Background: Radiographers’ ability and competence is a matter of vital importance for patients. Nursing care is an integral part of the radiographer’s work. The demand for high competence in clinical activities has increased in diagnostic radiology and has had an impact on the development of the profession.

Aim: The aim was to describe the radiographer’s areas of professional competence in relation to good nursing care based on critical incidents that occur in the course of radiological examinations and interventions.

Method: A descriptive design with a qualitative approach, using the Critical Incident Technique was employed. Interviews were conducted with a strategic sample of registered radiographers (n = 14), based at different hospitals in Sweden.

Ethical issues: The appropriate ethical principles were followed. All the participants provided informed consent, and formal approval for conducting the research was obtained according to national and local directives.

Results: The data analysis resulted in two main areas; direct and indirect patient-related areas of competence, which describe the radiographers’ skills that either facilitate or hinder good nursing care. In the direct patient-related area of competence, four categories emerged, which illustrate good nursing care in the patient’s immediate surroundings. In the indirect patient-related area of competence, four categories illuminated good nursing care that is provided without direct contact with the patient.

Conclusions: The study highlights the different areas of the radiographer’s unique professional competence. The findings provide insight into the radiographer’s profession, on one hand as a carer and on the other as a medical technologist as well as highlighting the importance of each role. The radiographer’s work encompasses a variety of components – from caring for the patient to handling and checking the technical equipment.

Skeletthälsa och livsstilsbeteenden hos unga kvinnor I Sverige kommer ungefär 50 % av alla kvinnor att drabbas av en fraktur någon gång under sitt liv. Ett starkt skelett med hög mängd benmassa är det som främst bidrar till att förebygga benskörhetsfrakturer. Kvinnor har efter ungdomsåren mindre mängd benmassa än män och mängden benmassa minskar hos kvinnor snabbare i samband med klimakteriet än hos män. Den mängd benmassa som en individ har styrs till stor del av ärftliga faktorer men påverkas även av vårt sätt att leva, genom våra naturliga livsstilsbeteenden. Denna avhandling bygger på antagandet att unga kvinnors naturliga livsstils beteenden är av betydelse för att kunna maximera benmassan tidigt i livet och i förlängningen kanske minska risken för benskörhet. Deltagarna i studien är 152 unga friska kvinnor som vid första datainsamlingen, 1999, var 16-24 år. Datainsamlingen bestod av bentäthetsmätning, längd, vikt, samt ett frågeformulär med frågor om bl.a. livsstilsbeteenden och menstruationsmönster och en ny datainsamling gjordes efter två år. Olika livsstilsbeteenden samvarierar och kan antas motverka varandra eller förstärka varandras inflytande på förändringar i mängden benmassan. För att få en så heltäckande bild som möjligt har livsstilsbeteenden betraktas och undersökts ur olika perspektiv tex. hänsyn har tagits till kroppsvikt, rökning och användning av p-piller för att tex. utvärdera betydelsen av fysisk aktivitet. Resultaten visade att 58 av kvinnorna hade ökat mängden benmassa och 94 hade en oförändrad eller minskad mängd benmassa under de två år som hade förflutit mellan de två mätningarna. Av dessa var det 27 som ökat sin benmassa och 45 som hade minskat sin benmassa med mer än 5%. Användning av p-piller och alkohol konsumtion innebar en ökad risk att tillhöra gruppen med minskad benmassa. Resultaten visade att rökning var förknippat med en minskad mängd benmassa och användning av p-piller föreföll kunna minska rökningens negativa förändring av benmassan. P-piller användare som rökte konsumerade mer alkohol och angav oftare än de kvinnor som varken rökte eller använde p-piller att de hade ökat och/eller minskat mer än 5 kilo i kroppsvikt under två års perioden mellan datainsamlingarna. Kvinnor vars menstruationer blivit regelbundna i samband med att be börjat med p-piller hade högre benmassa än de med oregelbundna menstruation som blivit naturligt regelbundna. Resultaten visade att oavsett om man använder p-piller eller röker så dämpar eller motverkar utevistelse de negativa effekterna som rökning och p-piller har. En förklaring till detta kan vara att solljuset omvandlas i huden till D-vitamin som är en av byggstenarna i skelettet. Förutom utevistelse så bidrog även en självrapporterad bättre sömntillfredsställelse till en ökning av mängden benmassa. Hälften av kvinnorna i studien hade bantat och de hade högre kroppsvikt och mer benmassa än de kvinnor som inte hade bantat. En möjlig förklaring till att kvinnor som bantar har högre kroppsvikt kan vara att när kroppen inte får tillräckligt med energi dämpas energiförbrukning och detta kvarstår en period efter det att man slutat banta och börjat äta normalt. Detta innebär att kroppen bättre tillvaratar energin när man börjar äta normal igen. Hög kroppsvikt har förknippats med ett starkt skelett. Body Mass Index (BMI= vikt/längd i meter x längd i meter) är ett mått som används för att beräkna övervikt (BMI>24), normalvikt (BMI 19-24) och undervikt (BMI<19) hos unga individer. Resultaten visar att om hänsyn tas till över-, normal och undervikt har levnadsvanor en varierande betydelse mängden benmassa. Resultaten visade en ökning av kroppsvikten hade störst betydelse för en ökad mängd benmassa för de kvinnor som hade en undervikt. Hög fysisk aktivitet, dvs. att ägna sig åt hård träning och tävling som tex. löpning, gymnastik regelbundet och flera gånger i veckan var associerat med en minskning av benmassan hos de kvinnor som hade en undervikt. Detta talar för att nivån på fysisk aktivitet bör anpassas så den inte överstiger energi intaget. Bland de med övervikt saknade kroppsvikten betydelse för mängden benmassa. Kunskap om unga kvinnors egen uppfattning om livsstilsbeteenden bidrog ytterligare till att komplettera bilden av livsstilsbeteenden och deras betydelse för utveckling av benmassa. Elva av kvinnorna deltog i individuella intervjuer där de berättade om sin inställning till olika levnadsvanor. De kvinnor som tillfrågades var de som hade förändringar i benmassa som både var typiska och atypiska för vad som kan förväntas utifrån rökvanor och graden av fysisk aktiviteten. I intervjuerna med de unga kvinnorna framträdde två olika förhållningssätt till livet, rigid eller avslappnad. Det visade sig att kvinnor med en avslappnad inställning till livet ökat mängden benmassa, oavsett rök och motionsvanor och att samtliga med en minskad mängd benmassan hade en rigid inställning till livet. Det framkom i resultaten från intervjuerna att kvinnornas inställning till livet karaktäriserades av ett antal aspekter, motivation, värderingar, handlingar och strategier som var sammanlänkade. De kvinnor som hade en avslappnad syn på livet bestämde aktivt över sin livssituation utifrån vad de kände. De kvinnor som hade en rigid syn på livet hade som mål att i varierande grad anpassa sig till yttre omständigheter och var påverkade av andras åsikter. Detta kan vara associerat till stress som kommer inifrån en person. Stress ger förhöjda nivåer av stresshormon bl.a. kortisol som i sin tur har associerats med en hämning av uppbygganden av benmassa, vilket kan förklara den minskade mängden benmassa hos dessa icke rökande kvinnor med hög fysisk aktivitet. Kvinnorna med en avslappnad inställning till livet hade fritidsaktivitet som de kände gav dem avkoppling och nöje medan kvinnorna med en rigid inställning ofta deltog i fritidsaktiviteter som var praktiska. Det kunde vara att man samåkte med någon eller man hade anammat en fritidsaktivet som en anhörig eller sambo hade och kan antas inte ge samma avkoppling som de fritidsaktiviteter man själv väljer. De kvinnor som hade en avslappnad inställning till livet var mer engagerade i vad de gjorde och det som motiverade dem var att erhålla inre tillfredställelse och avkoppling. Det visade sig att fyra av fem kvinnor med en avslappnad inställning till livet upplevde att de ofta eller rutinmässigt fick tillräckligt med sömn medan fem av de sex kvinnorna som hade en rigid inställning till livet upplevde att de aldrig eller endast ibland fick tillräckligt med sömn. Samtliga kvinnor i studien, 152, indelades i två grupper utifrån självrapporterad tillfredställelse med sömnen. En jämförelse mellan dessa två grupper visade att de som var mer tillfreds med sin sömn förutom att det var mer sannolikt att de skulle ha ökat sin benmassa även hade rapporterat en bättre självskattad hälsa, färre sjukskrivningsdagar och färre läkarbesök. Det var färre antal rökare, de hade en lägre kroppsvikt och det var också färre som hade bantat i denna gruppen. Den gruppen kvinnor som var mer tillfreds med sin sömn uppgav även att de var mer fysiskt aktiva och konsumerade mer grönsaker. Sammanfattningsvis kan man säga att oavsett vilka livsstilsvanor som unga kvinnor har, kan de genom sina naturliga livsstilsbeteenden, främja uppbyggnaden av ett starkt skelett genom att öka den tid de vistas ute, framförallt vintertid och då under dygnets ljusa timmar. Det är också viktigt att ha fritidsaktiviteter som man känner motivation för och som är roliga eftersom avkopplande aktiviteter förefaller kunna förbättra förutsättningarna för att nå en optimal mängd benmassa. Viktigt är också att försöka förbättra tillfredställelsen med den egna sömnen och äta tillräckligt för att täcka behovet av energi som går åt till den fysiska aktiviteten man har, framförallt om man har en undervikt.

AIM: The aim of this study was to describe the perceptions of lifestyle among women of retirement age. BACKGROUND: Women go through many transitions during their lives, which impact on their lifestyle and possibly their outlook on life. Family circumstances such as motherhood and marital status change over time and the menopause is also likely to influence their view of life. METHOD: Data were collected through interviews with 20 women, aged 61-70, selected by means of strategic sampling. The interviews were analysed using a phenomenographic approach. FINDINGS: Three structural aspects emerged: being healthy as life turns out, living life in their own way, and taking care of everyday life. The women described lifestyle as a means of being healthy, having an active role in society, being content with what one has and the need to adapt oneself to limiting circumstances. Lifestyle was also associated with being in charge and making one's own choices in life based on one's own values. They reported that they were independent and made decisions about their life. The informants considered that lifestyle was an asset that helped them to cope with everyday life and to make the most of each day. CONCLUSION: Lifestyle is a tool that requires independence, the right to self-determination over everyday life and adjustment to limitations in order to ensure the psychological well-being of women of retirement age. Further research is needed in order to delineate the possible association between lifestyle and psychological well-being.

The objective of the study was to investigate bone mineral density and bone turnover among female students aged 16-24 years in relation to lifestyle factors, such as dietary habits and physical activity, as well as physiological factors, such as age, body weight, and menstrual pattern. Female college and university students (n = 218) were given a validated questionnaire with 34 questions concerning diet, recreational physical activity, alcohol, smoking, menstrual pattern, weight gain and loss. Bone mineral density (BMD) measurements were performed using a heel bone scanner (DEXA). Deoxypyridinoline (DPD) levels were measured in urine samples. The data were analyzed by linear regression and multiple regression analysis. The mean BMD was 0.568 g/cm2. Multiple regression showed that hormonal age was a better predictor of high BMD and low bone mineral turnover than chronological age. The best model predicting high BMD was composed of physical activity, regular menstruation, hormonal age and body weight. Smoking, alcohol consumption and current calcium intake did not contribute to the model. A negative association between BMD and DPD was found, indicating an enhanced bone remodeling. A correlation was found between DPD and hormonal age, chronological age, sugar intake and time with irregular menses. In multiple regression analysis, hormonal age, high sugar intake and weight loss were the factors best predicting DPD. BMD was positively influenced by a healthy lifestyle, including a physically active life and healthy dietary habits without dieting. Our study shows that hormonal age is a stronger BMD predictor than chronological age. Menstrual disturbances might be an indication of a risk for low BMD and might therefore be a reason for measuring BMD among young females.

Achievement of a high peak bone mass is considered a pivotal preventive strategy against future osteoporotic fractures. The ostensible interaction between physiology and lifestylefor the development of bone mass over time is sparsely outlined among young women. The aim of this study was to follow bone density and bone resorption over time among healthy young women in relation to lifestyle factors and to evaluate the perceived influence of other factors. Data were collected in 1999 and in 2001. Healthy young women (n=152) were given a structured questionnaire, a heel bone scanner (dual X-ray absorptiometry) performed bone mineral density measurements and deoxypyridinoline was measured in urine. Data were analyzed by linear, multiple and logistic regression analysis. Mean bone mineral density (BMD) was 0.562 g/cm2 (+/-0.090). Bone density at baseline was the best predictorfor the bone density atfollow-up. Bone density at baseline together with smoking and alcohol (dichotomized) accounted for 86.5% of the variation in bone density 2 years later. Of the participants 62% had decreased/unchanged bone density and 38% had increased their bone density from 1999 to 2001. Use of oral contraceptives or alcohol at baseline was associated with an increased risk of belonging to the group who decreased their bone density. Deoxypyridinoline was not a strongpredictor to bone density and all potential predictors of deoxypyridinoline had a minor influence (<10%). In conclusion, lifestyle behaviors such as use of oral contraceptives, smoking and alcohol consumption seem to have a negative influence on BMD development among young women and warrant further scrutiny.

BACKGROUND: Only limited information is available on healthy young women's perspective of their own lifestyle behaviours. By lifestyle behaviours, e.g. smoking and physical activity, individuals have the possibility to influence bone mineral density (BMD). The aim of this study was to generate a theoretical model of lifestyle behaviours among young women with different BMD changes. METHODS: Data were collected by interviewing with 11 women, and the material was analysed by means of the grounded theory. FINDINGS: Two core categories were generated: (i) the respondents' outlook on life and (ii) their life situation. The respondents' outlook on life was either 'rigid' or 'relaxed'. Respondents who had a rigid outlook on life adjusted with others and had a decreased BMD while those with a relaxed outlook on life were doing things for fun and had an increased BMD level. Life situation also consisted of two categories: 'stagnation' and 'development'. Respondents in a static life situation did not pursue any active actions while in a developing life situation, the respondents were actively striving towards a goal. Four dimensions which characterized the respondents' outlook on life in relation to their life situation emerged: subordinating and enduring with a decreased BMD level or compromising and discerning with an increased BMD level. CONCLUSION: It seems as if the outlook on life has a greater influence than the acted lifestyle behaviour for bone development. Further research is needed to generalize the findings of this study and to explore the importance of the outlook on life among women of all ages.

AIM: To identify important predictors among lifestyle behaviours and physiological factors of bone mineral density (BMD) in relation to body mass index (BMI) among young women over a 2-year period. DESIGN, SAMPLE AND MEASUREMENTS: Data were collected in 1999 and 2001. Healthy young women (n=152) completed a questionnaire. BMD measurements were performed by DEXA in the calcaneus. The women were subdivided into three categories according to baseline BMI. RESULTS: Baseline bodyweight explained 25% of the variability in BMD at follow-up in the BMI<19 category, and high physical activity seemed to hinder BMD development. In the BMI>24 category, a difference in time spent outdoors during winter between baseline and follow-up was the single most important factor for BMD levels. Overweight women with periods of amenorrhoea had lower BMD than overweight women without such periods. CONCLUSIONS: Predictors and lifestyle behaviours associated with BMD are likely to be based on women of normal weight. BMI should be considered when advising on physical activity, since high physical activity seems to impair BMD development among underweight young women, possibly due to energy imbalance. Among overweight women, sleep satisfaction is the greatest predictor associated with BMD change and may indicate better bone formation conditions. Energy balance and sleep quality may be prerequisites of bone health and should be considered in prevention.

The aim was to investigate, by means of a salutogenic approach, bone mineral density (BMD) and changes in BMD over a two-year period in a group of women in relation to lifestyle behaviours and to explore their perceptions of these behaviours. The method used was multiple and sequential triangulation. Over the two years, 62% had decreased/unchanged BMD, while 38% had increased their BMD. Self-rated sleep satisfaction explained 3% of the variability in BMD and women who reported greater satisfaction with their sleep were more likely to have a healthier lifestyle. Time spent outdoors may moderate the negative influence of smoking. Women's views on lifestyle behaviours were characterised by a number of interrelated dimensions; motivation, goals, actions and strategies. Women with a relaxed outlook on life had increased BMD while women with a rigid outlook on life had decreased their BMD irrespective of smoking and physical activity. Women with a rigid outlook on life viewed actions such as lifestyle habits as a means to an end while respondents with a relaxed outlook on life, the enacted lifestyle behaviours were a goal in themselves. Motivation and sleep may be salutary factors associated with improved BMD. A tentative bio-psychosocial salutary model of the association between motivation, outlook on life, sleep, lifestyle behaviours and BMD is presented.

The aim of this study was to describe middle-aged women's perceptions of lifestyle and how it was experienced in their daily lives. Interviews with 15 women selected using network sampling were analysed using a phenomenographic approach. Lifestyle was perceived as either 'handle life', describing a framework of how everyday life should manifest itself in different areas of life, or 'relate to life' implying accepting life as it is and making the best of it based on previous experiences. In terms of providing preventive and health-promoting guiding, it is essential that nurses have an insight into people's reasoning to support them to improve health or deal with illness.

The aim of this study was to describe young women’s perceptions of lifestyle and how it was experienced in their daily lives. Traditionally, the outlook on illness and health is pathogenic, i.e. preventing illness and disease in order to achieve health, by focusing lifestyle behaviors such as physical activity and smoking. Lifestyle based on a salutary perspective cannot be measured or observed from the outside but must be described by the individual since lifestyle is an aspect of one’s life situation. Little is known about how lifestyle is perceived and what it means in ordinary people’s lives. Data were collected through interviews with 25 women selected by strategic sampling and analyzed using a phenomenographic approach. Three structural aspects emerged: enjoying life, living life, and balancing everyday life. Women described how they used lifestyle as a tool for achieving a sense of satisfaction, relaxation and happiness in everyday life. Lifestyle was also perceived as a never-ending balancing act between different personal needs and the expectations of others and society. It involved how the women used their time or lack of time as effectively as possible in order to organize their day. Lifestyle seems to be a tool in which intrinsic behaviors may be central to enhance quality of life and health. Intrinsic behaviors should be encouraged in salutary health promotion work.

The objective of the study was to explore the influence of menstrual irregularities, oral contraceptives and smoking on bone mineral density (BMD) development and bone turnover with time. Healthy young women (n = 118) were divided into four categories: (a) women neither smoking nor using oral contraceptives; (b) women who were smokers; (c) women using oral contraceptives; (d) women who were smoking and using oral contraceptives. They responded to a validated questionnaire with 34 questions concerning lifestyle and the Sense of Coherence scale (SOC). BMD was measured by dual energy x-ray absorptiometry (DEXA). Deoxypyridinoline (DPD) was measured in urine. Data were analyzed by multiple linear regression analysis. Among smokers, BMD level decreased during a 2-year period and smoking was associated with a larger negative change in BMD. Use of oral contraceptives moderated the negative impact of smoking. Women using oral contraceptives at baseline and with regular bleeding induced by contraceptive pills had a significantly higher BMD at baseline and at follow-up. They also had lower SOC than women who had natural regular bleedings. Use of oral contraceptives in combination with smoking was linked to high alcohol consumption and higher frequency of self-reported body weight reduction, which reduced the negative BMD change in this category. DPD level and difference were strongly associated with estrogen influence. It is concluded that smokers without OCs had a negative BMD development and BMD in young women with irregular menstruations seems to be improved by OC.

Aim:

To describe patients' experiences of intravitreal injections for wet macular degeneration.

Method:

16 informants, aged 62–89 years (11 women and _five men) were interviewed after a treatment period of intravitreal injections (IVI). The first question was open ended: ‘Can you please describe, in as much detail as possible, your experiences of the period when you received three IVI?’. Qualitative content analysis was employed to analyse the transcribed interviews.

Results:

The main theme demonstrated that the patients submitted themselves to and allowed the process to run its course. Four categories emerged: handing over responsibility — they placed their trust in the healthcare professionals; being given an opportunity — they appreciated that action was taken; enduring discomfort — they endured physical discomfort and mental unease; having nothing to lose — they accepted the treatment offered.

Conclusions:

It is necessary to strengthen patient participation during IVI treatment. The ophthalmic nurse can inform the patient about the effects of the treatment in a pedagogical manner. Patient participation can be strengthened by increased knowledge of the treatment effects.

Nurse assistant has as first-line caregivers in care of older people, a unique opportunity to encourage physical activity and exercise in older people. Hence,the staff’s perceptions about physical activity and exercise among older persons are essential. The aim of this study was to describe how nurse assistants in their work perceived physical activity and exercise for older people over 65 receiving home care and home help services. Method: Data were collected through interviews with 19 nurse assistants selected by strategic sampling and analysed using a phenomenographic approach. Results: The findings show two different perceptions of physical activity: “physical activity is to move “as everyday movements that older people did in activities of daily living andoutdoors activities and “physical activity is to make an effort” which older people makes handling their daily living and outdoors activities or struggling to be less inactive with healthy activities. Three differen tperceptions of exercise emerged: “exercise as physical activity” as movements that could be done either through an individual exercise programs from physiotherapist or by activities of daily life such as dressing, cleaning or shopping; “exercise as rehabilitation” as part of the rehabilitation processor as a prescription to follow and “exercise as an agent” enhancing health and well being of older people principally related to the mobility or enhancing older people’s social activities. Conclusion: By describing nurse assistants perceptions of physical activity and exercise among older people, this study provides information about two different approaches used by nurse assistants inhome help services. Nurse assistants have two different approaches towards the older person: a health promoting approach and a preventive approach. An educational awareness about the different approaches could enable staff to engage and support the older person to be physically active and to exercise regularly. A supportive organisation with flexibility and a closely collaboration between social services and health professionals could facilitate and strengthening a health promoting and a preventive approach by nurse assistant.