Ihminen on kevyempi siirtää kuin nostaa : Potilaan liikkumisen avustamisen opas Kivipuron hoitohenkilökunnalle

Toistuvat potilassiirrot ovat merkittävä kuormitustekijä hoitoalalla. Vanhat potilas-siirtomenetelmät on havaittu useissa tutkimuksissa kuormittavan hoitohenkilökunnan tuki- ja liikuntaelimistöä sekä saattavan vaurioittaa selkää. Vanhat siirtomenetelmät passivoivat potilasta helposti, kun taas uusilla tavoilla pyritään potilaan aktivointiin. Uudet potilaan avustusmenetelmät kuormittavat hoitajia vähemmän kuin vanhat tavat avustaa. Merkittävästi hoitajien kuormittumisen vähentymiseen vaikuttaa, että potilaat ottavat tukea uusissa menetelmissä muualta kuin hoitajasta sekä potilaiden oman aktiivisuuden lisääntyminen. Potilasta aktivoiva toiminta ja voimavarojen hyödyntäminen edistävät potilaan kuntoutumista. Potilaan omatoimisuuden lisääntyminen helpottaa myös perushoitoa ja nostaa merkittävästi hoidon tasoa. Hoitohenkilökunnan koulutukseen tulisi kiinnittää erityistä huomiota, sillä edelleen yleisessä käytössä ovat vanhat siirtomenetelmät, kuten nostaminen ja kantaminen, mitkä eivät perustu potilaan omien voimavarojen hyödyntämiseen. Hoitoalan opiskelijat saavat liian vähän opetusta avustamistilanteista ja osa opettajista opettaa edelleen vanhoja siirtotapoja. Koulujen opetuksen tasoa tulisi nostaa ja työelämässä olevaa hoitohenkilökuntaa tulisi kouluttaa käyttämään uusia avustusmenetelmiä ja hyödyntämään apuvälineitä avustustilanteissa. Opinnäytetyössämme käsittelemme kuinka avustamistilanteessa potilaan aktivoimisella ja omien voimavarojen hyödyntämisellä voidaan vähentää hoitajan kuormittumista. Teoriaosuudessa käsittelemme lisäksi kuntouttavaa työotetta, avustustilanteessa ohjaamista, potilaan liikkumisen avustusmenetelmiä sekä potilassiirtojen kuormittavuuden ja hoitajien siirtotaitojen arviointimenetelmiä. Käsittelemme työssämme myös uusien potilaan liikkumisen avustusmenetelmien jalkauttamista työyhteisöihin ergonomiavastaavan ja hoitohenkilökunnan kouluttautumisen avulla. Toiminnallisen opinnäytetyömme tarkoituksena oli tuottaa tietoa millä keinoin hoitaja pystyy vähentämään omaa kuormittumistaan työssään. Tavoitteena oli pitää Kivipuron hoitohenkilökunnalle potilaan liikkumisen avustamisesta opastustuokio ja tuottaa kuvitettu kirjallinen opas.Recurrent patient transfers are one of the main strain factors in health care. In several studies, the old methods to assist patients have been found to strain the nurse’s musculoskeletal system and to increase the risk of back injury. The old patient transfer methods can easily make the patient passive, whereas the new methods aim at patient activation. The new patient transfer methods strain the nursing personnel less than the older methods. The most significant factors that reduce nurses’ strain is to have the patients not lean only on nurses and to in-crease patients’ own activity. The patient activation and better use of patients’ own resources will promote their rehabilitation. Patient activity will also facilitate and enhance the quality of basic nursing. In nursing education, attention should be paid to the fact that old methods, such as lifting or carrying patients are still used. These methods are not based on patients’ own resources. Nursing students do not have enough lessons on how to activate patients and some lecturers still teach old methods. The level of training should be higher and nurses already working should be taught to use new methods and assistive devices in their everyday work. Our thesis deals with reducing nurses’ strain when assisting patients by patient activation and use of patients’ own resources. The theory part also discusses the rehabilitative approach to work, counselling when assisting patients, new methods of transferring patients and methods of evaluating the strain and nurses’ skills related to patient transfers. The thesis also discusses informing and training nursing staff. The purpose of our thesis was to produce information for nurses on how they can decrease strain at work. Our aim was to give a lesson on how to assist patient moving and to produce an illustrated guide for nursing personnel in Kivipuro

Rätt, makt och institutionell förändring : En kritisk analys av myndigheters samverkan i barnahus

The overarching objective of the dissertation is to study inter-organisational collaboration processes and their associated consequences in a critical manner, with particular emphasis on the importance of law and power. The analysis of the empirical material, reflecting collaboration in the context of Barnahus on six locations in Sweden (collaboration under one roof regarding investigations of suspected crimes against children), has been undertaken in two stages: an initial empirical analysis and a second theoretically grounded re-analysis. Different theoretical perspectives, research methods as well as various empirical materials have been combined in the re-analysis, in order to achieve an in-depth and composite understanding of collaboration that elucidates its complexity and different dimensions. To this end, I have developed and applied a theoretical grounded analytical model in my study, which combines institutional perspectives with perspectives and concepts from the sociology of law and from theories of power that together illustrate different levels and dimensions. The analysis shows that the institutionalisation processes include both patterns and variations, i.e., both homogenising and differentiating processes, at different levels, among different Barnahus operations, organisations and collaborative actors. Content and results of collaboration become dependent on the negotiations and power games that emerge among the collaborative actors based on their respective institutional logics. In relation to the collaboration in Barnahus, the tension between the criminal law oriented and the treatment oriented logics comprises the most central one. The analysis has shown how the criminal law logic has gained the priority right of interpretation at the expense of the treatment logic, and also how those collaborative actors, who, in institutional terms, are a part of the treatment logic, have, to a greater extent, adopted a criminal law oriented logic because of their collaboration in Barnahus than vice versa. I have thus noted a general process of juridification, as an institutional change resulting from collaboration, which includes a norm and responsibility shift away from a treatment logic and towards a criminal law logic, which also entails a substantive focus on what has been (ex post) rather than on what will follow (ex ante). More specifically, this implies a focusing on the suspected crimes committed, rather than on investigation of needs and how the children and the families’ future situation can be improved through support and treatment measures. Therefore, in the light of the analysis, there is a risk that the holistic perspective, which based on the collaborative idea is expected to grow actually in practice will diminish through collaboration. The analysis has cast light on how law becomes part of power and vice versa, and that the forms of power that are actualised in the collaboration assume both clear and diffuse guises that are shaped in an interplay between structure- and actor-oriented power. In the light of the fact that law in a collaborative context contributes to tensions, normative conflicts and dilemmas for the collaborative practice, it also contributes to an uncertainty that characterises the interaction processes and the negotiations that take shape. In negotiations and interaction the law is interpreted according to different logics and acquires its content depending on the forms of power that are actualised and realised in collaboration

Vad behöver vi kunna?

Hästens och människans historia har varit sammanvävd under tusentals år. Användningsområdena har fluktuerat med människans behov och intressen, men under lång tid har vi använt hästar som sport- och tävlingsdjur. Inom travsporten, liksom i galopp- och ridsport, används hästen som ett medel att nå framgång samt fungerar som nöje och underhållning för människan. Travsport är en typ av hästsport där hästens spänns framför en sulky och tävlar i en specifik gångart – trav. Sporten är allra mest befäst i de nordiska länderna och Frankrike, men finns representerad över hela världen och blir alltmer populär. Det anses föreligga större risk för försämrad djurvälfärd för djur som används i tävlingssyften än djur som hålls för hobby och kunnandet om hästar är omgivet av en kokong av myter, missförstånd och antropomorfistiska termer. Syftet med denna enkätstudie var att undersöka om det finns ett samband mellan travtränares kunskap om djurskydd och hästens biologi och de disciplinära åtgärder som vidtagits för djurskyddsrelaterade förseelser i travlopp. 194 svenska travtränare har via Svensk Travsports hemsida besvarat en anonym enkät om sin utbildning och erfarenhet av hästar, sin kunskap om djurskydd och hästens biologi, samt besvarat ett fåtal kunskapsfrågor inom dessa två ämnesområden. Enkäten visade att det finns en övertro på den egna kunskapen som sedan inte kunnat valideras, framförallt vad gäller djurskydd. Resultaten visar också att endast en femtedel av de travtränare som uppgav att de blivit tilldömda en disciplinär åtgärd kan bedömas ha goda kunskaper om djurskydd och hästars biologi. Av resultaten från denna enkätstudie kan konstateras att det finns ett behov av såväl grund- som fortutbildning av svenska travtränare. Sådan utbildning bör behandla såväl hästens biologiska bakgrund och beteenden som gällande relevant djurskyddslagstiftning. Relevant och kvalitativ utbildning skulle kunna utgöra ett medel för att kvalitetssäkra svensk travsport i den mening att sporten upprätthåller gott djurskydd på alla plan.The evolutionary history of man and horse has been intertwined for thousands of years. Areas of utilization has fluctuated with human need and interests, but horses have been used for sport and competition for a very long time. In harness racing, as well as in thoroughbred racing and equestrian sports, the horse functions as means for success, pleasure and entertainment. Harness racing is a sport where the horse is put in front of a cart (sulky) and raced in a specific gait, namely trot. Harness racing is widely spread over the continents of the world and steadily increasing, but its popularity is probably at its greatest in the Nordic region and France. When it comes to horses used for sports and competition, there is an increasingly vivid voice of concern for the welfare of these animals and the knowledge of horses is embedded in a cocoon of myths, misconceptions and anthropomorfistic terms. The aim of this survey was to investigate if there is a connection between the knowledge of animal welfare and the biology of the horse and the animal welfare related disciplinary actions taken within the Swedish horse racing trainer community. 194 Swedish horse racing trainers answered an anonymous survey at the Swedish Trotting Association’s webpage. The survey consisted of questions about the experience and education of trainers and their knowledge of animal welfare legislation and the biology of the horse. The results of the survey showed that overconfidence of the own knowledge is very common, and that this alleged knowledge could not be vouched for, especially concerning knowledge of animal welfare legislation. The results also showed that only 20 % of trainers who have been sentenced with some kind of disciplinary action are graded as trainers with good knowledge of animal welfare legislation and the biology of the horse, according to the criteria of this survey. It could be concluded, from the results of this survey, that there is a need for education within the Swedish horse racing trainer’s community. Both animal welfare legislation and the biology of the horse should be subjects of such education. Qualitative and relevant education could be means of considerable effect for securing the quality of Swedish harness racing, with enhanced animal welfare being the objective

Improving Visual Function after Mild Traumatic Brain Injury Using a Vision Therapy Program: Case Reports

This case report describes the outcome of vision therapy for three patients who were referred to therapy due to visual symptoms after mild traumatic brain injury (MTBI). The criterion for inclusion was a high score (>21p) on the Convergence Insufficiency Symptom Survey (CISS) scale. The vision therapy program (VTP) included both face-to-face sessions and home-based tasks. Cases #1 and #2 had a substantial CISS scale evaluation improvement, and case #2 normalized the CISS scale score from 36 to 19. All patients agreed that vision therapy helped them understand their own vision and changes in their vision, which helped their overall recovery after MTBI. Rehabilitation professionals have an important role in screening for vision impairments and treating functional vision challenges after mild traumatic brain injury

Sorting Out the Debate Over Customary International Law

Att personer saknar eller har nedsatt arbetsförmåga skapar effekter på såväl individ, organisations och samhällsnivå. Arbetslivsinriktad rehabilitering genomförs för att personer ska återfå sin arbetsförmåga och i Sverige omfattar denna process flera aktörer från olika organisationer och professioner. Dessa måste därför samverka för att rehabiliteringen ska få ett bra resultat.Detta har i tidigare forskning visat sig medföra flera olika typer av utmaningar för de involverade personerna. Syftet med föreliggande studie är studera samverkan mellan personer som tillhör olika organisationer och professioner utifrån ett förhandlings-och nyinstitutionellt perspektiv. Studien har genomförts utifrån grundad teori och baseras på sju intervjuer med personer som på olika sätt arbetar med arbetslivsinriktad rehabilitering. Resultatet visar att aktörerna som är delaktiga måste förhålla sig till faktorer som de har väldigt begränsad möjlighet att påverka exempelvis institutioner, lagar, medicinsk bedömning och resurser. Dessa faktorer har visat sig både kunna ha positiv och negativ inverkan på den arbetslivinriktade rehabiliteringen. Vidare har resultatet visat att de yrkesverksamma personerna vilka är delaktiga i processen har ett ansvar att använda det förhandlingsutrymme som dessa faktorer skapar på ett så fördelaktigt sätt som möjligt. Samverkansprocessen kan illustreras som en cyklisk process där aktörerna försöker skapa balans mellan att å ena sidan se till sin egen verksamhet, sina resurser och ”se till sitt”. Å andra sidan ”ge och ta” genom att bortse från professionsgränser, se till helheten och vara lösningsorienterad. Föreställningar om andra professioner och organisationers intentioner och mål kan i vissa fall försvåra samverkan. Detta leder till att aktörerna försöker skapa personliga relationer, kontinuitet, tillit, respekt och trygghet för att överbrygga utmaningarna och istället dra nytta av att tillhöra olika organisationer och professioner. Målet blir därför att tillsammans skapa en väg framåt genom att samverka och hitta lösningar som är godtagbar ur såväl formell synpunkt i relation till lagar och regler som i relation till vad som är moraliskt rätt och individanpassat

Bacterial Contamination of Equine Dentistry Equipment—Effect of Cleaning and Disinfection

Simple Summary Some of the equipment used in equine dentistry is difficult to clean and disinfect. Since it is vital to avoid the spread of infections in equine healthcare it is important to develop practical and easy-to-follow methods for cleaning and disinfecting dental equipment. The aim of this study was to investigate hygiene in equine dentistry. Dental equipment and the head support, where horses rest their head during dental care, were sampled for the amount of bacteria between each patient before and after dental care as well as after cleaning and/or disinfecting. The amount of bacteria was, in general, high on dental equipment and the head support after dental procedures. Bacteria were found in different amounts on most of the dental equipment after cleaning or disinfecting, which indicates a risk for spreading infections when using the equipment. For the head support, cleaning and/or disinfecting generally resulted in a reduced amount of bacteria, indicating a lowered risk for spreading infections. There is a great need for evidence-based guidelines on hygiene in equine dentistry to decrease the risk of transmitting infections between patients, facilities, and stables. Equine dentistry has developed immensely and human dental equipment, such as handpieces, are often used. Measures to avoid the spread of infectious microorganisms are important, but this is challenging since handpieces are difficult to decontaminate. Thus, it is necessary to develop effective IPC measures in equine dentistry. The aim of this study was to contribute to the evidence needed for future evidence-based guidelines on IPC by investigating hygiene in equine dentistry. Used handpieces and dummies (i.e., handpieces not used during dental procedure, reflecting environmental bacterial contamination) and the head support were sampled each day before the first patient, for each patient after treatment, and after decontamination. All equipment was sampled with 3M (TM) Swab Samplers and the head support additionally sampled with dip slides. After dental procedures, the detected bacterial load was often high on used handpieces, dummies, and the head support. After decontamination, handpieces did not meet the criteria for high-level disinfected equipment. In all but one case decontamination of the head support resulted in a lowered bacterial load. There is a great need for evidence-based guidelines on hygiene in equine dentistry, including IPC measures, to decrease the risk of spreading infectious microorganisms between patients, facilities, and stables

The cost-benefit of salmonella control in Swedish pigs

Analysis of the expected costs and benefits of salmonella control pre-harvest in the pork production has been performed on EU level (1). As optimal measures to begin salmonella control in pig production in a high prevalence situation are not known, estimates of the costs for initiating such a control include large uncertainties. However the costs for running a salmonella control program can be estimated in countries where such programs are in place. In Sweden, where approximately 3 million pigs are slaughtered yearly and the prevalence of salmonella is low, the cost of the control is shared by the tax payers and the producers

Longitudinal age-and cohort trends in body mass index in Sweden - a 24-year follow-up study

Background: The aim of this longitudinal study was to analyze whether mean Body Mass Index (BMI), assessed at four occasions, changed within different age groups and birth cohorts over time, i.e., between 1980/81 and 2004/05, after adjustment for possible confounders. Methods: A sample of 2728 men and 2770 women aged 16-71 years at study start were randomly drawn from the Swedish Total Population Register and followed from 1980/81 to 2004/05. The same sample was assessed on four occasions during the 24-year study period (i.e., every eighth year). The outcome variable, BMI, was based on self-reported height and weight. A mixed model, with random intercept and random slope, was used to estimate annual changes in BMI within the different age groups and birth cohorts. Results: Mean BMI increased from 24.1 to 25.5 for men and from 23.1 to 24.3 for women during the 24-year study period. The annual change by age group was highest in the ages of 32-39, 40-47 and 48-55 years among men, and in the ages of 24-31, 32-39, and 40-47 years among women. The highest annual changes were found in the youngest birth cohorts for both men and women, i.e., those born 1958-65, 1966-73, and 1974-81. For each birth cohort, the annual change in BMI increased compared to the previous, i.e., older, birth cohort. In addition, age-by-cohort interaction tests revealed that the increase in BMI by increasing age was higher in the younger birth cohorts (1966-1989) than in the older ones. Conclusions: Public health policies should target those age groups and birth cohorts with the highest increases in BMI. For example, younger birth cohorts had higher annual increases in BMI than older birth cohorts, which means that younger cohorts increased their BMI more than older ones during the study period

Структура и стабильность бессвинцового сплава Zn-10 мас. % Sn, полученного сверхбыстрым затвердеванием

Материалы XIII Междунар. науч.-техн. конф. (науч. чтения, посвящ. 125-летию со дня рождения П. О. Сухого), Гомель, 22 окт. 2020 г