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  • 1. Kikhia, Basel
    et al.
    Bengtsson, Johan
    Luleå tekniska universitet, Institutionen för system- och rymdteknik, Datavetenskap.
    Melander, Catharina
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Sävenstedt, Stefan
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Life logging in the context of dementia care: My life story2015Ingår i: Alzheimer's & Dementia, ISSN 1552-5260, E-ISSN 1552-5279, Vol. 11, nr 7, s. P165-Artikel i tidskrift (Refereegranskat)
  • 2.
    Kikhia, Basel
    et al.
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Stavropoulos, Thanos G.
    Information Technologies Institute, Centre for Research & Technology Hellas.
    Andreadis, Stelios
    Information Technologies Institute, Centre for Research & Technology Hellas.
    Karvonen, Niklas
    Luleå tekniska universitet, Institutionen för system- och rymdteknik, Datavetenskap.
    Kompatsiaris, Ioannis
    Information Technologies Institute, Centre for Research & Technology Hellas.
    Sävenstedt, Stefan
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Pijl, Marten
    Personal Health Solutions, Philips Research.
    Melander, Catharina
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Utilizing a Wristband Sensor to Measure the Stress Level for People with Dementia2016Ingår i: Sensors, ISSN 1424-8220, E-ISSN 1424-8220, Vol. 16, nr 12, artikel-id 1989Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Stress is a common problem that affects most people with dementia and their caregivers. Stress symptoms for people with dementia are often measured by answering a checklist of questions by the clinical staff who work closely with the person with the dementia. This process requires a lot of effort with continuous observation of the person with dementia over the long term. This article investigates the effectiveness of using a straightforward method, based on a single wristband sensor to classify events of "Stressed" and "Not stressed" for people with dementia. The presented system calculates the stress level as an integer value from zero to five, providing clinical information of behavioral patterns to the clinical staff. Thirty staff members participated in this experiment, together with six residents suffering from dementia, from two nursing homes. The residents were equipped with the wristband sensor during the day, and the staff were writing observation notes during the experiment to serve as ground truth. Experimental evaluation showed relationships between staff observations and sensor analysis, while stress level thresholds adjusted to each individual can serve different scenarios.

  • 3.
    Kikhia, Basel
    et al.
    Luleå tekniska universitet, Institutionen för system- och rymdteknik, Datavetenskap.
    Stavropoulos, Thanos G.
    Information Technologies Institute, Centre for Research & Technology Hellas.
    Meditskos, Georgios
    Information Technologies Institute, Centre for Research & Technology Hellas.
    Kompatsiaris, Ioannis
    Information Technologies Institute, Centre for Research & Technology Hellas.
    Hallberg, Josef
    Luleå tekniska universitet, Institutionen för system- och rymdteknik, Datavetenskap.
    Sävenstedt, Stefan
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Melander, Catharina
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Utilizing ambient and wearable sensors to monitor sleep and stress for people with BPSD in nursing homes2018Ingår i: Journal of Ambient Intelligence and Humanized Computing, ISSN 1868-5137, E-ISSN 1868-5145, Vol. 9, nr 2, s. 261-273Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Clinical assessment of behavioral and psychological symptoms of dementia (BPSD) in nursing homes is often based on staff member’s observations and the use of the Neuropsychiatric Inventory-Nursing Home version (NPI-NH) instrument. This requires continuous observation of the person with BPSD, and a lot of effort and manual input from the nursing home staff. This article presents the DemaWare@NH monitoring framework system, which complements traditional methods in measuring patterns of behavior, namely sleep and stress, for people with BPSD in nursing homes. The framework relies on ambient and wearable sensors for observing the users and analytics to assess their conditions. In our proof-of-concept scenario, four residents from two nursing homes were equipped with sleep and skin sensors, whose data is retrieved, processed and analyzed by the framework, detecting and highlighting behavioral problems, and providing relevant, accurate information to clinicians on sleep and stress patterns. The results indicate that structured information from sensors can ease and improve the understanding of behavioral patterns, and, as a consequence, the efficiency of care interventions, yielding a positive impact on the quality of the clinical assessment process for people with BPSD in nursing homes.

  • 4.
    Melander, Catharina
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Piecing together a fragmented world: Structures to promote the understanding of people with advanced dementia2018Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Understanding people with dementia whose verbal ability has been impaired is a complex and challenging task, even for professional nursing staff. The aim of this PhD thesis was to explore structures that may promote the understanding of people with advanced dementia living in nursing homes. It focusses specifically on (I) the clinical reasoning employed by assistant nurses when utilizing the NPI-NH (Neuropsychiatric Inventory Nursing Home version) as a tool to assess frequency and severity of BPSD (behavioural and psychological symptoms in dementia, i.e. problematic behaviours) in people with advanced dementia, (II) whether a sensor measuring electrodermal activity (EDA) can improve the identification of agitation in individuals with dementia, (III) how an EDA sensor impacts assistant nurses’ structured assessments of problematic behaviours amongst people with dementia and their choices of care interventions, and (IV) how Martha Nussbaum’s approach to human capabilities can apply to dignity in the lives of people with advanced dementia living in nursing homes. Study I used a method of discourse analysis that focussed on clinical reasoning utilized by assistant nurses when assessing problematic behaviours. In study II, a nonexperimental and correlational observation of the relationship between a sensor measuring EDA and assistant nurses’ structured observations of agitation in people with advanced dementia was applied. Study III used both quantitative and qualitative approaches; data were collected during structured assessments of problematic behaviours conducted by assistant nurses, as well as by focus group interviews with assistant nurses. Study IV took an ethnographic approach with participatory observations that were analyzed with a recursive analysis using a theoretical framework for the conditions necessary for a dignified human life. The structure of the NPI-NH provided a supportive framework that encouraged assistant nurses to discuss and broaden their understanding of the person with dementia (I). The EDA sensor provided continuous information regardless of staff presence and the potential to identify EDA prior to observing these behaviours (II, III), which supported the understanding of the person and when to introduce timely interventions to prevent the onset of problematic behaviours (III). The structure of Nussbaum’s approach to human capabilities illuminated that people with advanced dementia were at risk of living a life in which their opportunities for human capabilities were limited, and hence, the possibility to live a dignified life (IV). An overview of the findings in this thesis indicates that the studied structures were used to piece together fragments of information to create a comprehensive understanding of the needs of the person with dementia. For the structures to support the understanding of the person with dementia, it was crucial that nursing staff were present, attentive and engaged in each person’s situation in order for them to figure out how to piece together and integrate the structures into the overall understanding of the person and, based on that, formulate caring actions in daily life that are meaningful from the perspective of the person with advanced dementia.

  • 5.
    Melander, Catharina
    et al.
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Kikhia, Basel
    Olsson, Malin
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Välivaara, Britt-Marie
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Sävenstedt, Stefan
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Assessment and evaluation of interventions in bpsd with the help of a multiple sensor system2015Ingår i: Alzheimer's & Dementia, ISSN 1552-5260, E-ISSN 1552-5279, Vol. 11, nr 7, s. P164-P165Artikel i tidskrift (Refereegranskat)
  • 6.
    Melander, Catharina
    et al.
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Kikhia, Basel
    Faculty of Health and Sport Sciences, Centre for EHEALTH, University of Agder, Grimstad, Norway.
    Olsson, Malin
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Wälivaara, Britt-Marie
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Sävenstedt, Stefan
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    The impact of using measurements of electrodermal activity in the assessment of problematic behaviour in dementia2018Ingår i: Dementia and geriatric cognitive disorders extra, E-ISSN 1664-5464, Vol. 8, nr 3, s. 333-347Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: A major and complex challenge when trying to support individuals with dementia is meeting the needs of those who experience changes in behaviour and mood. Aim: To explore how a sensor measuring electrodermal activity (EDA) impacts assistant nurses' structured assessments of problematic behaviours amongst people with dementia and their choices of care interventions. Methods: Fourteen individuals with dementia wore a sensor that measured EDA. The information from the sensor was presented to assistant nurses during structured assessments of problematic behaviours. The evaluation process included scorings with the instrument NPI-NH (Neuropsychiatric Inventory-Nursing Home version), the care interventions suggested by assistant nurses to decrease problematic behaviours, and the assistant nurses' experiences obtained by focus group interviews. Results: The information from the sensor measuring EDA was perceived to make behavioural patterns more visual and clear, which enhanced assistant nurses' understanding of time-related patterns of behaviours. In turn, this enhancement facilitated timely care interventions to prevent the patterns and decrease the levels of problematic behaviour. Conclusion: With the addition of information from the sensor, nursing staff could target causes and triggers in a better way, making care interventions more specific and directed towards certain times throughout the day to prevent patterns of problematic behaviours.

  • 7.
    Melander, Catharina
    et al.
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Martinsson, Jesper
    Luleå tekniska universitet, Institutionen för teknikvetenskap och matematik, Matematiska vetenskaper.
    Gustafsson, Silje
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Measuring Electrodermal Activity to Improve the Identification of Agitation in Individuals with Dementia2017Ingår i: Dementia and geriatric cognitive disorders extra, E-ISSN 1664-5464, Vol. 7, nr 3, s. 430-439Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Understanding and interpreting the complexity of agitation in people with dementia is challenging. Objective: To explore whether a sensor measuring electrodermal activity (EDA) can improve the identification of agitation in individuals with dementia. Methods: Nine individuals with dementia wore a sensor that measured EDA. During the same time, assistant nurses annotated the observed behavior of the person with dementia. A binary logistic regression model was applied to assess the relationship between the sensor and the assistant nurses’ structured observations of agitation. Results: The sensor values correlated with the assistant nurses’ observations both at the time of the observation and 1 and 2 h prior to the observation. Conclusion: A sensor measuring EDA can support early detection of agitation in persons with dementia

  • 8.
    Melander, Catharina
    et al.
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Sävenstedt, Stefan
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Olsson, Malin
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Välivaara, Britt-Marie
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Assessing BPSD with the support of the NPI-NH: a discourse analysis of clinical reasoning2018Ingår i: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 30, nr 4, s. 581-589Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The ability of nursing staff to assess and evaluate behavioral and psychological symptoms of dementia (BPSD) to determine when intervention is needed is essential. In order to assist with the assessment process, the current use of the Neuropsychiatric Inventory Nursing Home version (NPI-NH) is internationally accepted. Even though the NPI-NH is thoroughly validated and has several advantages, there are also various challenges when implementing this system in practice. Thus, the aim of this study was to explore clinical reasoning employed by assistant nurses when utilizing the NPI-NH as a tool to assess frequency and severity of BPSD in individuals with advanced dementia.

    Twenty structured assessment sessions in which assistant nurses used the NPI-NH were audio recorded and analyzed with a discourse analysis focusing on the activities in the communication.

    Four categories were identified to convey assistant nurses' clinical reasoning when assessing and evaluating BPSD using the NPI-NH: considering deteriorations in ability and awareness, incorporating individual and contextual factors, overcoming variations in behaviors and ambiguous formulations in the instrument, and sense-making interactions with colleagues.

    The NPI-NH served as a supportive frame and structure for the clinical reasoning performed during the assessment. The clinical reasoning employed by assistant nurses became a way to reach a consensual and broader understanding of the individual with dementia, with the support of NPI-NH as an important framework.

  • 9.
    Melander, Catharina
    et al.
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Sävenstedt, Stefan
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Välivaara, Britt-Marie
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Olsson, Malin
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Human capabilities in advanced dementia: Nussbaum's approach2018Ingår i: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 13, nr 2, artikel-id 12178Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aims and objectives

    To explore how Martha Nussbaum's approach to human capabilities can apply to dignity in the lives of people with advanced dementia living in nursing homes.

    Background

    Challenges experienced when supporting people with advanced dementia who express problematic behaviours include understanding their needs and ensuring a dignified life for them.

    Design and methods

    Data were gathered using an ethnographic approach based on participatory observation. Nussbaum's capability approach was then used as a framework for the analysis. Four women diagnosed with advanced dementia who also expressed problematic behaviours were recruited from a nursing home in Northern Sweden. The data collection was performed during 2015.

    Findings

    Individuals with advanced dementia had difficulties in participating in the planning of their lives and achieving the human capability of practical reasoning. They were also at risk of being placed outside the social group, thus hindering them from attaining the human capability of affiliation. A dignified life for individuals with advanced dementia requires nursing staff to be present and to provide adapted support to ensure that the individual can actually pursue human capabilities.

    Conclusion

    Creating opportunities for the human capabilities of practical reasoning and affiliation is essential as they permeate all other human capabilities. For these individuals, it was crucial not only to create opportunities for human capabilities but also to attend to their expressions and needs and to guide and steer them towards a dignified life.

    Implications for Practice

    The normative structure of the capability approach described by Nussbaum can ensure that nursing staffs move beyond fulfilling patients’ basic needs to consider other capabilities vital for a dignified life.

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