<p>ABSTRAKT</p><p>Kvinnors tillfredsställelse med mödrahälsovården (MHV), påverkas av olika faktorer, dels av kvinnornas egna förväntningar inför födandet, amningen och föräldraskapet, som bland andra vi som barnmorskor är med och skapar, dels av faktorer av organisatorisk karaktär.</p><p>Syftet med denna studie var att beskriva kvinnors tillfredsställelse med MHV samt att studera om denna förändrats över tid.</p><p>En enkätstudie utfördes vid Sundsvalls sjukhus före och efter införandet av eftervård för nyförlösta kvinnor på vårdhotell år 2005. Under dessa år genom¬fördes även vissa organisatoriska förändringar inom MHV för Medelpad- Ångermanland. Studien är epidemiologisk, icke-experimentell och deskriptiv med retrospektiva jämförelser av data från två kohorter föräldrapar, 2004 respektive 2006. En beräkning av relativa risker med 95 % konfidensintervall och en logistisk regressionsanalys av de signifikanta variablerna med beräkning av oddskvot för tillfredsställelsen gjordes.</p><p>Resultatet visade att de viktigaste faktorerna för tillfredsställelse med helheten av MHV var att få stöd av barnmorskan, att få information om graviditeten, förlossningen och tiden efter förlossningen, samt att inte få färre besök än enligt gällande basprogram. Det fanns en minskad tillfredsställelse med helheten av MHV mellan åren 2004 och 2006. Resultatet genererar ett behov av förbättrat stöd, samt en upprepad mätning av tillfredsställelsen med MHV inom enheten.</p><p>Nyckelord: Barnmorskor, enkäter, hälsoupplysning, mödravårdscentraler, psykosocialt stöd, socialt nätverk.</p>

<p>The discussion of a palliative care and a dignified death has almost exclusively been applied to people dying of cancer. As people are getting older and are living longer, nursing homes have become an important place for end-of-life care and death. Dignity is a concept often used in health care documents but their meaning is rarely clarified. </p><p>The main aim of this thesis was to gain a deeper understanding of what dignity meant to older people in end of life care as well as to nursing home staff. The thesis comprises four studies. The first and second study involved older people living in nursing home settings studied from a hermeneutic perspective. In the first study twelve older people in two nursing homes were interviewed two to four times over a period of 18–24 months during 2002–2003. Altogether, 39 interviews were analyzed by a hermeneutic method. Dignity was closely linked to self-image and identity. The themes of unrecognizable body, dependence and fragility constituted threats to dignity. The third theme, inner strength and sense of coherence, seemed to assist the older people in maintaining dignity of identity. In the second study the aim was to acquire a deeper understanding of how three older women from study I, created meaning in everyday life at the nursing home. A secondary analysis was carried out and showed meaning in everyday life was created by an inner dialogue, communication and relationships with others. The third study was to explore nursing home staff members’ experience of what dignity in end-of –life care means to older people and to themselves. </p><p>Totally 21 interviews with staff were carried out and analyzed through a qualitative content analysis. The meaning of older people’s dignity was conceptualized as feeling trust, which implied being shown respect. Staff members’ dignity was conceptualized as maintaining self-respect. Dignity was threatened in situations where staff experienced themselves and the older people as being ignored and thereby marginalized. The fourth study was carried out through focus groups discussions with 20 staff members about seven older peoples dying death and care. The analyses showed that conversations and discussions about death were rare. Death was surrounded by silence. It was disclosed that the older dying person’s thoughts and attitudes of death were not explicitly known. A dignified death meant alleviation of bodily suffering and pain and meaningfulness. The staff’s ethical reasoning mainly concerned their experience of a gap between their personal ideals of what a dignified end of life should include and what they were able to provide in reality, which could result in conscious stress. Staff members need training and support. End of life care demands competence and teamwork. </p><p>A challenge for future care of older people would be to develop a nursing home environment in which human dignity is promoted. </p>

<p>Isaksson, A-K. 2007 Chronic sorrow and quality of life in patients with multiple</p><p>sclerosis. Written in English with a Swedish summary. Örebro Studies in Caring</p><p>Sciences 12. Pp.85.</p><p>The overall aim of this thesis was to increase our understanding and knowledge of</p><p>patients’ experiences of living with multiple sclerosis (MS). A mixed-method design was used, including both qualitative and quantitative methods. Thirty-one</p><p>immunologically treated MS patients were randomly selected and matched with</p><p>patients without immunological treatment. Matching criteria were gender, impairment, time since diagnosis and age. One patient dropped out and therefore the final sample consisted of 61 patients. All 61 were interviewed (Studies I, III and IV) and completed the 36-item Short Form health survey questionnaire (SF-36), the Subjective estimation of Quality of Life questionnaire (SQoL), the Self-reported Impairment Check-list (SIC) (Study II) and the Montgomery–Asberg Depression Rating Scale questionnaire (MADRS) (Study III). The interviews were subjected to content analysis.</p><p>Initial symptoms and being diagnosed with MS were described in terms of</p><p>becoming vulnerable and remaining in that vulnerability long after the diagnosis.</p><p>Eventually the patients were able to manage this emotional distress and acquired</p><p>strength in their illness situation (Study I). In the matched analysis, 29 pairs of patients were included after internal drop-out. There were no statistically significant differences between the treatment and control groups. Concerning the total group of 61 patients, the self-reported impairment check-list showed that they had various problems of impairment, most evident in balance and walking. The score on health-related quality of life (SF-36) was reduced, disclosing a negative influence on vitality, physical role and function. However, subjective quality of life (SQoL) was not reduced, showing that the patients estimated their well-being to be quite unaffected (Study II). Thirty-eight of the 61 patients (62%) experienced chronic sorrow (Study III). The group were not</p><p>depressed in general, only four having mild symptoms of depression, revealing that chronic sorrow is a particular form of emotional distress in MS. Chronic sorrow was experienced in terms of loss of hope, loss of control over the body and loss of integrity and dignity. When the patients could not adequately manage their sorrow and lacked support, they were struggling with their vulnerability. In the successful management of MS, losses and emotional distress are managed in such a way as to enhance personal growth, appreciation and trust in life. The theoretical model of chronic sorrow facilitated the sorting of the empirical data and the linking of these data to theory, showing the usefulness of the model (Study IV).</p><p>Key words: Multiple sclerosis, illness experience, diagnosis experience, impairment, health-related quality of life, subjective quality of life, immunological treatment, chronic sorrow, depression, managing chronic illness, content analysis, well-being.</p><p>Ann-Kristin Isaksson, Department of Health Sciences, Örebro University,</p><p>SE-701 82 Örebro, Sweden. E-mail: ann-kristin.isaksson@hi.oru.se</p>

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The discussion of a palliative care and a dignified death has almost exclusively been applied to people dying of cancer. As people are getting older and are living longer, nursing homes have become an important place for end-of-life care and death. Dignity is a concept often used in health care documents but their meaning is rarely clarified. The main aim of this thesis was to gain a deeper understanding of what dignity meant to older people in end of life care as well as to nursing home staff. The thesis comprises four studies. The first and second study involved older people living in nursing home settings studied from a hermeneutic perspective. In the first study twelve older people in two nursing homes were interviewed two to four times over a period of 18–24 months during 2002–2003. Altogether, 39 interviews were analyzed by a hermeneutic method. Dignity was closely linked to self-image and identity. The themes of unrecognizable body, dependence and fragility constituted threats to dignity. The third theme, inner strength and sense of coherence, seemed to assist the older people in maintaining dignity of identity. In the second study the aim was to acquire a deeper understanding of how three older women from study I, created meaning in everyday life at the nursing home. A secondary analysis was carried out and showed meaning in everyday life was created by an inner dialogue, communication and relationships with others. The third study was to explore nursing home staff members’ experience of what dignity in end-of –life care means to older people and to themselves. Totally 21 interviews with staff were carried out and analyzed through a qualitative content analysis. The meaning of older people’s dignity was conceptualized as feeling trust, which implied being shown respect. Staff members’ dignity was conceptualized as maintaining self-respect. Dignity was threatened in situations where staff experienced themselves and the older people as being ignored and thereby marginalized. The fourth study was carried out through focus groups discussions with 20 staff members about seven older peoples dying death and care. The analyses showed that conversations and discussions about death were rare. Death was surrounded by silence. It was disclosed that the older dying person’s thoughts and attitudes of death were not explicitly known. A dignified death meant alleviation of bodily suffering and pain and meaningfulness. The staff’s ethical reasoning mainly concerned their experience of a gap between their personal ideals of what a dignified end of life should include and what they were able to provide in reality, which could result in conscious stress. Staff members need training and support. End of life care demands competence and teamwork. A challenge for future care of older people would be to develop a nursing home environment in which human dignity is promoted. / Hemmet som den sista vårdplatsen

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ABSTRAKT Kvinnors tillfredsställelse med mödrahälsovården (MHV), påverkas av olika faktorer, dels av kvinnornas egna förväntningar inför födandet, amningen och föräldraskapet, som bland andra vi som barnmorskor är med och skapar, dels av faktorer av organisatorisk karaktär. Syftet med denna studie var att beskriva kvinnors tillfredsställelse med MHV samt att studera om denna förändrats över tid. En enkätstudie utfördes vid Sundsvalls sjukhus före och efter införandet av eftervård för nyförlösta kvinnor på vårdhotell år 2005. Under dessa år genom¬fördes även vissa organisatoriska förändringar inom MHV för Medelpad- Ångermanland. Studien är epidemiologisk, icke-experimentell och deskriptiv med retrospektiva jämförelser av data från två kohorter föräldrapar, 2004 respektive 2006. En beräkning av relativa risker med 95 % konfidensintervall och en logistisk regressionsanalys av de signifikanta variablerna med beräkning av oddskvot för tillfredsställelsen gjordes. Resultatet visade att de viktigaste faktorerna för tillfredsställelse med helheten av MHV var att få stöd av barnmorskan, att få information om graviditeten, förlossningen och tiden efter förlossningen, samt att inte få färre besök än enligt gällande basprogram. Det fanns en minskad tillfredsställelse med helheten av MHV mellan åren 2004 och 2006. Resultatet genererar ett behov av förbättrat stöd, samt en upprepad mätning av tillfredsställelsen med MHV inom enheten. Nyckelord: Barnmorskor, enkäter, hälsoupplysning, mödravårdscentraler, psykosocialt stöd, socialt nätverk.