731 research outputs found
MRSA and other resistant bacteria : prevalence, patient and staff experiences, wounds and infection control
Antibiotic resistance has become a major and serious global problem in healthcare.
Limited treatment options for infections caused by these organisms can lead to increased morbidity and
mortality. Sweden has a low prevalence of antibiotic resistance compared to most other countries but this
presents an increasing problem for society and healthcare even in Sweden.
The overall aim of this thesis was to illuminate potential problems related to antibiotic resistance from
different perspectives: assessing the prevalence of resistant bacteria methicillin-resistant Staphylococcus
aureus (MRSA) and vancomycin-resistant enterococci (VRE) or other resistant bacteria, and associated
wound types, patient and health staff experiences when confronted with resistant bacteria infection, and
the occurrence of such infections in the nursing home environment.
In the first study a total of 2172 patients admitted to hospital or as out-patient visit at a University hospital
during one day were examined with the purpose to identify all wounds, wound types and wound
characteristics, and to identify bacteria in all wounds, particularly MRSA, VRE and multi-resistant Gramnegative rods. Four hundred and eight (19%) patients had a total of 668 wounds. Of these, 248 wounds,
from 216 patients were cultured. Two unknown MRSA-patients were identified. No patient with VRE
was found and there was a low prevalence of other multi-resistant bacteria.
In the second study fifteen patients with MRSA infected wounds were interviewed. The aim was to
ascertain and describe patientsâ knowledge, perceptions and experiences of being MRSA-positive. The
interviews were analyzed according to qualitative content analysis. From the analysis three categories
and one overall theme were identified. Results showed that information about the MRSA diagnosis
often caused a shock-like reaction. The patientsâ perception of being MRSA-positive was that it was
stigmatizing like the plague or leprosy; they felt dirty and a severe threat to their environment. Fears of
infecting someone else and being rejected were commonly expressed. Knowledge and empathy from
staff involved in their care was crucial to optimise patientsâ experiences. Staffâs needs of education to
meet patientsâ demands for information, and to prevent spread of antibiotic contamination was
essential.
In the third study eight nurses and seven assistant nurses from different hospital wards and nursing homes
were interviewed regarding their experiences of caring for MRSA-positive patients. Qualitative content
analysis was carried out when analysing the data and three themes were identified during the process.
Stress and too high workload were factors which were described to cause concerns in the caring situation.
A major concern was that nurses felt at risk of becoming infected themselves and then transmitting the
infection to other patients and to family members. Knowledge and ignorance about MRSA affected the
nursesâ caring; ignorance made them afraid and insecure while knowledge and understanding shaped
confidence in their role as caregivers.
In the fourth study 560 residents in a total of 67 wards, in nine nursing homes were investigated for
prevalence of MRSA, VRE and extended-spectrum ÎČ-lactamase (ESBL) - producing Enterobacteriaceae
and if carriage of resistant bacteria was related to antibiotic treatment, other risk factors and/or staffÂŽs
adherence to guidelines for infection control. In all 296 staff members were interviewed and observed.
No resident was positive for MRSA or VRE. Fifteen residents were found to be ESBL-positive. Usage of
antibiotics was higher in wards where ESBL-positive residents were detected and there was an indication
that there was transmission of ESBL between residents. StaffÂŽs adherence to infection control guidelines
sometimes revealed shortcomings but no significant difference regarding adherence to the guidelines
could be found.
In conclusion: Prevalence of MRSA appears low in both hospitalized patients, out-patients and nursing
home residents. Adherence to infection control guidelines among healthcare staff, however, needs further
improvement. MRSA colonized patients experienced psychological pressure and stigmatization.
Knowledge and empathy from staff involved in their care is crucial to optimise patientsâ experiences.
Staff education to meet patients' demands for information and the prevention of contamination is
essential
Sharing experiences and the co-creation of knowledge through personal stories â tools for critical thinking:student perspectives
Hjelper det Ă„ snakke om det? En kvalitativ studie om betydningen prosessveiledning har for barnevernkonsulenter sin motivasjon til Ă„ bli barneverntjenesten
Denne masteroppgaven handler om barnevernkonsulenters opplevelse av
prosessveiledning, og dens betydning for deres motivasjon til Ă„ bli i jobben. Kommunal
barneverntjeneste har hĂžy turnover. Det er kjent at barnevernkonsulenter blir utsatt for
emosjonelle belastninger og er i risiko for utbrenthet. I dag er det opp til de enkelte
tjenestene hvordan de ivaretar sine ansatte og bidrar til deres faglige utvikling. Gjennom fem
kvalitative dybdeintervjuer sĂžker denne oppgaven kunnskap om barnevernkonsulenters
opplevelse av sammenhengen mellom prosessveiledning, egen motivasjon og emosjonelle
belastninger i arbeidet.
Funnene viser store variasjoner i veiledningstilbudet i de ulike tjenestene. Deltakerne
opplever alle at prosessveiledning er av betydning for deres arbeidshverdag, faglig trygghet
og motivasjon til Ä bli i jobben. Samtidig er det bÄde ulike og samsvarende faktorer som
vektlegges som vesentlige for at veiledningen skal oppleves nyttig, og faktisk ha en direkte
pÄvirkning pÄ barnevernkonsulentenes motivasjon
How to reach the national environmental objective âsustainable forestsâ in the County of JĂ€mtland
Det finns i dagslÀget 16 miljömÄl i Sverige. Ett miljömÄl beskriver den kvalitet och det tillstÄnd för Sveriges miljö-, natur- och kulturresurser som Àr miljömÀssigt hÄllbara pÄ lÄng sikt. Dessa mÄl anpassas för olika geografiska omrÄdet: nationellt, regional samt lokalt dÀr varje geografisk nivÄ ocksÄ har understÄende delmÄl.
Som en del i sektorsansvaret för miljömĂ„let âlevande skogarâ har Skogsstyrelsen, genomfört ett projekt i JĂ€mtlands lĂ€n: âSeminarium för skogsbruket i JĂ€mtlands lĂ€n â nu ska vi nĂ„ de regionala miljömĂ„lenâ. Syftet var att fĂ„ en ökad intensitet i arbetet att nĂ„ miljömĂ„len och ökad förstĂ„else för miljömĂ„lsarbetet inom skogssektorn inom lĂ€net.
Under seminariet redovisades nio förelĂ€sares erfarenheter kring omrĂ„det, trots Ă„tgĂ€rder Ă€r det endast âförstĂ€rkt biologisk mĂ„ngfald i all skogâ som tros blir uppnĂ„tt till mĂ„lĂ„ret 2010. Samtliga förelĂ€sare var överens om att mer areal skog mĂ„ste skyddas, samt att den generella hĂ€nsynen vid avverkning mĂ„ste vidtas i större utstrĂ€ckning Ă€n vad som görs i dagslĂ€get. Seminariet har sammanfattats i kombination med en litteraturstudie kring Ă€mnet, dĂ€r det samlande syftet med rapporten varit att studera hur olika aktörer inom skogsbruket arbetar med miljömĂ„lsfrĂ„gor samt utvĂ€rdera hur lĂ„ngt JĂ€mtlands lĂ€n har kvar tills miljömĂ„let âlevande skogarâ Ă€r uppnĂ„tt.
Det samlade resultatet tyder tyvĂ€rr pĂ„ att miljömĂ„let âlevande skogarâ i JĂ€mtlands lĂ€n Ă€r mycket svĂ„rt att nĂ„ inom den utsatta tidsramen Ă€ven om ytterligare Ă„tgĂ€rder sĂ€tts in/genomförs (LĂ€nsstyrelsen JĂ€mtlands lĂ€n, MiljömĂ„lsbedömningar, 2009).Today we have 16 environmental goals in Sweden. The Environmental objectives describe the quality and the state that Swedenâs environmental-, nature- and culture resource thatâs environmental sustainable in long-term should have. Environmental goals are bookmarked for different geographical areas: National, regional and local, every area has their own milestones.
Swedish Forest Agency has a sector responsibility for the environmental objective âliving forestsâ, as a part of their sector they have been implemented a project in the country of JĂ€mtland: "Seminar on forestry in the country of JĂ€mtland - now we will reach the regional environmental objectives". The aim was to obtain an increased intensity of work to achieve environmental objectives and increased understanding of environmental work in the forestry sector in the County.
In the seminar there were nine speakers that were sharing their experiences around this subject. The conclusion was that even of measures were taken to achieve each of the four strands, "enhanced biodiversity of all forests" is the only one of the four milestones that are believed to reach the target until year 2010th. All speakers agreed that larger forest areas need to be protected, and in general, considerations must be taken when logging to a greater extent than is done in the present situation.
The seminar was summarized in combination with a literature review on the subject environmental goal. Overall purpose of the project was to study how various forestry stakeholders involved in environmental issues and to evaluate how far the progress has come before the environmental goal of "living forest" is reached in the country of JÀmtland. The result show, unfortunately, that the environmental goal of "living forest" in the country of JÀmtland is very difficult to achieve within the required time frame, even with action taken for implementation (LÀnsstyrelsen JÀmtlands lÀn, MiljömÄlsbedömningar, 2009)
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