Compulsory care of a child is one of the most intrusive interventions that can be made in a child's life, but a protective task that social services have been obliged to carry out. In the case of compulsory care of a child, the social secretary is faced with a number of different difficulties and dilemmas that can be linked to coercion in LVU legislation and consideration of the child's best interests. The aim of this qualitative study is to investigate social workers, in social services' child and family investigation, experience of how the child's best interests are taken into account in LVU processes och what thoughts and ethical dilemmas arise for social workers in connection to the LVU process in the meetings with children and parents, and also how can this be understood in relation to their professional role. By using an interview based qualitative method, this study strives to reach a deeper understanding of social workers' experience of the subject matter. The results of this study shows that the experience of the child's best interests is a concept that social workers must constantly define and describe as situational, based on the child's situation. A common description of the child's best interests is that it is a concept that needs a definition and frame of reference, as the lack of a definition makes it more difficult for social workers to consider what is in the child's best interests. This study reaches the conclusion that social workers experience the LVU process to be harmful to the relationship between both children and parents, and parents and social services. Based on this, the social workers felt that it was a huge ethical dilemma to use LVU, as the implementation of the LVU law was both emotionally stressful and comes with its limitations. This despite knowing that LVU should function as a protection for the child and its best interests.

Background: Ethical dilemmas are present in all areas of healthcare and arise particularly when working with patients. When a nurse has to act in contrast to what they consider to be morally correct they risk developing moral distress. Moral distress can lead to mental health problems, burnout or even a career change. The element of compassion is at the core of nursing and is present during ethical challenges and patient suffering. Aim: The aim of this study was to investigate what causes moral distress in nurses.Method: A qualitative literature-review based on 19 articles. Results: The result consists of one overall theme with three main categories and ten subcategories. The overall theme was patient suffering. Main categories were: Organizational causes, internal causes and relational causes. Conclusion: Moral distress in the nursing profession is a complex multi-factored problem. Both organizational and individual-focused solutions need to be implemented to reduce moral distress and there by reduce burnout and mental health problems in nurses. Future research in this area should focus on nurses and how they can better manage and cope with moral stress. / Bakgrund: Etiska dilemman uppkommer inom alla områden inom hälso- och sjukvård, i synnerhet vid patientarbete. När sjuksköterskan måste agera mot sina egna moraliska värderingar riskerar hen att drabbas av moralisk stress. Moralisk stress kan leda till psykisk ohälsa, utmattningssyndrom och karriärbyte. Medkänsla är en grundpelare inom omvårdnad och är närvarande vid etiska utmaningar och vid lindrande av patientens lidande.Syfte: Syftet med studien var att undersöka orsaker till moralisk stress hos sjuksköterskor. Metod: En litteraturstudie med kvalitativ ansats utfördes. Studien baseras på 19 artiklar. Resultat: I resultatet framkom ett övergripande tema samt tre huvudkategorier med tio tillhörande underkategorier. Det övergripande temat var patientens lidande. Huvudkategorierna var: Organisatoriska orsaker, inre orsaker och relationella orsaker. Slutsats: Moralisk stress inom sjuksköterskeyrket är ett komplext och mångfacetterat problem. För att lösa problemet måste både organisatoriska och individbaserade lösningar implementeras, för att därigenom minska utbrändhet och psykisk ohälsa bland sjuksköterskor. Framtida forskning bör fokusera på sjuksköterskan och hur denne bättre kan hantera moralisk stress.

Abstrakt Introduktion: Intensivvårdssjuksköterskor möter i sin yrkesroll många individer och en vård som bedrivs i enlighet med vetenskap och beprövad erfarenhet skall erbjudas till såväl patienter som anhöriga. Upplevelsen av vården bygger på intensivvårdssjuksköterskans förmåga att utveckla en trygg och pålitlig relation. Studier visar att när intensivvårdssjuksköterskor konfronteras med etiska dilemman, leder de inre konflikterna till osäkerhet i hur situationen ska hanteras vilket i sin tur påverkar vården och upplevelsen av mötet med patienter och anhöriga. Syfte: Att beskriva intensivvårdssjuksköterskors upplevelser av att vårda eller möta patienter eller anhöriga som de har en relation till. Metod: Studien genomfördes med kvalitativ metod. Ändamålsenligt urval användes där inklusionskriterierna var sjuksköterskor med en specialistutbildning inom intensivvård, att de i sin roll som intensivvårdssjuksköterskor mött eller vårdat en patient eller anhörig som de hade en relation till samt att de hade en nuvarande anställning på en intensivvårdsavdelning. Datainsamlingen genomfördes med ostrukturerade intervjuer, dessa transkriberades och analyserades genom kvalitativ innehållsanalys med induktiv ansats. Resultat: Resultatet presenteras med fem huvudkategorier och elva subkategorier. Resultatet visar att intensivvårdssjuksköterskorna vill undvika att vårda någon de har en relation till, men under vissa omständigheter kan de känna sig tvungna att vårda även fast de inte vill. Intensivvårdssjuksköterskorna poängterar vikten av att värna om patientens integritet i vården och mötet. Att möta eller vårda någon de har en relation till skapar starka känslor oavsett hur nära relationen är, ett bra stöd på arbetsplatsen underlättar i dessa situationer. Intensivvårdssjuksköterskorna beskriver att de upplever press för att vården ska bli bra och anstränger sig därför mer i situationer som involverar någon de har en relation till. Det kan vara en positiv upplevelse för anhöriga att den som vårdar är någon de har en relation till, då de upplever mer tillit och trygghet i situationen. Intensivvårdssjuksköterskorna upplever också en inre konflikt mellan att vara vän eller personal och de beskriver ett behov av att distansera sig fysiskt och känslomässigt för att klara av situationen. Slutsats: Intensivvårdssjuksköterskorna upplever det svårt och påfrestande att vårda eller möta någon de har en relation till men relationens karaktär påverkar upplevelsen. Det finns en stark oro och ovilja över att behöva ställas emot detta, men när det inträffar så underlättas situationen av ett bra stöd på arbetsplatsen. Det är därför viktigt med bra och utförliga rutiner för hanteringen av dessa situationer.

Bakgrund: Det ställs inre och yttre krav på sjuksköterskor som i sin yrkesroll måste göra medvetna val. Valen skall baseras på individuell vård för varje patient, vara rättssäkra och samtidigt vara effektiva för såväl avdelningen som organisationen. Kraven som ställs på sjuksköterskor kan utgöra en psykisk påfrestning som kan yttra sig i form av moralisk stress. Moralisk stress är de känslor och upplevelser som utgörs av en moralisk motsättning, där personen i fråga vet vilken handling som är korrekt men blir begränsad att utföra den på grund av organisatoriska, strukturella och ekonomiska faktorer. Moralisk stress grundar sig i det fysiologiska fenomenet stress som är kroppens överlevnadsreaktion vid yttre belastning i form av stressorer. För att upprätthålla en god och säker omvårdnad ska sjuksköterskor följa olika styrande riktlinjer och förordningar inom hälso- och sjukvård. Syfte: Belysa sjuksköterskors erfarenheter av moralisk stress. Metod: En litteraturstudie med elva kvalitativa artiklar som insamlats med hjälp av systematisk databassökning där datamaterial sedan granskades och analyserades. Goodmans sju-stegsmodell användes som stöd i metoden för att finna och bedöma relevant vetenskaplig litteratur. Resultat: Efter analys av datamaterial framkom fem teman: Bristande samverkan mellan yrkeskategorier, organisationen försvårar sjuksköterskans arbete, känsla av otillräcklighet, känslomässiga reaktioner och ökat kollegialt stöd. Konklusion: Moralisk stress är globalt förekommande bland sjuksköterskor som uttrycker olika erfarenheter kring fenomenet. Bristande samverkan mellan läkare och sjuksköterskor i kombination med organisatoriska svårigheter leder till en känsla av otillräcklighet för sjuksköterskor. / Background: There are internal and external demands on nurses who must make conscious choices. The choices must be based on individual care for each patient, be legally secure and at the same time be effective for both the ward and the organization. The demands set on nurses can become a psychological distress that can be seen as an internal conflict in the form of moral stress. Moral stress are the feelings and experiences that consist of a moral contradiction, where the person know the correct way to act but is limited to execute it because of organizational, structural and economic factors. Moral stress is based on the physiological phenomenon of stress, which is the body's survival reaction to external burden in the form of stressors. There are various controlling factors and guidelines that nurses should follow in healthcare in order to maintain a good and safe care. Objective: To illuminate nurses’ experience of moral stress.Method: A literature review of eleven qualitative studies that were generated by systematic database search and then reviewed and analysed. To support the method Goodman’s seven-step model was used to find and assess the relevant scientific literature.Results: After analysing data five themes were revealed: Lack of collaboration between professionals, organization that complicate nurses’ work, feelings of inadequacy, emotional reactions and increased support from colleagues. Conclusion: Moral stress is a globally occurring phenomenon which nurses’ express a variety of different experiences. Lack of collaboration between physicians and nurses combined with organizational difficulties leading to a feeling of inadequacy for nurses.

Sammanfattning Bakgrund: Covid-19 innebar en stor påfrestning på sjukvården globalt och påverkade sjuksköterskor genom en föränderlig arbetssituation vilket orsakade fysisk och psykisk ansträngning. Syfte: Syftet med litteraturstudien var att beskriva sjuksköterskors upplevelser av att arbeta på sjukhus i Europa under Covid-19. Metod:Sammanställningen utgjordes av 12 vetenskapliga artiklar med kvalitativ ansats identifierade genom databassökning i PubMed. Huvudresultat: I resultatet framkom upplevelser av en turbulent arbetssituation med frekventa arbetsmiljöförändringar, otillräckligt chefsstöd och förberedelse inför situationen. Detta resulterade i osäkerhet relaterat till den okända situationen, rädsla över risken att ingå i smittkedjan och stigmatisering från omgivningen. Omvårdnadsutmaningar, i samband med egen rädsla, ledde till etiska dilemman för sjuksköterskorna som upplevde sig ge otillräcklig vård. Resultatet påvisar också hur sjuksköterskorna vuxit i sin yrkesroll, antagit större ansvar och vidgat sitt självständiga arbete samt tillsammans med team, erfarenhet och individuella strategier hittat sätt att hantera situationen. Slutsats: Att vara sjuksköterska på sjukhus i Europa under Covid-19 upplevdes vara en turbulent arbetssituation med psykisk och fysisk påfrestning och etiska dilemman gällande omvårdnaden. Sjuksköterskor upplevde otillräcklig förberedelse och kunskap inför situationen, vilket orsakade osäkerhet och rädsla. Trots det föranleddes en positiv utveckling av sjuksköterskerollen. Huvudresultatet antyder att behov av tydlig beredskap och utbildning inför extraordinära situationer, utvecklat psykosocialt stöd för sjuksköterskor och distinkta omvårdnadsriktlinjer för att minska etiska dilemman finns. / Abstract Background: Covid-19 placed a great strain on global healthcare and affected nurses through a changing work situation, which caused physical and mental strain. Aim: The aim of the literature study was to describe nurses' experiences of working in European hospitals during Covid-19. Method: The compilation consisted of 12 scientific articles with a qualitative approach identified through database search in PubMed. Main results: The results revealed experiences of a turbulent work situation with frequent changes in the work environment, insufficient managerial support and insufficient preparation for the situation. This prompted uncertainty related to the unknown situation, fear over the risk of being part of the infection chain and stigmatizing reactions from the surrounding. Nursing challenges, in conjunction with their own fear, led to ethical dilemmas for the nurses who felt they provided inadequate care. The results also demonstrate how the nurses growed in their professional role, assumed greater responsibility and expanded their independent work and together with team, experience and individual strategies found ways to master the situation. Conclusion: Being a nurse in a European hospital during the Covid-19 was experienced as a turbulent work situation with mental and physical stress and ethical dilemmas regarding nursing. Nurses experienced insufficient preparation and knowledge for the situation, which caused uncertainty and fear. Despite this, a positive development of the nursing role was induced. The main result suggests that there is a need for clear preparedness and training for extraordinary situations, developed psychosocial support for nurses and distinct nursing guidelines to reduce ethical dilemmas.

Thesis (MPhil)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: This thesis discusses ethical dilemmas faced by district surgeons in South Africa. District surgeons render clinical forensic services, which means that they deal mainly with detainees and victims of crime. The main functions of district surgeons are the collection of forensic evidence from patients and the care of detainees. So the focus is to assist in the administration of justice rather than improvement of patient wellbeing. The district surgeon may therefore find himself in a situation where patients’ interests are in conflict with those of law enforcement agencies. Being a medical practitioner in clinical forensic medicine, the district surgeon has an obligation to assist in the administration of justice, as opposed to the traditional obligation to care for patients and put patient’s interests first. This allegiance to both administration of justice as well as patient wellbeing lead to an ethical dilemma of dual loyalties. A dual obligations presents an ethical dilemma for the district surgeon, especially if they are in conflict and mutually exclusive. I discuss the detention and subsequent death of Steve Biko to illustrate how dual obligations can lead to serious human rights violations and even death. Dual obligations are however not limited to detainees and police custody settings, and I demonstrate this by discussing three other scenarios commonly encountered by district surgeons. There is a lack clear guidance for district surgeons who are faced with a conflict of obligations. I explore several ethical theories including consequentialism, deontology and virtue ethics, in search of an ethical framework suitable for resolving conflicts in clinical forensic medicine. I therefore argue that a duty based ethical framework is central to clinical forensic medicine and the resolution of loyalty conflicts. I recommend the resolution of conflicts by using an approach developed by Benjamin (2006). This approach involves weighing -up the different duties in conflict, applying philosophical reasoning and then amelioration. By adopting a structured and wellreasoned ethical framework, district surgeons will be able to deal with conflicts of obligations better. / AFRIKAANSE OPSOMMING: Hierdie tesis bespreek etiese dilemmas wat in die gesig gestaar word deur distriksgeneeshere in Suid-Afrika. Distriksgeneeshere lewer kliniese forensiese dienste, wat beteken dat hulle handel hoofsaaklik oor die gevangenes en slagoffers van misdaad. Die belangrikste funksies van distriksgeneeshere is die insameling van forensiese getuienis van pasiënte, en die sorg van gevangenes. Met hierdie benadering is die fokus om te help met die administratiewe doeleindes van geregtigheid, eerder as die verbetering van die pasiënt se welstand. Die distriksgeneesheer kan hom dus in 'n situasie vind waarby die pasiënte se belange in konflik is met dié van wetstoepassingsagentskappe. As 'n geneesheer in kliniese forensiese geneeskunde, het die distriksgeneesheer 'n verpligting om te help met die administrasie van geregtigheid, in teenstelling met die tradisionele verpligting om te sorg vir hul pasiënte, en hul welstand eerste te plaas. Hierdie getrouheid gaan gepaard met beide regspleging, sowel as die welstand van die pasiënt, wat kan lei tot 'n etiese dilemma van dubbele lojaliteit. Dubbele verpligtinge bied 'n etiese dilemma vir die distriksgeneesheer, veral as hulle in konflik en wedersyds uitsluitend is. Ek bespreek die aanhouding en die daaropvolgende dood van Steve Biko om te illustreer hoe dubbele verpligtinge kan lei tot ernstige skending van menseregte en selfs die dood. Dubbele verpligtinge is egter nie beperk tot die gevangenes en polisie-aanhouding instellings nie, en ek demonstreer dit deur die bespreking van drie ander “scenario's” wat oor die algemeen eervaar word deur distriksgeneeshere. Daar is 'n gebrek aan duidelike riglyne vir distriksgeneeshere wat 'n botsing van verpligtinge in die gesig staar. Ek verken verskeie etiese teorieë insluitende konsekwensialisme, deontologie en deugde-etiek, op soek na 'n etiese raamwerk geskik vir die oplossing van konflikte in kliniese geregtelike geneeskunde. Ek argumenteer dus dat 'n pligsgebaseerde etiese raamwerk sentraal is tot kliniese forensiese geneeskunde, en die resolusie van lojaliteit konflikte. Ek beveel die oplossing van konflikte deur die gebruik van 'n benadering wat ontwikkel is deur Benjamin (2006). Hierdie benadering behels 'n gewigsoorweging tussen die verskillende pligte in konflik, die toepassing van filosofiese redenasie en verbetering. Deur die aanneming van 'n gestruktureerde en beredeneerde etiese raamwerk, sal distriksgeneeshere dus in staat wees om konflikte van verpligtinge beter te hanteer.

Nursing moral philosophy in the care of the terminally ill Abstract The aim of the work The aim of the research part of the diploma thesis was to fid out what ethical dilemmas the medical staff recognizes in the care of the terminally ill and what role it occupies in accompanying the dying. The method to reach the goal To achieve the goal, we chose a qualitative research solution using a semi-structured interview, which ethical dilemmas of the non-medical healthcare staff recognizes and what roles it takes to make decisions at the end of the patient's life. The research group was consisted of 10 nurses who are part of palliative teams in selected health care institutions. The interviews which were provided, were rewritten, and using of coding techniques "paper-pencil", the data was organized into each categories. The gained knowledge and the conclusion The research which we have conducted reveals what ethical dilemmas we see as a non-medical healthcare professionals in their practice and which attitudes and roles we hold to the terminally ill, dying patients and their families. The patients with an incurable illness at the end of their lives find themselves in a very difficult situation. It is very important to improve the quality of the care and to be close to these patients. The medical staff member should be aware that any decision can become an ethical dilemma that we should recognize to find the best solution to meet the needs of the patient, respect his desire with maintain one´s dignity. Only that palliative care can be characterized as a first-rate care, focused on the patient's individuality and uniqueness

Esta tese estuda as possibilidades de propor discussões que dêem visibilidade às relações ético-políticas do indivíduo no coletivo assente na atividade da escuta do outro, operacionalizada em estratégias de problematização de dilemas éticos em informática, com estudantes de graduação, a partir de conteúdos de uma disciplina desse curso. A expressão “a munhu i munhu ka vanhu” é proveniente do Xirhonga (uma das línguas nacionais de Moçambique, também chamadas línguas bantu) e significa que “uma pessoa é uma pessoa através de outras pessoas” (tradução literária), ou que a pessoa se forma no coletivo; não estamos sozinhos no mundo, fazemos parte um do outro. Num contexto fortemente marcado pela oralidade a munhu i munhu ka vanhu é usada para orientar a aprendizagem dos conhecimentos (cognitiva), das habilidades e competências (técnica), na articulação com a vivência de valores e da ética com base na experimentação de situações de exposição ao conhecimento específico, permitindo inferir generalizações, conhecimentos universais, bem como interação entre as verdades particular e universal, buscando desenvolver o espírito de tolerância, a capacidade de entender e acolher o outro, o respeito pelas multiplicidades/diferenças e pela dignidade humana em prol de uma convivência harmoniosa. O estudo questiona se possibilidades de vivências, através de experimentações éticas, podem ser desenvolvidas/utilizadas no contexto escolar (no ensino presencial, semi-presencial, a distância), considerando a filosofia a munhu i munhu ka vanhu, a disponibilidade e pluralidade das TIC e a participação ativa dos estudantes, reconhecendo, analisando e acolhendo com “empatia” os posicionamentos/contribuições dos colegas frente a uma situação-problema no coletivo. A tese surge do questionamento do autor às suas práticas docentes instigadas pela imersão nas dinâmicas e vivências do Laboratório de Estudos em Linguagem, Interação e Cognição/Criação (LELIC/UFRGS) através do Projeto Civitas Moçambique-Brasil. A pesquisa sustenta-se na intervenção, pelo viés de in(ter)venção, adotando uma abordagem dialógica guiada pelos princípios orientadores da pesquisa em ciências humanas propostos por Bakhtin e seus comentadores. Os enunciados (orais e escritos, verbais e não-verbais) dos estudantes e do professor-pesquisador, produzidos no contexto interacional de construção e discussão dos dilemas éticos (em sala de aula presencial, no Forchat e as anotações no diário de campo) constituiram o objeto de análise e, foram apreciados dentro do quadro teórico que nos permitiu trabalhar a arquitetônica dialógica da relação eu-outro na perspectiva do ato responsável. Os resultados dão pistas para falar de uma experimentação (est)ética enquanto modo de trabalhar colaborativamente e como potência criadora. A estratégia de uso de dilemas éticos possibilita ressignificar a noção da educação como sistema de valores (valores éticos/morais, cognitivos, técnicos, sociais, culturais,…), podendo ser exercitada criticamente nas salas de aulas, em meio a interações complexas com o contexto problemático que envolve este, e considerando a participação ativa-responsiva dos estudantes, na construção e incorporação de novos conhecimentos ao seu sistema individual de valores, este agenciado ético-politicamente em benefício de uma relação empática e responsável com o coletivo. / This thesis studies the possibilities to propose discussions that give visibility to the ethical-political relations of the individual in the collective based in one-another listening activity, operationalized by ethical dilemmas strategies of questioning in computer science, with undergraduate students, from contents of a given subject in the same course. The expression "a munhu i munhu kana vanhu" comes from Xirhonga (one of the national languages of Mozambique, also called Bantu languages) and means "a person is a person through other people" (literary translation), or that the person is formed in the collective; we are not alone in the world, we are part of each other. In a context strongly marked by orality a munhu i munhu kana vanhu is used to guide the learning of knowledge (cognitive), skills and competences (technical), in articulation with experience of values and ethics based on experience of being self exposed to situations of the specific knowledge, allowing to infer generalizations, universal knowledge and interaction between the particular and universal truths seeking to develop the spirit of tolerance, the ability to understand and accept each other, respect for multiplicities/differences and human dignity for the sake of a harmonious coexistence. This research is wondering what approach possibilities of experiences through ethical trials, can be developed/used in the school context (in the classroom, blended and distance learning), considering the philosophy a munhu i munhu ka vanhu, in the context of availability and plurality of ICT and the active participation of students, recognizing, analyzing and accepting with "empathy" ideas/contributions from colleagues face to a problem situation in the collective? The thesis arises from the author's questioning on his teaching practices instigated by his immersion in its dynamic and experiences of Laboratório de Estudos em Linguagem, Interação e Cognição/Designing (LELIC/UFRGS) through Civitas Project Mozambique-Brazil. The research is based on intervention by means of in(ter)vention, adopting a dialogic approach guided by the guiding principles of research in the humanities proposed by Bakhin and his commentators. The enunciations (oral and written, verbal and non-verbal) of the students and the teacher, produced in the interaction context of construction and discussion of ethical dilemmas (classroom environment, Forchat and notes in logbook) constituted the object analysis and were appreciated within the theoretical framework that allowed us to work the architectural dialogic relationship I-other (one-another) in the perspective of act responsible. The results give clues to speak of ethics-esthetics experimentation as a way to work collaboratively and as creative power. The ethical dilemmas of using strategy enables reframe the notion of education as a value system (ethical values / moral, cognitive, technical, social, cultural, ...) and can be exercised critically in the classroom, through complex interactions with the learning environment challenges, and considering the active-responsive student participation in the construction and development of new knowledge in his/hers individual value system, intermediated ethical-politically in the benefit of an empathic and responsible relationship with the collective.

Inledning: Att vårda kognitivt sviktande personer är ofta en stor utmaning för distriktssköterskan. Syfte: Att belysa distriktssköterskors erfarenhet av situationer i hemsjukvården där kognitivt sviktande personers självbestämmande har skapat etiska dilemman. Metod: Intervjustudie med kvalitativ ansats. Tio distriktssköterskor verksamma inom hemsjukvården i två av Sveriges kommuner intervjuades med semistrukturerade intervjuer. Materialet transkriberades och analyserades med kvalitativ innehållsanalys. Resultat: Det framkom fyra kategorier och 13 underkategorier. Kategorin Mycket svåra situationer av olika karaktär visar på hur svåra situationer kan komma akut eller pågå över lång tid. De svåra situationerna gestaltas även genom att patienterna nekar behandling och hjälp av hemtjänst. Patienterna kan även leva under dåliga förhållanden samt hot eller misshandel. Den andra kategorin som var Distriktssköterskans hantering av situationerna har underkategorier som beskriver på vilket sätt distriktssköterskorna hanterar situationerna för att det i slutänden ska bli så bra som möjligt för patienten. Kategorin Närstående påverkar situationerna lyfter hur närstående både kan fungera som stöd och som hinder för patienterna. Slutligen kommer kategorin Skapar reflektion hos distriktssköterskan där distriktssköterskorna reflekterade över hur självbestämmandet för patienten kan se ut samt vilka möjligheter de har att påverka vården inom hemsjukvård. Slutsats: Etiska dilemman uppstår i vården av kognitivt sviktande personer. Distriktssköterskorna använder sig av flera strategier för att lösa dem på bästa sätt. / Introduction: To provide nursing care for patients who suffer from cognitive impairment is often a big challenge for the district nurse. Aim: To illuminate the district nurses´ experience in home care when situations with cognitive impaired person’s autonomy creates ethical dilemmas. Method: A qualitative interview study. Ten district nurses´ in two different counties in Sweden were interviewed using semi-structured interview. The interviews were transcribed and analyzed using qualitative content analysis. Results: Four generic categories and 13 sub-categories emerged. The generic category Very difficult situations of different nature show how situations can emerge acute or develop over a long period of time. The difficult situations are also demonstrated when patients´ decline help or treatment, live under poor circumstances or have assault and violence around them. The second generic category How the district nurses´ handle the situations has subcategories which describe how the district nurses´ handle the situations with the aim of what´s best for the patient. The generic category The relatives influence in the situations lifts how relatives can work as support for the patient as well as obstacle for the patients wellbeing. The final generic category was Leaves the district nurse with reflections where the district nurses´ reflected on how the patients’ autonomy should be and what possibilities they have to affect the home care situations. Conclusion: Difficult ethical dilemmas emerge when caring for patients´ with cognitive impairment. The district nurses have a lot of strategies to solve them the best way possible.

Syftet med denna studie var att undersöka kunskap och uppfattningar om papperslösas tillgång och rätt till vård hos personal inom öppen hälso- och sjukvård i Landstinget i Uppsala län. Ett ytterligare syfte var att undersöka om information kring handhavandet av papperslösa finns på arbetsplatserna, vad personal i så fall anser om detta, samt vad de önskar för information.   Studien är av en deskriptiv design med kvantitativ ansats. 86 anställda vid vårdcentraler i Uppsala län besvarade enkäter med frågor angående kunskap och uppfattningar om lagstiftning samt tillgång till och önskan om information gällande papperslösa. Insamlad data har sammanställts i Microsoft Excel och presenterats i tabeller och diagram.   Resultatet av studien tyder på att det finns en kunskapsbrist bland personal inom öppen hälso- och sjukvård angående lagstiftningen om papperslösas tillgång till sjukvård. Enligt de medverkandes vetskap finns ingen information tillgänglig på arbetsplatsen gällande papperslösa, och så gott som alla önskar information av något slag. Majoriteten av de tillfrågade anser att papperslösa ska ha samma rätt till vård som svenska medborgare.   Slutsatsen av denna studie är att det finns ett behov av information och riktlinjer gällande handläggning av papperslösa i Landstinget i Uppsala län. / The aim of this study was to investigate knowledge and opinions concerning undocumented migrants’ access and right to health care among employees within the primary health care sector in the county council of Uppsala. An additional aim was to investigate whether there is information available about management of undocumented migrants at the workplaces, and if so what the employees think about it and what kind of information they wish to receive.   The study is quantitative with a descriptive design. 86 employees at primary health care centres within the county of Uppsala answered questionnaires concerning knowledge and opinions about legislation as well as access to and demand for information concerning undocumented migrants. Collected data was compiled using Microsoft Excel and was then presented in tables and diagrams.   The result of the study indicates that there is a lack of knowledge among employees within the primary health care sector concerning legislation on undocumented migrants’ access to health care. According to the employees’ knowledge there is no information available at the workplace concerning undocumented migrants, and nearly everyone requested information of some kind. The majority of the employees are of the opinion that undocumented migrants should have the same right to health care as Swedish citizens.   The conclusion of this study is that there is a need for information and guidelines concerning management of undocumented migrants in the county council of Uppsala.