Dissertations / Theses on the topic 'Medicine and Literature'

Background: Pressure ulcers are a common problem and cause great suffering for those who develop it, and are also an expensive cost to the society. Aim: To describe nursing measures for prevention of pressure ulcers among elderly people in ordinary and nursing homes. Method: A literature review by structured analyze of scientific articles. Result: The analyze resulted in six subjects for prevention of pressure ulcers. These subjects were; risk assesment, nutrition, repositioning, skin/hygiene, nurse knowledge and documentation. Conclusion: Repositioning more often did not prevent pressure ulcers better than repositioning less frequent, nursing staff should offer patient´s pads with high absorption for peaceful rest and documentation should be improved.

The objective of this literature study was to describe the nurse’s preventive actions to prevent diabetes type 2 among children and adolescents in school age. It emerged from the analysis that the nurse is working according to three pillars; screening, lifestyle changes and counselling/education. This result showed that what often increase difficulties when working with screening are: undefined guidelines, lack of time and resources. Overweight/obesity is one of many indicators to develop diabetes type 2, therefore it is important that both BMI and waist are measured. The nurse was working actively with education and intervention, for example engaging schools to make diet changes and increase physical activity. She/he was also giving counselling to children, adolescents and their families about the disease diabetes type 2 and how it could be prevented. Barriers often experienced by the nurse in her/his preventive work were the families’ attitudes and lifestyles. There were often an expressed wish from nurses to receive guidance in their work on motivating to lifestyle changes.

Background: Asthma is an illness that many adolescents have today. The symtom can prevent them to live like contemporaries and the development phase they experience makes asthma difficult to get control of. Aim: The aim of this study was to describe adolescent’s experience of living with asthma. Method: The literature review was performed by reviewing nine scientific articles. Results: The categories which developed were social, physical and psychical experiences. Adolescents experienced poor quality of life and their feelings were described with words like fear, anxiety, anger and depression. Physical activities experience troublesome by the adolescents and they experienced support from friends and teachers were not enough. To be like everyone else and experience ego became an expression from the adolescents. Discussion: Experience of physical activities, quality of life, enhanced understanding and adolescents view at the future were discussed with Antonovskys concept of KASAM and integrated with the nurse competence. Conclusion: Adolescents experience of living with asthma is frustration, fear and anxiety. They sometimes don’t medicate because they want to be like their friends. Understanding from friends and teachers could be better. Suggestions for new reaserch are teachers understanding and friend’s apprehension about the person which is suffering from asthma.

Background: Almost every 20th child is borne premature in Sweden, before the parents are ready to care for a new family member. The parents need to cope with the stress and anxiety of having their newborn child in the neonatal ward and influenced by nursing care of neonatal staff grow their parental role.

Purpose: The aim of this study was to illustrate experiences of parenthood within the care of premature at the neonatal ward.

Method: A review where 18 articles between 2000 and 2005 were chosen and examined. The articles were analysed according to VIPS, which facilitates the practical use of the result.

Result: The study reveals that parenthood is experienced as a time dependent process with three phases, primary, secondary and tertiary, where the parent’s needs and experiences changed character. The parents experienced that they developed from passive to active in the care of the premature child when the neonatal staff guided their participation, gave information/education and support. Interventions concerned the environment and coordination was experienced as enhancing parenthood because it made it possible for the parents to be close to their premature child.

Conclusion: There’s still interventions that needs to be done at the neonatal ward to enhance parents experience of their parenthood.

There are an increasing number of people suffering from depression and depressed mood. Concurrently important benefits have been noticed from the effects of massage, effects that can be assumed to restore individual’s health with depression and depressed mood. The aim of the study was to examine the importance of gentle massage in connection with depression and depressed mood. The research was based on scientific studies that were applied through the databases Cinahl, elin@Kristianstad, PsycARTICLES, PsycINFO, PubMed and the journal Vård i Norden as well as by manual searches. In all, ten studies were included and content analysed. The contents were analyzed through identifying variables, establishing subject areas and creating categories. The important effects of gentle massage resulted in three categories: biological, emotional and social change. The categories underlie a holistic model over the research results. The results show that gentle massage had a positive influence in individuals with depression and depressed mood. The model can be used for increased knowledge and understanding about gentle massage importance in depression and depressed mood. Through the model, nurses can explain how the categories influence each other in a dynamic process. More research in this specific area is needed.

Bakgrund: Förstoppning är ett av de vanligaste symtomen från mag- och tarmkanalen och att drabbas av förstoppning kan vara en hemsk upplevelse. Tillståndet påverkar personen både fysiskt, mental, socialt och existentiellt, vilket leder till försämrad livskvalité. Syfte: Att beskriva vilka icke-farmakologiska åtgärder som finns för att förebygga förstoppning hos äldre personer över 65 år. Metod: Studien genomfördes som en allmän litteraturstudie där vetenskapliga artiklar söktes i databaser på Internet och manuellt i referenslistor. Åtta vetenskapliga artiklar inkluderades i studien och dessa analyserades och utformades till ett resultat. Resultat: Olika metoder som ökade fiberinnehållet i kosten kunde öka avföringsfrekvensen och minska användningen av laxermedel. Den metod som var mest effektiv för att förebygga förstoppning var Pajalagröten som innehöll mycket frukt och fiber. Ett adekvat vätskeintag kunde också öka avföringsfrekvensen och minska användningen av laxermedel. Att dricka minst 1500 ml per dygn visade sig vara en adekvat mängd vätska för att förebygga förstoppning. Regelbunden motion påverkade inte avföringsfrekvensen, men för att få starkare bevis för att motion inte kan förebygga förstoppning behöver fler studier göras. Slutsats: Att äta Pajalagröt till frukost och dricka minst 1500 ml per dygn kan förebygga förstoppning hos äldre personer över 65 år.

Background: Constipation is one of the most common symptom from the intestines and to suffer from constipation can be a horrible experience. The condition affects the person both physical, mental, social and existential, which lead to deteriorated quality of life. Aim: To describe which non-pharmacological measures there is to prevent constipation for older people over 65 years. Method: The study was carried out as a literature review and scientific articles were searched for in databases on the Internet and manual in the articles references. Eight scientific articles was included in the study and these were analysed and designed as a result. Results: Different methods that increased the fibre contents in the diet could increase the frequency of faeces and decrease the use of laxatives. The most effective method to prevent constipation was the Pajala porridge who contents a lot of fruit and fibre. An adequate fluid intake could also increase the frequency of faeces and decrease the use of laxatives. To drink at least 1500 ml each day showed to be an adequate amount of fluid to prevent constipation. Regular exercise didn’t affect the frequency of faeces, but to get stronger evidence that exercise doesn’t prevent constipation more studies need to be done. Conclusion: To eat Pajala porridge for breakfast and to drink at least 1500 ml each day can prevent constipation for older people over 65 years.

För ungdomar som är mitt uppe i frigörelseprocessen från föräldrarna kan det vara en känslomässig balansgång när en förälder insjuknar i cancer. Det är viktigt att denna oro uppmärksammas och bekräftas för att inte ge långsiktiga negativa konsekvenser. Syftet med litteraturstudien var att belysa ungdomars reaktioner när en förälder har cancer. Studien genomfördes som en allmän litteraturstudie. Nio vetenskapliga studier inkluderades i resultatet. Fyra olika tema identifierades, familjens inverkan på ungdomars reaktioner, ångest och depressionssymtom, stressrelaterade symtom och motstridiga känslor och reaktioner. Det framkom att familjen hade en stor inverkan på ungdomars reaktioner. Ett gott känslomässig klimat och tillåtelse att uttrycka sina känslor minskade ångesten. Ungdomar som hade förmåga att separera känslorna kring föräldern med cancersjukdom och sitt vardagliga liv för övrigt visade sig ha lägre nivåer av ångest och stressymtom. Det visade sig att flickor till mödrar med cancer var de som visade upp fler reaktioner än vad pojkarna gjorde. Skolsköterskans uppgift kan vara att identifiera de ungdomar som är mest sårbara och behöver extra stöd då en förälder har cancer.

Abstract in English:

Adolescents in the process of teenage liberation from their parents can find themselves in an emotional balancing act if a parent falls ill to cancer. Therefore, it is important to acknowledge and recognize the potential negative consequences this will have for the adolescent in the long-term. The aim of this study was to highlight how adolescents react to a parent falling ill with cancer. The study was carried out using a general literature review of the results from nine scientific studies. Four different themes were identified: the family’s response to the youth’s reaction, anxiety and depression symptoms, stress related symptoms, and contradictory feelings and reactions. An environment with good emotional support and freedom to express one’s feelings reduced anxiety. Adolescents that had the ability to separate their emotional feelings about their parent’s cancer illness and their daily activities generally showed a lower level of anxiety and stress symptoms. The study showed that girls, with mothers that had fallen ill with cancer, exhibited more reactions than boys did. In cases where a adolescent’s parent falls ill with cancer, it is suggested that school nurses identify those adolescents that are most vulnerable and in need of extra support.

Background: Delirium is a serious condition that often affects hospitalized elder. The condition can be described as an overstrain of the brain which results in a disturbed consciousness. Elder people are particularly vulnerable since many of the risk factors develops with old age. The treatment aims to find and treat the underlying cause. Purpose: The purpose of this literature review was to illuminate factors beneficial for the nursing care of hospitalized elder with delirium. Method: A general literature review based on eleven scientific studies. Result: Factors that proved beneficial to change in order to improve care were organisation of care, educating the staff, pharmaceutical, environment and the encounter with the patient. Conclusion: There are measures that can improve the care of elder with delirium. The difficulty is to get the information out to care providers in the field. There is a need for developing guidelines for education and routine changes and to implicate these in nursing care.

Background: Type 1 Diabetes Mellitus is a chronical disease that often occurs early in life. In 2005 around 7000 children in Sweden was estimated with type 1 diabetes. When a child gets a chronical disease it affects the whole family. The parents will be the ones who take the main responsible for the child´s care. Purpose: The aim of this literature review was to describe the parents experiences of living with a child with type 1 diabetes. Method: A literature review was carried trough based on 14 scientific articles. The articles were analysed and six categories emerged. Result: All parents experienced chock and confusion in the initial stage. They needed a lot of knowledge and experienced a huge responsibilty in managing their child´s diabetes. To have a young child or an adolescent could offer different difficulties. Increased knowledge and experiences contributed to higher confidence and optimism in parents. Conclusion: The parents are the most important persons in a child´s life, and accordingly to that it is important that caregivers make sure they will educate the parents in no hurry and to support them in the great art of taking care of their chronically ill child.

The primary objective of this thesis project is to investigate Woolf's narrative construction of consciousness and its enactment of resistance against the clinical model of cognitive normativity, using Mrs. Dalloway. This objective is part of an effort to identify the ways in which Woolf's writing can be used, foundationally, to challenge the contemporary language of clinical diagnosis, as it functions to maintain power imbalances and serves as a mechanism of the rigid policing of normativity. It is also intended to support the suggestion that Woolf's novels and essays make a valuable contribution, when advanced by theory—including disability theory, to scientific conversations on the mind. One major benefit is that doing so encourages border-crossing between disciplines and views. More specifically, this project examines the ways in which Mrs. Dalloway resists the compulsory practice of categorizing and dividing the mind. The novel, I assert, supports an alternative narrative treatment, not of the mind but, of the normative social forces that police it. It allows and encourages readers to reframe stigmatizing, divisive, and power-based categories of cognitive difference and to resist the scientific tendency to dismiss pertinent philosophical and theoretical treatments of consciousness that are viable in literature. The critical portion of the project is concerned with the way in which Mrs. Dalloway addresses consciousness and challenges medical authority. Its implications urge the formation of an investigative alliance between Woolf's work and psychology that will undermine the power differential, call attention to and dismantle the stigma of "mental illness," and propel clinical treatment into new diagnostic practices.

Malnutrition is a common problem for patients with cancer that leads to anxiety and frustration for the whole family. Patients with palliative cancer disease treated at home are entitled to an adequate nutrition treatment suited to individual needs.

Aim: The aim of the literature review was to describe how cancer patients experience their nutriment situation before and after the introduction of parental nutrition and the experience of getting home parental nutrition. Methods: A literature study was carried out where qualitative and quantitative articles were examined. Findings: Five qualitative and five quantitative articles were examined. Four categories were created; patients experiences of their nutriment situation before the introduction of parental nutrition, mental experiences receiving parental nutrition at home, physical experiences receiving parental nutrition at home, patients experiences in general receiving parental nutrition at home. Conclusion: Through the parental nutrition treatment at home patients felt that the physical condition improved and the physiological symptoms were decreased. Even though family life was affected patients strived for a normal life. More studies are needed on the role of the nurse in the palliative care regarding nutritional treatment and how her support affects the patient’s positive experience.

Background: Atopic eczema has increased in the last decade among children. The nurse can have a major role to prevent the disease. Aim: the aim of this study as to describe the nurses´ work in primary care with prevention to families with atopi with focus on atopic eczema among children. Method: A literature review based on analysis of fifteen scientific articles was done. Results: If the child was breastfed both positive and negative effects were evident. Exposure to smoking lead to increased development of the eczema. Studies showed that if the child is exposed to animals, the developing eczema declined. Increased education, information and demonstration of the medical treatment lead to less flares of eczema outbreak and increased quality of life for the family. Discussion: Whether the Swedish guidelines of allergy studies should be followed or not needs more research. Improved information about the effects of smoking is important to reduce the risk of developing eczema. Conclusion: The Calgary Family Models can be efficent tools to help the nurse educate the family from their perspective. By involving the family in the education, the child may not develop further in this disease or can become a manageable condition.

Bakgrund: trauma är en svår kroppslig skada som uppkommit genom yttre våld. Eftersom sorg visar sig olika hos olika individer är det viktigt att kunna se sorgens olika uttryck. Anhörig är den person som patienten anger som sin närmaste. När någon som står en nära plötsligt avlider genom trauma, hamnar de anhöriga i en kris och reagerar och handlar utifrån den. Syfte: är att belysa akut- och intensivvårdssjuksköterskors bemötande av anhöriga vid oväntat dödsfall i ett trauma utifrån sjuksköterskors och anhörigas perspektiv. Metod: en allmän litteratur studie har gjorts och en kvalitativ innehållsanalys användes. Artikelsökning skedde i databaser men även manuellt. Därefter analyserades resultaten och meningsbärande enheter identifierades och kategoriserades. Resultat: i resultatet framkom fakta som presenterar hur sjuksköterskors bemötande är och bör vara. De anhörigas upplevelser och behov ligger till grund för hur sjuksköterskan kan utveckla sitt bemötande. De anhöriga fick i en studie rangordna de omvårdnadsåtgärder som för dem var viktiga. Slutsats: det framkom att sjuksköterskor inte anser sig ha tillräcklig kunskap och utbildning i bemötandet av anhöriga som förlorat någon i ett trauma. Det visade sig att anhöriga hade både positiva och negativa upplevelser av sjuksköterskans bemötande i en krissituation.

Abstract in English:

Background: the trauma is a severe injury incurred by external violence. Because grief is found in various different individuals, it is important to be able to see the mourning various guises. Relative is the person who is next to the patient. When someone close suddenly dies by trauma, ports the relatives in a crisis and react and act accordingly. Objective: to highlight the acute and intensive care nurses' treatment of relatives by an unexpected death in a trauma according to nurses’ and relatives perspective. Method: a general literature study has been made and a qualitative content analysis was used. Article search took place in various databases, but also manually. Since then analyzed the results and meaning-bearing units were identified and the categorized. Result: the results revealed facts that show how nurses' encounters are and should be. The family experiences and needs are the basis for the nurse to develop their encounter. The relatives were in a study ranking the nursing measures which was important for them. Conclusion: it emerged that nurses do not believe they have sufficient knowledge and training in responding to families who lost someone in a trauma. It turned out that relatives had both positive and negative experiences of the nurse response in a crisis situation.

Bakgrund: Förekomsten av diabetes typ 2 ökar ständigt och undervisning med patienter är betydelsefullt i sjuksköterskors omvårdnadsarbete. Undervisning kan dock upplevas mer blockerande än stödjande. Syfte: Att beskriva sjuksköterskors stöd i undervisningen angående förändring av kost- och motionsvanor hos patienter med diabetes typ 2. Metod: En litteraturstudie har gjorts baserad på åtta vetenskapliga artiklar. Resultat: Bemötande och identifiera behov; empati, respekt och engagemang samt att vara insatt i var patienter befinner sig i förändringsprocessen förbättrar möjligheterna att påverka. Träning i acceptans av svåra känslor; att uppleva och försonas med känslor kan hjälpa patienter att inte fortsätta i gamla vanor. Motivera förändring och utveckla mål; stärkning av patienters självförtroende har inverkan liksom att gemensamt kommunicera om strukturer som kan leda till att samstämmiga mål utvecklas. Stöd under förändringen; gruppundervisning kan generera empati och gemenskap medan utforskning av attityder kan leda till problemlösning. Stöd att bibehålla vanorna och finna balans; strategier för att förhindra återfall kan utvecklas samt tillsammans kan sjuksköterskor och patienter finna balans i levnadsvanorna. Slutsats: Med lyhördhet för var i förändringsprocessen patienter befinner sig och med respekt för patienters självbestämmande kan behandling stödjas samt samstämmighet om mål och strategier främjas. Ett patientcentrerat förhållningssätt i mötet med patienter ligger i sjuksköterskors ansvar.

Background: The incidence of type 2 diabetes is constantly increasing, and patient education is important in nursing. Teaching can be obstructive rather than supportive. Objective: To describe the nurses´ support in education concerning change of diet and physical activity in patients with type 2 diabetes. Method: A literature review based on eight scientific articles. Results: Responding and identifying needs; empathy, respect and commitment, along with taking account of patients stage of change improve opportunities to influence. Training in the acceptance of difficult feelings; to experience and reconciling emotions can help patients not to continue in old habits. Motivate change and develop goals; strengthening of patient's self-confidence has impact as well as jointly communicate on a structure that may lead to agreement on goals. Support for change; group education can generate empathy and communities and the exploration of personal barriers can lead to problem solving. Support to maintain habits and finding balance; strategies to prevent relapse can be developed and together can nurses and patients find balance in habits. Conclusion: with sensitivity of patients stage of change and with respect for patients autonomy treatment can be supported and agreement of goals and strategies promotes. It is the nurses' responsibility having a patient-centered approach in meeting with patients.

Background: Obesity surgery is the only technique that has proved to have a long-lasting effect on weight loss. Operation is not a solution but rather a lifelong involvement for the person. To loose a lot of weight means a big adjustment for both body and mind and the operated person may need support, advice, information and encouragement. Aim: The aim was to describe how a person, operated for obesity, can be supported in order to reach improved health pre- and postoperative. Method: A systematic literature study was made which resulted in 18 scientific articles that have been reviewed. Findings: Three categories were created. Support through family and surrounding, attitude and spirit affects the weight loss and well being. Support through nursingcare to reach self care, professional knowledge in the team can promote health. Support through supportgroups, finding strategies to handle life-style changes and to reach self awareness. Conclusion: Commitment, effort and self-perception is required in order to reach improved health. In addition family support may be needed as well as a support from surroundings and from the team. When all this exists, “the easier life” can be reached.

Underscoring the extent to which narrative plays a part in how patients come to integrate their illnesses, and also underscoring the extent to which narrative fluency bears upon the physician-patient interaction, Rita Charon proposed the practice of narrative medicine. Charon defines narrative practice as medicine practiced with the narrative skills of “recognizing, absorbing, interpreting, and being moved by the stories of illness”. To this end, several medical schools now incorporate literary studies into their curricula as a means to promote ethical, compassionate, and holistic care.

This dissertation advocates the use of J. M. Coetzee’s fiction as one means through which medical students and trainees can achieve the skills advocated by Charon, skills necessary for entering into the practice of narrative medicine. By guiding medical students and trainees through a careful examination of Coetzee’s works instructors can help students to: 1) gain narrative fluency, 2) increase awareness of the themes facing ill, dis/abled, or aging patients, and 3) more compassionately inhabit the plights of those who present for care. Coetzee’s fictional novels are particularly suited to such study. He utilizes a wide array of narrative structures. Inside his works, embedded meta-fictional elements are discovered vis-à-vis close reading, and such a discovery process becomes a means for building the clinical skills of close listening and attention. Furthermore, Coetzee’s fictions are detailed and incisive, meticulously elaborating the experiences of his varied characters. Through indirection, Coetzee provides vicarious experiences of illness and suffering to developing physicians, experiences that become transferable to their future interactions with patients. Additionally, Coetzee’s stories resist moralizing; rather, by entraining readers into the plights of his protagonists, he raises questions about the construction of self-story, the ethics of care, and innumerable motifs surrounding the condition of suffering.

Finally, as students traverse Coetzee’s texts, opportunities arise to experience a bird’s-eye view of the effect of “narrative wreckage” on protagonists. These opportunities will mimic those encountered in clinical practice as developing physicians interact with patients whose lives are changed by the advent of illness. By affording medical students and trainees these lessons, Coetzee’s stories become a foundation from which competent, holistic, narrative practice can develop.