This thesis describes a qualitative study exploring the use of critical care diaries from the experiences and perspectives of patients, family members and nurses in a Scottish Intensive Care Unit (ICU). Diaries are currently used in some ICUs across Europe, the UK, Australia and other countries to help patients come to terms with the experience of critical illness. Started in the ICU, the diary is written at the bedside by nurses and family members providing an account of what happened when the patient was in ICU. Following discharge, the diary is handed over to the patient for them to read and refer to during their recovery. Therefore, the diary is used by different people, at different times and in different ways throughout the critical illness journey. However, until recently, research has mainly focused on the diary being read by the patient after ICU as an aid to recovery with little known about family members and nurses despite them being the main authors during the time in ICU. This doctoral research was designed to explore critical care diaries from multiple perspectives and experiences to gain a greater understanding of the different ways in which diaries can be used. Furthermore, it is the first known research study in this area to have been undertaken in NHS Scotland where the use of diaries remains a relatively new practice. The theoretical perspective of Symbolic Interactionism helped to inform the development and design of the research study. A focused ethnographic approach was taken to explore the use of critical care diaries from the different groups identified, during and after a stay in ICU. The setting was an Adult ICU in Scotland where diaries were being used as part of a follow up service for patients and family members after ICU. Data were collected from February 2013 to June 2014. Semi-structured interviews were the main method of data collection. A purposive sampling strategy was adopted to recruit participants in triads with a related patient, family member and nurse involved in their care during the time in ICU. This is a novel and unique approach to research in this area. Four complete triads and two incomplete triads were recruited giving a total of sixteen interviews with four patients, six family members and six nurses. Interviews were supplemented with a small number of formal observations of nurses carrying out diary related activities (n=9) and field notes from time spent at the site. Transcribed interview data were analysed using a thematic approach, uncovering five main themes: (1) Information; (2) Communication; (3) Emotion; (4) Person Centered and (5) Gender. The concept of ‘Stories as joint actions’ developed by the sociologist Ken Plummer in 1995 was used as a framework to discuss and explain the findings. Diaries were found to support information sharing and facilitate communication interactions between nurses, family members and patients in the ICU as well as promoting and demonstrating a person centered approach to care. Emotional support was experienced by family members from writing in and reading the diary during the time in ICU whereas patients experienced emotional support from reading diary entries after the time in ICU. However emotional effort was associated with reading and writing in the diary during and after the time in ICU for patients, family members and nurses. Male family members were found to be less likely to write in the diary compared to female family members. Factors such as gender and literacy appeared to influence diary use however this requires further investigation. A new conceptual model ‘Critical Care Diaries as Joint Actions’ was created to address the complex nature of experiences with critical care diaries. Exploring the use of diaries from multiple perspectives and experiences has provided valuable insight into the different ways in which diaries are used during and after the time in ICU demonstrating that although the diary is primarily written for the patient, family members, nurses and patients use the diary in different ways to support their needs and others needs throughout the experience of critical illness.

In 1998 World Health Organisation Europe outlined a vision of a new community-based nurse called the Family Health Nurse (FHN) who would help individuals, families and communities to cope with illness and to improve their health. Scotland was the first European country to develop this idea through policy, education and practice. The two phase national pilot project (2001-2006) primarily involved remote and rural regions. Despite its vanguard position, Scottish family health nursing has been subject to little in-depth critical analysis. This thesis addresses this deficit by analysing why and how family health nursing developed in Scotland. The research methods used are: critical review of textual sources; empirical research into policy, education and practice; and critical review and application of relevant theoretical perspectives to enable interpretation. Grounded primarily in constructivism, this approach builds explanation of the development of family health nursing in Scotland as a phenomenon in contemporary nursing history. This explanation highlights the importance of key factors and processes, particularly: agency at policy formulation level; use of the piloting mechanism to mediate knowledge production, containment and expansion; tensions between generalism and specialism as manifest within the promulgated FHN concept, the educational programme, and the FHN role as it was variously enacted in practice; related difficulty in engaging substantially with families; and the strong influence of local context on the nature and scope of FHN role development, especially in terms of situated power and embedded culture of place. The explanation is summarised as a synoptic story. A new integrative, explanatory model of the development of family health nursing in Scotland is also posited. This knowledge is then examined in relation to contemporary community nursing and primary care in order to understand influence and implications. This highlights the importance of the development of family health nursing in shaping the new Community Health Nurse (CHN) role which emerged from the Review of Nursing in the Community in Scotland 2006. The new explanatory model constructed within the thesis is then applied in its more generic MAPPED format (Model for Analysing Policy to Practice Executive Developments) to analyse the new policy formulation advancing the CHN role and to anticipate key developmental factors and processes. On this basis, the thesis argues that the MAPPED model is potentially valuable for the analysis of developments that require purview from policy through to practice. The thesis concludes by summarising its contributions to understandings of community nursing policy, practice, research and theory, and makes a number of related recommendations.

Bakgrund: Varje år drabbas cirka 7000 kvinnor av bröstcancer i Sverige. Beskedet kan innebära en livskris och en livsomställning. Kvinnan kan behöva hjälp och vägledning i den behandling som måste genomgås. För sjuksköterskan kan kunskap kring hur kvinnans hälsa påverkas av behandlingen vid bröstcancer vara till hjälp då möte kan ske med de drabbade kvinnorna inom den allmänna hälso- och sjukvården. På så vis kan bättre stöd ges för att uppnå hälsa.  Syfte: Syftet med denna litteraturöversikt var att belysa hur kvinnors hälsa påverkas av behandlingen i samband med bröstcancer.    Metod:  En litteraturöversikt utfördes i överensstämmelse med metoden av Friberg (2017) genom användning av databaserna CINAHL COMPLETE och PubMed. Kvalitativa och kvantitativa artiklar sammanställdes till resultatet.  Resultat: Till resultatet användes tio vetenskapliga artiklar som sammanfattades till två huvudteman; Hälsa i relation till behandling och behandlingens påverkan på familj relationer och två subteman; Kemoterapins påverkan på hälsan och mastektomins påverkan på hälsan.  Diskussion: Diskussionen inkluderar en metoddiskussion och en resultatdiskussion. I metoddiskussionen tar författarna upp för och nackdelar med arbetets tillvägagångssätt. I resultatdiskussionen tar författarna upp tidigare forskning, teoretisk referensram och författarnas egna reflektioner. / Background: Every year, about 7,000 women suffer from breast cancer in Sweden. The information about the breast cancer can mean a life crisis and a life adjustment. The woman may need help and guidance in the treatment she must undergo. For the nurse, knowledge about this subject can be helpful in meeting the affected women in the public health care system. In this way, support can be given to achieve health. Aim: The aim of this literature review was to illuminate how women's health is affected by the treatment associated with breast cancer. Method: A literature review was performed in accordance with the method of Friberg (2017) using the databases CINAHL COMPLETE and PubMed. Qualitative and quantitative articles were compiled for the result. Results: To the result, ten scientific articles were used which were summarized into two main themes; Health in relation to treatment and treatment impact on family relationships and two sub-subjects; Chemotherapy´s impact on health and mastectomy's impact on health. Discussion: The discussion includes a method discussion and a discussion of results. In the method discussion, the authors discuss pros and cons with the work approach. In the result discussion, the authors discuss earlier research, the theoretical frame of reference and the authors' own reflections.

<p> </p><p>Bakgrund:Smärta är en naturlig upplevelse vilken alla människor kommer i kontakt med och känner någon gång i livet. Smärta benämns kronisk om personen haft smärtan mer än sex månader i följd. Betydelsefullt för personer med kronisk smärta är att sjuksköterskan kan hantera smärtproblematik. Syfte: Syftet var att beskriva personers upplevelser av att leva med kronisk smärta. Metod: En allmän litteraturstudie har legat till grund för arbetet. Nio vetenskapliga artiklar har analyserats genom en kvalitativ och kvantitativ innehållsanalys. Resultat: Accepterande av kronisk smärta var ett påtagligt problem för dessa personer. En del påverkades så djupt av sin smärta att de hamnade i depression. Familjen har stort inflytande för personen med kronisk smärta. Egenvården är en viktig del för personer med kronisk smärta. Diskussion: Accepterande av smärta byggde i hög grad på hur smärtstillad personen upplevde sig vara. Sjukdom kan upplevas positivt trots att den är kronisk enligt Dorothea Orem. Slutsats: Studiens betydelse för sjuksköterskor är att kunna bemöta och ge en bättre omvårdnad till personer som lider av kronisk smärta. Med djupare kunskaper om hur personer med kronisk smärta upplever sjuksköterskans bemötande kan detta leda till bättre omvårdnad och patientkontakt.</p><p> </p> / <p> </p><p>Background: Pain is a natural experience which all people come into contact with and feels at some point in their lives. Chronic pain is when the person had pain for more than six consecutive months. It is significant for a person with chronic pain that a nurse can deal with pain problems. Aim: The aim was to describe people's experiences of living with chronic pain. Method: A general literature study has been the basis for the work. Nine scientific articles have been analyzed trough qualitative and quantitative content analysis. Results: Acceptance of chronic pain was a substantial problem for these people. Some were affected so deeply by their pain that they went into depression. The family has great influence on people with chronic pain. Self-care is an important part of people with chronic pain. Discussion: Acceptance of pain was based largely on how people experienced the pain. Illness may be viewed positively, although it is chronic according to Dorothea Orem. Conclusion: The study is important for nurses in order to respond and provide better care to people suffering from chronic pain. With a deeper understanding of how people with chronic pain perceive the nurse's response, this can lead to better care and patient contact.</p><p> </p>

Bakgrund:Smärta är en naturlig upplevelse vilken alla människor kommer i kontakt med och känner någon gång i livet. Smärta benämns kronisk om personen haft smärtan mer än sex månader i följd. Betydelsefullt för personer med kronisk smärta är att sjuksköterskan kan hantera smärtproblematik. Syfte: Syftet var att beskriva personers upplevelser av att leva med kronisk smärta. Metod: En allmän litteraturstudie har legat till grund för arbetet. Nio vetenskapliga artiklar har analyserats genom en kvalitativ och kvantitativ innehållsanalys. Resultat: Accepterande av kronisk smärta var ett påtagligt problem för dessa personer. En del påverkades så djupt av sin smärta att de hamnade i depression. Familjen har stort inflytande för personen med kronisk smärta. Egenvården är en viktig del för personer med kronisk smärta. Diskussion: Accepterande av smärta byggde i hög grad på hur smärtstillad personen upplevde sig vara. Sjukdom kan upplevas positivt trots att den är kronisk enligt Dorothea Orem. Slutsats: Studiens betydelse för sjuksköterskor är att kunna bemöta och ge en bättre omvårdnad till personer som lider av kronisk smärta. Med djupare kunskaper om hur personer med kronisk smärta upplever sjuksköterskans bemötande kan detta leda till bättre omvårdnad och patientkontakt. / Background: Pain is a natural experience which all people come into contact with and feels at some point in their lives. Chronic pain is when the person had pain for more than six consecutive months. It is significant for a person with chronic pain that a nurse can deal with pain problems. Aim: The aim was to describe people's experiences of living with chronic pain. Method: A general literature study has been the basis for the work. Nine scientific articles have been analyzed trough qualitative and quantitative content analysis. Results: Acceptance of chronic pain was a substantial problem for these people. Some were affected so deeply by their pain that they went into depression. The family has great influence on people with chronic pain. Self-care is an important part of people with chronic pain. Discussion: Acceptance of pain was based largely on how people experienced the pain. Illness may be viewed positively, although it is chronic according to Dorothea Orem. Conclusion: The study is important for nurses in order to respond and provide better care to people suffering from chronic pain. With a deeper understanding of how people with chronic pain perceive the nurse's response, this can lead to better care and patient contact.

Community health nurses, like all other health professionals, are being called to develop new clinical practices based on collaboration and are faced with the demands of working both interprofessionally and interorganizationally (D’Amour et al., 2008). In Capital Health, public health nurses (PHNs), family practice nurses (FPNs) and nurse practitioners (NPs) are all working in different aspects of breastfeeding support and promotion. However, there is no formal structure for collaboration of services, despite the strong desire of these nurses to work together to improve breastfeeding outcomes. The purpose of this study was to explore the roles of PHNs, FPNs and NPs who work in breastfeeding support and promotion in Capital Health and the structures and processes needed to support the development of collaboration amongst these groups of nurses. Through the analysis of semi-structured focus group interviews and follow-up focus group interviews with a purposeful sample (n=10) of four PHNs, four FPNs and two NPs, four major themes and sub themes were identified that represented the nurses experience with collaboration between public health and primary care in breastfeeding support and promotion. The data generated revealed that participants had not experienced active collaboration, rather developing or potential collaboration (D’Amour et al., 2008). The first theme, Establishing Interpersonal Relationships, provided an overview of the precipitators and barriers to forming relationships and the outcomes of interpersonal relationships between public health and primary care nurses. The second major theme, The Organizational Context: Structures and Processes in the Everyday Work Environment outlines the impact of the organizational context of the nurses work environment on the development of collaboration. Benefits of Collaboration was the third theme identified in the study. Consistent with other studies on collaboration between primary care and public health nurses, the nurses interviewed believed that the development of collaboration in breastfeeding support and promotion would benefit health care professionals and the clients that they serviced. The last theme, Development of New Practices Grounded in Collaboration, described new initiatives or innovations that the participants explained were needed for the development of collaboration between PHNs, FPNs and NPs. Implications for practice include organizational support for PHNs, FPNs and NPs to work to the full scope of their competencies and providing them with opportunities to meet and establish relationships to facilitate joint planning initiatives related to breastfeeding support and promotion. Additionally, exploration of flexible roles and funding structures as alternatives to fee-for-service should be explored in primary care organizations. The development of a communication infrastructure is necessary for future development of collaboration between public health and primary care in breastfeeding support and promotion. Future research is needed in this area with a broader, more diverse sample, exploring organizational structures needed to improve breastfeeding outcomes and optimize FPN and NP roles. PHNs, FPNs and NPs have the opportunity to impact the model of care for breastfeeding families in the Capital Health District of Nova Scotia, optimizing their capacity to address issues in practice and ensuring that breastfeeding support and promotion activities address the complex social factors that influence the breastfeeding experience.

Thesis (M.Sc.), Memorial University of Newfoundland, Faculty of Medicine, 1999. / Typescript. Bibliography: p. 84-89.