This thesis explores some of the themes and issues that social workers may wish to consider when investigating and addressing matters pertaining to wellness in individuals with sex-variances. Foundational literature includes writings by John Money, the Chicago Consensus, and the clinical guidelines of the Intersex Society of North America. A three pillars model is introduced as a potential means for fostering better understanding and diversity in relation to sex, gender, and sexuality. Semi-structured interviews surrounding wellness are conducted with four individuals who have sex-variances. Interview results are analysed using Interpretative Phenomenological Analysis. Recommendations are put forth in a manner designed to allow social workers to work collaboratively with individuals who have sex-variances and their families, as well as with other medical and health professionals who provide services thereof. The analyses and recommendations presented in this thesis are situated within a context of evidence-based anti-oppressive practice.

Public health nurses (PHNs) are ideally situated to reduce health inequities and based on documents articulating their role, should be working upstream to promote equity, prevent chronic diseases, and improve population health outcomes. In reality however, numerous barriers contribute to lack of role clarity for PHNs, and this goal has not been attainable in practice. A common vision for PHN practice based on discipline specific competencies and full scope of practice has been identified as a priority by Canadian experts. The intention of this study was to develop a model to support PHN practice in an urban Canadian city. This study used a participatory action research approach, grounded in local experience and context. The action was the development of a professional practice model. Data were gathered using semi-structured interview guides during audio-recorded research working group (RWG) meetings from November 2012 to July 2013. A researcher reflexive journal and field notes were kept. The data were analyzed using qualitative methods. A significant feature was full participant involvement throughout the course of the study. A professional practice model was a key organizational tool that provided the framework to develop an autonomous PHN role and the structures necessary to support PHN practice within the health system. The professional practice model fostered full scope of practice and role clarity, with a focus on population health and equity, so that a consistent and evidence-based practice was attainable. The result was that RWG participants reported a shift in their practice, with greater awareness of theory. Participatory action research was essential in developing the framework and common language, and is a research methodology that should continue to be explored with nurses in Canada.

Syftet med denna studie är att undersöka hur familjebehandlare upplever det att arbeta med FFT-metoden samt de faktorerna som gör den funktionell. Eftersom FFT är anpassad till den amerikanska kulturen som skiljer sig ganska mycket från den svenska, båda i kultur och socialsystem är det viktigt att inte bara utvärdera utifrån modellen men också hur implementering och anpassning av modellen har gått. För att kunna besvara syftet och frågeställningar har fem kvalitativa intervjuer genomförts av semistrukturerad karaktär. Urvalet av respondenter gjordes utifrån snöbollsmetoden där de intervjuade arbetar inom socialtjänstens öppenvård. Resultaten visade att det finns många saker som ska tas hänsyn till vid anpassning till andra kulturer, bland annat utbildningar, målgrupper och ekonomi. FFT är en behandlingsmetod och en påbyggnadsutbildning där gränsen mellan det som är klientens behandling och det som är FFT-terapeuternas utbildning är diffus. Studien kan bidra med tankar om hur man skulle kunna göra vidare studier rörande utbildning och implementering av evidensbaserade modeller.

Allt högre krav ställs på en vetenskapligt grundad praktik inom det sociala arbetet, en så kallad evidensbaserad praktik. Studiens syfte är att undersöka evidensbasering i det sociala arbetets praktik. Detta uppnås genom en undersökning av arbetsmetoder och synen på evidensbaserat arbete hos fältassistenter verksamma i Rinkeby-Kista stadsdelsförvaltning. Studien genomförs med hjälp av intervjuer vilka analyseras tillsammans med olika dokument och ställs mot det teoretiska ramverket. Dokumenten utgörs av en populärvetenskaplig artikel och två arbetsplatsannonser samt skriftlig information från fältassistenterna. Författarna utgår därmed ifrån en kombination av olika sätt att inhämta kunskap. Det teoretiska ramverket utgörs av Socialstyrelsens modell för evidensbaserat arbete och tillämpad teoretisk litteratur gällande evidensbasering, socialt arbete och fältarbete. Studiens resultat visar enligt författarna att det råder en osäkerhet kring evidensbegreppet bland de fältassistenter som ingår i undersökningen. Detta leder till att den evidensbaserade praktiken till stor del utförs utan en professionell medvetenhet. / Increasingly high demands, in western welfare states, are placed on a scientifically based social work practice; a so-called evidence based practice. The aim for the study is to investigate evidence based social work practice. This is achieved through a study of the work methods of detached youth workers from Rinkeyby-Kista district administration in Stockholm and their view on evidence based social work. The study is conducted using interviews which together with various documents are analyzed and set against a theoretical framework. The documents consist of a popular science article, two job advertisements and data from detached youth workers. The authors thus use different methods of collecting data. The theoretical framework consists of the National Board model for evidence based work and applied theoretical literature regarding evidence based practice, social work and outreach work. The results demonstrate that there is uncertainty about the concept of evidence based practice among detached youth workers included in the survey. This furthermore leads to an evidence based practice which is largely carried out without a professional awareness.

Syftet med denna studie är att undersöka diskurser inom det sociala välfärdsarbetet utifrån ideologiskt politiska aspekter. Studien grundar sig på artiklar och publikationer från ideologiskt förankrade tidskrifter och organisationer. I arbetet har vi inspirerats av Faircloughs (2003) kritiska diskursanalys, då den inte enbart fokuserar på diskurs utan även strukturerna som påverkar den. I studien kan vi se hur liberala och socialistiska ideal är dominerande inom välfärdsdebatten. Dessa har kommit att bilda två olika diskurser som konkurrerar med varandra om att bli dominerande gällande hur välfärden ska bedrivas. Idag kan vi se hur den marknadsekonomiska diskursen är den som vunnit mest mark, men det finns vissa indikationer på en eventuell diskursiv förändring. Arbetet tar sin utgångspunkt i två idag etablerade begrepp; New Public Management och Evidensbaserad praktik och de diskursiva svängningar begreppen vållat. / The purpose of this study is to investigate discourses influence of the social welfare, based on ideological and political aspects. The study is based on articles and publications from ideologically entrenched magazines and web-sites. We have been influenced by Faircloughs (2003) critical discourse analysis, as it not only focuses on the discourse but also the structures that affects it. In the study, we can see how liberal and socialist ideals are dominant in the welfare debate. These have come to form two different discourses competing to become the dominant force in welfare. Today we can see how the market-economy discourse is the one which has gained most ground, but there are some indications of a discursive change. The work takes its starting point from two established concepts and the discursive fluctuations caused by the New Public Management and the Evidence Based Practice.

No description available.

Doctor of Philosophy / Similar to their colleagues throughout the world, nurses and midwives in New South Wales (NSW), Australia, welcome evidencebased practice (EBP) as a means to improve patient or client outcomes. This thesis explores the way nurses and midwives understand evidence for EBP and aims to determine whether members of these professions currently have the knowledge and skills necessary to implement evidence‐based care. Three separate studies were conducted to explore NSW nurses’ readiness for EBP. Attitudes, knowledge and skill were investigated using an EBP questionnaire returned by 383 nurses. The views of 23 nursing opinion leaders were elicited during qualitative in‐depth interviews, and their ideas on maximising the potential for future nurses to confidently engage in EBP were explored. Current approaches to teaching EBP in undergraduate nursing programs were investigated by examining documents issued by NSW nursing education providers. The results demonstrate many differences between the ways NSW nurses currently understand evidence for EBP, and a range of approaches to teaching EBP in undergraduate nursing programs. Under current conditions, nurses graduating from universities in NSW commence practice with varying levels of preparation for EBP and enter into a professional arena that is itself struggling to cope with the concepts and language of this approach to improving healthcare. v Evidence for the effectiveness of EBP is slowly accumulating and despite some small positive signs, the collective results of this thesis suggest that current educational approaches are not capable of producing the kind of results that are both necessary and desirable for the promotion of evidence‐based nursing practice in NSW. Articulating a commitment to EBP, using a common language and a consistent approach are among the recommendations made for the future promotion of EBP in nursing education.

Depression och ångestsyndrom hör till de vanligaste psykiska sjukdomarna och medför stora aktivitetsbegränsningar inom arbete, fritid och personlig vård. Trots det finns det få litteraturstudier om arbetsterapeutiska interventioner för denna målgrupp. Syftet var att beskriva arbetsterapeutiska interventioner för vuxna personer med depression eller ångestsyndrom. En systematisk litteraturstudie genomfördes i Pubmed, PsycInfo, Scopus och Cinahl. Arton artiklar inkluderades. Artiklarna analyserades med stöd av Friberg (2012). Tre huvudteman identifierades: 1) Att hjälpa klienterna få ökad insikt om sin livssituation, 2) Att lära klienten hantera och förebygga symtom och 3) Aktivitet som medel i interventionen. Resultatet har betydelse för hur arbetsterapeuter kan välja, kommunicera och genomföra interventioner samt för framtida forskning. Betydelsen av val av behandlingsstrategier i interventionerna diskuterades också. / Depression and anxiety disorders are among the most common mental disorders and lead to serious activity limitations in work, leisure and self-care.  In spite of this, there are few systematic reviews on occupational therapy interventions for this client group. The study aim was to describe occupational therapy interventions for adults with depression or anxiety disorders. A systematic review was conducted in Pubmed, PsycInfo, Scopus and Cinahl. Eighteen articles were included. The articles were analyzed in accordance with Friberg (2012). Three main themes were identified: 1) To help clients gain insight into their life situation, 2) To teach clients how to manage and prevent symptoms, and 3) Occupation as means in the intervention. The findings have implications for how therapists can choose, communicate and carry out interventions as well as for future research. The importance of therapeutic strategies in the interventions was also discussed.

Bakgrund: Evidensbaserad vård är en indikator på god och säker vård. Att arbeta evidensbaserat är ett förhållningssätt som förutsätter kunskap och praktiskt handlande. Förhållningssättet innebär viljan att tillämpa bästa tillgängliga vetenskapliga kunskap som underlag för vårdbeslut och det praktiska handlandet är processen i vilken sjuksköterskor tillämpar vetenskaplig kunskap. Anestesisjuksköterskor behöver vara rustade för att delta aktivt och ta ansvar för evidensprocessen i den anestesiologiska omvårdnaden. Syfte: Att beskriva anestesisjuksköterskors uppfattningar av evidensbaserad vård som förhållningssätt och process. Metod: En kvalitativ forskningsansats med fenomenografisk inriktning. Insamlad data från 18 kvalitativa intervjuer, som genomfördes med anestesisjuksköterskor från två sjukhus i Sverige, analyserades induktivt. Resultat: Tre beskrivningskategorier om anestesisjuksköterskors uppfattningar av evidensbaserad vård framträdde och presenteras i ett utfallsrum; Vårdkultur med fokus på vårdvetenskapens dolda funktion, Kunskap med ansvar och begränsningar och De goda handlingarna: att vilja bättre för patienten, Vårdkultur och vårdvetenskapens dolda funktion förefaller ha en övergripande position i förhållande till övriga beskrivningskategorier. Slutsats: För att förbättra den evidensbaserade vården och stärka anestesisjuksköterskornas profession kan insikten om de olika uppfattningarna mötas med utbildning och kunskapsöverföring. Särskilt viktigt är att stärka den egna professionen genom att värdera det vårdvetenskapliga evidensbegreppet. / Background: Evidence-based practice is an indicator of best practice. Evidence-based practice is an approach that requires knowledge and practical action. The approach is the willingness to apply the best available scientific knowledge as a basis for clinical decisions, and practice is the process in which nurses apply scientific knowledge. Nurse anesthetist’s need to be equipped to participate actively and take responsibility for the evidence process in the anesthetic care. Aim: To describe the nurse anesthetist’s’ perceptions of evidence-based practice as an approach and a process. Method: A qualitative research design with a phenomenography approach. Data from 18 qualitative interviews, conducted with nurse anesthetists from two hospitals in Sweden, were analyzed inductively. Findings: Three descriptive categories of nurse anesthetist’s perceptions of evidence-based practice appeared presented in an outcome space: Culture in healthcare settings: focusing on the hidden function of caring science, Knowledge with responsibility and limitations, and Good actions: To want better for the patient. The culture in healthcare settings and the hidden function of caring science seems to have an overall position in relation to the other descriptive categories. Conclusions: In order to improve evidence-based practice and strengthen the profession of nurse anesthetists, the insight of different perceptions can be met with education and knowledge. Particularly important is to strengthen the nurse anesthetist’s profession by appraising the concept of caring science.

A úlcera por pressão, considerada um evento adverso, compromete a segurança do paciente sob os cuidados dos profissionais de saúde. Uma das formas de proporcionar segurança é por meio da prática baseada em evidência que pode ser implementada com estudantes pelo uso de metodologias ativas de ensino- aprendizagem. O objetivo geral do estudo foi propor uma metodologia de ensino para estudantes do curso de Enfermagem da Universidade Estadual de Londrina, pela avaliação do risco de desenvolvimento da úlcera por pressão em pacientes internados em uma unidade médico-cirúrgica e pela identificação das prescrições de enfermagem para a prevenção nos registros em prontuários. A pesquisa foi aprovada pelo Comitê de Ética e Pesquisa institucional e realizou-se utilizando métodos quantitativos e qualitativos, com delineamento descritivo, ocorrendo em três fases. A primeira foi um workshop sobre prática baseada em evidência. A segunda foi desenvolvida pelos estudantes e pesquisadora e a coleta de dados foi realizada com 21 pacientes hospitalizados em unidade médico-cirúrgica durante 15 dias sequenciais, em que avaliou-se o risco para úlcera por pressão por meio da Escala de Braden e os registros das prescrições de enfermagem relacionados ao uso das evidências para prevenção de úlcera por pressão. A terceira foi desenvolvida com os estudantes para investigar o significado da experiência com a metodologia de ensino. Os 21 pacientes avaliados tinham a média de idade de 44,76 anos e diagnósticos médicos mais frequentes de doenças do sistema osteomuscular e do tecido conjuntivo (42,86%). No primeiro dia de avaliação, considerando a escore total da Escala de Braden, 17 pacientes (80,95%) tinham risco entre moderado e muito alto. Na inspeção da pele foram identificadas 25 úlceras por pressão, sendo a localização mais frequente na região sacral (44%) e as classificações predominantes foram no estágio I e II. Na análise dos prontuários, não foram identificadas anotações dos enfermeiros referentes à avaliação do risco e nem ao uso da Escala de Braden. As prescrições de enfermagem mais frequentes para a prevenção da úlcera foram mudança de decúbito, uso de coxins, proteção contra a umidade e uso de cremes hidratantes, e a menos frequente foi a manutenção da cabeceira até 30 graus. Não foi encontrada associação entre as medidas de prevenção prescritas e os subescores da escala de Braden. O significado das experiências de oito estudantes que participaram da pesquisa foi investigado pela análise de conteúdo das falas obtidas nas discussões em grupo e identificaram-se duas categorias: aprendendo sobre o tema úlcera por pressão e conhecendo a realidade da instituição e da enfermagem sobre a úlcera por pressão. Concluiu-se que os estudantes relacionaram a teoria à prática, identificaram as competências do enfermeiro na avaliação do paciente com risco para úlcera por pressão, aprimoraram o conhecimento nos estágios da úlcera por pressão e identificaram a Escala de Braden como suporte para avaliação de risco para a úlcera por pressão. Os estudantes, ainda, identificaram a falta de cuidados pela equipe de enfermagem e a importância da presença da família e perceberam a necessidade da prática segura em relação à úlcera por pressão / Pressure ulcers, considered an adverse event, compromise the safety of patients under the care of health professionals. One way to provide safety is through evidence-based practice, which can be implemented with students through the use of active teaching-learning methods. The general study objective was to propose a teaching method for students from the Nursing program at the Universidade Estadual de Londrina, to assess the risk of pressure ulcer development in patients hospitalized at a medical-surgical unit and to identify the nursing prescriptions for this prevention in the records in patient files. Approval for the research was obtained from the institutional Research Ethics Committee and quantitative and qualitative methods were applied, with a descriptive design, involving three phases. The first was a workshop on evidence-based practice. The second was developed by the students and researcher and the data were collected with 21 patients, hospitalized at the medical-surgical unit for 15 continuous days, in which the risk of pressure ulcer was assessed through the Braden Scale and the records of the nursing prescriptions related to the use of evidences to prevent pressure ulcers. The third was developed with the students to investigate the meaning of the experience with the teaching method. The 21 patients assessed had a mean age of 44.76 years and the most frequent medical diagnoses were diseases of the musculoskeletal system and connective tissue (42.86%). On the first assessment day, considering the total score on the Braden Scale, 17 patients (80.95%) had a moderate to very high risk. In the skin inspection, 25 pressure ulcers were identified, with the sacral region as the most frequent location (44%) and stages I and II as the predominant classifications. In the analysis of the files, no nursing notes were identified with regard to the risk assessment, nor related to the use of the Braden Scale. The most frequent nursing prescriptions to prevent ulcers were decubitus change, use of cushions, protection against humidity and use of hydrating creams, and the least frequent was the maintenance of the headrest at 30 degrees. No association was found between the prescribed prevention measures and the subscores of the Braden scale. The meaning of the experience of the eight students who participated in the research was investigated by means of the content analysis of the statements obtained in the group discussions and two categories were identified: learning about the theme pressure ulcer and getting to know the reality of the institution and nursing with regard to pressure ulcer. In conclusion, the students related the theory with the practice, identified the nurses\' competences in the assessment of patients with risk of pressure ulcers, improved the knowledge on the pressure ulcer stages and identified the Braden Scale to support the risk assessment for pressure ulcer. The students also identified the lack of care by the nursing team and the importance of the family\'s presence and perceived the need for safe practice with regard to pressure ulcers