Use of coercion against persons with dementia

Bachelor i sykepleie, 2012Presentasjon av problemstilling: Sykdommen demens angriper hjernen som gjør at du på sikt mister oversikten over deg selv og dine behov, gjør at det er vanskelig å ta vare på seg selv og ta egne beslutninger. På sikt vil mye av den du var forsvinne hen (Rokstad, 2008). I følge forkningsartikkelen til Hem, Gjerberg, Pedersen og Førde (2010) opplyser de at enkelte ganger er ikke pasienten i stand til å gjøre det som er til det beste for seg selv, derfor har man et helsepersonell som skal være der for og hjelpe pasienten igjennom hverdagen. Mange av de tingene som gjøres for pasientens beste, kan oppleves krenkende og ubehagelig for pasienten og derfor kan pasienten stritte imot det som blir gjort, og det da blir utført tvang av helsepersonell. Grensene mellom frivillighet og tvang er ofte uklare (ibid). Som sykepleier og helsepersonell ser vi behovet for at de skal ha kunnskap om det å unngå at det blir utført nettopp tvang, at det finnes andre måter å løse Side 6 av 37 problemene på en utøvelse av tvang. Vi har derfor valgt å formulere problemstillingen vår slik: Hvordan kan sykepleiere redusere bruken av tvang til pasienter med demens i sykehjem, som motsetter seg helsehjelp

Frequency of fatigue and its changes in the first 6 months after traumatic brain injury: results from the CENTER-TBI study.

BACKGROUND: Fatigue is one of the most commonly reported subjective symptoms following traumatic brain injury (TBI). The aims were to assess frequency of fatigue over the first 6 months after TBI, and examine whether fatigue changes could be predicted by demographic characteristics, injury severity and comorbidities. METHODS: Patients with acute TBI admitted to 65 trauma centers were enrolled in the study Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI). Subjective fatigue was measured by single item on the Rivermead Post-Concussion Symptoms Questionnaire (RPQ), administered at baseline, three and 6 months postinjury. Patients were categorized by clinical care pathway: admitted to an emergency room (ER), a ward (ADM) or an intensive care unit (ICU). Injury severity, preinjury somatic- and psychiatric conditions, depressive and sleep problems were registered at baseline. For prediction of fatigue changes, descriptive statistics and mixed effect logistic regression analysis are reported. RESULTS: Fatigue was experienced by 47% of patients at baseline, 48% at 3 months and 46% at 6 months. Patients admitted to ICU had a higher probability of experiencing fatigue than those in ER and ADM strata. Females and individuals with lower age, higher education, more severe intracranial injury, preinjury somatic and psychiatric conditions, sleep disturbance and feeling depressed postinjury had a higher probability of fatigue. CONCLUSION: A high and stable frequency of fatigue was found during the first 6 months after TBI. Specific socio-demographic factors, comorbidities and injury severity characteristics were predictors of fatigue in this study

Frequency of fatigue and its changes in the first 6 months after traumatic brain injury: results from the CENTER-TBI study

Background Fatigue is one of the most commonly reported subjective symptoms following traumatic brain injury (TBI). The aims were to assess frequency of fatigue over the first 6 months after TBI, and examine whether fatigue changes could be predicted by demographic characteristics, injury severity and comorbidities. Methods Patients with acute TBI admitted to 65 trauma centers were enrolled in the study Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI). Subjective fatigue was measured by single item on the Rivermead Post-Concussion Symptoms Questionnaire (RPQ), administered at baseline, three and 6 months postinjury. Patients were categorized by clinical care pathway: admitted to an emergency room (ER), a ward (ADM) or an intensive care unit (ICU). Injury severity, preinjury somatic- and psychiatric conditions, depressive and sleep problems were registered at baseline. For prediction of fatigue changes, descriptive statistics and mixed effect logistic regression analysis are reported. Results Fatigue was experienced by 47% of patients at baseline, 48% at 3 months and 46% at 6 months. Patients admitted to ICU had a higher probability of experiencing fatigue than those in ER and ADM strata. Females and individuals with lower age, higher education, more severe intracranial injury, preinjury somatic and psychiatric conditions, sleep disturbance and feeling depressed postinjury had a higher probability of fatigue. Conclusion A high and stable frequency of fatigue was found during the first 6 months after TBI. Specific socio-demographic factors, comorbidities and injury severity characteristics were predictors of fatigue in this study.</p

Unmet Rehabilitation Needs after Traumatic Brain Injury across Europe: Results from the CENTER-TBI Study

This study aims to assess rehabilitation needs and provision of rehabilitation services for individuals with moderate-to-severe disability and investigate factors influencing the probability of receiving rehabilitation within six months after traumatic brain injury (TBI). Overall, the analyses included 1206 individuals enrolled in the CENTER-TBI study with severe-to-moderate disability. Impairments in five outcome domains (daily life activities, physical, cognition, speech/language, and psychological) and the use of respective rehabilitation services (occupational therapy, physiotherapy, cognitive and speech therapies, and psychological counselling) were recorded. Sociodemographic and injury-related factors were used to investigate the probability of receiving rehabilitation. Physiotherapy was the most frequently provided rehabilitation service, followed by speech and occupational therapy. Psychological counselling was the least frequently accessed service. The probability of receiving a rehabilitative intervention increased for individuals with greater brain injury severity (odds ratio (OR) 1.75, CI 95%: 1.27-2.42), physical (OR 1.92, CI 95%: 1.21-3.05) and cognitive problems (OR 4.00, CI 95%: 2.34-6.83) but decreased for individuals reporting psychological problems (OR 0.57, CI 95%: 1.21-3.05). The study results emphasize the need for more extensive prescription of rehabilitation services for individuals with disability. Moreover, targeted rehabilitation programs, which aim to improve outcomes, should specifically involve psychological services to meet the needs of individuals recovering from TBI

Unmet rehabilitation needs after traumatic brain injury across Europe: Results from the CENTER-TBI Study

This study aims to assess rehabilitation needs and provision of rehabilitation services for individuals with moderate-to-severe disability and investigate factors influencing the probability of receiving rehabilitation within six months after traumatic brain injury (TBI). Overall, the analyses included 1206 individuals enrolled in the CENTER-TBI study with severe-to-moderate disability. Impairments in five outcome domains (daily life activities, physical, cognition, speech/language, and psychological) and the use of respective rehabilitation services (occupational therapy, physiotherapy, cognitive and speech therapies, and psychological counselling) were recorded. Sociodemographic and injury-related factors were used to investigate the probability of receiving rehabilitation. Physiotherapy was the most frequently provided rehabilitation service, followed by speech and occupational therapy. Psychological counselling was the least frequently accessed service. The probability of receiving a rehabilitative intervention increased for individuals with greater brain injury severity (odds ratio (OR) 1.75, CI 95%: 1.27–2.42), physical (OR 1.92, CI 95%: 1.21–3.05) and cognitive problems (OR 4.00, CI 95%: 2.34–6.83) but decreased for individuals reporting psychological problems (OR 0.57, CI 95%: 1.21–3.05). The study results emphasize the need for more extensive prescription of rehabilitation services for individuals with disability. Moreover, targeted rehabilitation programs, which aim to improve outcomes, should specifically involve psychological services to meet the needs of individuals recovering from TBI

Rehabilitation and outcomes after complicated vs uncomplicated mild TBI:results from the CENTER-TBI study

Background: Despite existing guidelines for managing mild traumatic brain injury (mTBI), evidence-based treatments are still scarce and large-scale studies on the provision and impact of specific rehabilitation services are needed. This study aimed to describe the provision of rehabilitation to patients after complicated and uncomplicated mTBI and investigate factors associated with functional outcome, symptom burden, and TBI-specific health-related quality of life (HRQOL) up to six months after injury. Methods: Patients (n = 1379) with mTBI from the Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) study who reported whether they received rehabilitation services during the first six months post-injury and who participated in outcome assessments were included. Functional outcome was measured with the Glasgow Outcome Scale – Extended (GOSE), symptom burden with the Rivermead Post Concussion Symptoms Questionnaire (RPQ), and HRQOL with the Quality of Life after Brain Injury – Overall Scale (QOLIBRI-OS). We examined whether transition of care (TOC) pathways, receiving rehabilitation services, sociodemographic (incl. geographic), premorbid, and injury-related factors were associated with outcomes using regression models. For easy comparison, we estimated ordinal regression models for all outcomes where the scores were classified based on quantiles. Results: Overall, 43% of patients with complicated and 20% with uncomplicated mTBI reported receiving rehabilitation services, primarily in physical and cognitive domains. Patients with complicated mTBI had lower functional level, higher symptom burden, and lower HRQOL compared to uncomplicated mTBI. Rehabilitation services at three or six months and a higher number of TOC were associated with unfavorable outcomes in all models, in addition to pre-morbid psychiatric problems. Being male and having more than 13 years of education was associated with more favorable outcomes. Sustaining major trauma was associated with unfavorable GOSE outcome, whereas living in Southern and Eastern European regions was associated with lower HRQOL. Conclusions: Patients with complicated mTBI reported more unfavorable outcomes and received rehabilitation services more frequently. Receiving rehabilitation services and higher number of care transitions were indicators of injury severity and associated with unfavorable outcomes. The findings should be interpreted carefully and validated in future studies as we applied a novel analytic approach. Trial registration: ClinicalTrials.gov NCT02210221.</p

Frequency of fatigue and its changes in the first 6 months after traumatic brain injury: results from the CENTER-TBI study

Background: Fatigue is one of the most commonly reported subjective symptoms following traumatic brain injury (TBI). The aims were to assess frequency of fatigue over the first 6 months after TBI, and examine whether fatigue changes could be predicted by demographic characteristics, injury severity and comorbidities. Methods: Patients with acute TBI admitted to 65 trauma centers were enrolled in the study Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI). Subj

Measures for Timely Delivery of Materials Transported by Automated Guided Vehicles (AGVs) in Hospitals

In recent years there has been an increase in material demand in Norwegian hospitals, and studies show that there are high expenditures for hospital logistics. This signifies the importance of developing favorable logistics solutions for the hospital supply chain. The hospital supply chain is characterized as highly complex with multiple suppliers and many operations that must be coordinated for the internal transportation of materials. St. Olav s Hospital have implemented an Automated Guided Vehicle (AGV) system for internal transportation of materials. The hospital is noticing problems related to timely delivery for the AGV system, however there is uncertainty regarding which measures that should be done to improve the degree of timely delivery. Little, if any, literature exists on timely delivery of materials in hospitals by using AGVs. Therefore, the project objective is to improve the transportation of materials performed by AGVs in order to achieve timely delivery. Research questions: 1. What is the current characteristics and dependencies of the internal transportation of materials performed by Automated Guided Vehicles at St. Olav s Hospital? 2. What measures should be done for the internal transportation of materials performed by Automated Guided Vehicles at St. Olav s Hospital to facilitate timely delivery? The methodology consists of a literature study and a case study. The literature study is focused around finding information on the hospital supply chain, internal transportation in hospitals, and AGV systems in particular. For the case study, the methods used are observations and semi structured interviews. Raw data on the AGV transportation was also retrieved and analyzed from the case company, to investigate the performance of the AGV system in regards to waiting times, transportation times, transportation volume, and transportation capacity. In the literature study, it was found that the hospital supply chain is characterized as highly complex with multiple suppliers and many operations that must be coordinated with the internal transportation. Such as supply and procurement, inventory management, distribution and scheduling, and having a holistic view of the supply chain where beneficial solutions are developed and responsibilities are appropriately allocated. The activities related to the supply chain must be coordinated with the AGV system. The AGV system is responsible for the transportation of consumer goods, laundry, food, sterile goods, pharmaceuticals, and waste. These materials must be internally transported from either in-house suppliers or the goods arrival at the hospital, to ten different hospital centers that each consists of various hospital departments. In the analysis, it was evident that the waiting times for materials waiting to be transported, can often be very high, and will be influenced by the transportation volume and the transportation capacity. A framework for measures for facilitating timely delivery by AGV is presented in the discussion. The framework is categorized into three main measures for achieving timely delivery. These are levelling the transportation volume, reducing the transportation volume and increasing the transportation capacity. So conclusively, this thesis adds to the research on AGV systems in a hospital environment, and gives a framework for possible measures for ensuring timely delivery of materials in hospitals

A Goal-Oriented Randomized Controlled Intervention in the Chronic Phase of Traumatic Brain Injury: Feasibility, Patient-Reported Problem Areas, and Goal Attainment

A broad range of symptoms may be expected in patients experiencing a traumatic brain injury (TBI), and for some these difficulties persist for decades after their injury. Further, many individuals with TBI and their families report long-term unmet health care needs. The variability in expected symptoms post TBI is high, which necessitates an individualized approach in assessing and treating these patients. Further, to improve the patient-centeredness and personal relevance of rehabilitation approaches, treatment should be goal-oriented and conducted within the context of the patient’s everyday life. This thesis was written in the context of a randomized controlled trial (RCT) that aims to investigate the efficacy of a goal-oriented and home-based rehabilitation intervention for individuals in the chronic phase of TBI. The overall aim of the thesis is to cover knowledge gaps about treatment needs and options in the chronic phase of TBI by developing an individualized rehabilitation intervention with suitable goal attainment measures to be evaluated in an RCT. This thesis displays the feasibility testing (paper I), the study protocol (paper II), the utility of an individualized assessment approach (paper III), and the goal attainment in the intervention group (paper IV). The first aim was to investigate the feasibility of the intervention delivery. Paper I displayed that although the intervention was considered feasible and acceptability was high, some amendments was needed before establishing the final protocol for the RCT. As a result of the feasibility trial, eligibility criteria were amended, the baseline assessment was abbreviated, and the included outcome measures and their order were modified. Paper II displays the full study protocol for the RCT, including study design, setting, intervention content and planned analyses for the efficacy evaluation of this trial. In paper III, an individualized approach (Target Outcomes) to attain information about main patient-reported problems areas after TBI was evaluated and compared to standardized outcome measures. In total 120 individuals with persistent symptoms at least two years after a TBI was included. Target Outcomes were reported in the domains of cognitive, physical, emotional, and social functioning, and covered 24 distinct sub-categories. Further, comparison with standardized measures displayed that the Target Outcome approach provided a more detailed picture of the problem profile of each participant. It was concluded that this approach might be a useful addition to assessing idiosyncratic TBI-related difficulties that may aid clinicians and researchers in planning interventions for these patients. Paper IV displayed goal attainment results from the intervention group of the RCT. Goal attainment was high and all 59 patients displayed overall improved goal attainment at the final intervention session. Goal attainment did not vary depending on the type of goal, i.e., goals within different domains (cognitive, physical, emotional, social) were attainable at the same levels. Individuals who were less educated, experienced less cognitive and executive impairments, and had high outcome expectation at session 3 showed higher goal attainment at session 8. These findings should be considered preliminary, and more research on indicators of goal attainment is warranted. In summary, this thesis displays insights into the delivery of an individualized approach to rehabilitation in the chronic phase of TBI. It provides a transparent look into aspects of conducting a RCT such as feasibility testing and protocol establishment. It also expands current knowledge about individualized approaches that may aid in the planning and delivery of rehabilitation interventions for patients in the chronic phase of TBI, ensuring the delivery of an evidence-based and patient-centered intervention. Individualized and patientcentered approaches are considered crucial to improve outcomes in the chronic phase of TBI. The efficacy evaluation of the RCT is pending the completion of final outcome assessments and results are expected to be available in 2022

Bruk av tvang overfor personer med demens

Presentasjon av problemstilling: Sykdommen demens angriper hjernen som gjør at du på sikt mister oversikten over deg selv og dine behov, gjør at det er vanskelig å ta vare på seg selv og ta egne beslutninger. På sikt vil mye av den du var forsvinne hen (Rokstad, 2008). I følge forkningsartikkelen til Hem, Gjerberg, Pedersen og Førde (2010) opplyser de at enkelte ganger er ikke pasienten i stand til å gjøre det som er til det beste for seg selv, derfor har man et helsepersonell som skal være der for og hjelpe pasienten igjennom hverdagen. Mange av de tingene som gjøres for pasientens beste, kan oppleves krenkende og ubehagelig for pasienten og derfor kan pasienten stritte imot det som blir gjort, og det da blir utført tvang av helsepersonell. Grensene mellom frivillighet og tvang er ofte uklare (ibid). Som sykepleier og helsepersonell ser vi behovet for at de skal ha kunnskap om det å unngå at det blir utført nettopp tvang, at det finnes andre måter å løse Side 6 av 37 problemene på en utøvelse av tvang. Vi har derfor valgt å formulere problemstillingen vår slik: Hvordan kan sykepleiere redusere bruken av tvang til pasienter med demens i sykehjem, som motsetter seg helsehjelp