Bakgrund: Komplementär och alternativmedicin (KAM) är ett samlingsbegrepp för tusentals olika metoder och terapier som mestadels eller delvis står utanför den konventionella etablerade vården. De senaste årtiondena har KAM blivit en allt vanligare inslag i människors liv. Vårdpersonal möter KAM i sitt jobb antingen för att man integrerat metoder eller för att de möter patienter som använder KAM. WHO har uppmärksammat betydelsen av KAM som komplement till konventionell vård och menar att KAM bör bli en självklar del inom den etablerade vården. Syfte: Syftet var att undersöka sjuksköterskors förhållningssätt till KAM.  Metod: Metoden är en litteraturöversikt. Artiklar söktes i tre databaser och 14 vetenskapliga originalartiklar valdes ut till resultatet, tio kvantitativa, två kvalitativa och en två med mixad metod. Artiklarna analyserades enligt Forsberg och Wengströms (2015) analys i fem steg.  Resultat: Resultatet utmynnade i fyra teman som var: KAM som en väg till holistisk vård, KAM som ett viktigt komplement till konventionell vård, Efterfrågan på kunskap och utbildning och Patientsäkerhet och efterfrågan på evidens.  Slutsats: Sjuksköterskorna upplever KAM som ett komplement till konventionell vård, då det bidrar till en mer holistisk vård. Det finns dock en bristande kunskap hos sjuksköterskor om KAM, som skulle kunna kompletteras med mer utbildning. Efterfrågan på mer evidens framkom också. / Background: Complementary and Alternative medicine (CAM) is a generic term for thousands of methods that for the most part or partly is practiced outside of conventional care. The latest decades CAM has seen an upswing and have become more common in the everyday life of people. Caregivers encounter CAM in their job either because CAM have been integrated or because of that they meet patients that use CAM. WHO has brought up the significance of CAM as a complement to conventional care and claim that CAM should become a given part within the established healthcare.  Aim: The aim was to examine nurses’ approach to CAM.   Method: The method is a literary review. Articles was searched in three databases and 14 scientific articles were selected, ten of quantitative design, two of qualitative design and two with a mixed methods design. The articles were analyzed according to Forsberg and Wengströms (2015) analysis in five steps. Results: The results were summarized in four themes that was: CAM as a way to holistic healthcare, CAM as an important complement to conventional healthcare, A demand for knowledge and education and Patient safety and a demand for more evidence.  Conclusion: The nurses perceive CAM as a complement to conventional care, as it contributes to a holistic healthcare. However, there is a lack of knowledge of among nurses about CAM that could be supplemented with more training. There is a need for more evidence and research.

Palliativ vård – vård i livets slutskede – är inte prioriterat i tredje världen. I Uganda grundades 1993 Hospice Africa Uganda (HAU), ett hospice som var tänkt som modell för andra afrikanska länder. Här utbildas bl a sjuksköterskor som har rätt att skriva ut morfin och andra läkemedel efter en nio månader lång kurs. I den här etnografiska fältstudien används observationer, intervjuer och gruppintervjuer för att undersöka sjuksköterskan roll inom palliativ vård i Uganda. I studien deltar sammanlagt 20 sjuksköterskor som jobbar på HAU, Mulago hospital och studenter i palliativ vård-kursen på HAU. Resultatet visar att sjuksköterskanS roll är mångfacetterad. Utöver förskrivning av läkemedel är deras roll att utföra vården holistisk, där de tar hänsyn till fysisk, psykosocial och andlig smärta. I sitt arbete möter de många utmaningar men de har även möjlighet att förbättra patientens livskvalitet. / Palliative care – end of life care – is not a priority in developing countries. In 1993 Hospice Africa Uganda (HAU) was founded and chosen as a model for other african counties. Among other things nurses are authorised to prescribe morphine and other palliative care drugs after undergoing a nine months clinical palliative care course at HAU. In this ethnographic field study observations, interviews and group interviews are used in order to explore the role of the palliative care nurse specialist in Uganda. In total there are 20 participants involved in this study, who are working at HAU, Mulago hospital and students from the clinical palliative care course. The result of the study reveal that the role of the palliative care nurse specialist is multifaceted. Beyond prescribing drugs their role is to deliver holistic care by taking into consideration the physical, psychosocial and spiritual pain patients and their family can have. They encounter many challenges in their work but they also have the possibility to improve the quality of the patients life.

The literature concerning what medical students learn from midwives during specialist obstetric rotations is scarce. In the UK, despite a long tradition of providing midwifery attachments for medical students, it is almost non-existent. Working with midwives is arguably the only opportunity medical students have to experience holistic or social models of maternity care, focusing on normality rather than on the medical concept of risk. This study sought to discover how medical students constructed their knowledge about childbirth during a six week specialist rotation in obstetrics in a Northern English teaching hospital (NETH), with particular emphasis on whether participants assimilated any concepts from midwifery knowledge (MK). A Delphi Study, done as the first phase of the research, focused on MK, utilizing an international sample of experienced midwives. Resulting themes were used to develop the data collection tool for the second phase of the research. The research employed a qualitative case study method with students from a single year cohort comprising the case. Data were collected using a tool consisting of three problem based learning (PBL) scenarios. These were presented to the students in consecutive interviews at the beginning, the middle and the end of their obstetric rotation. Following analysis, five main themes were identified which illuminated the medical students' construction of knowledge about maternity care. These were explored and discussed. The thesis concludes with recommendations for increasing opportunities for IPE in the medical and midwifery curricula.

Le sida représente un défi pour l’humanité, comme le montre l’engagement des gouvernements et des organisations internationales. La lutte contre le VIH/SIDA reste à la croisée des chemins, eu égard à ses enjeux spécifiques et aux différentes sphères d’intervention : Etat-Eglise-ONG/Associations. L'enquête sociologique menée au Togo, s'est révélée un outil indispensable de questionnement préalable et de source de réflexion. La présente étude explore certains facteurs mêlant des intérêts et des conflits entre les différents protagonistes. Qu’en est-il du malade lui-même ? Au delà des stratégies de prévention et de prise en charge, une alliance multiforme, thérapeutique, institutionnelle explore un nouveau chemin. L’auteur ouvre des pistes pour une plus grande efficacité du travail des acteurs concernés initiant des lieux de dialogue et une vraie réflexion sur les nœuds éthiques et théologiques de la lutte contre le sida. La prise en charge insuffisante des malades impose aux acteurs une vision holistique de la personne en lien avec ses besoins fondamentaux. / HIV/AIDS is still a serious challenge for humanity as evinced by the commitment of Governments and International Organizations. The fight against it conjures many actors, given the specific challenges it poses and the different spheres of intervention it requires. This study explores the ambivalent interweaving of interests and conflicts among the different protagonists. What about the sick in all these? The sociological study carried out in Togo proved to be an indispensable source of reflection on the subject. Beyond strategies of prevention and care, this study proposes forming multifaceted - therapeutic and institutional - alliances as a new way forward. For the highest level of efficiency on the part of actors, the author proposes: initiating centers of dialogue and undertaking a true reflection on the knotty ethical and theological issues in the fight against HIV/AIDS. Inadequacies in the present system of care warrants a new holistic vision of the human person in line with all fundamental human needs.

Bakgrund: Distriktssköterskan triagerar dagligen patienter med psykisk ohälsa i primärvården. Psykisk ohälsa är mångfacetterat och till viss del tabubelagt i samhället. Detta kräver att distriktssköterskan har god kännedom om psykisk ohälsa och hur den kan uttrycka sig hos olika patienter. Distriktssköterskan behöver även ha ett holistiskt synsätt med personcentrerad vård i fokus. Syfte: Syftet med studien var att belysa distriktssköterskans erfarenheter av triagering av patienter med psykisk ohälsa inom primärvården. Metod: En kvalitativ intervjustudie med åtta distriktssköterskor/sjuksköterskor verksamma i primärvården. Analysmetoden var kvalitativ innehållsanalys. Resultat: Resultatet var tre kategorier och tio underkategorier. De tre kategorierna var: Brister i utbildning, Utmaningar vid triagering samt Brister i samverkan. Resultatet visade att distriktssköterskan behöver ha mer kunskap om psykisk ohälsa samt ha de förutsättningar som krävs för att genomföra en bra triagering såsom stödverktyg och trygghet i dialog om självmordstankar hos patienten. Distriktssköterskan behöver vara medveten om somatisering och dess påverkan i triageringen. Samarbetet mellan primärvården och öppen psykiatriska mottagningen behöver förbättras. Konklusion: För att triagering av psykisk ohälsa ska bli bättre behöver distriktssköterskan erhålla mer utbildning av psykisk ohälsa. Där har både arbetsgivare och utbildningsansvariga ett ansvar att påverka möjligheterna till triagering av psykisk ohälsa i primärvården. Distriktssköterskan behöver även ha stödverktyg för att säkerhetsställa likvärdig triagering av psykisk ohälsa i primärvården. / Background: The district nurse triage daily patients with mental illness in primary care. Mental illness is multifaceted and to some extent taboo in society. This requires that the district nurse has a good knowledge of mental illness and how it can express itself in different patients. The district nurse also needs to take a holistic approach with person-centred care in focus. Aim: The aim was the district nurse experiences with triage of patients with mental illness in primary care. Method: A qualitative research approach based on interviews with eight district nurse/nurse active in primary care. Qualitative content analysis. Result: The result was three categories and ten subcategories. The three categories were: Deficiencies in education, Challenges in triage and Deficiencies in collaboration. The results showed that the district nurse needs to have more knowledge about mental illness and have the conditions required to carry out a good triage, such as support tools and security in dialogue about suicidal thoughts in the patient. The district nurse needs to be aware of somatization and its impact on triage. The collaboration between primary care and the open psychiatric clinic needs to be improved. Conclusion: In order for triage of mental illness to improve, the district nurse needs to receive more training in mental illness. There, both employers and education managers have a responsibility to influence the opportunities for triage of mental illness in primary care. The district nurse also needs support tools to ensure equivalent triage of mental illness in primary care.

The literature concerning what medical students learn from midwives during specialist obstetric rotations is scarce. In the UK, despite a long tradition of providing midwifery attachments for medical students, it is almost non-existent. Working with midwives is arguably the only opportunity medical students have to experience holistic or social models of maternity care, focusing on normality rather than on the medical concept of risk. This study sought to discover how medical students constructed their knowledge about childbirth during a six week specialist rotation in obstetrics in a Northern English teaching hospital (NETH), with particular emphasis on whether participants assimilated any concepts from midwifery knowledge (MK). A Delphi Study, done as the first phase of the research, focused on MK, utilizing an international sample of experienced midwives. Resulting themes were used to develop the data collection tool for the second phase of the research. The research employed a qualitative case study method with students from a single year cohort comprising the case. Data were collected using a tool consisting of three problem based learning (PBL) scenarios. These were presented to the students in consecutive interviews at the beginning, the middle and the end of their obstetric rotation. Following analysis, five main themes were identified which illuminated the medical students' construction of knowledge about maternity care. These were explored and discussed. The thesis concludes with recommendations for increasing opportunities for IPE in the medical and midwifery curricula.

A qualitative, non-experimental, explorative and descriptive research design based on the phenomenological philosophical tradition by Heidegger to broaden hermeneutics was conducted. The study was conducted at Umkhanyakude District to investigate the perspectives of eligible nursing students relating to the provision of spiritual care to patients. A purposive sample of 9 participants was recruited and consent form obtained. An unstructured interview guide, with a grand tour question, was used to conduct face to face individual interviews. The Thematic analysis and interpretative phenomenological method of analysis were employed until three themes, six categories and eleven subcategories emerged from the data. Data analysis revealed that nurses had difficulty to differentiate spiritual care from religious care. Commonly cited methods of providing spiritual care were prayer, reading sacred text and singing spiritual songs. Nurses still felt inadequately prepared educationally on how to provide spiritual care in nursing practice. Most of the participants provided spiritual care out of their own interest and not as part of their professional responsibility. Recommendations proposed that the matter be taken up by nurse managers to conduct related in-service education and mentoring programs and nurse educators to guide curriculum planning which evidently include spiritual care. / Health Studies / M.A. (Health Studies)

Bakgrund: Att ge andlig omvårdnad ligger i sjuksköterskans ansvar. Trots alltmer forskning som visar att en tillfredställande andlig omvårdnad har positiv inverkan på hälsa, har detta dock ofta försummats inom vården. Begreppet andlighet kan ha olika betydelser och behöver därför uppfattas i sin bredd. Syfte: Beskriva vuxna patienters (18+) upplevelse av andlig omvårdnad inom somatisk slutenvård. Metod: En integrativ översikt bestående av nio kvalitativa originalartiklar från USA, Singapore, Kanada, Nederländerna, Iran och Australien. Data samlades genom CINAHL, Medline och manuell sökning. Analys gjordes efter inspiration av Friberg och Whittemore och Knafl analysmodeller. Resultat: Andlig omvårdnad kunde av patienterna upplevas positiv, negativ eller obefintlig beroende på olika faktorer. Patienterna i studien upplevde andlig omvårdnad genom att få möjlighet till uttryck av sin andlighet, genom att få möjlighet till relationer, genom att få ha sin värdighet i behåll och genom sjuksköterskans närvaro. Andlig omvårdnad ska utföras utifrån en personcentrerad vård eftersom uttryck av andlighet kan variera mellan individer. Slutsats: För att kunna prata om andlig omvårdnad behöver både personalen och patienter ha förståelse för vad andlighet kan innebära. Sjuksköterskan behöver få kunskap och verktyg för att lätt kunna införa andlig omvårdnad i sitt arbete och känna sig trygg med att utföra en holistisk vård dvs att se hela människan. Detta skulle resulterar i mer tillfreställda patienter.

Introduction: Les propriétés apaisantes de l’hypnose conversationnelle (HC) - une intervention brève inspirée de l’hypnose médicale - pour optimiser la gestion de symptômes liés aux traitements antinéoplasiques sont reconnues depuis plusieurs années. Toutefois, la perception des infirmières qui ont eu à intégrer cette pratique innovante dans leurs soins entourant l’administration de chimiothérapie à la clinique externe d’oncologie n’a jamais été documentée. Méthode: Une étude qualitative descriptive a été conduite auprès de 6 infirmières avec une expérience préalable avec l’HC durant l’administration de chimiothérapie à la clinique externe d’oncologie. Des entretiens individuels et une analyse de contenu ont été réalisés selon les méthodes de Miles et al. (2014). Le cadre de référence sur les soins fondamentaux centrés sur la personne de Kitson et al. (2013) a servi d’assise théorique à l’étude. Résultats: L’analyse des données a révélé cinq grands thèmes : deux adressant l’importance de l’environnement de soins et d’une bonne planification dans l’application de l’HC ; et trois portant sur la valeur ajoutée de l’HC en clinique, notamment pour la gestion de la douleur du patient, ainsi que la gestion du stress de l’infirmière et son besoin d’offrir des soins holistiques pendant la chimiothérapie. Conclusions: Pour une première fois, ces résultats révèlent le point de vue des infirmières en oncologie sur les défis logistiques et les avantages cliniques/personnels de l'intégration de l’HC dans les soins entourant la chimiothérapie. De tels résultats serviront à informer les activités de transfert de connaissances portant sur l’HC en soins infirmiers oncologiques. / Introduction: The soothing properties of conversational hypnosis (CH) - a brief intervention inspired by medical hypnosis - to optimize the management of symptoms associated with antineoplastic treatments have been recognized for several years. However, the perception of nurses who had to integrate this innovative practice into their care regarding the safe administration of chemotherapy at the outpatient oncology clinic has never been documented. Methods: A descriptive qualitative study was conducted with 6 nurses with prior experience with CH during chemotherapy administration at the outpatient oncology clinic. Individual interviews and content analysis were carried out using the methods of Miles et al. (2014). The framework Reclaiming and redefining the fundamentals of care (Kitson et al., 2013) served as the theoretical foundation for this study. Results: Data analysis revealed five broad themes: two addressing the importance of the health care environment and good planning in the application of CH; and three focusing on the added value of CH at the oncology clinic, particularly for the management of patients with pain, the reduction of nursing stress, and the need to provide holistic care during chemotherapy. Conclusions: For the first time, these results reveal the perspective of oncology nurses on the logistical challenges as well as the clinical / personal benefits of integrating HC into their routine care. Such results will be used to inform future knowledge transfer activities related to HC in oncology nursing.

The purpose of this study was to describe and compare the perceptions of the registered nurses and the nurse managers regarding the role of the registered nurse in integrated primary health care. Quantitative, descriptive research was conducted to determine if there were any discrepancies between role perceptions and role expectations. Data collection was done using structured questionnaires. Two groups of respondents participated in the study. The registered nurse group (n=40) provided direct clinical care in integrated primary health care settings. The second group was composed of nurse managers (n=20) managing integrated primary health care services. The findings revealed that there are some areas where there is lack of congruence between the perceptions of registered nurses and nurse managers regarding the functions that registered nurses perform. These differences may result in confusion and role conflict among registered nurses, which can ultimately impede the attainment of integrated primary health care goals. / Advanced Nursing Sciences / M.A.(Nursing Science)