Background: People with a chronic illness such as asthma / COPD (chronic obstructive pulmonary disease), diabetes and congestive heart failure/hypertension are now a days returning to home from hospital a lot earlier than before and therefore need more support, advice, and help from the primary care nurse to be able to manage the disease Aim: The aim of the study was to describe the nurse´s strategies in the meeting with the patient in order to create the best preconditions for a good self-care. Method: A qualitative study was set up. Eight nurses with specialist responsibility within the area of asthma / COPD (chronic obstructive pulmonary disease), diabetes or congestive heart failure/hypertension were interviewed. The interviews were analyzed according to a qualitative content analysis. Results: From the analyzed interview material four categories with each three sub-categories emerged. The four categories that appeared was: To be based on the patient´s needs, to see the whole individual, to reach the patient through means and to move forward when things does not work out as planned. Common for these four categories is the rule of the nurse guiding the patient in the realization of a good self-care. Conclusion: All nurses in the study stresses the importance of seeing and meeting the patient on his level, in order to be able to support, help and provide the tools needed for the realization of a good self-care. / Bakgrund: Många patienter med kroniska sjukdomar såsom astma/KOL, diabetes och hjärtsvikt/hypertoni kommer hem allt tidigare från en sjukhusvistelse och behöver därför mer support, råd och hjälp från sjuksköterskan inom primärvården för att kunna hantera sin sjukdom. Syfte: Syftet med studien var att beskriva sjuksköterskans strategier för att skapa så goda förutsättningar som möjligt för en bra egenvård hos patienten. Metod : En kvalitativ studie genomfördes. Åtta sjuksköterskor med specialistansvar som astma/KOL, diabetes eller hjärtsvikt/hypertonisjuksköterska på vårdcentral intervjuades. En kvalitativ innehållsanalys av insamlad data genomfördes. Resultat: Ur det analyserade intervjumaterialet växte fyra kategorier med vardera tre tillhörande subkategorier fram. De fyra kategorierna som framkom var: Att utgå ifrån patientens behov, Att se hela individen, Att nå patienten genom användning av hjälpmedel och Att komma vidare när det inte blir som planerat. Som en röd tråd genom dessa kategorier går sjuksköterskans roll i att vägleda patienten i genomförandet av en god egenvård. Slutsats: Samtliga sjuksköterskor i studien framhåller vikten av att se och möta patienten på dennes nivå. Detta för att nå fram till patienten och kunna stötta och ge den hjälp och de redskap patienten behöver i genomförandet av egenvård.

In this thesis I set out to show that the bioethical literature concerning the treatment of chronic suicidal ideation occupies a serious omission: it does not discuss the critical function that self-trust serves in the recovery process. Self-trust is a core component of autonomy, and therefore plays a pivotal role in the shaping of one’s sense of self and his or her capacity to effectively engage in therapeutic interventions. I begin by discussing the relationship between agency and self-trust, and how this influences one’s ability to make decisions and self-advocate. Secondly, I evaluate how self-trust relates to aspects of the suicidal mind, including existential distress and negative urgency. Finally, I will offer recommendations as to how the explicit (re-) development of self-trust skills can significantly enhance the effectiveness and timeliness of contemporary dialectical treatment practices. / Thesis / Master of Arts (MA)

The purposes of this study were to explore the needs and concerns of the siblings of children hospitalized with a chronic illness and to explore the role that Child Life Specialists play in the lives of siblings. Face-to-face and telephone interviews with Child Life Specialists from three central Florida pediatric hospitals were conducted and analyzed. Through these interviews, I gained the perspective of the Child Life Specialist’s role concerning the needs and concerns of siblings as well as their role in meeting those needs. The interviews were tape-recorded and later transcribed and analyzed with a qualitative approach. I predicted that the results would show many similarities among Child Life Specialists' perceptions related to their experiences with siblings and would solidify the role that they play in meeting the needs of siblings. This study validated the worth of the Child Life Specialist in the hospital setting in aiding in the psychosocial development of hospitalized children and their families. I concluded from the data that all of the Child Life Specialists agreed that they were needed in the hospitals to help siblings deal with the psychosocial needs separate from the needs of the hospitalized child. All the Child Life Specialists helped siblings in the hospital; however there was a fair amount of inconsistency regarding how the needs of siblings were met. All the Specialists believed they were relieving anxiety; with differences in the methods to relieve anxiety. They all believed they made a positive impact in the siblings’ hospital experiences with a fair amount of variance in their perceived level of impact. There are very few research studies in the fields of child development and child life regarding psychosocial development of siblings of chronically ill children. Therefore, I felt it pertinent to conduct an exploratory study that would provide relevant and factual information to both fields that could, in turn, inspire future research in both fields. Through this study, I have discovered that Child Life Specialists employ a variety of methods in meeting the needs of siblings of children diagnosed with a chronic illness. I have also discovered that Child Life Specialists perceive themselves as being able to make a positive impact on the coping and psychosocial needs of the siblings of children hospitalized with chronic illness Further research in this area is needed. First and foremost, a study is needed in which the siblings are interviewed so that their needs are correctly identified, and Child Life Specialists can intervene appropriately. Second, this particular study focused on central Florida, and future studies should expand the geographic regions to other areas of the United States. Third, this particular study focused on chronic disease diagnosis of the child in the hospital, and additional studies are needed so that all siblings of all children in the hospital for any reason are studied. Therefore, I predicted that siblings would have different needs of attention from one another, depending on diagnosis of chronically ill sibling and family situation, and that Child Life Specialists would employ a variety of methods in differentiating for and meeting those needs.

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