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 patients’ 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 patients’ 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 patients’ experiences. Staff’s needs of education to meet patients’ 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 nurses’ 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 β-lactamase (ESBL) - producing Enterobacteriaceae and if carriage of resistant bacteria was related to antibiotic treatment, other risk factors and/or staff´s 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. Staff´s 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 patients’ experiences. Staff education to meet patients' demands for information and the prevention of contamination is essential

Building Employability Skills for Graduate Students

Universities have recently been placing a greater emphasis on employability of their graduates. Academic discussions have introduced concepts such as transferable skills, employability, co-creation, active and networked learning, and sustainable transformation as strategies for bridging the gap between university studies and full-time employment after graduation. Collaborative initiatives with companies and organizations have become increasingly prevalent in university curricula, and administrative units have been established to help students transition from students to employees or entrepreneurs (Clark, 2015). This calls for innovating education, for example through increased emphasis on networked learning ((Dohn, Hansen, Hansen, de Laat & Ryberg 2021). This paper will present a case study that explores the effects of exposing university students to different environments than the traditional university campus and lecture rooms. The aim is to investigate whether this change of surroundings and introduction of different educational tools can broaden students' perspectives on their own capabilities and skills in co-creating solutions through, for example, collaborative engagement (NLEC 2021). The focus is on engaging students to address (wicked) problems in new contexts, which are often situated within sustainability and sustainable transformation frameworks. To accomplish this, the students are equipped with skills acquired at AAU and applied in diverse contexts (employability), and they are encouraged to think ‘outside the box’ through co-creation. This includes adapting to diverse sets of norms, values, and agendas, as well as hidden power alliances, when working and co-creating with external partners in a different context

Hjelper det å snakke om det? En kvalitativ studie om betydningen prosessveiledning har for barnevernkonsulenter sin motivasjon til å bli barneverntjenesten

Denne masteroppgaven handler om barnevernkonsulenters opplevelse av prosessveiledning, og dens betydning for deres motivasjon til å bli i jobben. Kommunal barneverntjeneste har høy 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 søker 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 å bli i jobben. Samtidig er det både ulike og samsvarende faktorer som vektlegges som vesentlige for at veiledningen skal oppleves nyttig, og faktisk ha en direkte påvirkning på barnevernkonsulentenes motivasjon