Background: Autism spectrum disorders (ASD) are a group of neuro-developmental disorders that are characterized by impaired social interaction, communication, and restricted or repetitive behavior. Children with an ASD also display significant sensory experiences due to sensory disintegration. This integrative review of literature examines the sensory experiences of children with an ASD and determines nursing interventions that will enable them to better cope within the hospital setting. Method: an extensive search of databases and current literature on sensory experiences of children with an ASD and interventions that facilitate coping. Results: Children with an ASD experience a wide range of sensitivity and defensiveness toward stimuli that differs on an individual basis. There is no current research that reflects nursing interventions for children with an ASD, therefore interventions from other heath care occupations were examined and applied to nursing. Conclusion: Further research is needed to better understand sensory defensiveness and research is needed in the area of nursing interventions to enable the best nursing care of children with an ASD.

People with dementia are hospitalized for a variety of reasons. The combination of dementia with additional health conditions creates a unique challenge to caregivers in acute care settings. There is a dearth of information available to provide guidance to the nursing staff caring for these patients. This integrated review of the literature examined the experiences of hospitalization from the perspective of the older adult with dementia, the family caregiver, and the patient care staff. Results showed a limited body of literature that addressed hospital experiences of people with dementia and those of family and professional caregivers. Additionally, few studies addressing this topic have been conducted in the United States. The primary finding from this study is that better communication is needed between nursing staff, patients, and their family caregivers. Nurses should carry out detailed assessments of cognition and pain in all elderly patients, and strive to provide appropriate palliative and end-of-life care. Dementia- specific training for all staff members may help to promote a better understanding of patients with dementia. Lastly, further research into the experiences of hospitalized dementia patients is needed, with a focus on acute care settings within the United States.

I sitt dagliga arbete möter sjuksköterskor svårt sjuka patienter. Ibland kan det bli aktuellt att på en del av dessa patienter ta ett förhandsbeslut om att inte återuppliva dem vid ett eventuellt hjärtstopp, ett så kallat ejHLR-beslut.Syftet med studien var att undersöka sjuksköterskors erfarenhet av ejHLR med fokus på vilken kunskap de har om innebörden av begreppet samt vilken syn sjuksköterskor har på sitt eget, patienters och de anhörigas deltagande i beslutstagandet. Studien som gjordes var en litteraturstudie och omfattade både kvantitativ och kvalitativ forskning där totalt 11 artiklar inkluderades. Resultatet visar på bristande kunskaper hos sjuksköterskor, dels om definitionen av ejHLR men även om riktlinjer för beslut om ejHLR. Det uppvisar också att sjuksköterskor anser att dem själva, patienten och anhöriga borde vara med och fatta ett eventuellt ejHLR-beslut men att rollerna i beslutsfattandet är vaga. En tydlig process för beslutsfattandet om ejHLR borde utarbetas och mer kunskap om ejHLR bör erbjudas redan under sjuksköterskeutbildningens gång. / In the daily practise nurses meet seriously ill patients. Sometimes it becomes necessary to make a decision in advance not to resuscitate some of these patients in case of a cardiac arrest, a so called DNR (Do-not.-resuscitate)-decision. The purpose of the study was to examine nurses’ experiences of DNR with focus on their knowledge about the meaning of the conception and also their perception about their own, patients and relatives participations in the decision making. This study was a literature review and included both quantitative and qualitative research. A total number of 11 articles were used for the study. The result shows that nurses’ lack in knowledge about the definition of DNR as well as the guidelines regarding the decision making of DNR. It also presents that nurses’ think that the nurses’, the patients and the relatives should be involved in the decision making of a possible DNR-decision but that the roles of the participants in the decision making was vague. A clear DNR-process should be developed and more knowledge about the DNR should be included in the nursing education.

Alzheimers sjukdom är den vanligaste demenssjukdomen och är en av Sveriges största folksjukdomar. Sjukdomen medför kognitiva försämringar som under sjukdomsförloppet kan försämras påtagligt, vilket kan ställa höga krav på anhöriga som vårdar personer med Alzheimer sjukdom. Syfte: Att öka och fördjupa kunskapen om anhörigas upplevelser av att vårda personer med Alzheimers sjukdom i hemmet. Metod: En litteraturstudie där 11 kvalitativa artiklar granskades och analyserades. Resultat: Analysen resulterade i tre huvudkategorier: Anhörigas positiva upplevelser av att vårda, anhörigas negativa upplevelser av att vårda samt behovet av stöd och information. Slutsats: En person med Alzheimers kräver mycket hjälp och tillsyn. Anhöriga upplevde förändrade roller samt svårigheter i omvårdnaden samt behov av stöd. Sjuksköterskor kan ge information, utbildning och stöd för att öka möjligheterna för anhöriga att hantera omvårdnaden samt klara av det dagliga livet bättre. / Alzheimer's disease is the most common form of dementia and is one of Sweden's most common diseases. The disease causes cognitive declines during the disease progression, which can markedly get worse, this puts very high demands on caregivers who’s caring for people with Alzheimer's disease. Aim: To increase and deepen the knowledge of caregivers experiences when caring for people with Alzheimer's disease at home. Method: A literature study where 11 of qualitative articles were reviewed and analyzed. Results: The analysis resulted in three main categories: Caregivers positive experiences of caring, caregivers negative experiences of caring and the need for support and information. Conclusion: A person with Alzheimer's requires a lot of help and supervision. Caregivers experienced changing roles and difficulties in the nursing care and the support needs. Nurses can provide information, training and support to increase the opportunities for families to manage the care and cope with daily life better.

Bakgrund: Klimakteriet är en period på ett antal år före och efter menopaus, kvinnans sista mens. Menopausen inträffar i genomsnitt vid 51-52 års ålder. Symptom som kan uppkomma under klimakteriet beror till stor del på sjunkande östrogennivåer som kan ge värmevallningar, svettningar samt tunna och sköra slemhinnor i underlivet. Klimakteriet innebär för kvinnan en tid av förändringar och hur hon upplever det kan variera. Syfte: Att beskriva kvinnors upplevelser av klimakteriet.Metod: Den valda metoden är en litteraturstudie och tio vetenskapliga studier med kvalitativ ansats inkluderades. Sökningarna efter vetenskapliga studier utfördes i PubMed och CINAHL. Resultat: Fem olika teman identifierades efter att resultaten i studierna analyserats: ”Behov av information”, ”En ny fas i livet”, ”Symptom i den nya livsfasen”, ”Kontakt med vården” och ”Att hantera klimakteriet”.Slutsats: Det finns en stor variation i hur klimakteriet upplevs. För vissa kvinnor påverkas det dagliga livet stort medan andra upplever det som en enkel passage. Flera kvinnor har obesvarade frågor och efterfrågar mer kunskap för att bättre kunna hantera de förändringar som klimakteriet medför. Därmed är det angeläget för sjuksköterskan att ha kunskaper om klimakteriet och de förändringar som det innebär för kvinnorna. / Background: Menopause is a period of several years before and after a woman's last menstrual period. The menopause occurs on average at the age of 51-52. Symptoms that may occur during menopause is due in large part to decreasing estrogen levels that may cause hot flashes, sweating and thin and fragile vaginal mucosa. For women, menopause is a time of change and the experiences can vary. Aim: To describe women’s experiences of menopause.Method: The chosen method is a literature review and ten qualitative research studies were included. The search for scientific studies was performed in PubMed and CINAHL. Results: Five different themes were identified following the analysis of the results: “Need for information”, “A new phase in life”, “Symptoms in the new life phase”, “Contact with health care” and “To manage menopause”.Conclusion: There is great variation in how women experience menopause. Some women’s daily life is affected while others experience it as an easy passage. Several women have unanswered questions and are in need for more knowledge to better manage the changes that menopause causes. It is therefore of great importance for the nurse to have knowledge about menopause and the changes it causes.

A Synthetic Learning Environment (SLE) the Virtual Field Trip (VFT) was designed to increase vocabulary acquisition and knowledge by utilizing simulation based technologies and leveraging sound educational findings. Vocabulary acquisition is considered a prerequisite to becoming a good reader and therefore a critical predictor of academic and lifelong success for early learners, however, teachers report that students lack the real world knowledge required for vocabulary knowledge. The VFT provides a meaningful context for anchored and situated instruction. Second grade students were assigned to either use the VFT or to listen to stories read aloud by a researcher on a video tape. While results did not indicate significant vocabulary acquisition on a series of 3 vocabulary tests; students who used the VFT did use significantly more words in a post exposure writing sample than students in the story group indicating an increase of words known at a level of depth sufficient to warrant their use in a writing sample. Students who used the VFT also reported increased motivation to use SLEs like the VFT for future learning objectives and that VFTs were fun. Findings related to the self-efficacy of students as measures immediately following each vocabulary test did not reveal a significant increase for VFT users. Students using the VFTs did not report learning more words than those students assigned to the story group. Limitations of the current study and directions for future research are discussed.

Background From a global perspective, around 8.4 million individuals live with diabetes type 1, which is a chronic disease for which complex medical treatment. The disease can lead to complications and women with type 1 diabetes have a higher risk of mental illness. Women with a medical disability also violate society's norms. Competence and understanding of the basic nurse can prevent ill health and alleviate suffering. Aim: The purpose of this literature review was to investigate women's experience of living with type 1 diabetes during reproductive age. Method: A literature study based on twelve articles of qualitative method were analyzed and a new result built up. Through analysis with the support of Friberg's five-step process, three main themes and ten subthemes emerged. Results: The result showed that the feeling of inadequacy in the form of physical, sexual and psychological limitations and lack of knowledge was described. The women also experienced a sense of sadness characterized by worry and fear for the future. To overcome this disease, support and motivation were important. Conclusion: The preventive work can prevent women with type 1 diabetes from risking exclusion, sexual ill health, necessary suffering and contracting mental illness. In order to promote women's health and help them reach acceptance, knowledge, support and confirmation from the health and medical services and relatives were required. By being able to make demands and question society's norms, work can be done for a more equal illness experience. / Syftet med denna litteraturstudie var att undersöka kvinnors upplevelse av att leva med diabetes typ 1 under reproduktiv ålder. I resultatet framkom en del skillnad i upplevelser beroende på vart i livet under den reproduktiva perioden kvinnorna befann sig, men även många likheter identifierades. Resultatet visade att kvinnor bar känslor som oro och rädsla, otillräcklighet samt en känsla av att vara annorlunda. Sjukdomen innebar begränsningar i vardagen som beskrevs som betungande. Frustration och besvikelse uttrycktes hos kvinnorna kring sjukdomens komplexitet och de beskrev känslor som att inte kunna ta en paus från sjukdomen, att bli berövad av sin spontanitet och frihet samt att inte duga till trots väl valda strategier att kontrollera sjukdomen. Acceptans kring att sjukdomen var en del av kvinnornas personlighet förknippades med bättre egenvård och motivation till att kontrollera sjukdomen. Förståelse och acceptansen erhölls främst genom stöd och hopp från hälso- och sjukvårdspersonal samt närstående. Även känslan av samhörighet och att inte vara ensam med sjukdomen var betydelsefull. Examensarbetet belyser två vårdvetenskapliga begrepp; människa och lidande. Denna litteraturstudie har en kvalitativ ansats då kvinnors upplevelser efterfrågas. Av tolv artiklar som analyserades framkom tre teman samt tio subteman som beskriver resultatet. Kompetens hos sjuksköterskor kring kvinnors upplevelse av att leva med diabetes typ 1 under reproduktiv ålder kan främja hälsa, identifiera ohälsa och lindra lidande. Diskussionen och slutsatsen i detta arbete lyfter normer kring att vara kvinna med en kronisk sjukdom samt konsekvenser som de upplevda känslorna kan leda till framför allt för de enskilda kvinnorna, men också ur ett hållbarhetsperspektiv för samhället.

Background: In low- and middle-income countries, several environmental barriers impede accessibility to antenatal care (ANC) services for women with disabilities, yet ANC is a critical entry point for pregnant women to receive quality maternity care services. These barriers are more pronounced in rural areas than urban areas in Uganda. Although the World Health Organisation recommends that ANC services should be designed and continually improved based on locally generated data to address access barriers, the experiences of rural pregnant women with physical disabilities are largely undocumented. Aim: This study aimed to investigate the experiences of pregnant women with physical disabilities in accessing and utilising ANC services and suggest strategies for improving the services in rural south-western Uganda. Objectives: The study sought to: - describe the accessibility of ANC services - explain the utilisation of ANC services - explore the relationship between women with physical disabilities and health care providers - explore how women with physical disabilities and midwives understand disability and the provision of ANC services in rural south-western Uganda Methods: An interpretive qualitative study using a multiple case study design was conducted. Twelve women with physical disabilities and six midwives from three health facilities in Sheema district in south-western Uganda, East Africa, were selected as study participants. Women were sampled using snowball sampling. Midwives and health facilities (health centre III, health centre IV and general hospital) were sampled using purposive sampling. Data was gathered through in-depth face-to-face interviews with the women and midwives, a focus group discussion with the women, and direct observation of the physical environment at the three health facilities, from November 2020 to January 2021. Data was transcribed, translated, and thematically analysed with support of NVivo software. Ethical approval was obtained from University of Cape Town and Uganda National Council of Science and Technology, including a Risk Management Plan for preventing the transmission of Covid-19. Findings: Four themes were generated: 1. ‘Optimising wellbeing' was shaped by exercising agency, accessing family and community support, and aligning policy and practice. 2. ‘Undermining wellbeing' involved ignorance and mental ill-health (including emotional and spiritual oppression), sociocultural prohibitions, and inaccessible transport and mobility systems. 3. ‘Unresponsive ANC policy to women's specific needs' included the integrated nature of ANC services, unresponsive ANC policy, and unaccommodating health facility designs. 4. ‘Improving quality of ANC services' related to women's mixed experiences, preparing midwives and other health workers through education, training, and mentoring, and enabling disability inclusion for fit-for-purpose ANC services. Conclusion: Despite a few enablers optimising their wellbeing, rural pregnant women with physical disabilities experience many barriers that negatively impact on their pregnancy experiences and pregnancy health care. Women's spirituality is integral to their wellbeing. Justice, equity, and respect for their human dignity need to be underscored in ANC policy, health system and infrastructure planning, and midwifery education, training, and practice. The establishment of accessible quality ANC services within under-served areas benefits all women. The spirit of Ubuntu, which may facilitate women's participation and functioning at the family, community, and health facility levels, cannot be overemphasised. Going forward: An integrated framework for disability inclusive family- and communityfocused ANC services for rural communities is proposed. This framework needs to be tested to determine its efficacy in other rural African settings. A further study to explore the effectiveness of maternity waiting homes from the perspective of women with physical disabilities and the community in the context of rural Ugandan setting is suggested.

Family Play Therapy is a creative therapeutic approach to engage children in therapy in the context of their family system. While the young field of family play therapy offers both the benefits of family therapy and play therapy, research concerning its efficacy is largely unavailable. The purpose of this qualitative study was to understand the experience of family play therapy in context of child sexual abuse treatment, from the perspective of child clients and their parents. A secondary purpose of this descriptive study was to provide contextual data to inform future quantitative research on family play therapy. In separate, semi-structured and open-ended interviews, eight children and their non-offending parents described their therapy experience of the family puppet interview intervention, in which they created and acted out a story with puppets. Participants' descriptions of their experience revealed five broad themes: (1) the perceived benefits of play (what participants liked), (2) parents feelings about play as a medium, (3) parent's perceived role in the session, (4) children's thoughts about family participation in therapy, and (5) suggestions for improvement. A discussion of the findings' relevance to previous literature, clinical practice and future research, as well as the limitations of this study is provided. / Master of Science

Thesis advisor: Rebekah Levine Coley / Research on adverse childhood experiences (ACEs) has demonstrated the high prevalence rates of such experiences, with about 60% of individuals in national U.S. samples reporting one or more types of ACEs as children (Chapman et al., 2013; Finkelhor et al., 2015). Further, research has established robust links between ACEs and a range of negative behavioral and health outcomes in adulthood (Felitti et al., 1998; Hughes et al., 2017; Kalmakis & Chandler, 2015; Wang et al., 2020; Wang & Maguire-Jack, 2018; Wolff et al., 2018). Less is known about when potential negative consequences of ACEs exposure emerge. The few studies that have examined the relationship between ACEs and early outcomes have employed inconsistent modeling strategies which has left the functional form of the relationship unclear, which could lead to either under-or over-estimating the risk associated with various levels of ACEs exposure (Crouch et al., 2019; Hughes et al., 2017; Lanier et al., 2018; Wang et al., 2019). Further, these studies have not comprehensively examined the potential moderating role of socio-ecological factors like neighborhood context. Theoretical frameworks suggest neighborhood resources might buffer children from negative consequences associated with ACEs while exposure to neighborhood-level adversities might exacerbate negative consequences. In order to address these gaps, the currently study examined the functional form of the relationship between ACEs experienced in the first four years of life and kindergarten behavioral outcomes and tested the moderating role of neighborhood resources and neighborhood adversities in a large, nationally representative sample of young children drawn from the Early Childhood Longitudinal Study - Birth Cohort (ECLS-B; N ≈ 10,700) linked with neighborhood administrative data. Using inverse probability weighting to strengthen internal validity, numerous modeling strategies supported a linear relationship between early childhood ACEs and kindergarten behavioral outcomes. Greater ACEs exposure was associated with significantly lower prosocial skills and significantly higher externalizing behavior problems, with small effect sizes of 0.075 to 0.143 standard deviation shifts in behaviors for each additional ACEs exposure. Interaction models found that ACEs were significantly associated with behavioral consequences regardless of neighborhood context. Overall, the robust modeling strategies employed provide the strongest evidence to date of the significant, linear relationship between ACEs and early behavioral consequences. / Thesis (PhD) — Boston College, 2023. / Submitted to: Boston College. Lynch School of Education. / Discipline: Counseling, Developmental and Educational Psychology.