Bakgrund: Det finns ett mörkertal av barn som utsätts för misshandel. Utan intervention riskerar de att drabbas av fysisk och psykisk ohälsa upp i vuxenlivet. Att möta barn som misstänkts vara utsatt för misshandel är en stark stressor för sjuksköterskor. Syfte: Att beskriva sjuksköterskors erfarenheter av att möta barn som utsatts för misshandel. Metod: En litteraturöversikt med kvalitativ design där 10 artiklar inkluderades i resultatet. Dataanalysen genomfördes enligt Fribergs femstegsanalys. Resultat: Erfarenheter av möten med barn utsatta för misshandel väckte motstridiga känslor inom sjuksköterskan och uppgiften ansågs också svår på grund av att sjuksköterskan kände en osäkerhet i hur de skulle handla i det enskilda fallet. Sjuksköterskors erfarenhet var att de gav stöd till barn och föräldrar genom förtroendefulla relationer men att de också själva var i behov av stöd och utbildning. Slutsats: Sjuksköterskor som ger omvårdnad till barn utsatta för misshandel löper ökad risk för psykisk ohälsa. Kollegialt stöd, handledning, debriefing och utbildning kan motverka detta. Dessa typer av stöd kan öka anmälningsfrekvensen till socialtjänsten gällande barn som utsätts för misshandel. / Background: There are an unknown number of children exposed to child abuse. Without intervention they risk suffering from physical and mental illness in adulthood. Encountering children where child abuse is suspected is a great stressor for nurses. Aim: To describe nurses’ experiences of encounters with children exposed to child abuse. Method: A literature review with qualitative design was conducted, including 10 articles in the result. Data were analysed using Friberg’s five-step analysis. Results: Experiences of encounters with children exposed to abuse aroused conflicting feelings within the nurse and the task was considered difficult because the nurse felt uncertain about how they would act in the individual case. The nurses’ experiences were that they provided support to children and parents through trusting relationships, but that they themselves were also in need of support and education. Conclusion: Caring for children suffering from child abuse leaves nurses in risk of their mental health. Collegiate support, supervision, debriefing and training may function as a counteract. These measures of support may increase the level of report to Social service concerning child abuse.

This study aims to investigate the impact of using stories in pre-school mathematics teaching in Saudi Arabia. An intervention was designed to promote interactive teaching and learning in eight classrooms across three private schools. Integral to the intervention was a series of five stories especially written by the researcher based around the same central characters; reflecting the cultural setting familiar to the children, and with a problem-solving storyline. The stories include a range of mathematical facts, skills and concepts applicable to young learners. Additional resource materials to accompany the stories were also designed and provided for the participating teachers. The researcher adopted a qualitative, constructivist, technical action research approach and three data collection tools were used: a bibliographical questionnaire for the teachers; pre- and post-interventions semi-structured interview schedules, and classroom observations. A thematic analysis of the pre- and post-intervention data was undertaken in order to monitor the impact of using the stories in the pre-school classrooms. The study considers the findings from the data in relation to both the teachers’ and the children's’ experiences pre- and post-intervention. In particular, the impact of the intervention on teachers’ subject knowledge, attitudes, confidence and classroom practice is discussed along with the impact on children’s engagement and enjoyment of mathematics; their mathematical understanding and thinking skills. The study concludes that using stories to teach mathematics had a positive impact on the quality of teaching and learning mathematics. Using the stories prompted a positive change in teacher’s and children’s attitudes and feelings towards mathematics; a greater understanding of key mathematical ideas; and an appreciation of the value and uses of mathematics in everyday life. The implications from the study highlight the importance of providing appropriate training for pre-school teachers (and elsewhere) and the pivotal role that using stories can play in ensuring high quality mathematics teaching and learning.

The purpose of this study was to research the therapeutic outcomes achieved by a five year-old boy with Asperger Syndrome (AS), by means of non-directive processes of child centred play therapy (CCP) and sand tray play therapy (STP). In this investigative-descriptive qualitative research design, a saturated, holistic, intrinsic single case study was used as research method. The therapeutic process, events and outcomes of a unique single case within the context of AS, non-directive play therapy and the interactional-pattern analysis (IPA), are described. This study was motivated by the fact that the researcher disposed of data for a unique single case study that could contribute meaningfully to the need for a research database that describes effective therapeutic interventions and outcomes with children with AS. From the perspective of Rogerian person-centred theory (RPT), the literature study focused on an integrated discussion of AS, CCP and STP by means of 17 interpersonal variables of the interactional-pattern analysis (IPA). The following data sources was investigated: interviews with parents and teachers; CCP-sessions of J recorded on video; photos of some of J’s STP-sessions and the therapists’ process notes. Triangulation was used to evaluate the various categories of therapeutic outcomes from different viewpoints and to give meaning to them. The conclusions indicated that this boy with AS had used the non-directive processes of CCP and STP to achieve various therapeutic outcomes in the areas of: imaginary play; dramatic play; social interaction with the therapist, parents, family, teachers, his peer group and with strangers; traumatic experiences during visits to the doctor and bath times; identification, expressing and regulating emotions; and minimising acting out behaviour. Therapeutic outcomes have been demonstrated in 8 IPA-variables, namely: empathy, defining of relationships, potential to evoke acceptance or rejection, sincere interest and congruent conduct, control, emotional distance, problem solving and aspects relating to the presenting problem. The conclusion was reached that the conduct of the boy with AS as well as his mother and the therapist, played a mutual role in achieving his therapeutic outcomes within the 17 IPA-variables. The unstructured process of the non-directive play (CCP and STP) was utilised by a young child with AS to achieve therapeutic outcomes that relate to his everyday existence. A final conclusion is that involving the boy’s mother in his therapy and utilising an adapted Filial play program, enabled the mother to make emotional contact with her son and to diminish conflict between them. Guidelines for therapists are suggested with regard to non-directive responding in therapeutic contexts as found in this study. Furthermore, the contribution of this research to Psychology as science and discipline, is presented. Limitations of this study are indicated and recommendations for further research are made. / Thesis (Ph.D. (Psigologie))--North-West University, Vaal Triangle Campus, 2013

The aim of this study is to analyse the discourses drawn upon by community paediatric nurses in relation to children’s rights to health. The philosophy of Michel Foucault has been used to underpin the analysis of the interviews and exemplars of five experienced community nurses, revealing conflicting power relationships and discourses. Rights are formalised morality and so from a children’s rights perspective, discourses reflect both the moral and ethical positions of the nurses. Children are constructed as developing human beings whose moral status gradually changes and who, through a lack of developmental autonomy, entrust their decision-making to their representatives (parents and caregivers) as their trustees. Rights are correlative with the obligations and duties toward children by both families and society. Society constructs legislative and politically organised structures to govern raising children because children are an intrinsic social concern. Whilst representing society’s interest in children’s rights to health, nurses in the home act as a conduit for multiple governing structures. The nurses in this study construct their “truths” and knowledge about children’s health rights from nursing, medicine, law, education, and social policy. However, the values of individual parents can conflict with universal values for children’s health and wellbeing. Therefore representing society positions nurses as “agents of the state”, a role that potentially holds power over parents and children and leads to the epithet of “the health police”. Within the institution of the family, and in the privacy of the home, there are also mechanisms of power that can resist the mechanisms of the state and its representatives. Therefore the discourse “it takes a village to raise a child” competes with the “my home is my castle” discourse. Nurses negotiate a fine balance between these power relations. Nurses are challenged with using power productively to promote children’s rights whilst respecting the role of parents and families. I argue that children’s rights are central to the moral and ethical work of nurses but that such work is often obscured and invisible. I propose that children’s community nurses are excellent at negotiating networking and connecting at a micro level, but need to create a more sophisticated and cohesive entity at a macro level to become fully political children’s rights advocates.

The purpose of this study was to research the therapeutic outcomes achieved by a five year-old boy with Asperger Syndrome (AS), by means of non-directive processes of child centred play therapy (CCP) and sand tray play therapy (STP). In this investigative-descriptive qualitative research design, a saturated, holistic, intrinsic single case study was used as research method. The therapeutic process, events and outcomes of a unique single case within the context of AS, non-directive play therapy and the interactional-pattern analysis (IPA), are described. This study was motivated by the fact that the researcher disposed of data for a unique single case study that could contribute meaningfully to the need for a research database that describes effective therapeutic interventions and outcomes with children with AS. From the perspective of Rogerian person-centred theory (RPT), the literature study focused on an integrated discussion of AS, CCP and STP by means of 17 interpersonal variables of the interactional-pattern analysis (IPA). The following data sources was investigated: interviews with parents and teachers; CCP-sessions of J recorded on video; photos of some of J’s STP-sessions and the therapists’ process notes. Triangulation was used to evaluate the various categories of therapeutic outcomes from different viewpoints and to give meaning to them. The conclusions indicated that this boy with AS had used the non-directive processes of CCP and STP to achieve various therapeutic outcomes in the areas of: imaginary play; dramatic play; social interaction with the therapist, parents, family, teachers, his peer group and with strangers; traumatic experiences during visits to the doctor and bath times; identification, expressing and regulating emotions; and minimising acting out behaviour. Therapeutic outcomes have been demonstrated in 8 IPA-variables, namely: empathy, defining of relationships, potential to evoke acceptance or rejection, sincere interest and congruent conduct, control, emotional distance, problem solving and aspects relating to the presenting problem. The conclusion was reached that the conduct of the boy with AS as well as his mother and the therapist, played a mutual role in achieving his therapeutic outcomes within the 17 IPA-variables. The unstructured process of the non-directive play (CCP and STP) was utilised by a young child with AS to achieve therapeutic outcomes that relate to his everyday existence. A final conclusion is that involving the boy’s mother in his therapy and utilising an adapted Filial play program, enabled the mother to make emotional contact with her son and to diminish conflict between them. Guidelines for therapists are suggested with regard to non-directive responding in therapeutic contexts as found in this study. Furthermore, the contribution of this research to Psychology as science and discipline, is presented. Limitations of this study are indicated and recommendations for further research are made. / Thesis (Ph.D. (Psigologie))--North-West University, Vaal Triangle Campus, 2013

The aim of this study is to analyse the discourses drawn upon by community paediatric nurses in relation to children’s rights to health. The philosophy of Michel Foucault has been used to underpin the analysis of the interviews and exemplars of five experienced community nurses, revealing conflicting power relationships and discourses. Rights are formalised morality and so from a children’s rights perspective, discourses reflect both the moral and ethical positions of the nurses. Children are constructed as developing human beings whose moral status gradually changes and who, through a lack of developmental autonomy, entrust their decision-making to their representatives (parents and caregivers) as their trustees. Rights are correlative with the obligations and duties toward children by both families and society. Society constructs legislative and politically organised structures to govern raising children because children are an intrinsic social concern. Whilst representing society’s interest in children’s rights to health, nurses in the home act as a conduit for multiple governing structures. The nurses in this study construct their “truths” and knowledge about children’s health rights from nursing, medicine, law, education, and social policy. However, the values of individual parents can conflict with universal values for children’s health and wellbeing. Therefore representing society positions nurses as “agents of the state”, a role that potentially holds power over parents and children and leads to the epithet of “the health police”. Within the institution of the family, and in the privacy of the home, there are also mechanisms of power that can resist the mechanisms of the state and its representatives. Therefore the discourse “it takes a village to raise a child” competes with the “my home is my castle” discourse. Nurses negotiate a fine balance between these power relations. Nurses are challenged with using power productively to promote children’s rights whilst respecting the role of parents and families. I argue that children’s rights are central to the moral and ethical work of nurses but that such work is often obscured and invisible. I propose that children’s community nurses are excellent at negotiating networking and connecting at a micro level, but need to create a more sophisticated and cohesive entity at a macro level to become fully political children’s rights advocates.

Barn är en stor patientgrupp inom ögonsjukvård, vilka har behov av att känna trygghet exempelvis genom att få förberedande information. För att möjliggöra detta krävs att barnet får möjlighet att kommunicera på sin nivå. Alternativ kompletterande kommunikation som till exempel bildstöd kan vara en möjlighet att ge barnet förutsättningar för att få sin röst hörd. Syftet med studien var att undersöka sjuksköterskors uppfattningar om att använda bildstöd i omvårdnaden av barn inom ögonsjukvård. En kvalitativ intervjustudie med induktiv ansats genomfördes där sex ögonsjuksköterskor och två allmänsjuksköterskor intervjuades med hjälp av semistrukturerade frågor. Data analyserades med hjälp av kvalitativ innehållsanalys, vilket resulterade i tre huvudkategorier: Barnet i centrum, Bildstödets betydelse, och Viljan att använda bildstöd. I resultatet framkom att ögonsjuksköterskan använder bildstöd i låg grad. Det fanns ett intresse för att börja använda sig av och implementera bildstöd. Genom att använda bildstöd kan barnet förberedas inför sitt besök och på så sätt skapas trygghet samt främjas kommunikation. Genom att göra barnets röst hörd skapas möjlighet att arbeta utifrån ett barncentrerat perspektiv. Då tidigare erfarenhet av bildstöd inom ögonsjukvård är bristfällig var det av stor vikt att utforska ämnet vidare. / Children are a large patient group in ophthalmic care. Children have a need to feel secure and have access to introductory information. To enable this, the child must be able to communicate at his or her level. Alternative augmentative communication such as image support may be an opportunity for the child to have their voice heard. The purpose of the study was to investigate nurses' perceptions of using image support in the care of children in ophthalmic care. A qualitative study was conducted with an inductive approach where six ophthalmic nurses and two registered nurses were interviewed with the help of a semi-structured questionnaire. Data was analyzed using content analysis, which resulted in three main categories: The child in focus, The meaning of image support and The willingness to use image support. The result showed that the ophthalmic nurse uses image support to a low degree. They showed an interest in using image support and implementing it in their routines. The use of image support provided security for the child by making them more prepared for the visit as well as promoted communication with the child. The thesis showed that by making the child's voice heard, the opportunity to work from a child-centered perspective was increased. As previous experience of image support in ophthalmic care is inadequate, it is of great importance to explore this subject further.

This research investigated the use of a self administrated health assessment questionnaire by children, and the significance of the translation from the source instrument (in English) into te reo Maori. The translation of a child health questionnaire was undertaken to produce a health survey tool that could be completed by a child over the age of 8 years in English or in te reo Maori. The questionnaire was pre-tested then used in a survey to determine both reliability and validity. The parents and caregivers of the children surveyed were also interviewed. The parent’s responses were compared with those of their children. The research undertaken has provided a new opportunity for children to take a central role in research into their own health. Children contributed as key experts, focus group participants and translators of the child questionnaire, alongside adults in some cases. Children provided a new perspective of their health and well-being by translating the questionnaire. This child-centred process added depth to the research of questionnaire validation and testing. The questionnaire was shown to perform adequately as a survey tool. New research is required in order to theorise beyond the questionnaire’s original two-factor conceptual model and to develop clinical and public health applications using a child-centred research process. The translation provided by the children demonstrated they are informed participants, who have an interest in their own health, are reliable and understand their health in a different manner to adults. This thesis argues that the direct and full involvement of participants in research that is designed to investigate their health is critical if new knowledge is to emerge. It also concludes the self administered questionnaire can be useful tools to understand the health of Maori speaking children.

Abstract This study investigates young children’s views of successful learning situations in their classroom activities and factors that contribute to their achievement in those situations. It is investigated how self-regulated learning is supported in these situations and how children appraise support as part of their success. The study consists of three different data sets that are reported in three empirical articles. The first empirical study investigated resilience displayed by young children in dyadic task performance. The second empirical study investigated views and appraisals that primary school children give to their success in classroom learning activities and how self-regulated learning is supported in the classrooms. The third empirical study investigated how primary school children appraise the reasons for their peers’ successes in learning situations. The data collection methods include video observations, stimulated recall interviews and photo elicitation interviews. The results of this dissertation indicated that success in learning activities results from individual and external factors. Among the individual assets that children bring to learning situations, the support that children receive from their teachers and peers were crucial for successful achievement. This study showed that, in general, the children’s self-regulated learning was supported in the classroom, especially through the support from a teacher and non-threatening evaluation. Children described their success through concrete actions that they took in the situations, such as the ability to accomplish the particular tasks or doing academic activities in order to achieve the task. The methodological findings indicate that it is possible to develop child-centred participatory methods in learning research. Results of this study contribute to the discussion of how successful learning experiences and self-regulated learning can be supported in the first years of primary school. / Tiivistelmä Tässä väitöstutkimuksessa tarkastellaan pienten lasten onnistumisen kokemuksia ja niiden syitä aidoissa oppimistilanteissa. Tavoitteena on selvittää, kuinka itsesäätöistä oppimista tuetaan ja kuinka lapset näkevät saamansa tuen auttavan heitä onnistumaan. Tutkimus koostuu kolmen aineiston analyyseista jotka on raportoitu kolmessa empiirisessä artikkelissa. Ensimmäinen tutkimus tarkasteli pienten lasten osoittamaa sinnikkyyttä yksilö- ja paritehtävässä. Toinen tutkimus selvitti, kuinka alakouluikäiset lapset selittivät onnistumistaan koululuokan oppimistilanteissa ja kuinka itsesäätöistä oppimista tuettiin kyseisissä tilanteissa. Kolmas tutkimus tarkasteli, kuinka alakouluikäiset oppilaat selittivät koulukavereidensa onnistumista oppimisessa. Tutkimusaineisto koostuu videohavainnoinneista sekä videoin ja valokuvin tuetuista haastatteluista. Tämän tutkimuksen tulokset osoittavat, että koululuokassa tapahtuvaan onnistumiseen vaikuttavat sekä ulkoiset että sisäiset tekijät. Sisäisiä tekijöitä ovat lasten yksilölliset taidot, kuten sinnikäs työskentely ja kyky suorittaa tehtävä onnistuneesti. Selittäessään omia ja kavereidensa onnistumisia lapset kuvailivat onnistumista konkreettisten toimien kautta. Lapset näkivät onnistumisen johtuneen toimista joita he tekivät tehtävien aikana, kuten tehtävien aktiivinen suorittaminen ja kyvykkyys suoriutua tehtävistä onnistuneesti. Ulkoisiin tekijöihin kuuluu tuki, jota lapset saavat oppimisen aikana. Tutkimuksessa havaittiin, että seuratuissa luokkahuoneissa lasten itsesäätöistä oppimista tukivat erityisesti opettajien tarjoama apu ja kannustava arviointi, jotka loivat luokkaan ymmärtävän ja rohkaisevan ilmapiirin. Metodologisesti tämä tutkimus näyttää, että oppimisen tutkimuksessa on mahdollista kehittää lapsilähtöisiä, osallistavia tutkimusmenetelmiä. Tutkimuksen tulokset lisäävät tietoa siitä, miten lasten onnistumisen kokemuksia ja itsesäätöistä oppimista voidaan tukea jokapäiväisissä luokkahuonetilanteissa.

Bakgrund: Våld i nära relationer är ett betydande problem för ungdomar som utsätts vad gäller försämrad fysisk och psykisk hälsa och sämre upplevd livskvalitet. Ungdomar berättar sällan om sin utsatthet om de inte blir tillfrågade. Sjuksköterskan på ungdomsmottagningen har i sin roll ett helhetsperspektiv på människan och vana av att rutinmässigt ställa frågor om våld i nära relationer. Trots detta är det endast en mindre del av ungdomarna som berättar om sin utsatthet. Syfte: Syftet var att beskriva sjuksköterskans erfarenheter av att samtala med ungdomar om våld i nära relationer. Metod: Studien är av kvalitativ ansats där semistrukturerade intervjuer genomfördes och resultatet analyserades med induktiv innehållsanalys. Resultat: I resultatet framkommer tre kategorier som beskriver sjuksköterskans erfarenheter. För att möjliggöra för ungdomens berättelse krävs en trygg miljö och en trygg relation i mötet med ungdomen samt organisatoriska aspekter och erfarenhet av att ställa frågor om våld. Bemästra konsten att lyssna innebär att vara mottaglig i samtalet, att lyssna aktivt på det ungdomen säger och vilka signaler som sänds ut samt att reflektera över det egna beteendet i mötet. Balansen i samspelet med ungdomen beskriver svårigheten av att balansera ungdomens vilja och medbestämmande gentemot sjuksköterskans roll och uppdrag för att arbeta mot ungdomens bästa. Slutsats: Att samtala med unga om våld är en komplex uppgift där sjuksköterskan praktiserar en balansgång mellan att dels arbeta utifrån barnets perspektiv, dels genom att inta barnperspektivet utifrån sjuksköterskans uppfattning. / Background: Domestic violence and intimate partner violence is a significant problem for adolescents who are exposed in terms of impaired physical and mental health and perceives lower quality of life. Young people rarely disclose their vulnerability if they are not asked. The role of the nurse at the youth clinic includes a holistic perspective on people and the nurse is used to routinely asking questions about domestic violence and violence in intimate relationships. Despite this, only a small proportion of adolescents report their vulnerability. Aim: The aim was to describe the nurses’ experiences of communicating with adolescents about domestic violence and intimate partner violence. Method: The study is of a qualitative approach where semi-structured interviews were conducted, and the results were analysed with inductive content analysis. Results: The results show three categories that describe the nurses’ experiences. To enable adolescents’ story to be told, a safe environment and a secure relationship with the young person are required, as well as organizational aspects and experience of asking questions about violence. Mastering the skill of listening means being receptive in the conversation, listening actively to what the young people are saying and what signals are being sent out, and reflecting on the nurses’ own behaviour in the meeting. The balance in the interaction with adolescent describes the difficulty of balancing the adolescents will and co-determination in relation to the nurses’ role and assignment to work towards the youth's best interests. Conclusion: Talking to young people about violence is a complex task where the nurse practices a balance between working from the child perspective, but also by taking the childs’ perspective based on the nurses’ perception.