Bakgrund – Stress påverkar kroppen både fysiskt och psykiskt, för att stressen inte ska ge negativa effekter är det viktigt med återhämtning. Stress i arbetet är vanligt förekommande framförallt inom sjukvården och kan uppstå då det ställs höga krav på individen. För att undvika att stressen ska påverka individen används olika former av hanteringsstrategier, det kan vara allt från problemlösande- till emotionellstrategier. Syfte – Att beskriva vårdpersonalens hanteringsstrategier vid arbetsrelaterad stress. Metod – En litteraturstudie med elva kvalitativa studier inkluderades, dessa analyserades med hjälp av Forsberg och Wengström, inspirerad av metod för innehållsanalys. Resultat – Författarnas resultat visade på två kategorier, ”problemlösande hanteringsstrategier” och ”känslomässiga hanteringsstrategier”, samt åtta underkategorier, ”att söka, ge och erhålla stöd”, ”att prioritera och planera arbetet”, ”att utföra aktiviteter”, ”reflektion och pauser”, ”att använda humor”, ”ilska och undvikande”, ”substansanvändning” och ”andlighet och tro”. Konklusion – Omvårdnadsyrket är ett krävande område där stress är oundvikligt, därför är det viktigt att hantera den stress som uppkommer i arbetet för att kunna bibehålla fokus. Mer forskning på effektiva strategier för stresshantering krävs. / Background - Stress affects the body both physically and mentally, to avoid negative effects of stress, it’s important with recovery. Occupational stress is common especially in health care personal and can occur when there are high work demands on the individual. To avoid occupational stress affect on the individual the use of various forms of coping strategies, it can vary from problemsolving- to emotional coping strategies. Purpose - To describe healthcare personnel management of occupationalstress. Method - A Literaturereview with eleven qualitative studies were included, these were analyzed by Forsberg and Wengströms, inspired by the method of content analysis. Results - The authors' results demonstrated in two categories, "problemsolving coping strategies" and "emotional coping strategies" and eight subcategories, "to seek, give and receive support", "to prioritize and plan work", "to perform activities", "reflection and breaks","use of humor", "anger and avoidance", "substance use" and "spirituality and faith". Conclusion – The nursing profession is a demanding area where stress is inevitable, therefore it is important to manage the stress that arises in the workplace in order to maintain focus. More research on effective strategies for stress management is required.

Hurricane Katrina devastated New Orleans in 2005. Certified Registered Nurse Anesthetists (CRNAs) and Student Registered Nurse Anesthetists (SRNAs) were impacted by the storm. CRNAs were required to be on duty during the storm and SRNAs’ education was disrupted by the storm. This dissertation is a compilation of three papers that represent the initial exploratory research into the impact of natural disasters on CRNAs and future CRNAs. The first article was a focused ethnography utilizing focus groups and described the shared experiences of CRNAs who were on duty in New Orleans during Hurricane Katrina and the psychosocial impact the storm had on them. Ten CRNAs participated in focus groups that were audio-recorded, transcribed and analyzed. Six major themes emerged from the study and represented how the CRNAs appraised and coped with the stressful events surrounding Hurricane Katrina. The psychosocial impact of Hurricane Katrina on the CRNAs resulted in short-term sleep disturbances and a temporary increase in alcohol consumption. The second article was also a focused ethnography that utilized focus groups to describe the shared experiences of SRNAs whose senior year was disrupted by Hurricane Katrina and the psychosocial impact the storm had on them. Ten former SRNAs participated in focus groups that were audio-recorded, transcribed, and analyzed. Three major themes emerged from the study and represented how the SRNAs appraised and coped with the stressful events surrounding Hurricane Katrina. The psychosocial impact of Hurricane Katrina on the SRNAs resulted in temporary increased alcohol consumption and anxiety. The third article discussed the results of an observational study regarding the impact of Hurricane Katrina on the outcome of the Self-Evaluation Exam (SEE) taken by senior-level students in the Louisiana State University Health Sciences Center Nurse Anesthesia Program. A convenience sample consisted of 174 former students. Regression analysis revealed the relationship between the overall percentile score of the SEE and the year the test was taken (prior to or after Hurricane Katrina) while adjusting for potential confounding variables. The findings suggest that Hurricane Katrina did not have an impact on the outcome of the SEE taken by these individuals.

Bakgrund – Stress påverkar kroppen både fysiskt och psykiskt, för att stressen inte ska ge negativa effekter är det viktigt med återhämtning. Stress i arbetet är vanligt förekommande framförallt inom sjukvården och kan uppstå då det ställs höga krav på individen. För att undvika att stressen ska påverka individen används olika former av hanteringsstrategier, det kan vara allt från problemlösande- till emotionellstrategier. Syfte – Att beskriva vårdpersonalens hanteringsstrategier vid arbetsrelaterad stress. Metod – En litteraturstudie med elva kvalitativa studier inkluderades, dessa analyserades med hjälp av Forsberg och Wengström, inspirerad av metod för innehållsanalys. Resultat – Författarnas resultat visade på två kategorier, ”problemlösande hanteringsstrategier” och ”känslomässiga hanteringsstrategier”, samt åtta underkategorier, ”att söka, ge och erhålla stöd”, ”att prioritera och planera arbetet”, ”att utföra aktiviteter”, ”reflektion och pauser”, ”att använda humor”, ”ilska och undvikande”, ”substansanvändning” och ”andlighet och tro”. Konklusion – Omvårdnadsyrket är ett krävande område där stress är oundvikligt, därför är det viktigt att hantera den stress som uppkommer i arbetet för att kunna bibehålla fokus. Mer forskning på effektiva strategier för stresshantering krävs. / Background - Stress affects the body both physically and mentally, to avoid negative effects of stress, it’s important with recovery. Occupational stress is common especially in health care personal and can occur when there are high work demands on the individual. To avoid occupational stress affect on the individual the use of various forms of coping strategies, it can vary from problemsolving- to emotional coping strategies. Purpose - To describe healthcare personnel management of occupationalstress. Method - A Literaturereview with eleven qualitative studies were included, these were analyzed by Forsberg and Wengströms, inspired by the method of content analysis. Results - The authors' results demonstrated in two categories, "problemsolving coping strategies" and "emotional coping strategies" and eight subcategories, "to seek, give and receive support", "to prioritize and plan work", "to perform activities", "reflection and breaks","use of humor", "anger and avoidance", "substance use" and "spirituality and faith". Conclusion – The nursing profession is a demanding area where stress is inevitable, therefore it is important to manage the stress that arises in the workplace in order to maintain focus. More research on effective strategies for stress management is required.

Bakgrund: I sin professionella roll är sjuksköterskan en vårdare med högre utbildning. Sjuksköterskor arbetar nära andra individer i sitt arbete; andra yrkeskategorier såväl som patienter, anhöriga och allmänhet. Sjuksköterskan är en individ med sin egen integritet och hälsa samt har behov av trygghet på arbetsplatsen. För trygghet och god hälsa spelar känslan av sammanhang på arbetet in. Sjuksköterskeyrket är kvinnodominerat. Det är vanligare att kvinnor än män utsätts för sexuella ofredanden.  Syfte: Syftet var att beskriva sjuksköterskors erfarenheter av sexuella ofredanden på arbetsplatsen. Metod: Litteraturöversikt med totalt tolv stycken ingående artiklar av kvantitativ och kvalitativ design. Resultat: Sexuella ofredanden mot sjuksköterskor kan begås av patienter, anhöriga och kollegor. Den som ofredar är i regel man. Sjuksköterskan kan ha svårigheter att avgöra ifall patienter med kognitiv svikt är medveten om sina sexuella handlingar. Sjuksköterskor som har blivit utsatta för sexuellt ofredande reagerar på olika sätt, både i den pågående händelsen och efteråt.  Att bli utsatt för sexuellt ofredande kan medföra olika sorters negativ påverkan i den professionella rollen och för individens egen hälsa. Konklusion:  Ytterligare forskning behövs, studien beskriver att sjuksköterskor har olika erfarenheter av sexuella ofredanden, där strategier för att hantera det i många fall saknas eller är otillräckliga. / Background: A registered nurse is a caregiver with an academic degree. In their profession, nurses have close encounters with other individuals; including colleagues with other professions as well as patients and their relatives. A nurse is also an individual with own sense of integrity and health, and with a need for a safe work enviroment. The majority of nurses are women. Women are more likely to be victims of sexual harassment than men. Purpose: The aim was to describe nurses experience of sexual harassment in their workplace. Method: Literature review containing twelve articles with qualitative and quantitative method. Result: The perpetrator in sexual harassment against nurses is either a patient or its family or a colleague, often a male. Patient whom suffers from cognitive impairment are difficult to assess if they are aware of their actions if they sexual harass a nurse. Nurses whom have been sexual harassed react in different ways, both in the on-going incident and afterwards. Being sexual harassed may lead to different kinds of negative influence in the nurse’s professional role as well in their own health. Conclusion: More research is necessary, this study describes that nurses have different experiences of sexual harassment, strategies for management is non-existing or not efficient enough.

Bakgrund: Barnmisshandel är ett stort globalt problem, i Sverige är trenden för anmälningar av misshandelsbrott mot barn stigande. Svenska lagen rättfärdigar hälso- och sjukvårdspersonal med anmälningsplikt att anmäla misstanke om barnmisshandel till socialtjänsten. Det finns dock forskning att anmälningar inte sker på grund av exempelvis okunskap kring upptäckt av misshandel samt anmälningsprocessen. Det finns oklarhet över de känslomässiga upplevelserna av att vara involverade i barnmisshandelsfall. Syfte: Att beskriva hur sjuksköterskor upplever att vara involverade i barnmisshandelsfall samt att beskriva en metodologisk aspekt i de inkluderande artiklarna. Metod: Beskrivande litteraturstudie utifrån tolv kvalitativa studier. Resultat: Det framkom att sjuksköterskorna upplevde att deras misstanke om barnmisshandel oftast baserades på en magkänsla vilket skapade osäkerhet och frustration. Känslan av osäkerhet är konstant genom hela processen från misstanke till utredning. De upplevdes svårt att upprätthålla ett professionellt förhållningssätt. Flera studier visar att många av deltagarna var rädda för sin egen säkerhet. Sjuksköterskorna kände att dessa fall lämnade djupa spår. Både oro och tillfredsställelse kunde uppstå i samband med anmälan. Under utredningsprocessen visar studier att uppgivenhet och frustration dominerade i samarbetet med Soc, exempelvis på grund av brist i statusuppdatering över fallen. De flesta sjuksköterskorna upplevde att kollegorna var ett stort stöd i processen, dock hade inte alla tillgång till det. Det var totalt 222 deltagare i de inkluderade artiklarna varav 161 sjuksköterskor, mellan 25 - 64 år gamla. Majoriteten var kvinnor och arbetslivserfarenhet som sjuksköterska låg mellan två och 38 år. Slutsats: De olika stegen i ett barnmisshandelsfall sätter framförallt negativa spår på sjuksköterskan. Osäkerhet spelar den största rollen och går som en röd tråd genom alla olika steg. Även om socialt stöd upplevdes som en bra resurs för att kunna hantera dessa situationer finns det många utmaningar kvar att hitta mer lösningsorienterade ansatser. Det behövs en mer salutogen synvinkel i forskning, sjuksköterskeutbildning och i verksamheter, för att förbättra förutsättningar för sjuksköterskor att kunna hantera dessa upplevelser. / Background: Child abuse is a huge global problem and the trend in Sweden in reporting child abuse is increasing. Swedish law obligates health care personnel to report any suspicion of child abuse to child protection services. However, research shows that reports are not happening to the extent they should. Lack in knowledge on how to identify abuse and which process to follow when reporting are the main factors. It is unclear how nurses are emotionally involved when handling a child abuse case. Aim: To describe how nurses experience to be involved in child abuse cases and to describe one methodological aspect of the articles this study is based on. Method: Descriptive literature review based on twelve qualitative studies. Result: Nurses felt that the initial suspicion about a child being abused was often based on gut feeling only, causing both insecurity and frustration. The feeling of insecurity followed most nurses throughout the whole case, from suspicion until investigation. Research showed that most nurses felt it was difficult to maintain a professional attitude. Moreover, nurses were scared for their own lives when dealing with child abuse. The negative emotions were often long lasting. When reporting such a case to the authorities nurses could experience both feelings of anxiety and satisfaction. Throughout the investigation resignation and frustration dominated the nurses' cooperation with child protection services due to lack of status updates, for example. One successful way to deal with insecurity was social support from colleagues, but not everyone had access to such a support network. In total, the included studies comprised 222 participants, 161 of whom were nurses, between 25-64 years old. The majority were women and the participants had work experience as a nurse between two and 38 years Conclusion: Dealing with child abuse cases as a nurse is mostly characterized by negative impressions. The feeling of insecurity is predominant and runs lika a red thread from suspicion to investigation. Social support is perceived as a vital resource in order to deal with child abuse cases. However many challenges remain to find more solution focused approaches. A more salutogenic view is needed in research, nursing education and on the work floor in order to improve the conditions for nurses to be able to cope with these experiences.

Qualified registered nurses are needed to provide bedside care to patients, yet there is a known registered nurse shortage in the United States, which has a global impact on the healthcare industry. Contributing to the nursing shortage is turnover, which is partly due to the inadequacies of preparation for role transition of newly qualified registered nurses. The purpose of this quantitative descriptive study was to determine if there was a relationship between retention and nursing career satisfaction of registered nurses who experience a transition to practice program and those who did not. Duchscher's transition shock theory served as the theoretical basis of this study. The Mariani Nursing Career Satisfaction Scale and the Turnover Intention Scale were completed by 271 registered nurses with 24 months or less of bedside clinical practice. Data collected were analyzed by performing a one-way multivariate analysis of variance. Results revealed there was no statistically significant difference between those who did and those who did not have a transition to practice program on the combined dependent variables of nursing career satisfaction and retention. A positive linear relationship was found between nursing career satisfaction and retention. Retaining satisfied nurses and easing the burden associated with transitioning into practice can impact positive social change. The positive social change can also impact other healthcare professionals, businesses, and consumers who are associated with the newly qualified registered nurse who is transitioning into practice. Results from this study can inspire future researchers to continue to focus on seeking effective methods that will increase nursing career satisfaction and retention of newly qualified registered nurses transitioning into practice.

Many newly graduated registered nurses (NGRNs) leave the nursing profession within the first 2 years of employment in a rural hospital located in the Southwestern region of Oklahoma. A strategy to address this problem was to introduce a mentorship process that would help support the NGRNs as they transition into independent practice in the clinical setting. The goal of this project was to develop a mentorship program for future implementation. The Partners In Nursing (PIN) program sponsored by the Robert Wood Johnson Foundation, and developed by the American Association of Colleges of Nursing and the American Nurses Association, was selected to support the NGRN transition from student nurse to practicing clinician with a goal to improve retention rates by 10 percent. Benner's novice to expert framework and the Psychological Empowerment model were used in the development of activities contained within the mentorship program modules. Barrett's theory of power helped to guide the development of resilience activities for the future participants. An evaluation plan was developed to monitor new nurse progress before and during the program using the Casey and Fink questionnaire to evaluate the needs and job performance of the participants. The target hospital National Database of Nursing Quality Indicators (NDNQI) was analyzed to help justify the project abe used in future evaluations. Facilitating mentorship will result in social change through increased autonomy of the new professionals, along with improved retention which positively impacts patient outcomes. Social change will bridge the gap in retention and the cost of replacing a NGRN. Dissemination of this project is planned to occur both within the facility and at the relevant national organizations supporting nurse educators.

For several decades, the field of nursing has focused on the integration of cultural competence content into its prelicensure educational programs. Despite this focus, little is known about the cultural competence of nurses extending their education past initial licensure into an advanced practice nursing specialty, such as nurse anesthesia. Researchers in other fields have found that provider race and previous cultural competence training are associated with higher levels of cultural competence. This research, guided by the culture care diversity and universality theory, sought to determine the relationship between the two subscales, Cultural Awareness and Sensitivity (CAS) and the Cultural Competence Behavior (CCB) of the Cultural Competence Assessment (CCA) tool, and describe the relationships that exist between selected demographic variables and the total cultural competence scores for nurse anesthetists. One hundred and fifty-eight members of the American Association of Nurse Anesthetists participated in the study. The total CCA score for the population was 4.98 out of a potential total score of 7 (SD = .79). Mean scores were 5.64 (SD = .73) and 4.38 (SD = 1.19) for the CAS and CCB subscales, respectively. Hierarchical multiple regression analysis confirmed a positive relationship between post graduate diversity training and total CCA score (B = .28, p < .05). Identifying the cultural competence of this population and the characteristics that are associated with high levels of cultural competence could lead to better provider awareness of their own interactions and perceptions of patients and improved patient-centered care for patients in minority populations who are served by certified registered nurse anesthetists, resulting in positive social change.

Obesity is a major U.S. public health epidemic. A review of the current literature identified a lack of obesity counseling with individuals. The gap in practice was a lack of understanding of nutrition, nutrition labeling, and how foods affect health. The objective of this project was to identify the community assessment need related to obesity and then educate APRNs on ways to better communicate with obese patients. This project focused on an education program for advanced practice registered nurses (APRNs) on using the 5 A's framework for obesity counseling to improve their knowledge and skill in counseling their overweight and obese patients in a rural primary care clinic. Knowles' adult learning theory was used to develop the education project. The education program was presented to and evaluated by 2 APRNs at a rural health clinic. The providers requested the information be placed online so they could give the presentation their undivided attention. The audio-based PowerPoint presentation and printed copies of the presentation content were e-mailed to each of the providers. The presenter went to the clinic 3 days after placing the presentation online to obtain the evaluations and answer any questions. An impact evaluation assessed the presenter, audience learning experience, and confidence and skill of the participant. The participants reported they had a better understanding of the reality of the obese population and how they could improve their communication by using the 5 A's method of assessment. Both participants reported the presentation was clear and easy to understand. A recommendation was made to conduct a future quality improvement project expanding the use of the educational program. This project has the potential to impact social change by improving health care education and ultimately reducing obesity.

Bakgrund: Sjuksköterskor som arbetar på akutmottagningar möter dagligen patienter som är alkohol- eller narkotikapåverkade. När patienter kommer till akutmottagningen och är påverkade av alkohol eller narkotika förekommer det ofta våld. Det vårdvetenskapliga perspektivet i examensarbetet är Kaséns syn på vårdrelationen och delaktighet. Syfte: Syftet är att beskriva sjuksköterskors erfarenheter av att möta patienter som är påverkade av alkohol eller narkotika på akutmottagning. Metod: Sex narrativa intervjuer har genomförts med sjuksköterskor som arbetar på en akutmottagning i mellersta Sverige. Intervjuerna har analyserats enligt Lundman och Graneheims metod för kvalitativ innehållsanalys. Resultat: Sjuksköterskornas erfarenheter från mötet med patienter med missbruksproblematik är att de kan vara våldsamma och framförallt är det viktigt att tänka på hur man bemöter dem. De ständigt återkommande mötena med dessa patienter på akutmottagningen tar mycket av sjuksköterskornas tid. Blandmissbrukare som är påverkade av både alkohol och narkotika anses vara mest våldsamma och det finns ett uttalat behov av utbildning främst av nya narkotikapreparat som finns på marknaden. Slutsats: Sjuksköterskor bör eftersträva ett professionellt bemötande av patienter med missbruksproblematik. Däremot kan det vara svårt att finna tiden för samtal med dessa patienter. Sjuksköterskor utsätts ibland för våld och trakasserier i mötet med patienter med missbruksproblematik. Därför bör det ställas högre krav på säkerheten på akutmottagningar, för både vårdpersonal och patienter. / Background: Nurses working in emergency departments encounter patients that under the influence of alcohol or narcotics on a daily basis. When patients come to the emergency department under the influence of alcohol or narcotics, there is often violence involved. As the caring science perspective used Kaséns view of the caring relationship and the participation. Aim: The aim is to describe the nurses’ experiences of encountering patients that are under the influence of alcohol or narcotics, in the emergency department. Method: Six narrative interviews were conducted with nurses working in an emergency department in mid-central Sweden. The interviews were analyzed according to Lundman and Graneheim method for qualitative manifest content analysis. Results: The nurses’ experiences of encountering patients with substance abuse problems are that they can be violent and above all it's important to consider their response. These constant and reoccurring encounters with patients in the emergency department are time consuming for the nurses. Among the patients under the influence of both alcohol and drugs are considered to be the most violent and there is a clear and present need for training in narcotics available currently in society. Conclusion: Nurses should seek to respond professionally to patients with substance abuse problems. However, it can be challenging to find the time to talk with these patients. Sometimes nurses are subjected to violence and harassment in the encounters with patients with substance abuse problems. Therefore, higher standards should be set regarding the safety of emergency departments, for both health professionals and patients.