According to the Crohn’s and Colitis Foundation of Canada, there is approximately 1 in every 200 individuals who is living with inflammatory bowel disease (IBD). Many of those living with IBD also need to have an ostomy. The literature on the effects IBD and an ostomy has on adolescents and young adults lacks consensus. Therefore, the purpose of this phenomenological study was to try to understand the lived experiences of adolescents and young adults (N=6) living with IBD and an ostomy. Sociodemographic information was collected, and the participants were interviewed in person using a semi-structured interview guide. The work of van Manen (1990) was used as a guide for data collection, analysis and interpretation of this study. Analysis revealed the essence of the adolescents’ and young adults’ lived experience as being “Concealing and Revealing the Self”. Three themes communicate the essence of their lived experience: (a) Uneasy feelings, (b) “It’s hard…”, and (c) A renewed sense of self. The needs of the adolescents and young adults, along with their recommendations to health care providers, are addressed. The study findings inform nurses in the areas of practice, education and research. Practice recommendations include being cognizant that these individuals need holistic care that addresses their psychological, psychosocial and physical needs. This study forms the basis for future research to explore some of the themes in greater detail, as well as a recommendation for a longitudinal study.

De senaste årtiondena har flyktingströmmar från länder som praktiserar kvinnlig könsstympning (FGM) kommit till länder i västvärlden. I mötet med den nya vården riskerar kvinnorna att få fel diagnos, omvårdnad och bemötande. Syftet var att belysa könsstympade kvinnors möte med vården i västvärlden, utifrån följande frågeställningar: hur erfar kvinnorna mötet med vårdpersonalen? Hur erfar vårdpersonalen mötet med kvinnor som genomgått FGM? Studien genomfördes som en litteraturstudie, baserad på 15 artiklar av kvalitativ design. Analysen resulterade i sju teman utifrån de två frågeställningarna. Resultatet visade att kvinnorna upplevde mötet med vårdpersonalen som diskriminerande, ångestfullt och oroande. Brist på stöd ledde till känslor av ensamhet och kvinnorna kände sig annorlunda i den nya kulturen. Vårdpersonalen upplevde mötet med kvinnor som genomgått FGM som stressande och såg kvinnorna som okunniga och outbildade. Språkbarriärer var en försvårande faktor i kommunikationen. En god kommunikation och förståelse är viktigt för att skapa ett tryggt vårdmöte. Sjuksköterskan bör ta hänsyn till såväl kroppsliga som kulturella faktorer. Undervisning om FGM bör inkluderas i samtliga grundutbildningar för sjuksköterskor och övrig vårdpersonal. Vidare forskning bör belysa interventioner om ökad kunskap om FGM, fokusera på de könsstympade kvinnornas möte med olika vårdprofessioner, samt den åldrande gruppen som genomgått FGM och är i behov av vård. / The last decades a large number of refugees from countries where female genital mutilation (FGM) is practiced have come to countries in the West. The risk in the health care meeting is that the woman gets the wrong diagnosis, therapy and treatment. The aim was to highlight genitally mutilated women's encounters with the health care in the Western world, based on the following questions: how do the women experience the meeting with the caregivers? How do the caregivers experience the meeting with women who have undergone FGM? The study was conducted as a literature study, based on 15 articles with qualitative design. The analysis resulted in seven themes based on the two questions. The results showed that women felt the meeting with caregivers as being discriminatory, anguished and upsetting. Lack of support led to feelings of loneliness and the women felt different in the new culture. The nursing staff felt that meetings with the women were stressful and saw the women as unexperienced and uneducated. Language barriers were an aggravating factor in communication. Good communication and understanding is important in order to create a safe care meeting. The nurse should take into account both physical and cultural factors in order to build a good relationship. Education about FGM should be a part of the basic education of nurses and other health care professionals. Further research should shed light on interventions of increased knowledge about FGM, focus on the mutilated woman's encounter with various health care professions, as well as the aging group who have undergone FGM and is in need of care.

Bakgrund: Patienter med försämrat munhälsotillstånd upplever obehag i munhålan vilket påverkar deras välbefinnande och medverkande i sociala situationer. Risken med ett försämrat munhälsotillstånd är flera och forskning visar ett samband mellan ett försämrat munhälsotillstånd och systematiska sjukdomar. Syfte: Syftet med examensarbetet var att beskriva vårdpersonalens upplevelser av att utföra munvård. Metod: En systematisk litteraturstudie med beskrivande syntes har genomförts där kvalitativa vårdvetenskapliga artiklar analyserats. Resultat: De teman som framkom var utmaningar samt en vilja att göra rätt. Under dessa huvudteman framkom totalt sex subteman som beskrev vårdpersonalens upplevelser av att utföra munvård. Upplevelserna som uppkom handlade om munvårdens prioritering, att utförandet försvårades när det kom till patienter som hade begränsade förutsättningar. En okunskap hos vårdpersonalen uppenbarade sig där de kände sig osäkra på hur de skulle utföra munvård. Obehagskänslor var något som uppkom i resultatet där vårdpersonalen upplevde obehag i samband med utförandet av munvård. Att värna om patientens integritet och en upplevelse av välbefinnande när dem utfört munvård var upplevelser som uppkom under temat en vilja att göra rätt. Slutsats: Slutsatsen visade ett behov av kunskap hos vårdpersonalen för att de ska känna trygghet i utförandet av munvård samt att deras personliga upplevelser av munvård hade betydelse för utförandet. / Background: Patients with declined oral health condition experienced discomfort in the oral cavity which affected their well-being and their participation in social activities. The risk with a declined oral health condition is several but present research shows a connection between declined oral health condition and systematic diseases. Aim: The aim was to describe the healthcare professional’s experiences of performing oral health care. Method: A systematic review of interpretive research with descriptive synthesis has been conducted through qualitative articles with caring science perspective has been analyzed. Result: The themes that showed were challenges to performing mouth care and a will to do the right thing that effected the performance of oral health care. Under these main themes a total of six subthemes emerged that described the experiences of the health care professional’s performance of oral health care. The experiences that turned out were about prioritization of the oral care. That the performance was complicated when it came to patients who had limited abilities. Poor knowledge was a barrier because the healthcare professional’s felt unsure in performing the oral health care. Discomfort were also something that arose in the results where the healthcare professional’s experienced discomfort associated with oral care. A feeling of wanting to care about the patient’s integrity and an experience of well-being when they performed the oral care were found under the theme a will to do the right thing. Conclusion: The conclusion showed that the health care professional’s need knowledge to feel safe in their performance of oral health care and that their personal experiences had a big influence on their performance.

p. 1-149 / Submitted by Santiago Fabio (fabio.ssantiago@hotmail.com) on 2013-05-02T18:22:02Z No. of bitstreams: 1 33333.pdf: 505332 bytes, checksum: f2af18ac00bae7fd79b0d6936fce509d (MD5) / Approved for entry into archive by Maria Creuza Silva(mariakreuza@yahoo.com.br) on 2013-05-04T17:42:18Z (GMT) No. of bitstreams: 1 33333.pdf: 505332 bytes, checksum: f2af18ac00bae7fd79b0d6936fce509d (MD5) / Made available in DSpace on 2013-05-04T17:42:18Z (GMT). No. of bitstreams: 1 33333.pdf: 505332 bytes, checksum: f2af18ac00bae7fd79b0d6936fce509d (MD5) Previous issue date: 2006 / Na atualidade, o crescimento populacional e a epidemia de Aids renovaram o lugar de poder da saúde enquanto campo de prescrição de condutas para distintos públicos, dentre eles os adolescentes, segmento populacional recentemente reconhecido como portador de direitos, que busca disputar significados e controles sobre seu corpo e sexualidade instaurados nas políticas públicas e num discurso médico tecnológico que recrudesce a perspectiva biologizante no campo da sexualidade. A presente pesquisa visou compreender como profissionais de saúde, em uma Unidade de Atenção Básica, atribuem significados à sexualidade do/a adolescente em suas práticas e discursos, buscando responder se há um lugar específico para a sexualidade do/a adolescente em suas rotinas de atenção, entendendo que profissionais de saúde tendem a reinterpretar e dar sentido às suas práticas a partir de seus referenciais e lugares de poder. As estratégias metodológicas, assentadas numa pesquisa etnográfica, numa unidade de saúde de atenção básica, numa região de periferia de Salvador-Bahia, combinou as técnicas de observação participante e entrevistas semi-estruturadas aplicadas para 10 profissionais de saúde de nível superior. A análise de conteúdo das narrativas orientou-se por categorias teóricas e empíricas para fazer revelar os significados das percepções relacionadas à adolescência e sexualidade. A unidade de saúde pesquisada não desenvolve ações específicas dirigidas ao adolescente, com práticas de atendimento ainda orientadas para a normatização das condutas, reforçando atitudes paternalistas no atendimento a este público, e responsabilização deste pelo baixo acesso ao serviço. As representações dos profissionais de saúde retratam um perfil de adolescente marcadamente sexualizado, enfatizando o lugar de atenção à adolescente grávida ou em vivência de sexualidade para prevenção de uma sexualidade com risco. O serviço de saúde pesquisado não disponibiliza um lugar de atenção à saúde sexual do adolescente, que leva em conta seus lugares de inserção. Torna-se necessário o estabelecimento de outros modelos programáticos de atenção à saúde do adolescente, que trabalhem as concepções dos profissionais de saúde, que oscilam entre modelos conceituais universalistas, com visões preconcebidas diante dos usuários adolescentes, orientadas por suas inserções em contextos de pobreza. / Salvador

Philosophiae Doctor - PhD / Diabetes is a chronic, metabolic disease that requires lifelong medical management, health education and self-management. According to a World Health Organisation report, there is a global increase in the prevalence of diabetes and even more so in the low-and middle-income countries, specifically Nigeria, which has the highest number of people with diabetes in the African region of the World Health Organisation. As a global issue, the positive health outcomes of diabetes are tied to health education and self-management of the disease and using the health resources of nations. However, in the context of limited resources in Nigeria, there is a need for improvement of health education in self-management of Type 2 diabetes. Health education that is provided in some Nigerian health facilities is reported to be unstructured, without patients’ active participation, not tailored to the needs and the interests of the patients and limited collaboration between multi-disciplinary professionals. In this context, the aim of the study was to develop a structured health education programme for self-management of patients with Type 2 diabetes, to facilitate the quality of the lives of these patients .An adapted intervention mapping framework provided a structured process for development of an evidenced based programme. A mixed method approach was followed. In the first phase of the study an exploratory descriptive qualitative research design was followed. A purposive sampling approach was used in selecting (i) participants, who were patients with Type 2 diabetes and (ii) health-care professionals working in two health-care institutions in Benin City, Edo State, Nigeria. In phase 1, Step1 of the research was a situation analysis, which consisted of conducting 30 semi-structured interviews with patients; observation of nurses providing health education; and five focus group discussions with health-care professionals (nurses, dieticians and social workers). Qualitative data analysis was accomplished through using Tesch’s (1990) steps of analysis to identify themes and categories. The situation analysis revealed, firstly, that there was a lack in the knowledge and self-management of Type 2 diabetes among patients. Secondly, that the health-care professionals acknowledged their collective role in health education and were burdened with the patients who were non-adherent to self-management. The result also revealed the necessity to change from a traditional teaching method to a structured educational process that is patient-centred. The second phase of the research was the stage of developing the educational programme through collaboration with the stakeholders (health-care professionals and patients with Type 2 diabetes) using the findings from the data-analysis of the first phase supported with literature. In phase 2, Step 2 was to develop matrices from the data analysis in Phase 1 for the programme. Step 3 added theory-based intervention methods and practical applications to the preliminary program and in Step 4 the programme was described. This was followed in Step 5 by preparing health-care professionals for offering the programme to patients and implementing and evaluating the programme. The evaluation of the programme was by means of a quantitative pilot study in which a pre-post-test in a quasi-experiment was conducted with 28 patients and qualitative interviews after the program and post intervention interviews with the participants. The evaluation showed that the program was effective in meeting its objectives. In Step 6 a plan for the adoption, implementation, sustainability and evaluation of future implementations was developed.

Sexual assault is a global public health and human rights challenge which cuts across all social classes. According to a literature review based on 50 studies from around the world, between 10% and 50% of women have experienced some act of physical violence while one in every four women experience sexual violence by an intimate partner at some point in their lives. In an emergency unit in the North West, South Africa there are policies, guidelines and procedures in place with regard to the management of the rape survivors after the incident which focus on a medical orientated approach. The views of female rape survivors on their management are neglected; therefore management is not patient-centred. The main objective of the study was to explore and describe the views of the female rape survivors regarding the management they received in emergency unit to enable the health care professionals to move towards a more patient-centred approach in the management these patients. Appreciative Inquiry was used a research methodology. A qualitative design using purposive sampling was used to select the participants. Unstructured interviews were conducted with 10 female rape survivors and Tesch steps were used to analyse the data. Three main themes were identified, namely 1) therapeutic environment, 2) optimal healthcare received and 3) excellence in service delivery. With regard to the disease orientated management received the female rape survivors found it to be good. The participants voiced that it is important that female rape survivors should have an opportunity to attend group therapy following the rape incident so that they are able to support each other. / Dissertation (MCur)--University of Pretoria, 2014. / lk2014 / Nursing Science / MCur / Unrestricted

Bakgrund: Möjligheten för anhöriga att närvara vid återupplivningsförsök är ett omdiskuterat ämne och rutinerna kring detta skiljer sig åt beroende länders olika riktlinjer kring ämnet. Det finns ett större antal kvantitativa studier som behandlar upplevelser av anhörigas närvaro vid återupplivningsförsök. Däremot finns det inte lika många kvalitativa studier som berör ämnet. Därför kan det vara relevant att studera dessa kvalitativa studier närmare och belysa de anhörigas upplevelser i relation till sjukvårdspersonalens.Syfte: Syftet med denna litteraturstudie var att belysa både anhörigas och sjukvårdspersonalens upplevelser av att anhörigas närvaro vid ett återupplivningsförsök på en närstående.Metod: En litteraturstudie baserad på tio kvalitativa artiklar som belyser både sjukvårdspersonalens och de anhörigas perspektiv. Artikelsökningen genomfördes i databaserna PubMed och CINAHL.Resultat: Fyra huvudkategorier med två underkategorier vardera identifierades. Delaktighet; Aktivt deltagande och Insyn och stöd, Information och kommunikation; God kommunikation och Bristande kommunikation, Trauma; Oro för familjen och Risker, Förutsättningar; personal- och platsbrist och Personalens upplevelse av utsatthet.Slutsats: I resultatet framkom både positiva och negativa effekter av att anhöriga närvarar vid ett återupplivningsförsök på en närstående. Möjligheten att ha fått vara närvarande kunde underlätta sorgearbetet för familjen och hjälpa dessa att acceptera situationens utfall. Närvaron kunde även ge familjen en chans att agera stöd åt patienten. De största orosmomenten för sjukvårdspersonalen handlade om hur familjens beteende eventuellt kunde påverka arbetet med patienten samt eventuella negativa effekter för familjens psykiska hälsa i framtiden. / Background: The opportunity for families to be present during resuscitation is a well discussed subject. The routines regarding family witnessed resuscitation (FWR) depends on the national guidelines. Research has been conducted regarding experiences of FWR. The majority of this previous research used quantitative methods. Therefore, it ́s relevant to further explore the existing qualitative research regarding FWR.Aim: The aim of this study was to illuminate families ́ and health care professionals ́ experiences of FWR.Method: A literature review based on ten qualitative articles obtained from PubMed and CINAHL.Results: Four main categories with two subcategories each were identified. Participation; Active participation and Transparent & support, Information and communication; Good communication and Lack of communication, Trauma; Concerns for the family and Risks, Conditions; Lack of staff and space and The staff ́s sense of exposure.Conclusion: The result that emerged showed both positive and negative effects of FWR. The opportunity to be present could help the family accept the outcome of the procedure and help to ease the grieving process. Family ́s presence could also function as a source of support for the patient. The health care professionals ́ biggest concerns were about the family's behavior and how it possibly could affect the situation in a negative way and also the risk of negative effects on the family ́s psychic health in the future.

Bakgrund En av tre kvinnor har någon gång under deras livstid blivit utsatta för våld i nära relation. Mäns våld mot kvinnor är ett jämställdhetsproblem som hindrar kvinnor från sina mänskliga rättigheter. Hälso- och sjukvården ska förespråka att våld i nära relation är oacceptabelt. För att kunna vårda dessa kvinnor behöver hälso- och sjukvården tid, beredskap, kunskap och goda rutiner. Syfte Att beskriva vilka erfarenheter kvinnor som utsätts för våld i nära relation har av kontakt med hälso- och sjukvården. Metod En strukturerad litteraturstudie som baseras på 10 vetenskapliga artiklar med kvalitativ och kvantitativ design. Artiklarna i studien eftersöktes i databaserna Cinahl, PubMed och PsycInfo. En kvalitetsgranskning gjordes med hjälp av SBU:s granskningsmallar och analyserades efter Fribergs analysmodell. Resultat I resultatet framkommer det att kvinnorna i de olika studierna har ett behov av trygghet, ett bra bemötande, stöd, integritet och att bli frågade om våldet. Utifrån det delades resultatet in i fem olika teman, bemötande, stöd och information, vikten av integritet, trygghet och tillit samt att ställa frågan. Slutsats Kvinnor som lever i våld i nära relation har liknande erfarenheter av kontakt med hälso-och sjukvården. De positiva erfarenheter präglas av ett gott bemötande och god information, vilket visar sig kunna lindra lidandet hos kvinnorna. De negativa erfarenheterna präglades av ett dåligt bemötande av hälso-och sjukvårdspersonalen vilket orsakade ett ökat vårdlindande. Studien visar att en god relation till kvinnorna och ett gott bemötande är viktigt. / Background One in three women has at some point in their lives been exposed to violence in a close relationship. Men's violence against women is a gender equality problem that prevents women from their human rights. The health care system must advocate that violence in a close relationship is unacceptable. To be able to care for these women, the health service needs time, preparedness, knowledge and good routines. Aim To describe what experiences women who are exposed to violence in close relationships have from contact with health care. Method A structured literature study based on 10 scientific articles with qualitative and quantitative design. The articles in the study were searched in the databases Cinahl, PubMed and PsycInfo. A quality review was performed with the help of SBU's review templates and was analyzed according to Friberg's analysis model. Results The results show that the women in the various studies have a need for security, a good treatment, support, integrity and to be asked about the violence. Based on this, the results were divided into five different themes, attitudes, support and information, the importance of integrity, security and trust and asking the question. Conclusions Women who live in violence in close relationships have similar experiences of contact with health care. The positive experiences are characterized by a good treatment and good information, which proves to alleviate the suffering of women. The negative experiences were characterized by a poor treatment of the health care staff, which caused an increase in care relief. The study shows that a good relationship with women and a good attitude are important.

Bakgrund: Mer än 700 000 liv globalt avslutas årligen till följd av suicid och omkring 45 procent av de som dör till följd av suicid har uppsökt primärvård månaden innan. Få studier har dock belyst vårdpersonalens perspektiv på suicidprevention i primärvård. Syfte: Att belysa hälso- och sjukvårdspersonals erfarenheter av att arbeta med suicidprevention i primärvården. Metod: Litteraturstudie baserad på tio kvalitativa studier. Databassökning genomfördes i Cinahl, PubMed och Scopus. Analysen genomfördes med inspiration av Fribergs analysmodell. Resultat: Av analysen framkom att hälso- och sjukvårdpersonal upplevde både hindrande och underlättande faktorer i arbetet med suicidprevention i primärvård. Låg kunskapsnivå, brist på utbildning, resursbrist, tidsbrist och avsaknad av riktlinjer utgjorde de huvudsakliga utmaningarna. Emellertid upplevdes fungerande teamarbete, tydlig ansvarsfördelning, lättillgänglig specialistvård, intuition och lång arbetslivserfarenhet som underlättande faktorer. Konklusion: För att förebygga suicid krävs ett systematiskt arbete samt förbättrad samverkan mellan instanser för att öka patientsäkerheten. Genom att uppmärksamma erfarenheter av brister i verksamheten och åtgärda dessa kan antalet suicid reduceras. / Background: Globally, more than 700 000 lives end annually due to suicide, and about 45 percent of those who died by suicide had visited primary care the previous month. Nonetheless, few studies have shed light on health care professionals’ experiences working with suicide prevention in primary care.  Aim: To illuminate health care professionals’ experiences of suicide prevention within primary care. Method: A literature study consisting of ten qualitative studies. Articles were found using Cinahl, PubMed and Scopus. Analysis was then performed with inspiration from Friberg's analytical model. Results: Findings suggest that health care professionals experienced both barriers and facilitators working with suicide prevention in primary care. Insufficient knowledge and education, lack of resources, time pressure and lack of guidelines were perceived as the main challenges. However, teamwork, clear division of responsibilities, easy access to specialist care, intuition and extensive clinical experience were seen as facilitators. Conclusion: To prevent suicide, a systematic approach and improved collaboration between primary and specialist care are needed. By adopting measures to correct perceived flaws in primary care, the number of suicides could be reduced.

I Sverige drabbades 1999 över 45.000 människor av cancer. Många av de insjuknade hade barn och ungdomar i skolåldern. Barn och ungdomar är de som får leva längst med sina trauman och eventuell förlust av förälder. Syftet med denna litteraturstudie var att få kännedom om och belysa barns upplevelser av att ha en förälder med cancersjukdom; deras tankar om förälderns cancer, hur de påverkas av förälderns cancersjukdom samt vad hälso- och sjukvårdspersonal kan göra för att hjälpa dem hantera situationen på bästa sätt. En analys av tio artiklar genomfördes. Resultatet visade att barn med cancersjuka föräldrar hade många tankar och funderingar om förälderns sjukdom. Barnen påverkades på många olika sätt, en del blev inneslutna i sig själva och ville fly medan andra agerade utåt med ilska, aggressioner eller häftig gråt. Många barn och ungdomar fick ångestsymtom, sömnsvårigheter, koncentrationsproblem samt hade problem att fungera socialt. Studien visade att hälso- och sjukvården bör bistå föräldrar med råd, stöd och kunskap om hur de kan stötta sitt barn att bemästra situationen. Hälso- och sjukvården borde också vara behjälplig med stödgrupper och individuell handledning för barn och ungdomar. / In 1999 more than 45.000 adult Swedes were diagnosed with cancer. Many of those had school age children and adolescents. Children and adolescents are those who live longest with the trauma and potential loss of a parent.The purpose of this study was to achive knowledge about childrens perceptions having a parent with cancer; their thoughts about the illness, how they are affected by their parents illness and to gain insight in what healthcare professionals can do to help the children deal with the situation. Ten articles were analysed in this literature study. The result shows that children having a parent with cancer had lots of thoughts about the disease, some became introvert and wished to escape while others were acting out with anger, aggressions or crying. Children and adolescents had anxiety problems, sleeping disorders, trouble concentrating and some even had social functioning disorders. The study showed that health care units need to provide parents with advice, support and knowledge how they can support their children cope with the situation. The health care also need to provide support groups and individual counselling for children and adolescents.