Patienterna blir allt äldre och deras komplexa akuta och kroniska ohälsotillstånd kräver specifik bedömning och vård av omvårdnadspersonalen. Utveckling av sjuksköterskans praktiska yrkeskunskap är en lång process samtidigt som nya sjuksköterskor upplever att klyftan mellan teori- och praktisk kunskap är stor. Sjuksköterskorna och verksamheterna behöver mer kunskap om hur sjuksköterskornas kompetensutveckling kan stödjas för att öka kvalificerade bedömningar i de komplexa omvårdnadssituationerna. Syftet med denna studie är att få ökad förståelse för sjuksköterskors upplevda erfarenheter av praktisk kunskap i de komplexa omvårdnadssituationerna. Metoden för denna studie har varit en fenomenologisk forskningsansats med kvalitativa intervjuer för att förstå sjuksköterskornas perspektiv på kunskap i de komplexa omvårdnadssituationerna. Data bearbetades och analyserades utifrån Giorgis analysmetod för den fenomenologiska analysens reduktion. Sjuksköterskornas praktiska kunskap baserades på två teman: Sjuksköterskans omdöme i de komplexa omvårdnadssituationerna och utveckling av praktisk kunskap och ett antal kategorier och underkategorier. Sjuksköterskornas beslutsfattande i de komplexa omvårdnadssituationerna baseras på deras tidigare erfarenheter, värderingar, professionella ambitioner, kritiska och logiska tänkande samt intuition. Nya situationer löses med hjälp av informationssökning, kritiskt och logiskt tänkande och med hjälp av andra. Sjuksköterskorna utvecklar sin kunskap genom självreflektion och reflektion i grupp. Resultaten visade att sjuksköterskornas medvetenhet om sin och yrkeskollektivets tysta kunskap är låg. För att säkerhetsställa att den legitimerade sjuksköterskan har den yrkeskunskap och kompetens som behövs för att möta patienter i de komplexa omvårdnadssituationerna behöver verksamheterna bättre stödja sjuksköterskorna i deras kompetensutveckling. De tysta föreställningar som påverkar beslutsfattande i komplexa omvårdnadssituationer behöver synliggöras och ifrågasättas för att de medvetet ska kunna basera sina beslut på kvalificerade bedömningar och erbjuda en god omvårdnadskvalitet som bygger på evidensbaserad kunskap. / The Swedish population lives longer, and a consequence is that healthcare professionalsencounter more older patients. Older patients and their complex acute and chronic ill health conditionsrequire specific assessment and care of nursing staff. The development of the nurse's practicalprofessional skills is a long process and nurses are thought to learn throughout their working lives. Atthe same time many new nurses experience a gap between theoretical and practical knowledge.Nurses, nurse trainers and clinical settings need more knowledge about how nurses’ skillsdevelopment can be supported to increase qualified assessments and nursing proficiency in complexnursing situations. The purpose of this study is to gain a better understanding of nurses’ experience of practicalknowledge in complex nursing situations. The study adopts a phenomenological method, using qualitative interviews to collect data, inorder to understand the nurses' experiences of complex nursing situations. Data was processed andanalyzed using Giorgi's phenomenological method. The study identifies two main themes: Nursing's judgment in the complex nursing situationsand the development of practical knowledge. A number of categories and subcategories are alsoidentified. Nurses decision making in complex nursing situations is based on their previousexperiences, values, professional ambitions, critical and logical thinking and intuition. New complexsituations are solved using information retrieval, logical thinking and the help of others. Nursesdevelop their knowledge through self-reflection and reflection in groups. The results showed that thenurses’ awareness about tacit knowledge, individually and in the nursing collective is low. In order toensure that the legitimate nurse has the professional skills and skills needed to meet patients incomplex nursing situations, nursing education and clinical settings need to better support the nurses intheir skills development in professional settings. Tacit knowledge and tacit theories need to be madevisible and open for critical reflection, so that nurses can consciously base their decisions on qualifiedassessments and offer good quality care based on evidence-based knowledge.

Background: It may be difficult for nurses to identify women who are victims of domestic violence, because the violence is hidden. When violence isn't addressed, it can lead to physical and mental illness and societal costs. It is the health care responsibility to pay attention to health needs and create a safe environment for patients. It requires knowledge and training to facilitate the identification of women who are subjected to violence. Aim: The purpose is to describe nurses' experiences when meeting women victims of domestic violence. Method: A literature based study with qualitative approach. Articles were read, reviewed and analyzed according to Fribergs analysis method. Results: This study presents two main themes and seven sub themes. The first theme is presented as Inability to help – related to lack of time, ignorance and how the woman handles the situation. The second theme is presented as Emotional impact – related to anger and frustration, sadness, fear and concern and joy, sympathy and meaningfulness. Conclusion: Nurses need increased training about domestic violence when screening, as well as the causes and consequences of violence. Education on violence can give more understanding of how the nurse should act in the meeting and what questions should be asked. Knowledge can also help the nurses to deal with the lack of time, as it enables the nurse to prioritize. Emotional support is needed so the nurse should not be negatively affected personally or professionally.

Bakgrund: I Sverige lever närmare 350 000 människor med diagnosen hjärtsvikt och med en åldrande befolkning kommer antalet drabbade att öka. Hjärtsvikt är en av de vanligaste folksjukdomarna och innebär en hög mortalitet. Syfte: Att beskriva patienters erfarenheter av att leva med hjärtsvikt. Metod: Detta är en litteraturöversikt som använder sig av Polit och Becks niostegsmodell samt en tematisk analys. Vetenskapliga artiklar införskaffades via Cinahl och PubMed.  Resultat: Efter genomgång och noggrann analys av artiklarna valdes tre teman med tillhörande underteman. Temat Fysisk påverkan i vardagslivet skildrades av två underteman, fysiska upplevelser av sjukdomen samt att ha ett begränsat liv. Temat Hjärtsvikts påverkan på känslolivet skildrades utifrån två underteman, förändringar i känslolivet efter insjuknande samt att kunna ha ett socialt nätverk. Temat Möten med hälso- och sjukvården skildrades utifrån tre underteman, brist från hälso- och sjukvården, att förlora kontrollen av sitt eget liv samt egenvård är viktigt för mig. Slutsats: Patienter med hjärtsvikt kämpar med fysiska och psykiska utmaningar. De fysiska begränsningarna har en inverkan i dagliga rutiner. Den psykiska ohälsan hos dessa patienter kan främjas genom att motivera till att bibehålla de sociala nätverken som de har. Sjuksköterskan behöver förbättra kvalitén på patientutbildning så att patienterna känner sig trygga med att sköta sin egenvård. / Background: In Sweden live roughly 350 000 citizens with diagnosed heart failure and with an aging population comes an increase in those cases. Heart failure is one of the most common “Folksjukdom” which also causes a higher mortality.  Aim: To describe patient´s experiences living with heart failure. Method: This study is a literature review using Polit and Beck’s nine step model and a thematic analysis. Scientific articles were gathered using Cinahl and PubMed. Result:  After a thorough analysis of articles three themes were chosen with added subthemes. The themes Physical constraints in daily life, was depicted into two subthemes, physical experiences of the illness, and to live a limited life. The theme Heart failures effect on the emotional life was also depicted in to two subthemes: changes in feelings after falling ill and to have a social network. The theme Meetings with healthcare services was depicted based on three subthemes, shortcomings from healthcare, to lose control over your own life and lastly self-care is important to me. Conclusion: Patients with heart failure struggle with physical and mental challenges. The physical limitations imposed challenges in their daily routines. The poor mental health among these patients can be improved by motivating them to maintain their social network. Healthcare staff need to increase the quality of patient education so that patients feel confident in managing their own self-care. Keywords: Experiences, heart failure and patients

The term ‘consumption experience’ has become ubiquitous in marketing and consumer research circles. In this thesis I question the appropriateness of this canonical term. In its stead I employ the non-dualistic term ‘experiaction’, coined by an ecological psychologist, which points to the functional inseparability of experiencing and actions. I adopt a field-theoretical, phenomenologically-informed, perspective, whilst participating in, analysing, and writing about ten video-recorded research conversations. Likewise I address the various spin-off texts deriving from the initial conversations, such as transcripts and viewing-logs. I show that ‘field’-embedded individuals notice and act on many aspects of their immediate micro-environments, including their own intra-personal goings-on and expressive outputs. Through data analysis I identify five categories of regulable variables that an individual can act on as s/he seeks to regulate his/her sensing, relative to his/her reference value(s). Seen through this cybernetic lens, momentary human being comprises of a cyclical, ongoing process of self-regulation, in which individuals expediently employ and/or modify accessible resources and goings-on, in the service of seeking to actualise their currently-preferred, or expected, states-of-being, and to minimise unwelcome deviations therefrom. This thesis challenges the prevalent notion that when people consume particular products/services these offerings sponsor offering-dedicated experiences - what some people describe as ‘consumption experiences’. The concept of experiaction, in contrast, comprises of an ongoing interaction between a person and his/her micro-environment, in which the individual attends to, and acts on, whichever aspect(s) of his/her 360°-‘inner’-‘outer’-‘field’ become(s) momentarily salient to him/her, within the parameters imposed by his/her currently-sustained reference value(s).

Thesis advisor: Rebecca Lowenhaupt / There is a need for schools to implement practices to disrupt the inequities that exist for marginalized students in public education. As the theory of critical consciousness details, inequality is sustained when the people most affected by it are unable to decode their social conditions (El-Amin et al., 2017). An equitable democracy depends on critically conscious citizens (Seider & Graves, 2020). When educators and students can identify oppressive systems, they are better prepared to take action to disrupt those systems. This study analyzes how adult learning opportunities might position educators as agents of social justice-oriented educational practice. For the sake of this research, adult learning is defined as encompassing the learning experiences of educators, including district professional development as well as outside learning experiences in higher education institutions or the community. There is limited research regarding how the construct of race impacts adult learning experiences for critical consciousness. Therefore, this research studies the impacts of the construct of race during the process of adult learning. This study investigates how educators narrate their experiences with race during adult learning through the lens of critical consciousness. / Thesis (EdD) — Boston College, 2022. / Submitted to: Boston College. Lynch School of Education. / Discipline: Educational Leadership and Higher Education.

Bakgrund Överrapportering av patienter sker mellan enheter, yrkesgrupper och vårdgivare och syftar till att förmedla konkret och väsentlig information. Tidspress och kommunikationsbarriärer är vanligt förekommande i vårdarbetet vilket leder till varierade upplevelser av överrapportering hos sjuksköterskor. SBAR är ett standardiserat kommunikationsverktyg som syftar till att effektivisera överrapportering för vårdpersonal samt för att öka patientsäkerheten. Syfte Att beskriva sjuksköterskors erfarenhet av överrapportering enligt SBAR. Metod Arbetet är en strukturerad litteraturöversikt med inslag av den metodologi som används vid systematiska översikter. 14 artiklar har analyserats och sammanställts. Artiklarna är från databaserna CINAHL och PubMed och är antingen av kvalitativ eller kvantitativ ansats. Resultat I studiens resultat framkom fyra huvudteman med sex underteman; Erfarenheter av SBAR/ISBAR, Teamarbete, Barriärer vid rapportering och Patientsäkerhet. Sjuksköterskors erfarenheter är att SBAR förbättrar och effektiviserar överrapportering inom vårdteamet, samt att patientsäkerheten ökar vid användning av verktyget. Slutsats Sjuksköterskors erfarenheter av överrapportering enligt SBAR varierar beroende på individuella uppfattningar av kommunikation samt en rad yttre omständigheter. Det finns ett behov av att standardisera överrapporteringsprocessen för att framhäva kontinuitet i användandet av verktyget. / Background Handovering of patients takes place between units, professional groups and healthcare providers and aims to convey concrete and essential information. The limitation of time and barriers of communication are common in nursing work, which leads to varied experiences of handovering by nurses. SBAR is a standardized communication tool that aims to streamline handovering for healthcare professionals and to increase patient safety. Aim To describe nurses experience of handovering according to SBAR. Method The work is a structured literature review with elements of the methodology used in systematic reviews. 14 articles have been analyzed and compiled. The articles are from the databases CINAHL and PubMed and are either qualitative or quantitative. Results In the result of the study, four main themes with six sub-themes emerged: Experience of SBAR/ISBAR, Teamwork, Barriers in reporting and Patient safety. Nurses' experience is that SBAR improves handovering within the careteam and makes it more efficient, patientsafety also improves when the tool is used. Conclusions Nurses' experiences of handovering according to SBAR varies depending on individual perceptions of communication as well as several external circumstantial features. There is a need to standardize the handovering process to emphasize continuity in the use of the tool.

Introduktion: Brännskada är ett globalt folkhälsoproblem och en traumatisk händelse för den som drabbas då det medför smärta och lidande med både psykiska, fysiska och psykosociala besvär. Brännskador kräver oftast intensivvård och många sjukhusvistelser med lång rehabilitering. Trots en avancerad sjukvård och adekvat behandling blir livet efter utskrivning aldrig exakt som det var innan brännskadan. Brännskadan leder bland annat till ett förändrat utseende, utanförskap och lidande som påverkar patientens hälsa.  Syfte: Syftet med denna litteraturöversikt var att undersöka patienters upplevelser av sin hälsa efter brännskada. Metod: En litteraturstudie har gjorts där 11 originalartiklar med kvalitativa studier från databaserna PubMed och CINAHL har inkluderats.   Resultat: Resultatet delades in i tre huvudkategorier och nio subkategorier. De tre huvudkategorierna var; förändring av den fysiska hälsan, påverkan på den psykiska hälsan och påverkan på den psykosociala hälsan. Den fysiska hälsan blev begränsad och det fanns en ökad smärta och sensibilitet. Den psykiska hälsan beskrev de känslomässiga påfrestningarna, hotad identitet, isolering och utanförskapen men också acceptans. Den psykosociala hälsan beskrev vikten av stöd från andra och av det sociala nätverket. Slutsats: De som varit med om en brännskada upplevde en förändrad hälsa och ett ökat lidande. Hälsan påverkades fysiskt, psykiskt och psykosocialt och det var därför viktigt för sjuksköterskan att se hela personen och inte enbart de fysiska skadorna. Utöver detta krävdes stöd från andra samt acceptans för att försonas med lidande. / Introduction: Burns are a global public health problem and a traumatic event for the patient, causing pain and suffering, including mental, physical and psychosocial problems. Burns usually require intensive care and multiple hospital visits with long rehabilitation time. Despite advanced medical care and adequate treatment, life after discharge will never be exactly as it was before the burn. The burn leads to, among other things, a changed appearance, alienation and suffering that affect the patient's health. Aim: The aim of this literature study was to investigate the experience of burn patients' health after burn.  Method: A literature study with 11 original articles with qualitative studies from the database PubMed and CINAHL were included in this study.  Results: The results were divided into three main categories and nine subcategories. The three main categories were; Change in physical health, impact on mental health and impact on psychosocial health. Physical health became restrained and there was increased pain and sensitivity. Mental health described the emotional stress, the threatened identity, the isolation and alienation and also acceptance. Psychosocial health described the importance of moral support from others and from the social network. Conclusion: Burn patients experienced a change in health and increased suffering. The health was affected physically, psychologically and psychosocially and thus the nurse’s job should not exclusively include physical treatment, but also include psychological treatment in support of the patient. Beyond professional treatment, the patient required support from others and acceptance to reconcile with their suffering.

Background: The burden of breast cancer may contribute to elevated psychological distress. Conversely, distress may negatively impact the development, recurrence and diagnosis of cancer as it compromises the immune system and adherence to treatment, creating a vicious cycle. With the breast cancer fatality rate significantly higher in Sub-Saharan African women than in women living in higher income countries, further research is needed to limit the devastating impact of chronic diseases on this population. Purpose: The aim of the study was to determine if Ghanaian breast cancer patients were more susceptible to higher psychological distress and lower quality of life than healthy Ghanaian women and how their lived experiences affect their mental health. Method: Sixty-four breast cancer patients and 64 healthy participants were recruited to complete the Kessler Psychological Distress Scale and World Health Organization Quality of life-BREF scale. The life experiences of women living with breast cancer were assessed through semi-structured interviews. Results: Breast cancer patients had higher psychological distress than the healthy women and also scored lower on the quality of life domains of physical health, psychological well-being and environment. The lived experiences of the breast cancer patients followed a similar journey from suspicion of ill-health to difficulty navigating the health system, feeling the effects of breast cancer and lastly, regaining confidence. Breast cancer had affected the women’s daily activities, health, female identity, roles and responsibilities. However, financial, emotional and social support, together with individual coping mechanisms such as religion and physical exercise, mitigated the impact of the breast disease. Conclusion: Patient centered care approaches could ease the psychological distress of breast cancer patients. Finally, future research should investigate methods of improving the women’s psychological well-being, physical health and environment as it may positively impact the prognosis of Ghanaian breast cancer patients. / Thesis / Master of Science (MSc)

Bakgrund: Sjukdomar som cancer leder till ökat antal patienter som behöver stomi. Patienter med stomi kan få komplikationer efter stomiläggning. Sjuksköterska kan stötta patienter med stomi genom rådgivning och information.  Syfte: Syftet med denna litteraturstudie är att belysa patienters erfarenheter av att ha stomi.  Metod: En systematisk litteraturstudie enligt Rosén (2017) med induktivt förhållningssätt och Kvalitativ metod. Artiklar söktes i två databaser Cinahl och PubMed och kvalitetsgranskades med hjälp av Forsberg & Wengström (2015) granskningsmall. Det resulterades i 10 artiklar som redovisas i resultat. Fribergs (2017) analysmodell användes för att bearbeta samtliga artiklar.  Resultat: Fem kategorier framkom i resultatet. Dessa är fysiska begränsningar i vardagen, utökade psykiska bekymmer i vardagen, minskade sociala interaktioner, försämrad sexualitet och intimitet, förenklad vardag. En del kroppsliga besvär ledde till psykiska besvär och påverkade i sin tur på sociala relationer för patienter med stomi. Slutsats: Patienters erfarenheter med stomi varierade mellan positiva och negativa. En del hade svårigheter med att anpassa sig till den nya situationen medan andra upplevde den som en faktor som hjälpte dem att bli mer sociala. Sjuksköterskor är en viktig stöttepelare i omvårdnad av de patienterna med stomi. / Background: Diseases such as cancer lead to an increased number of patients who need a stoma. The patient with a stoma can have complications after stoma placement. Nurses can support patients with ostomy through counseling and information. Aim: The aim of this literature study is to shed light on patients' experiences of having a stoma. Method: A systematic literature study according to Rosén (2017) with an inductive approach and Qualitative method. Articles were searched in two databases Cinahl and PubMed and quality checked using the Forsberg & Wengström (2015) review template. It resulted in 10 articles which will be reported in thr resualt. Friberg's (2017) analysis model was used to process all articles. Results: Five categories emerged in the results. These are physical limitations in everyday life,increased psychological concerns in everyday life, decreased social interactions, impaired sexuality and intimacy, simplified everyday life. Some physical problems led to mental problems and in turn affected social relations for patients with stoma. Conclusion: Patients' experiences with stoma varied between positive and negative. Onesome had difficulty adapting to the new situation while others experienced it as a factor that helped them become more social. Nurses are an important mainstay in the care of those patients with a stoma.

The purpose of this qualitative phenomenological study was to investigate the perceptions of classroom-level educators regarding the application of trauma-informed instructional practices. This was achieved by evaluating educators' understanding of the influence of trauma on students, their level of familiarity with trauma-informed instructional practices, and their assessments of the effectiveness of these practices. Trauma refers to an individual's response to a single traumatic incident, a succession of traumatic events, or extended exposure to a traumatic event (SAMHSA, 2014). As awareness of the prevalence of childhood trauma has increased, it is acknowledged as a serious public health issue (Lang et al., 2015). Trauma-informed care is a strengths-based, victim-centered framework under which organizations recognize trauma, understand, and limit the potential long-term repercussions of exposure to traumatic experiences, even if an individual does not perceive trauma as influencing their behavior (Kubiak et al., 2017; Office for Victims of Crime, n.d.). Educators have a distinct advantage in identifying students' traumatic stress symptoms, which can directly affect social-emotional growth and academic achievement (Conley et al., 2014; Donisch et al., 2022). Schools play a crucial role in establishing settings that safeguard students against adverse childhood experiences (ACEs), cultivate resilience, and nurture a sense of belongingness (Conley et al., 2014; Hertz, 2020). Eight educators from one northeast Tennessee school district who provided general and special education instruction to students in PreK-12th grade participated in the study. Data collection consisted of one-on-one video conferencing interviews. The data were coded and analyzed to identify emerging themes, synthesized, and summarized (Creswell & Creswell, 2018). The following themes emerged: (a) increased awareness of trauma and ACEs, (b) desire for additional training, (c) diversity of adverse childhood experiences (ACEs) and trauma exposures, (d) perceived negative behaviors resulting from or masking trauma, (e) the significance of procedures and structure, (f) the need for supplementary resources, (g) the importance of relationship building, (h) importance of opportunities for success, (i) facilitation of individualized instruction, (j) increased empathy, (k) increased patience and self-awareness, and (l) emotional, physical, and mental stress.