<p>Sjuksköterskan är dokumentationsskyldig enligt ett flertal lagar och förordningar. Dessa ger oss ramar men inga enhetliga riktlinjer och verktyg för hur strukturen för omvårdnadsdokumentationen ska se ut. Syftet med litteraturstudien var att granska hur den vetenskapliga litteraturen beskriver omvårdnadsdokumentationen utifrån VIPS-modellen och ICF som tillämpbar inom omvårdnadsdomänen. Metoden som användes var litteraturstudie där sammanlagt 18 st. vetenskapliga artiklar granskades. Resultatet påvisar brister i omvårdnadsdokumentationen. Få av de granskade journalerna uppfyllde kraven enligt patientjournallagen. Enligt granskningsinstrumentet Cat-ch-Ing förbättrades dokumentationen efter utbildningsinterventioner som byggde på VIPS-modellen. </p><p>Det framkom en diskrepans mellan patienters egen uppfattning av sina problem, sjuksköterskors uppfattning och vad som fanns dokumenterat i journalen. Sjuksköterskan skriver ner sina iakttagelser utan att stämma av med patienten. Studierna visade att de flesta omvårdnadsdiagnoser kunde omvandlas till International Classification of Functioning, Disability and Health (ICF) koder. I vissa fall ansåg sjuksköterskorna att koderna inte var tillräckligt specifika. Konklusionen är att en dokumentationsmodell eller klassifikation inte är tillräckligt för att säkerställa kvalitén i omvårdnadsdokumentationen utifrån omvårdnadsprocessen och gällande lagar. Som komplement krävs kontinuerlig journalgranskning och återkommande utbildningsinterventioner. ICF-klassifikationen anses tillämpbar inom omvårdnadsdomänen och kan främja en tvärprofessionell kommunikation. De tillkortakommanden som identifierats kan undanröjas genom att sjuksköterskor tar en aktiv roll i kommande revisioner. Om ICF skall implementeras måste det ske nationellt.</p><p>Dokumentationen bör förenklas i så stor grad som möjligt i standardiserade modeller så tid kan ägnas åt det patientnära arbetet. ICF är en strukturerad modell som kan underlätta dokumentationsarbetet.</p>

This thesis examined inhibition, executive functioning and their possible relation to childhood problems of hyperactivity and inattention, in its clinical form referred to as Attention Deficit Hyper-activity Disorder (ADHD). Concurrent as well as longitudinal relations were of interest, and both clinical and non-clinical samples were studied. Study I demonstrated concurrent relations between executive inhibition and both hyperactivity and conduct problems in preschool. However, the relation between inhibition and conduct problems could be attributed to the large overlap between hyperactivity and conduct problems. In Study II, linear relations were found between executive inhibition and hyperactivity, whereas inhibition to the unfamiliar was related to hyperactivity, social initiative, as well as social anxiety. Non-linear analyses showed that children with high levels of both types of inhibition were at risk for developing low social initiative and social anxiety, whereas children with low levels of inhibition were at risk for developing hyperactivity, but at the same time protected from social anxiety. In Study III, executive inhibition was longitudinally related to ADHD symptoms in both school and at home for boys, but only in the school context for girls. Executive inhibition was also related to more general executive functioning deficits, and concurrent relations were found between executive functioning and ADHD symptoms, although in both cases only for boys. Inhibition and executive functioning made independent contributions to the understanding of ADHD symptoms for boys, and together explained about half the variance in inattention problems. In Study IV, group differences were found between ADHD children and controls for both inhibition and various other executive function measures. These measures also discriminated well between groups. The best model, which included measures tapping inhibition, working memory and emotion regulation, classified 86% of the children correctly. In summary, the results of the present thesis were mostly supportive of Barkley’s hybrid model of ADHD, although it should be noted that the question of whether inhibition should be regarded as primary to other executive functions requires further investigation.

Sjuksköterskan är dokumentationsskyldig enligt ett flertal lagar och förordningar. Dessa ger oss ramar men inga enhetliga riktlinjer och verktyg för hur strukturen för omvårdnadsdokumentationen ska se ut. Syftet med litteraturstudien var att granska hur den vetenskapliga litteraturen beskriver omvårdnadsdokumentationen utifrån VIPS-modellen och ICF som tillämpbar inom omvårdnadsdomänen. Metoden som användes var litteraturstudie där sammanlagt 18 st. vetenskapliga artiklar granskades. Resultatet påvisar brister i omvårdnadsdokumentationen. Få av de granskade journalerna uppfyllde kraven enligt patientjournallagen. Enligt granskningsinstrumentet Cat-ch-Ing förbättrades dokumentationen efter utbildningsinterventioner som byggde på VIPS-modellen. Det framkom en diskrepans mellan patienters egen uppfattning av sina problem, sjuksköterskors uppfattning och vad som fanns dokumenterat i journalen. Sjuksköterskan skriver ner sina iakttagelser utan att stämma av med patienten. Studierna visade att de flesta omvårdnadsdiagnoser kunde omvandlas till International Classification of Functioning, Disability and Health (ICF) koder. I vissa fall ansåg sjuksköterskorna att koderna inte var tillräckligt specifika. Konklusionen är att en dokumentationsmodell eller klassifikation inte är tillräckligt för att säkerställa kvalitén i omvårdnadsdokumentationen utifrån omvårdnadsprocessen och gällande lagar. Som komplement krävs kontinuerlig journalgranskning och återkommande utbildningsinterventioner. ICF-klassifikationen anses tillämpbar inom omvårdnadsdomänen och kan främja en tvärprofessionell kommunikation. De tillkortakommanden som identifierats kan undanröjas genom att sjuksköterskor tar en aktiv roll i kommande revisioner. Om ICF skall implementeras måste det ske nationellt. Dokumentationen bör förenklas i så stor grad som möjligt i standardiserade modeller så tid kan ägnas åt det patientnära arbetet. ICF är en strukturerad modell som kan underlätta dokumentationsarbetet.

The purpose of this study was to illuminate the experienced impact of childhood sexual abuse (CSA) within the context of intimate relationships. Few studies have examined the lived experience of CSA within the context of a relationship from the perspective both partners. Further, previous research in the area of CSA has primarily focused on the trauma experienced by the survivor, thus excluding the impact of CSA on the couple relationship. Examining the impact of CSA on intimate relationships is important as those individuals in close relationship with the survivor will often also experience the impact of the long-term sequelae associated with CSA. Interpretative phenomenological analysis (IPA) was used to explore the lived experiences of individuals who have experienced CSA and their partners. Data generated during two joint interviews with three participant couples were transcribed and analysed using an interpretative phenomenological analysis approach. An over-arching theme of hope and healing: past yet present, healed yet healing emerged from the data; this theme was impacted by the additional themes identified throughout the analysis process. The additional three themes were: living with the unknown, (barely) surviving, and commitment. Given the limited research on the impact of CSA on intimate partnerships and the focus of existing studies on the more negative aspects of the impact CSA has on relationships, the theme of hope and healing: past yet present, healed yet healing provides a valuable contribution to the literature. These themes are discussed along with implications for counselling practices and future research.

Prior research has demonstrated that bilinguals outperform monolinguals on tasks requiring set shifting – that is, the ability to shift between different ways of thinking about an object or situation. For example, bilingual children have been shown to outperform monolingual controls on false-belief tasks and on the Dimensional Change Card Sort (DCCS) task. The present study aimed (a) to examine whether the bilingual advantage in false-belief and DCCS tasks can be replicated when accounting for languages/cultures and socio-economic status and (b) to determine whether inhibitory control, metarepresentation, and/or working memory underlie the advantage, if any exists. Three language groups (24 English monolingual, 24 French monolingual, and 24 English-French bilingual preschoolers) were tested on the following tasks: false-belief (FB) tasks, the DCCS task, an inhibitory control task (Stroop task), a metarepresentation task (Identity Statements task), a working memory task (Backward Word Span), and receptive language proficiency tests. Socio-economic status was measured through a parental questionnaire containing questions about parental income and education. Results showed that the three language groups were equivalent on socio-economic measures. Despite having significantly lower language proficiency scores, bilinguals’ raw scores on FB and DCCS tasks did not differ from monolinguals’ raw scores. After statistically controlling for language proficiency and age, bilinguals had significantly higher FB scores, but did not differ from monolinguals on DCCS scores. Analyses were then performed to determine whether inhibitory control, metarepresentation, and/or working memory help bilinguals “do more” in FB “with less” language proficiency. Working memory emerged as the likely candidate that compensates for the negative effect of bilingual children’s low language proficiency on FB performance because, after controlling for age and language proficiency, it was the only cognitive ability that fulfilled both criteria: (a) its measure correlated significantly with FB and (b) there was a bilingual advantage over both monolingual groups in the measure. A mediation analysis confirmed that the working memory measure significantly mediates the relation between bilingual status and FB while controlling for age and language proficiency. Both components of the working memory measure – that is, understanding of task instructions and maintenance/manipulation capacity – mediate this relation.

The aim of the current studies was to first determine the convergent validity of several observer and self-report measures of defense mechanisms, and second to determine whether participants in the depressed and anxious groups could successfully be differentiated using observer and self-report measures of defenses. In Study 1, defensive functioning of 150 university students was assessed using the Defense-Q, Defense Mechanism Rating Scale, Defense Style Questionnaire, and the Defense Mechanisms Inventory. The results of the Pearson r analyses indicated that the defense measures were correlated in a theoretically consistent manner at the overall and defense level analyses, with the strongest relations at the mature and immature ends of the scales. Four of the 17 individual defenses were correlated in a theoretically consistent manner. In Study 2, 1182 university students completed the Personality Assessment Inventory and those scoring in the clinical range on depression or anxiety indices were selected for participation in this study. The extent to which these participants could be correctly classified into their respective groups using defense scores from the Defense-Q and the Defense Style Questionnaire was assessed using discriminant analyses. Results indicated that defense scores from both observer and self-report measures can be used to classify participants correctly into depressed and anxious groups. The Defense-Q discriminant function primarily identified depression-related defenses as important for differentiation, whereas the Defense Style Questionnaire discriminant function primarily identified anxiety-related disorders. Confirmatory stepwise discriminant analyses confirmed that the defenses previously identified in the literature were among the most effective in differentiating between the groups. The results from the present investigation identify substantial differences between the defenses assessed by observer and self-report measures and indicate that both methods can be informative for differentiating between depressed and anxious participants.

Prior research has demonstrated that bilinguals outperform monolinguals on tasks requiring set shifting – that is, the ability to shift between different ways of thinking about an object or situation. For example, bilingual children have been shown to outperform monolingual controls on false-belief tasks and on the Dimensional Change Card Sort (DCCS) task. The present study aimed (a) to examine whether the bilingual advantage in false-belief and DCCS tasks can be replicated when accounting for languages/cultures and socio-economic status and (b) to determine whether inhibitory control, metarepresentation, and/or working memory underlie the advantage, if any exists. Three language groups (24 English monolingual, 24 French monolingual, and 24 English-French bilingual preschoolers) were tested on the following tasks: false-belief (FB) tasks, the DCCS task, an inhibitory control task (Stroop task), a metarepresentation task (Identity Statements task), a working memory task (Backward Word Span), and receptive language proficiency tests. Socio-economic status was measured through a parental questionnaire containing questions about parental income and education. Results showed that the three language groups were equivalent on socio-economic measures. Despite having significantly lower language proficiency scores, bilinguals’ raw scores on FB and DCCS tasks did not differ from monolinguals’ raw scores. After statistically controlling for language proficiency and age, bilinguals had significantly higher FB scores, but did not differ from monolinguals on DCCS scores. Analyses were then performed to determine whether inhibitory control, metarepresentation, and/or working memory help bilinguals “do more” in FB “with less” language proficiency. Working memory emerged as the likely candidate that compensates for the negative effect of bilingual children’s low language proficiency on FB performance because, after controlling for age and language proficiency, it was the only cognitive ability that fulfilled both criteria: (a) its measure correlated significantly with FB and (b) there was a bilingual advantage over both monolingual groups in the measure. A mediation analysis confirmed that the working memory measure significantly mediates the relation between bilingual status and FB while controlling for age and language proficiency. Both components of the working memory measure – that is, understanding of task instructions and maintenance/manipulation capacity – mediate this relation.

According to Barlow’s model of sexual dysfunction (1986; Sbrocco & Barlow, 1996), anxiety in sexual situations leads to attentional focus on sexual performance at the expense of erotic cues, which compromises sexual arousal. This negative experience will enhance anxiety in future sexual situations, and non-erotic thoughts (NETs) relevant to performance will receive attentional priority. Previous research with student samples (Purdon & Holdaway, 2006; Purdon & Watson, 2009) has found that people experience many types of NETs in addition to performance-relevant thoughts, and that, consistent with Barlow’s model, the frequency of and anxiety evoked by these thoughts is negatively associated with sexual functioning. Extending this previous work, the current study found that in a community sample of women (N= 81) and men (N= 72) in long-term relationships women were more likely to report body image concerns and external consequences of the sexual activity, while men were more likely to report performance-related concerns. Equally likely among men and women were thoughts regarding the emotional consequences of the sexual activity. Regardless of thought content, experiencing more frequent NETs was associated with more sexual problems in both women and men. Moreover, as per Barlow’s model, greater negative affect in anticipation of and during sexual activity predicted greater frequency of NETs and greater anxiety during sex was associated with greater difficulty dismissing the thoughts. However, greater difficulty in refocusing on erotic thoughts during sexual activity uniquely predicted more sexual problems above the frequency and dismissability of NETs. Together these data support the cognitive interference mechanism implicated by Barlow’s causal model of sexual dysfunction and have implications for the treatment of sexual problems.

According to Barlow’s model of sexual dysfunction (1986; Sbrocco & Barlow, 1996), anxiety in sexual situations leads to attentional focus on sexual performance at the expense of erotic cues, which compromises sexual arousal. This negative experience will enhance anxiety in future sexual situations, and non-erotic thoughts (NETs) relevant to performance will receive attentional priority. Previous research with student samples (Purdon & Holdaway, 2006; Purdon & Watson, 2009) has found that people experience many types of NETs in addition to performance-relevant thoughts, and that, consistent with Barlow’s model, the frequency of and anxiety evoked by these thoughts is negatively associated with sexual functioning. Extending this previous work, the current study found that in a community sample of women (N= 81) and men (N= 72) in long-term relationships women were more likely to report body image concerns and external consequences of the sexual activity, while men were more likely to report performance-related concerns. Equally likely among men and women were thoughts regarding the emotional consequences of the sexual activity. Regardless of thought content, experiencing more frequent NETs was associated with more sexual problems in both women and men. Moreover, as per Barlow’s model, greater negative affect in anticipation of and during sexual activity predicted greater frequency of NETs and greater anxiety during sex was associated with greater difficulty dismissing the thoughts. However, greater difficulty in refocusing on erotic thoughts during sexual activity uniquely predicted more sexual problems above the frequency and dismissability of NETs. Together these data support the cognitive interference mechanism implicated by Barlow’s causal model of sexual dysfunction and have implications for the treatment of sexual problems.

Moderate and severe pediatric traumatic brain injuries (TBI) are associated with significant familial stress and child cognitive and adaptive sequelae (Taylor et al., 1999). Research has demonstrated a relationship between familial stress and resources and child recovery of functioning following TBI (Taylor et al., 1999). We built on these findings by examining authoritarian parenting values and styles as a mediator of the relationship between parental stress and child adaptive outcomes 12-36 months following TBI or orthopedic injury (ORTHO). Participants were 21 children/adolescents with traumatic brain injuries and 23 with orthopedic injuries and one of their parents/guardians. Parents completed measures of demographics, parental stress, parenting values and styles, and child adaptive functioning. Child participants completed brief demographic questionnaires and intelligence screeners. Moderation was examined using hierarchical multiple regression. Mediation and moderated mediation were examined using bootstrapping tests of the indirect effect of parental stress on child adaptive functioning. After controlling for family insurance status, higher levels of parental stress were associated with reduced child adaptive functioning in the TBI group but not the ORTHO group. An examination of the mediational analyses revealed that higher levels of parental stress were associated with a greater reliance on authoritarian parenting styles, which was associated with reduced overall adaptive functioning and daily living skills across the two injury groups. Therefore, across groups, the relationship between parental stress and child overall adaptive functioning and daily living skills was found to be partially mediated by an authoritarian parenting style. Moderated mediation results revealed the presence of a significant interaction and 95% confidence interval on the socialization domain and indicated that the relationship between authoritarian parenting styles and child adaptive social skills differed significantly between the two groups. Our findings suggest a relationship between parental stress, authoritarian parenting styles, and child adaptive functioning in the 12-36 months following pediatric traumatic injury. Future research should explore the association among these, as well as other potentially mediating variables, both within and between the two groups with the goal of further elucidating the relationship between familial/environmental variables and child adaptive functioning following traumatic brain and orthopedic injury.