Research areas in Health Care Sciences
Health care sciences are extensive subjects that include studies in a number of disciplines such as nursing, physiotherapy, occupational therapy and health economics. Studies at Karolinska Institutet can be applied to such widely-separated areas as cancer, dementia and musculoskeletal problems. They can also include defined sub-sets of the general population such as the elderly, women, children and people of different cultural origins.
Nursing encompasses a number of core concepts, such as the individual, nursing activity/relation, health and environment. Nursing research has its starting point in the experiences and reactions of the individual to their existential situation, and is based on knowledge from both science and experience; this in turn is characterised by an independent development of knowledge on practical and theoretical grounds.
This understanding is applied at the levels of patient, group and community and takes into account such perspectives as genus and social culture. Closely related disciplines, such as medical and social behaviour and the humanities, influence the advancement of knowledge in this area.
Natural Ageing and the Care and Nursing of the Elderly
With an increasing elderly population medical research on aging is an important area of research. At Karolinska Institutet we perform broad research on dementia and the ageing of the brain, on treatment and care of the elderly and on the healthy aging. This covers, amongst other things, how the process of change that normal ageing involves is affected by individual characteristics and the social environment. It also deals with the individuals need for care and nursing in the terminal stage of life.
Some of the most important subjects are: contact between the patient and caregiver, relatives and the staff, the ethical and fundamental philosophical aspects of health care. The starting point is a holistic view of the individual in which physiological, psychological, sociological, cultural, ethnic and spiritual aspects of well-being are central aspects. Geriatric nursing is examined in various contexts; in the home, at the hospital and in sheltered accommodation, with the aim of supporting every-day situations and optimising quality of life.
People Living with Chronic Conditions
At KI, there is multi-disciplinary research that focuses on people living for many years with chronic conditions, in order to identify their needs for care. This is above all directed at cancer patients, those with rheumatic diseases and those with HIV. Some project examples are social life among adolescents and young adults during and after treatment for a life-threatening disease, fertility among adults that are being or have been treated for cancer, sexuality and sexual health and symptom management.
Women's and Children's Health
Nursing care research into women's and children's health at KI is concerned with subjects such as sexuality, pregnancy, delivery and the time after birth. Other subjects include the neo-natal period, including breast-feeding, and the control of fertility, including abortion, and the prevention of sexual dysfunction. This kind of research involves physical, psychological, social and cultural aspects, and has as its goal the advancement of knowledge of the subject in order to support health promotion and disease prevention.
Cancer Care and Palliative Care
Nursing research in cancer encompasses physical and psychosocial aspects of contracting and living with cancer, from the point of view of both the patient and their relatives. This research uses a variety of approaches in order to develop and implement knowledge to improve the care of individuals with cancer, all the way from prevention to palliative care.
One branch of research examines the experience of symptoms among cancer patients. This aims both to decrease the symptoms themselves and to combat the anxiety that they cause. Nutritional problems resulting from the taste and olfactory changes that accompany chemotherapy are also investigated.
Nursing care research can also examine the way in which parents deal with a child who has cancer, how the next of kin experience cancer in a close relative and what can be done to provide them with optimal support.
Transcultural care is a rather recent research activity in Sweden. Initially directed more toward ethnicity, transcultural research at KI today examines cultural attributes, that is to say every aspect of an individual such as sex, age and socio-economic factors.
Cultural competence is a central concept; it can be described as the ability to understand oneself and others from a cultural perspective. Cultural competence is essential for the ability to provide good nursing care. The basic idea is that nurses, or other care staff, who have a high level of cultural competence can understand their patients better, which, in turn, results in improved communication even in situations where the patient has a different cultural background to the nurse.
Researchers at KI have, for example, constructed a measure with which to evaluate the cultural competence of an entire workplace; it registers the attitudes of staff to patients and to each other. Many research projects at KI begin with questions about what factors separate and what are common to people from different backgrounds. Other projects look at geriatric nursing care from a gender perspective, and alienation and the perception of social exclusion and ill health among young people in Stockholm.
The study of kinetics is central to research in physiotherapy. This comprises biomechanics and the physiological and psychological factors involved in movement. This research aims to influence the health and quality of life of the individual in their physical and social environment.
Physiotherapy researchers at KI are investigating balance, walking ability, physical activity and health-related quality of life in adults and the elderly, as well as physical activity in rheumatic disease. Other areas of activity are neuroepidemiology and nursing care related to the causes and consequences of neurological disease/damage, as well as rehabilitation, cumulative trauma issues, movement, physical activity and occupational health questions.
A large number of diseases and other circumstances can result in a difficulty in performing routine daily activities. KI researchers in occupational therapy examine the relationship between the activity of the individual, in a broad sense, and their health and quality of life, concentrating, in particular, on how to help individuals back to a normal life after illness or injury.
Activity is defined in this context as work-related and recreational activities as well as day-to-day tasks and play. The aim of this research is to develop new knowledge in order to improve understanding and management of the consequences of illness and injury which patients encounter during their rehabilitation in the home or workplace.
A branch of research in occupation health therapy at KI is directed at the elderly, including those suffering from dementia or stroke, and their relatives. Another research field is that of children with disabilities, such as cerebral palsy, and the significance of the physical environment. Here the researchers are looking to increase understanding of how factors, such as the development of methods, assessments and treatments affect the chances of experiencing an active and independent life.
Nutrition is concerned with the study of nutrients, their function and metabolism in the body. Nutrition is regarded as that part of medicine in which food and nutrients are the corner-stone of treatment for such illnesses as cardiovascular disease, diabetes, cancer, kidney disease and chronic obstructive pulmonary disease (COPD). Adequate nutrition reduces the risks of complications, helps to prevent infection and helps to maintain or rebuild muscle mass.
Food, meals and eating incorporate many dimensions. At KI current research is focussed on, for example, nutrition during illness, including recording weight change in patients after operations for oesophageal cancer, and on finding the causes of and developing treatments for malnutrition.
Another project is concerned with the nutritional treatment of seriously ill cancer patients who are part of the advanced home nursing programme in the Stockholm region, and patients and their relatives experiences of parenteral nutrition (i.e., intravenous administration of fluid nutrients) when administered in the home environment.
Other areas that KI-researchers are looking at are the combined effect of nutritional treatment and physical activity/training, such as whether this combination can be used as a way of reducing loss of or maintaining muscular power and mass. Anorexia and obesity are other areas that are under investigation in various research projects.
Integrative care research at KI aims to advance the evidence-based development of health care. This will result in a safer, more cost-effective and more appealing health care for both patients and care providers, supplemented by relevant help from complementary medicine.
Researchers also attempt to explain the increasing interest for complementary medicine. In addition to developing and evaluating guidelines and legislation they also develop models of co-operation between certain types of complementary medicine and conventional medicine all parts of the world.
One of the research programmes within integrative care at KI is concerned with the co-ordination of complementary and alternative medicine within a European framework, in order to develop a road map for future research in the speciality. Another program is concerned with obtaining further understanding of benefits and risks with complementary cancer therapies. A third example of research taking place at KI in this area concerns how to improve the health of stroke patients by helping them to become more independent through the use of complementary therapies in the rehabilitation process.
KI research in social work is multi-disciplinary and focuses on the correlation between psychosocial factors and health/ill-health and on social and psychosocial aspects of health care. The focus is on the existential condition of the patient in a highly-specialised care apparatus and the evaluation of social and psycho-social approach to patients and their next of kin.
This kind of research includes sexual health, rehabilitation, well-being, perception of sickness, and the life situation of children and adolescents, as well as psycho-social approaches to children and their families. Other research investigates the cancer patient and interplay within the care network of patients.
Organisation, Management, Health Informatics and Health Economics
Health care researchers at KI also investigate how care is managed and how it works at the macro-, meso- and micro levels and contribute knowledge as to how this can be improved. Central themes are organisation and structure, management, guidelines, economics and insurance systems.
Organisation and Management
Health systems are complex. They have their own anatomy, incorporating hospitals, primary care centres, pharmacies and households; and their own physiology, which encompasses management, regulation, finance, personnel, pharmaceuticals and technical services.
Research in health care systems creates the foundations for rational decision-making processes in health care. This concerns, for example, creating platforms for rational decision-making in health care. Amongst other things this requires that the organisation and management of health care contributes to using resources more effectively, and improving patient safety and the quality of care. This research is multi-disciplinary and researchers, practitioners and decision-makers all work together.
Health informatics is concerned with the systematic collection, processing, storage and communication of data, information and knowledge in health services, nursing and care. Central tools are modelling, simulation and visualisation. The aim is to make clinical information easy to understand, reliable, easily accessible and reusable, with the goal of improving the quality of care, and the safety and health of the patient by means of the more effective management of information.
At KI research is aimed at developing the health care computer environment in order to simplify patient care and to make the information that is needed for intensive care available to doctors more quickly, more safely and more simply.
Health economics researchers at KI study how limited resources can be used to improve health care nationally and internationally. This area of research evaluates methods of treatment by comparing the costs and benefits of different treatments, as well as studying how reforms in health care affect productivity, efficiency and equality.