Utskrift från Malmö högskola - mah.se
Browsing Licentiate Theses /HS VV by Issue Date
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Browsing Licentiate Theses /HS VV by Issue Date
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Olycksfallsrisker i barnets hemmiljö : fokus på skållskador 
Carlsson, Anna : Malmö högskola, Hälsa och samhälle
FoU-rapport;1 Malmö studies in Nursing Sciences;1 (2005)LICENTIATE
THESIS
English abstract: The overall aim of this licentiate thesis was to increase the knowledge about children’s (0–6 years old) exposure to accidents in the home environment through parents’ opinions about accidents and parents’ self-reported compliance with precautions. Data were collected from parents of 10-month-old children who answered a questionnaire. The questionnaire prompted responses related to parents’ background and socio-economic factors as well as questions about precautions they had taken to decrease hazards in their home. The questions focused on actions parents had taken upon receipt of preventive advice given to them during the eight-month Child Health Care nurse assessment. Thirty-two percent of the parents complied with less than half of the suggested precautions. Univariate odds ratios (OR) and 95% confidence intervals (95% C I) were calculated to investigate the associations between compliance and parents’ different background/socio-economic characteristics. The variables foreign born, low occupational level, 12 years’ education or less, rented housing and information provided at Child Health Care clinics proved to be statistically significant for the non-compliant group. Multiple logistic regression analysis was performed in order to adjust the estimated odds ratios for the influence of potential confounders such as parents’ nationality, educational and occupational level, place of information and habitation. After the adjustment the variable nationality and educational level stayed significant (Ι). Data in article ΙΙ were collected from medical records, in a retrospectively designed study. Burn-injured children (0–6 years old) consulting the University Hospital or the health centres (21) during 1998 and 2002 were included. Chi-squared test was used to analyse differences in nominal data and cross-tabulation was used to analyse the proportions between the characteristics of the injuries and sex, age and nationality. There were 148 burn injuries, 80% of which were scalds caused by hot liquid (71%) or hot food (29%). The majority were to boys between one and two years old. Children of foreign-born parents were more frequently affected and the extent of injuries often larger. The data collection method in article ΙΙΙ was tape-recorded interviews, analysed by content analysis, with parents of 20 children (0–6 years old) recently suffering from scalds. Parents told their perceptions about causes of the scalds. The analysis resulted in eight categories and two themes. One theme was ‘Deviation from the normal’, which could be when something unusual happened, such as a sudden visit by a friend or when a family member was tired, stressed or ill. The tiredness could be due to fever, a cold, other illnesses or mental stress. It could also be when something was broken in the kitchen and routines were changed. ‘Misjudgement of the child’s capacity’ was the other theme, which it concerned the children’s preventive capacity, rapidity and reach. It was hard for the parents to keep up with the fast development of the small children (9 months–2 years). The parents said that they often did not realise the child’s capacities until the accident occurred. Key words: accident, burns, child, compliance, intervention, prevention and scalds Swedish abstract: Denna licentiatavhandling syftar till att beskriva barns (0-6 år) utsatthet för olycksfallsrisker i hemmiljön genom att fokusera på omfattningen av bränn- och skållskador, föräldrars uppfattningar om påverkande faktorer till olyckshändelser samt föräldrars uppgifter om egen följsamhet till olycksförebyggande råd och anvisningar. I barnhälsovården (BHV) ges råd och anvisningar kring olika åtgärder lämpliga i förhållande till barns utveckling. Dessa råd ges kontinuerligt och under barnens 6 första år. Innehållet i råden är reglerat i det basprogram som föräldrar till alla barn i Sverige erbjuds fram till skolstart. Få studier beskriver i vilken utsträckning föräldrar följer dessa råd och vilka faktorer som påverkar dels föräldrarnas följsamhet till råden dels faktorer som påverkar risken för barnolycksfall. I denna licentiatavhandling är exemplet skållskador (ΙΙ, ΙΙΙ) beskrivet som ett av flera möjliga olycksfall i hemmiljö som barn drabbas av. 
annaslic.pdf
(237.9Kb)
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Sjuksköterskors kliniska beslutsfattande med fokus på perifera venkat...
Eiman Johansson, Maria : Malmö university, Faculty of Health and Society
FoU-rapport;3 (2007)LICENTIATE
THESIS
English abstract: Every working shift nurses make several decisions, including decisions about management of peripheral venous catheters (PVC). Peripheral catheterisation is a common procedure, which affects numerous patients in health care today. PVC are for example used for intravenous infusions with antibiotics, nutrients and blood components. Having PVC in situ may lead to complications such as thrombophlebitis. Clinical guidelines have been developed within the area to assist nurses in their decision-making, but clinical guidelines are not always adhered to. There are several reasons why clinicians do not always adhere to clinical guidelines, although such adherence may lead to fewer complications. Choices for decisions regarding PVC management have been investigated in previous studies, but not in a naturalistic setting. The overall aim of this licentiate thesis was to describe nurses’ clinical decision-making through focusing on their adherence to clinical guidelines and their clinical reasoning concerning decisions of PVC. Two studies have been conducted and data were collected during a six-month period, from December 2004 to June 2005. Study I investigated nurses’ adherence to national and local PVC guidelines by focusing on time in situ, site, size and documentation at the dressing. The thrombophlebitis frequency associated with PVC in situ was also investigated. Structured observations through two protocols were carried out and data about 343 PVC were analysed. Study II investigated nurses’ clinical reasoning regarding PVC management and cues and factors of importance in the decision10 making process were analysed. Nurses were observed in their daily work with focus on PVC management. They were interviewed both about the PVC decisions made in the observed situations and about factors influencing their reasoning regarding PVC management in general. The observations facilitated the interviews. Transcribed interview texts were analysed with content analysis. The results in study I showed that thrombophlebitis frequency was 7.0% and the nurses seemed to replace or remove PVC before any severe complications arose in accordance with clinical guidelines. Nurses partly adhered to national and local guidelines concerning site, size, documentation at the dressing and time in situ. Differences in guideline adherence were observed for wards with local or national guidelines, as well as for wards with different specialities. The results indicate that local guidelines may have an impact on guideline adherence but these results need further exploration. Analysis of interview texts in study II resulted in a category system with three main categories describing cues and factors of importance in the nurses’ clinical reasoning about PVC: the individual patient situation, the nurse’s work situation, and experience of PVC management. An overall theme was also revealed in the interview texts and the nurses balance in their clinical reasoning between avoiding or minimizing discomfort and pain for the patient and preventing complications from the PVC. The results from this licentiate thesis have implications for the education of nurses as well as during implementation of clinical guidelines. Swedish abstract: För att kunna ge vård av säker och god kvalitet krävs att sjuksköterskor har kunskap inom många områden, eftersom de har ansvar för såväl bedömning, planering och genomförande, som utvärdering och dokumentation av omvårdnadsarbetet. Ett av flera ansvarsområden för sjuksköterskor i deras dagliga arbete är beslutsfattande om insättning och skötsel av perifera venkatetrar (PVK). En PVK är en tunn plastkateter som sätts in i ett blodkärl via en kanyl. PVK används vid intravenös behandling med till exempel antibiotika och andra läkemedel, blodkomponenter eller näringslösningar. En stor andel av alla patienter inom hälsooch sjukvård kommer någon gång i kontakt med en PVK och riskerar då också att utsättas för komplikationer. En vanlig komplikation i samband med PVK är tromboflebit. Tromboflebit förekommer i olika svårighetsgrader och innebär att inflammation har uppstått i blodkärlet i kombination med samtidig blodpropp. Symtom som kan uppstå är rodnad, svullnad, smärta, hårdhet i kärlet och varig infektion. Det finns kliniska riktlinjer om PVK framtagna både på nationell och på lokal nivå som fungerar som ett stöd i beslutsfattandet. Tidigare forskning har visat att kliniskt verksamma ibland inte följer riktlinjer. Anledningar till att inte riktlinjer följs kan till exempel vara att de kliniskt verksamma inte håller med om det som rekommenderas, inte känner till rekommendationerna, inte har tid eller möjlighet att påverka de beslut som fattas eller att det finns individuella faktorer att ta hänsyn till för den enskilda patienten. 52 Frågan kan ställas om sjuksköterskor använder sig av kliniska riktlinjer i sitt dagliga arbete eller om det är andra faktorer och aspekter som har betydelse och påverkar beslutsfattandet. Denna licentiatavhandling syftade till att beskriva sjuksköterskors kliniska beslutsfattande genom att fokusera på deras följsamhet till riktlinjer och beslutsresonemang om PVK. Två studier har genomförts inom ramen för denna licentiatavhandling. Studie I undersökte i vilken utsträckning sjuksköterskor följer nationella och lokala riktlinjer om PVK. PVKns placering och storlek, tiden som PVKn varit placerad i blodkärlet, dokumentation vid PVKns förband samt om det fanns tecken på tromboflebit vid PVKn var variabler som undersöktes i relation till de rekommendationer som fanns. Utifrån två protokoll samlades strukturerad data in och analyserades. Totalt 343 PVK ingick i analysen. I studie II undersöktes de tecken och påverkande faktorer som har betydelse när sjuksköterskor fattar beslut om skötsel av PVK. I studien observerades 43 sjuksköterskor i sitt dagliga arbete. Sjuksköterskorna intervjuades också dels om PVK-besluten som de fattade under observationerna, dels om deras beslutsfattande om PVK-skötsel i allmänhet. Studie I visade att sjuksköterskor delvis följer riktlinjer. Det fanns skillnader mellan de vårdavdelningar som hade nationella riktlinjer och de som hade lokala riktlinjer, i hur de olika avdelningarna valde placering, storlek och dokumenterade vid PVKns förband. PVKn hade suttit längre tid än rekommenderat i varierande utsträckning. Andelen tromboflebiter var låg (7.0%) och tromboflebiterna var milda. Det tyder på att sjuksköterskor är noga med att ta bort PVK vid tecken på komplikationer. Studie II visade att sjuksköterskor i sitt kliniska resonemang om PVK-skötsel tar hänsyn till den individuella patientsituationen, sjuksköterskans arbetssituation och erfarenhet av PVK-skötsel. Det framkom även att sjuksköterskor balanserar mellan att undvika eller minimera obehag och smärta för patienten och samtidigt förebygga komplikationer från PVKn. Resultaten från denna licentiatavhandling kan få betydelse för undervisning av sjuksköterskestudenter och även när kliniska riktlinjer ska införas på vårdavdelningar. -
Domestic violence and pregnancy : impact on outcome and midwives' awa...
Finnbogadóttir, Hafrún : Malmö Högskola, Health and Society
FoU rapport;3 (2011)
Article I : http://dx.doi.org/10.1186/1471-2393-11-14 Article II : http://dx.doi.org/10.1016/j.midw.2010.11.010LICENTIATE
THESIS
English abstract: Objective: The overall aim of this thesis was to investigate whether selfreported history of violence is associated with increased risk of labour dystocia in nulliparous women at term and to elucidate midwives’ awareness of domestic violence during pregnancy in southern Sweden. Design/Method/Setting/Population: Paper I utilised a population-based multi-centre cohort study design. A self-administrated questionnaire was administered at four points in time with start at 37 weeks of gestation, at nine obstetric departments in Denmark. The total cohort comprised 2652 nulliparous women, among whom 985 (37.1%) met the protocol criteria for labour dystocia. In paper II an inductive qualitative design was utilised, based on focus group interviews. Participants were midwives with experience of working in antenatal care units connected to two university hospitals in southern Sweden. Sixteen midwives were recruited by network sampling complemented by purposive sampling, and were divided into four focus groups of 3 to 5 individuals. Results: In paper I cohort of the total, 940 (35.4 %) women reported experience of violence and of these 66 (2.5 %) women reported exposure of violence during their first pregnancy. Further, 39.5% (n = 26) of those had never been exposed to violence before. Univariate logistic regression analysis showed no association between history of violence or experienced violence during pregnancy and labour dystocia at term, crude OR 0.91, 95% CI (0.77-1.08), OR 0.90, 95% CI (0.54-1.50), respectively. However, violence exposed women consuming alcoholic beverages during late pregnancy had increased odds of labour dystocia (crude OR 1.49, CI: 1.07 – 2.07) compared to unexposed to violence women who were alcohol consumers (crude OR 0.89, 95 % CI: 0.69- 1.14). In paper II five categories emerged: 1) ‘Knowledge about ‘the different faces’ of violence’, perpetrator and survivor behaviour, and violence-related consequences. 2) ‘Identified and visible vulnerable groups’, ‘at risk’ groups for exposure to domestic violence during pregnancy, e.g. immigrants and substance users. 3) ‘Barriers towards asking the right questions’, the midwife herself as an obstacle, lack of knowledge among midwives as to how to handle disclosure of violence, and presence of the father-to-be at visits to the midwife. 4) ‘Handling the delicate situation’, e.g. the potential conflict between the midwife’s professional obligation to protect the abused woman and the unborn baby and the survivor’s wish to avoid interference. 5) ‘The crucial role of the midwife’, insufficient or non-existent support, lack of guidelines and/or written plans of action in situations when domestic violence is disclosed. The above five categories were subsumed under the overarching category ‘Failing both mother and the unborn baby’ which highlights the vulnerability of the unborn baby and the need to provide protection for the unborn baby by means of adequate care to the pregnant woman. Conclusions: Our findings indicate that nulliparous women who have a history of violence or experienced violence during pregnancy do not appear to have a higher risk of labour dystocia at term, according to the definition of labour dystocia used in this study. Additional research on this topic would be beneficial, including further evaluation of the criteria for labour dystocia (Paper I). Avoidance of questions concerning the experience of violence during pregnancy may be regarded as a failing not only to the pregnant woman but also to the unprotected and unborn baby. Nevertheless, certain hindrances must be overcome before the implementation of routine enquiry concerning pregnant women’s experiences of violence. It is of importance to develop guidelines and a plan of action for all health care personnel at antenatal clinics as well as continuous education and professional support for midwives in southern Sweden (Paper II).
ERRATA.pdf
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Finnbogadottir.pdf
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