<p>Caregivers of individuals with dementia describe a wide spectrum of caregiving experiences, ranging from very negative to very positive. Previous literature acknowledges these differing experiences, but how and why they differ has rarely been investigated. Dementia caregiving can be burdensome with many psychological, physical, social and financial challenges. However, it can also be an opportunity for growth and transcendence as caregivers find meaning in caregiving. High levels of mutuality (the perception that the quality of the care relationship is positive), reportedly ameliorates negative caregiver outcomes. Thus, this dissertation consists of three studies that explore aspects of the caregiver-care recipient relationship that may enhance positive caregiving experiences. </p><p> The first study was a secondary analysis of factors related to caregivers' perceptions of care relationship mutuality over a 12 month period. Caregivers who reported high mutuality were less likely to be depressed and more likely to provide care for longer periods before deciding to institutionalize the care recipient. The second study was a secondary analysis of caregiver interviews. It revealed that caregivers who reported a positive caregiving experience described both their past and present relationship in loving terms and reported that they understood their care recipient could not reciprocate. These caregivers focused on aspects of the relationship that still existed, rather than on what they had lost. They expressed satisfaction with caregiving, were other-focused, and reported little caregiving burden. The third study was a qualitative descriptive study. Caregivers who reported finding meaning in caregiving were interviewed to explore how they were able to do so. These caregivers used strategies such as accepting the situation, deciding to care, choosing a positive attitude, focusing on the blessings of caregiving, and actively seeking care resources. They demonstrated altruistic values and the determination and discipline to live those values. They also possessed strong faith, love, and social support, and said they had derived strength from past challenges.</p><p> Clinicians and researchers should explore the quality of the caregiving relationship as a critical factor in caregiver and care recipient outcomes. Caregiver interventions should include relationship-building skills and empathy building techniques to offset adverse caregiver outcomes and enhance understanding and acceptance of changes that occur in the care recipient over time.</p> / Dissertation

Bakgrund: Att leva med trauma kan leda till stor psykisk påfrestning. Ångest, skam, skuld, sorg och ilska är vanliga känslor som kan uppkomma. Sjuksköterskan bör besitta självförtroende, kunskaper och skicklighet i att hantera frågor gällande trauma hos patienter. Syfte: Att beskriva patienters upplevelser av att hantera och leva med trauma. Metod: En litteraturbaserad studie, baserad på analys av elva kvalitativa vetenskapliga artiklar. Resultat: Resultatet presenterades i två huvudkategorier; Betydelsen av gemenskap vid bearbetning av trauma samt betydande faktorer för att hantera trauma. Med sju tillhörande underkategorier; samhörighet och tillhörighet, den främjande effekten av att hjälpa andra, återhämtningsstrategier, copingstrategier, relevansen av en god vårdrelation, andlig och spirituell vägledning samt stöttning vid återhämtning från trauma. Det mest framträdande i resultatet, var att patienternas återhämtning främjades av att vara i sammanhang med andra som hade liknande erfarenheter. Coping- och återhämtningsstrategier, var individuellt framgångsrika hos patienterna och det var därför angeläget att få prova på flera olika strategier under behandlingen. Konklusion: Patienter har olika uppfattning om fungerande strategier för att hantera trauma. En god vårdrelation är betydande för patienter som bearbetar trauma. Sjuksköterskan behöver besitta kompetens för att kunna bemöta dessa patienter. / Background: Living with trauma can lead to great mental stress. Anxiety, shame, guilt, sadness and anger are common emotions that can arise. The nurse needs to have self-confidence, knowledge and skills in dealing with questions regarding trauma in patients. Aim: To describe patients’ experiences of dealing with and living with trauma. Method: A literature-based study, based on the analysis of eleven qualitative scientific articles. Findings: The results were presented in two main categories; The importance of community in processing trauma and significant factors in dealing with trauma. With seven associated subcategories; togetherness and belonging, the fostering effect of helping others, recovery strategies, coping strategies, the relevance of a good caregiving relationship, spiritual and spiritual guidance and support in recovery from trauma. Most prominent in the results, was that the patients' recovery was promoted by being in context with others who had similar experiences. Coping and recovery strategies were individually successful with the patients and it was therefore important to try several different strategies during the treatment. Conclusion: Patients have different perceptions of effective strategies for dealing with trauma. A good caregiving relationship is significant for patients processing trauma. The nurse needs to have competence to be able to deal with these patients.

The ideal of reason is central to contemporary accounts of citizenship in American constitutional law. The individual capacity for reasoned choice lies closely aligned with the constitutional values of personal liberty and democratic self-government as they have evolved in Supreme Court decisions over the past century. Yet as presently conceived, the ideal of reason in constitutional law overlooks the process by which individuals actually acquire the capacity to choose their own values and commitments or to engage in reasoned thinking about collective ends. This paper argues that we cannot hope to sustain and foster a constitutional polity committed to the principles of individual liberty and democratic self-government without knowing something about how individual citizens come to possess this requisite skill of mind. A developmental perspective on reason in constitutional law provides a framework for examining the source and contours of the psychological skills that make it possible to lead an autonomous, self directed life and to participate meaningfully in the processes of democratic self-government. Developmental psychology, together with research in related fields, provides empirical support for the proposition that the psychological capacity for reasoned thinking has its roots in the early caregiving relationship. Thus, a comprehensive and integrated constitutional family law must recognize the role of early caregiving in the political socialization of children. This developmental approach offers a substantial reworking of constitutional doctrine in the areas of family privacy, parental rights, congressional power, and affirmative welfare rights. / El ideal de la razón es central a las nociones contemporáneas de ciudadanía en el derecho constitucional estadounidense. La capacidad individual de hacer elecciones razonadas es afín a los valores de libertad personal y de autogobierno democrático, tal como se han desarrollado en las decisiones de la Corte Suprema a lo largo del último siglo. Sin embargo, en su concepción actual, el ideal de la razón en el derecho constitucional estadounidense ignora el proceso mediante el cual los individuos adquieren efectivamente la capacidad de escoger sus propios valores y compromisos, o de razonar acerca de sus objetivos colectivos. Este ensayo sostiene que no podemos fomentar y mantener un cuerpo social entregado a los principios de la libertad individual y del autogobierno democrático sin entender cómo es que los ciudadanos adquieren esta habilidad mental necesaria. Una perspectiva del desarrollo acerca de la razón en el derecho constitucional nos proporciona un marco para examinar el origen y el perfil de las habilidades psicológicas que permiten llevar una vida autónoma y autodirigida así como participar significativamente en los procesos de autogobierno democrático. La psicología del desarrollo, en conjunto con la investigación en áreas relacionadas, proporciona un sustento empírico a la proposición de que la capacidad psicológica para el pensamiento razonado tiene sus raíces en la relación temprana de cuidado. Por ello, un derecho constitucional de familia integral e integrado debe reconocer el rol del cuidado infantil temprano en la socialización política de los niños. Esta perspectiva de la psicología del desarrollo ofrece un replanteo de la doctrina constitucional en lo que respecta a privacidad familiar, derechos parentales, facultades del Congreso y derechos de bienestar social afirmativos.

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