The dynamic experience of pain in burn patients: A phenomenological study

Although pain is one of the main sources of suffering during the acute phase and rehabilitation in burn patients, it remains as a major challenge for burn care, and clinical management not always correlates with the experience felt by patients. The aim of this study was to understand the experience of pain from people who has suffered severe burns, to identify personal strategies used to cope with this challenging event. A qualitative phenomenological study with purposive sampling was carried out with severe burn patients admitted to a Burn Unit. Through individual in-depth interviews, verbatim transcription and content analysis, two main categories were isolated: a dynamic and changing experience of pain, from the onset to the hospital discharge, and diverse strategies developed by patients to cope with pain, being distraction the most frequently used. Pain experienced acquires its maximum intensity during wound care, and divergent patients’ opinions about sedation are present. This study highlights how understanding subjective experiences is an invaluable aid to improve care in pain assessment and management. Furthermore, it points out the need to guarantee patient involvement in the organization and improvement of burn care, inasmuch as traditional professional centered approach is not ensuring an optimal management

Fjärrvärme i en liberaliserad energimarknad: en ny ordning? : Planering och utveckling i Stockholmsregionen, 1978-2012

This dissertation analyses how district heating systems in the Stockholm region have evolved and developed during the period 1978-2012. The thesis comprises four papers analyzing how district heating has been handled in municipal and regional planning. The examination explores how actors have worked together to create regional, interconnected district heating systems with economic, technological and environmental benefits. An investigation is undertaken on the effects of liberalization (and the subsequent commercialization of the district heating market) on the planning and cooperation of these systems. The impact on the present and future district heating market is also discussed. The dissertation shows that energy companies cooperated on a regional level to create interconnected regional systems. Through openness, the capacity to make high-level decisions and municipal legitimacy, the regional strategies could be implemented at the municipal level. This can be considered a form of regional planning from below that developed through the initiative of the municipalities. The regional energy planning authority Stoseb could therefore succeed where other regional planning authorities in the Stockholm region have previous failed, to gather and unite the municipalities into a regional force. This cooperation changed around the time of the liberalization of the energy market in 1996, which led to sales of several municipal energy companies and a subsequent concentration of ownership in the region. The organizational distance between energy companies and municipalities has increased and affected the communication between them. Regional cooperation could not be maintained and this has meant that opportunities and tools to implement energy strategies today are weaker than earlier. This is a case of ‘regional splintering’. The liberalization of the energy market thus had a major impact on the district heating sector.Denna sammanläggningsavhandling analyserar hur fjärrvärmesystemen iStockholmsregionen vuxit och förändrats, mellan 1978 och 2012. Avhandlingen består av fyra artiklar som analyserar hur fjärrvärme hanterats i kommunal och regional planering, hur aktörer samarbetat för att skapa regionala, sammankopplade fjärrvärmesystem med ekonomiska, tekniska och miljömässiga vinster som följd, hur elavregleringen, och den påföljande kommersialiseringen av fjärrvärmemarknaden, påverkade planering och samverkan kring dessa system, samt fjärrvärmemarknadens nuläge och framtid. Avhandlingen visar att energibolagen samarbetat på regional nivå för att skapa sammanhängande regionala system, genom öppet samarbete och att man tack vare hög beslutskompetens kunnat implementera de regionala strategierna på kommunal nivå. Det var en form av regional planering underifrån, då initiativet kom från kommunerna och samarbetsorganet lyckades med vad regionala planorgan haft svårt att genomföra under flertalet decennier i Stockholmsregion, nämligen att samla och ena kommunerna kring strategier som implementerats. Detta samarbete förändrades vid tiden runt liberaliseringen av energimarknaden, som genomfördes 1996, vilket ledde till försäljning av flertalet kommunala energibolag och en efterföljande koncentration av ägandeskapet i regionen. Det organisatoriska avståndet mellan energibolag och kommun har därmed blivit längre och påverkat kommunikationen dem emellan. Det regionala samarbetet kunde därmed inte fortsätta som tidigare och detta gör att möjligheterna och verktyg att implementera regionala energistrategier idag är svaga. Detta var ett fall av ”regional splintering”. Liberaliseringen av energimarknaden hade således stor påverkan påfjärrvärmesektorn

Incremento de la participación de Atención Primaria en la asistencia al virus de la inmunodeficiencia humana: opinan los profesionales de las unidades hospitalarias

Objetivo: Conocer las opiniones de los profesionales de enfermedades infecciosas sobre las posibilidades de seguimiento del paciente con VIH en Atención Primaria (AP). Diseño: Estudio cualitativo fenomenológico mediante entrevistas en profundidad. Emplazamiento: Unidad de Enfermedades Infecciosas del Hospital Universitario «Virgen de la Victoria» de Málaga. Participantes: Profesionales de la salud con más de un año de experiencia laboral en enfermedades infecciosas. Un total de 25 entrevistados: 5 médicos, 15 enfermeras y 5 auxiliares enfermería. Método: Muestreo por conveniencia. Se realizaron entrevistas semiestructuradas que se transcribieron literalmente. Análisis de contenido según Taylor y Bogdan con soporte informático. Validación de la información mediante análisis complementarios, participación de expertos y devolución de parte de los resultados a los participantes. Resultados: Los profesionales de AH atribuyeron características de complejidad al VIH en relación a la enfermedad, el tratamiento y sus aspectos sociales, con repercusiones sobre el nivel organizativo de la atención. Los profesionales resaltaron los beneficios de una atención especializada, aunque difieren las opiniones de facultativos y de enfermería en relación con el seguimiento en AP. Surgieron dudas sobre los niveles de formación, la gestión del secreto y la presión asistencial en este nivel, pero también se manifestaron las ventajas potenciales en cuanto a la accesibilidad de los pacientes a AP. Conclusiones: Los facultativos perciben dificultades en el seguimiento del VIH en AP, incluso para usuarios con buen control del VIH. Enfermeras y auxiliares de enfermería se muestran más abiertos a esta posibilidad por la cercanía domiciliaria y la promoción de la salud de AP

Assessment of the attitude towards childbirth in health sciences students - development and validation of the questionnaire Cave-St

BACKGROUND: The purpose of this study is to report on the validation process of the Spanish version of a questionnaire that explores health science students’ attitudes towards women’s childbirth experiences. This questionnaire could help inform education programs to enhance the quality of woman-professional interactions, and to improve women’s experiences of childbirth. METHODS: A standardised procedure for the development and validation of the questionnaire included: item development and psychometric pre-validation, Cronbach’s Alpha and split-half coefficients calculation, test–retest and item-total correlation for the reliability analysis. Content validity was undertaken by Delphi method with sixteen panelists over two rounds. We determined the factor structure and refined and validated the questionnaire according to the responses of a cohort of 160 students using principal components factor analysis with varimax rotation. RESULTS: A 52-items questionnaire CAVE-st: (acronym for cuestionario de actitudes sobre vivencias y experiencias en el parto) was developed and validated. The questionnaire had a high construct validity, with a Cronbach´s alpha > 0.92. The intraclass correlations (0.80) indicated adequate test–retest reliability. The results of the exploratory factor analysis revealed fourteen latent components that explained more than the 70% of the observed total variance. CONCLUSIONS: The Spanish version of the questionnaire CAVE-st has been developed and validated. Its psychometrics indicate that it is a valid and reliable tool to assess health sciences students’ attitude towards women´s childbirth experience. Further work to translate and adapt the instrument in other cultures and languages will be undertaken

Regulation and current status of patient safety content in pre-registration nurse education in 27 countries: Findings from the Rationing - Missed nursing care (RANCARE) COST Action project

Patient safety, as a contemporary health care concern, must remain a priority for nurse educators. This on-line consultation, carried out within the RANCARE COST Action project, determined to establish how patient safety teaching is incorporated into pre-registration education of nurses across 27 countries. How nursing is regulated within countries was examined, along with national guidelines related to nurse education. HEIs were asked to provide details of pre-registration nurse training and how patient safety is taught within programmes. The results confirm that the topic of patient safety is generally not explicitly taught, rather it remains a hidden element within the curriculum, taught across many subjects. Variation in how nursing is regulated exists across the countries also, with the professionalization of nursing remaining a challenge in some states. No guidelines exist at EU level which address how patient safety should be taught to nursing students, and as yet regulatory bodies have not put forward criteria on the subject. As a result individual HEIs determine how patient safety should be taught. The WHO guidelines for teaching patient safety are currently underutilized in nurse education, but could offer a structure and standard which would address the deficits identified in this work

Advancing the science of unfinished nursing care: Exploring the benefits of cross‐disciplinary knowledge exchange, knowledge integration and transdisciplinarity

Aims The aims of this paper are to explore the role of cross-disciplinary knowledge exchange and integration in advancing the science of unfinished nursing care and to offer preliminary guidance for theory development activities for this growing international community of scholars. Background Unfinished nursing care, also known as missed care or rationed care is a highly prevalent problem with negative consequences for patients, nurses and healthcare organizations around the world. It presents as a 'wicked' sustainability problem resulting from structural obstacles to effective resource allocation that have been resistant to conventional solutions. Research activity related to this problem is on the rise internationally but is hindered by inconsistencies in conceptualizations of the problem and lack of robust theory development around the phenomenon. A unified conceptual framework is needed to focus scholarly activities and facilitate advancement of a robust science of unfinished nursing care. Design Discussion paper. Data Sources This discussion paper is based on our own experiences in international and interdisciplinary research partnerships related to unfinished nursing care. These experiences are placed in the context of both classic and current literature related to the evolution of scientific knowledge. Implications for Nursing The problem of unfinished nursing care crosses multiple scientific disciplines. It is imperative that the community of scholars interested in solving this wicked problem engage in meaningful cross-disciplinary knowledge integration and move towards transdisciplinarity. Conclusion Metatheorizing guided by structuration theory should be considered as a strategy to promote transdiciplinarity around the problem of unfinished nursing care