligaste cancerformen hos kvinnor över hela världen. Till skillnad från äldre kvinnor drabbas yngre kvinnor oftare av en mer aggressiv cancerform. Att få diagnosen bröstcancer kan innebära stora förändringar i livet med behandlingar som orsakar svåra biverkningar och oförutsägbara sjukhusbesök, en omställning som kan komma att påverka livskvalitén för de unga drabbade kvinnorna. I samband med de biverkningar som uppkommer till följd av behandling krävs stöd från både hälso-och sjukvård och anhöriga. Personcentrerad omvårdnad ligger till grund för att främja den psykiska, fysiska och existentiella hälsan hos vårdsökande person.Syfte: Att beskriva upplevelser av att genomgå bröstcancerbehandling som ung kvinna.Metod: En litteraturöversikt med kvalitativ metod och induktiv ansats. Artikelsökning gjordes i Medline och CINAHL. Resultatet framställs av 12 vetenskapliga artiklar.Resultat: Innefattar två kategorier följt av sex subkategorier. Kategorierna är: upplevelser av den psykosociala påverkan som kan uppstå vid behandling samt upplevelser av biverkningar efter bröstcancerbehandling.Slutsatser: Huvudfynd i de 12 artiklarna fokuserade främst på bristfällig information från hälso-och sjukvård gällande bröstcancerbehandling, samt de konsekvenser som förändrad kroppsbild efter genomgående behandlingen kom att få.
The needs for support among children with a seriously ill parent, who is waiting for heart transplantation, are unknown today. The aim was to describe now adult children's experiences of social support in relation to a parent's heart transplant during childhood. Nine females and four males were interviewed. The median age for the children was 18 at the transplantation and their parents had been ill before for 18 months (median) and on waiting list for 161 days (mean). Three categories emerged: health care professionals' approaches, family and friends' approaches, and society approaches. Our results show that there was lack of support for children of heart transplantation patients. Support in the shape of information was in most cases provided by the sick or healthy parent. It is of great clinical importance to develop psychosocial support programs for children with a seriously ill parent waiting for heart transplantation (before, during, and after surgery).
Coping with Neuromuscular disease and the Implications for Interventions
The lecture is based on results from three theses and about 25 scientifically articles about the plight of the patient with muscular dystrophy (MD), and the patients’ ways of coping with illness-related problems from a psychosocial perspective. MD is a group of inherited disorders characterised by muscular weakness caused by muscle wasting. Three subgroups are distinguished in our research: one group with different types of proximal MD and the other two groups characterized chiefly by distal weakness. The research was to elucidate how persons with muscular dystrophy experience their everyday life over a ten years period. The research includes four data collections with qualitative and quantitative methods. The data was selected in three different county councils in Sweden.
The persons with MD described the change from being independent to being an individual in need of assistive devices and/or personal support to manage activities of every day life. Besides muscular weakness the persons have the strain it means to have a hereditary disease. The deterioration in a decennium was mainly with regard to ambulation. The number of persons walking without assistive devices and working has almost been halved. They experienced periods of sorrow due to losses of independence, control, status and social roles and the loss of one’s identity as a healthy person. The sorrow connecting with repeated losses are in the literature designate as chronic or episodic sorrow. Also, in the lecture the patients’ illness trajectory were described by a model of Sullivan (1994) into four dimensions in order to increase the understanding of what it means to live with muscular dystrophy.
The aim of interventions is to support the patient’s appropriate ways of coping as Problem-focused coping/Searching for a solution, Fighting spirit/Struggling, Re-appraising of life values, Maintaining hope, Social comparison, Laughing and joking and Caring about self.
Aims and objectives. The aims of the present study were to describe losses narrated by persons afflicted with severe chronic physical illness and to identify the concomitant occurrence of chronic sorrow. Background. Reactions connected with repeated losses are referred to in the literature as chronic sorrow, which has recently been described in conjunction with chronic illness. Design. A qualitative study with an abductive approach of analysis, including both inductive and deductive interpretations. Method. The study is based on 30 persons of working age with average disease duration of 18 years. The average age was 51 years. All of the persons had personal assistance for at least three months because of considerable need for help in daily life due to physical disability. Each person was interviewed twice. There was also an independent assessment of the deductive results concerning chronic sorrow. Results. The inductive findings show that all persons had experienced repeated physical, emotional and social losses. Most common were 'Loss of bodily function', 'Loss of relationship', 'Loss of autonomous life' and 'Loss of the life imagined'. 'Loss of identity' included the loss of human worth, dignity and a changed self-image. In addition, the deductive findings suggest that chronic sorrow exists in the study population. Sixteen of 30 participating subjects were assessed by both assessors to be in a state of chronic sorrow and there was an especially high agreement with respect to one criterion of chronic sorrow 'Loss experience, ongoing or single event' (28 of 30 subjects). Conclusions. This study shows that persons with severe chronic illness often experience recurring losses. These experiences are consistent with the phenomenon of chronic sorrow. Relevance to clinical practice. Knowledge of the existence of chronic sorrow in persons with chronic illness will enable nurses to support these persons in a more sensitive and appropriate way.
We all need to start where we are and also wanting to go further all the time. This is the essence in quality improvement. The leader and the teachers must own this attitude themselves in order to have the ability to be trustworthy for the students. There is evidence in the literature about the impact of education on the professional attitude and role. This means that it is important to work with better professional development for better outcomes in the faculty.
One starting point for us in the planning of our different programs are that improvement knowledge will be a streak through the whole education in order to establish a professional attitude of daily inspiration to produce the best practise. We have applied all curricula to Boologna declaration and in this system progression in learning is a key point. We have four levels in the basic education (3-years education which lead to Bachelor degree) where we start to introduce 1) Concepts and models in health improvement. Then let our students make a 2) Personal improvement in their everyday life. Later in the education we teach about 3) Evidence practise and systematic literature reviews. Finally the students are 4) Making health improvements in collaboration with the staff during one clinical education.
All educational programmes on basic level since 2007 include aim descriptions about quality improvement. The aim of the learning is to have the competence to initiate and participate in work about health care improvements.
Finally, besides the mentions aspects in improvement education there are some other factors that needs for better system performance.
Since one of the aims of this meeting is to create a strategy for the participants to connect and share experiences post-conference I will start by giving a very brief account of Jönköping University and the School of Health Sciences, this in order to give you a sense of the school as a possible partner for collaboration. Then I will describe how teachers work to increase knowledge with regard to health care improvement within the nursing program. Thereafter I will talk about a research project and relate this to what we can learn about interprofessional education. The basic values regarding health care improvement described by Paul Batalden and his colleagues are central to our present development. We share the theoretical assumptions concerning the Clinical Microsystem and the view of redesigning health care education in order to produce the best care for the patient and his/her family. So within our organization both teachers and students — like nurses — have two jobs, one of which is to bring about improvement. So we have started the process where the educators need to change their teaching for the sake of better patient outcomes, better system performance, and better professional development. This means communicating not only the existing evidence-based knowledge but also improvement knowledge which involves a substantial shift in our idea of the work of health care — a challenging task that can benefit from the use of a wide variety of tools and methods. A key concern for us in the planning of our different programs is that the improvement of knowledge shall permeate the education and contribute to establishing a professional attitude marked by daily inspiration to produce the best care. The basic education involves four stages. First there is an introduction to concepts and models in health care improvement. This content is in the first semester. Second the students’ are making a personal improvement in their everyday life. The students apply PDSA-cycle for improvement of an issue, commonly their time-table for studies, time spending for eating breakfast in the morning or eating habits in general. The third stage involves evidence-based nursing and systematic literature reviews and in the fourth stage, the students make health care improvements in collaboration with the staff during a clinical training period. The nurses at the clinic formulate the area of improvement. Then the students work systematically in pairs to collect data and the results are reported to the nurses. The latter stage is a new content in nursing education but we know from occupational therapy that the staff appreciated these works and the results were in most cases used by the staff in their job.
The overall aim of the research project “Bridging the gaps” is to generate evidence about the process and outcome of clinical work within the area of quality improvement. The project contributes to an advanced environment for learning and innovation, research and development in the field of health-care management and improvement. There are 14 doctoral students at the research school, who takes part in the research project. Three of them are nurses and doctoral students at the School of Health Sciences. All PhD students have to take two compulsory courses, one is named “Bridging the gaps — a multidisciplinary research field” and the other is named “Interactive Research Methodology”. The Microsystem as a theoretical model is included in the mention research course “Bridging the gaps” and in each doctoral student’s research proposal. The PhD students shall work together with health-care staff by way of an interactive research method. This means that there is an integration of research and practice. The PhD students and the health-care staff are working together throughout the project. The staff is involved at every stage, from designing the improvement work, formulating the research questions to reporting the results. Research with this methodology generates knowledge of great relevance for clinical practice.
Patients with neurological diseases increasingly are being cared for at home. The purpose of this study was to describe stressful everyday experiences in connection with neurological disorders, to learn how people cope with such experiences, and gain knowledge about coping resources. Twenty-seven persons receiving personal assistance were interviewed twice at home. The 54 interviews were subjected to inductive content analysis. The persons encountered many problems in everyday life and usually handled them by means of acceptance, avoidance, practical problem solving, and reappraisal. Dependence on personal assistance gave rise to a sense of helplessness, but it was also the major coping resource. Nurses can improve home care by giving instruction and guidance to persons working as personal assistants.
In the county of Orebro, Sweden, 32 individuals with myotonic disorders and 25 with other types of muscular dystrophy were examined. Disability was assessed with functional tests and standardized observations of muscle function (mainly based on those proposed by Dr. Brooke), a new self-administered questionnaire regarding the Activities of Daily Living (ADL) and the ADL staircase (based on Katz ADL index). The results of the different tests of disability were highly correlated. The Sickness Impact Profile and the Kaasa test were used for assessing the quality of life, and no significant differences were found between the groups of muscular dystrophy. In an explanatory factor analysis three main factors of disability were found. The factors "walk and move" and "finger function" were fair to good associated with the quality of life. This study offers an approach for research on the consequences of muscular dystrophy using established as well as new methods.