published_or_final_version / Nursing Studies / Master / Master of Nursing

published_or_final_version / Nursing Studies / Master / Master of Nursing

Syftet med litteraturstudien var att belysa vad motivation är och kan vara inom omvårdnad. Metoden för studien var litteraturstudie där åtta vetenskapliga artiklar redovisas i resultatet. Begreppet motivation är en viktig faktor för människan som patient i olika övergångar/rörelser från ohälsa till hälsa. Det är patientens egen motivation som är avgörande hur patienten lyckas att nå sina mål. Viktiga faktorer i motivationen är att patienten har en självmedvetenhet, att patienten känner förtroende för sjuksköterskan och en närvaro av de närstående. Motivationen kan grunda sig i rädslan för det oönskade jaget och en strävan till det önskade jaget där patientens ekonomiska förutsättningar kan ha en negativ inverkan på motivationen då ekonomin på olika sätt kan ge förutsättningar för patienten att genomföra de uppsatta målen. Sjuksköterskans arbete skall präglas av evidensbaserad omvårdnad. Begreppet motivation saknas som meningsbärande evidensbaserat ord i delar av omvårdnadsprocessen, omvårdnadsdiagnos, omvårdnadsmål och omvårdnadsåtgärder. Att förbise patientens motivationsrörelse i omvårdnadsprocessen kan leda till minskad motivation hos patienten, ökad vårdtid och en ökad kostnad för samhället. Motivationens betydelse i omvårdnadsprocessen och vikten av motivation uppmanas att i framtiden vidareutvecklas. / The aim of the study was to highlight the meaning of what motivation is and can be in the area of nursing care. The method used was a literature study comprised of eight scientific articles.  Motivation is an important factor for human beings in the transition from illness to well-being/health. It is the patient’s own motivation that determines how they will reach their goals. Important motivational factors are that the patient has self-awareness, confidence in his/her nurse and a presence of loved ones (relatives and friends). Motivation can be based on fear of the undesired self and pursuit of the desired self where the patients’ financial conditions can negatively affect the motivation due to the fact that financial constraints can affect the patients’ possibility to reach their determined goals. Evidenced based nursing care should define the nursing process and care given by the nurses. The term motivation is missing as a defined evidence based word in the nursing process, nursing diagnosis, nursing goals and nursing measures. To ignore the patients’ motivational journey in the nursing process can lead to a decrease in motivation, increased length of stay and therefore an increased financial cost for society. It is of great importance for future reference to further determine the effect of motivation on the nursing process.

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This thesis explores nurses' and patients' perceptions of caring relationships in a hospital context. An attempt is made to discover the meaning these caring relationships have for the nurses who provide care and for the patients who participate in this process. The nurses enter into the caring relationship as voluntary and professional participants. The patients come into hospital because of illness. The relationship entered into is claimed to be a caring relationship yet little is known about the personal experiences of the participants. In the first part of the study the repertory grid technique was used to structure interviews with 25 experienced nurses. Personal constructs were elicited and rated during the interviews. Six major themes emerged from a content analysis of the constructs. These were: personal qualities, clinical work style, interpersonal approach, level of motivation, concern for others, and use of time. The personal cost of caring for the nurses surfaced as a significant aspect of the caring relationship. In the second part of the study 10 nurses and 10 hospitalised patients were interviewed. These were analysed by means of a method grounded in interpretive phenomenology which focuses on the informants' lived experiences. Nine general themes emerged which captured the nurses' experiences of caring relationships. The themes were: patient dependency, patient circumstances, effectiveness, emotional involvement, stress, preparedness, ward constraints, role uncertainty, and personal benefits. The patients' experiences of being cared for were embodied in four general themes quite different from the nurses. The themes were: vulnerability, self-presentation, service evaluation, and other concerns. The thesis provides many details about the perceptions of caring relationships through the exploration of the lived experiences of nurses and patients in hospital. An extended picture of caring relationships in nursing has emerged. The need to take account of both the professional and consumer perspective is emphasised as it highlights important discrepancies between the views of carers and those they care for. Professional carers must be able to understand the patient in order to care in a personalised way and the approach used here demonstrates how this understanding can be achieved. Such an approach could also be used in nursing practice. The findings and methods used here should also be of interest to other helping professions and consumers of health care.

This study examines specific speech forms that comprise physicians' language use, and motives for use. A coding system combining work on verbal immediacy and conversational involvement was used to assess the language of 19 physicians during 58 videotaped interactions with patients. Physicians were found to use more nonimmediate than immediate speech. Information-giving was positively related to use of nonimmediate speech. Use of implicit nonimmediacy was positively related to physicians' perceptions of the medical community's consensus regarding a patient's condition and recommendations for treatment. Experience was positively related to use of spatial nonimmediacy and automatic phrases. Gender and experience interact to predict use of temporal, implicit, and qualified nonimmediacy. Inexperienced males used the least of these forms of speech, while experienced males used the most. No relationship was found between use of nonimmediate speech and patients' understanding, satisfaction, or met expectations. Implicit nonimmediacy was directly related to patients' behavioral intent to comply. Findings are reviewed for implications to both Communication and Medicine.

The purpose of this study was to investigate how therapists' use of humor in psychotherapy would affect subjects' ratings of those therapists. Short excerpts illustrating different levels of humor were developed by having four professional therapists view videotapes of actual therapy sessions and rate the therapists on amount of humor used. Interjudge agreement was obtained on six excerpts. These six included two excerpts in which the therapists were judged to have used no humor, two in which the therapists were judged to have used a slight amount of humor and two in which the therapists were judged to have used a moderate amount of humor. These six excerpts were then viewed and rated by 72 subjects on the dimensions of empathy, respect, warmth, genuineness, concreteness and self-disclosure. It was found that significant differences existed between all three humor groups on the condition of respect. The group judged to have used no humor was rated superior to the two groups using humor in amount to respect shown by the therapists to the clients. When the two groups judged to have used humor were compared, the group in which the therapists used more humor was rated significantly lower than the group judged to have used a slight amount of humor. It was concluded that subjects' ratings on the condition of respect decreased as greater amounts of humor were introduced by the therapists. Significant differences were not found between humor groups on the conditions of empathy, warmth, genuineness, concreteness and self-disclosure. However, the pattern observed in the subjects' ratings on the conditions of empathy and warmth suggested that the ratings given to therapists decreased as amount of humor increased. The results on the conditions of genuineness and concreteness were inconclusive. On the condition of self-disclosure, the pattern observed in the ratings suggested that a direct relationship existed between amount of humor and ratings received.

This investigation explored the effects of two independent variables choosing a therapist and pretherapy training (PTT) and their interaction on psychotherapeutic outcome. The subjects were students who applied for counseling services at the University of Arizona's Student Counseling Serivice. Six therapists participated in the study by seeing the subjects who were assigned to them by the investigator for three sessions each. Subjects were assigned to one of six groups: (1) first choice therapy and viewing of pretherapy training videotape, (2) other than first choice therapist and viewing of pretherapy training videotape, (3) no choice therapist (random assignment) and viewing of pretherapy training videotape, (4) first choice therapist and not viewing the pretherapy training videotape, (5) other than first choice therapist and not viewing the pretherapy training videotape and, (6) no choice of therapist (random assignment) and not viewing the pretherapy training videotape. All therapists in the study were videotaped conducting a ten minute intake interview with the same model client. Subjects that were in groups requiring choosing a therapist, groups one, two, four, and five, viewed videotapes of three therapists and made their selection from that subgroup. The pretherapy training videotape was a model counseling session between a model therapist and model client followed by a commentary of the ways in which the client behaved appropriately during the counseling session. The two instruments used were a self-report instrument for the clients, the Brief Symptom Psychiatric Rating Scale (Overall and Aronson, 1962). Pretest measures were taken using the Brief Symptom Inventory (BSI) prior to treatment and using the Brief Psychiatric Rating Scale (BPRS) after the first session. Post-test measures using both instruments were taken after the 3rd therapy session. ANCOVAs were performed, using the pre-test score as the covariate. No significant effects were found for the choice variable on either the BSI or the BPRS. Significant effects were found for pre-therapy training on the Depressive Mood and Hostility scales of the BPRS although no effect was found for pretherapy training on the BSI. The only significant interaction effect for the two independent variables was found on the Hostility subscale of the BSI.

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