Culture is critical to delivering effective mental health care, necessitating tailored approaches aligned with the respective cultural contexts. The rise of globalization and transcultural psychiatry highlights the importance of integrating culture comprehensively into mental health and psychosocial interventions within humanitarian contexts. Existing research underscores the significance of culture in mental health. However, a prevailing influence of Western perspectives on mental health is evident globally, leading to the widespread implementation of Euro-American viewpoints in humanitarian fieldwork. This approach negatively impacts individuals affected by crisis by sidelining culturally grounded understandings of illness. While several studies examine the impact of culture on mental health care, there is limited research on how humanitarian organizations perceive and incorporate culture in training materials. This study aims to examine how the Red Cross Red Crescent Movement conceptualizes and integrates culture within its mental health and psychosocial support (MHPSS) intervention. I collected data from nineteen Red Cross guidebooks to conduct a thematic analysis and extract insights into the organization’s approach. I found nine themes: understanding culture through self, culture as behaviour, culture as meanings, community-based approach, assessment, planning and implementation, training, monitoring and evaluation, and universality of mental illness. My findings indicate that the Red Cross conceptualizes culture holistically, and by doing so, they aim to produce culturally relevant care. While the Red Cross emphasizes cultural relativism in its MHPSS responses, encouraging cultural competency, it also tends towards universalism when discussing mental health, reflecting the nuanced nature of MHPSS interventions. This tension highlights the complex relationship between these two perspectives in creating the Movement’s MHPSS responses and speaks to broader challenges in delivering mental health and psychosocial care in humanitarian fields. Further avenues for research lie in exploring strategies to reconcile relativist and universalist frameworks, aiming to produce seamless MHPSSs. / Thesis / Master of Arts (MA) / Effective mental health care respects and incorporates the cultural beliefs and practices of the individuals receiving it. However, according to the literature, there is a pattern amongst international aid agencies of applying Westernized mental health ideas globally. In this study, I investigate how the Red Cross Red Crescent Movement understands and incorporates local culture in its mental health and psychosocial supports (MHPSS). The study reveals that the Movement recognizes culture holistically. The Movement closely works with communities, aiming to ensure that the support matches local ways of understanding well-being and distress. However, the Movement tends to apply a more universal understanding regarding specific mental disorders. This discrepancy highlights issues within the humanitarian field at large. My findings suggest that while the Red Cross does well to integrate cultural understandings of psychosocial distress, there is a need for better collaboration between universal and local perspectives in MHPSS.

Cluster randomized controlled trials are increasingly used to assess the effectiveness of life-style interventions in improvement of health services or prevention of disease. However, statistical methods in the analysis of cluster randomized controlled trials are not well established especially for analyzing binary outcomes. This project is motivated by the Community Hypertension Assessment Trial (CHAT) to assess the effectiveness of a 12-month community-based blood pressure management program in improving the management and monitoring of high blood pressure (BP) among older people. The study is a paired cluster randomized controlled trial, where the family physicians' practices are the clusters randomly allocated to CHAT intervention or usual practice, and a random sample of 55 patients 65 years and older were selected from the 14 practices in each study arm for health record review. The primary outcome was controlled BP over 12 months defined as systolic BP c:; 140 and diastolic BP c:; 90 for patients without diabetes or target organ damage or systolic BP c:; 130 and diastolic BP c:; 80 for patients with diabetes or target organ damage. Secondary outcomes include frequency of BP monitoring and average BP over a 12 month period. The clinical objective of this project is to evaluate the effectiveness of the CHAT intervention. The statistical objective is to compare Bayesian and classical methods of analyzing cluster-randomized trials using CHAT study as an example. We compared the results of different cluster-level analysis methods: i) un-weighted regression, ii) weighted regression, iii) random-effects meta-analytic approach, and different individual-level analyses: i) standard logistic regression, ii) robust standard errors approach, iii) generalized estimating equations, iv) random-effect logistic regression, v) Bayesian random-effect regression. We find that there is no sufficient evidence in support of the effectiveness of the CHAT intervention on all outcomes. For BP control, odds ratio (95% confidence interval) is 1.14 (0.72, 1.80) from generalized estimating equations. This result remains robust under different methods. We also find that the results from different statistical methods are different. The results from cluster-level analysis methods are quite different, while the results from the individual-level analysis methods are similar. We conclude that using various methods to analyze the trial provide good sensitivity analyses to help in interpreting the results of cluster randomized trials. Extensive simulation studies comparing the statistical powers of the different methods in different situations are required. / Thesis / Master of Science (MS)

Historical hydroelectric stations are part of an aging industrial heritage that is still extremely relevant today through its form of generating energy. Many stations built in the 20th c. are categorized as architectural heritage, therefore protected against demolition or radical change, thus also a radical expansion that would allow to modernize the station and allow for bigger energy output. Viskafors power station in Borås (Sweden) built in 1917 for the former local textile factory,  is a small-scale power station that is marked as architectural heritage, currently owned by Vattenfall.  The town of Viskafors is one of many factory towns along the river and as the industry went bankrupt in the 1970-ties it has become a suburb to the city of Borås. The only public buildings in Viskafors are schools. The town once defined by the industry is now left with an inaccessible waterfront and plenty of unused and unattainable space.The former factory grounds and the restricted area around the hydroelectric station, railway and regional road block the waterfront.The latest station renovation happened in 2013, leaving the second floor and the lift tower empty. Forming another void in the total space that Viskafors has to offer.Can this void be used as leverage to explore the potential of formerly unattainable space within the station and in connection to the waterfront? Keeping this in mind, this thesis aims to find meaningful ways to inhabit and repurpose formerly unattainable space as it is today; to find methods of organizing complex landscapes; initiate a discussion of new thinking of potential hybrid scenarios for the complexities of our future settlements.Can the future be a link to the past and vice versa?The project space stretches from the street level approaching the building to the rooftop, extends into the empty space of the station's second floor, and continues over the other side of the river. The existing second-floor space dimensions are  33 m x 11m x 5.5 m forming a box space. In theory, a box space this size holds infinite potential as long as it remains empty and has no walls, this project aims to explore the method of placing programmed pavilions/interventions as a space-organizing method of work and extending the approach to the rest of the project site area.The aim is to keep the hydroelectric station running while inhabiting the empty space surrounding it, and learning how to live with it.

Depression is a common psychopathology that causes affective, behavioral, and cognitive dysfunction and is present across cultural identities. To reduce the dysfunction and treat the symptoms that arise from depression, researchers have created positive psychological interventions (PPIs), which are empirically supported interventions that cause a positive change by targeting a positive variable. In the current study, I created a new PPI, the Best-Self PPI, that draws from elements of optimism, coherence, and character strengths PPIs. Specifically, I hypothesized that the Best-Self PPI would work by positively biasing self-referential processing, which may predict depression and psychological well-being. Participants (n = 133) were undergraduates between the ages of 18 and 32 (M = 19.97, SD = 1.66). Participants were primarily female (n = 85; 63.91%) and White (n = 87; 65.41%) and completed either the Best-Self PPI or wrote about a childhood memory (T1, +0 Days), completed the Self-Referential Encoding Task (T2 +1 Day), and then completed a set of outcome measures (T3, +8 Days). Although the intervention appeared to have no effect on depression, well-being, or affect compared to the control group, I found that: 1) self-referential processing bias partially mediates the relationship between self-critical rumination and depression, 2) self-referential processing bias and state self-esteem fully explain the relationship between self-critical rumination and depression, and 3) self-esteem fully explains the relationship between self-critical rumination and psychological well-being. The results provide new empirical evidence for why some interventions may reduce depression and promote psychological well-being through changes in self-evaluations. I encourage researchers to use the evidence in the current study that modifying self-referential processing and state self-esteem may affect depression and psychological well-being to improve existing interventions and create new interventions to promote psychological well-being above and beyond the elimination of suffering.

Bakgrund: Postoperativa sårinfektioner är infektioner som uppträder i sårområdet inom 30 dagar efter ett kirurgiskt ingrepp. Infektioner i postoperativa sår är en av de vanligaste vårdrelaterade infektionerna. När mikroorganismer hamnar i såret startar en inflammationsprocess och skapar en infektion i såret. Postoperativa sårinfektioner innebär ett stort lidande för patienten, dessvärre minskar inte postoperativa sårinfektioner i önskad takt. Syfte: Att belysa hur sjuksköterskan kan arbeta med förebyggande omvårdnadsinsatser i relation till postoperativa sårinfektioner. Metod: Studien genomfördes som en allmän litteraturstudie baserat på tio resultatartiklar av kvalitativ, kvantitativ och mixad metod. Resultatartiklarna analyserades och sammanfattades till tre kategorier och fem underkategorier. Resultat: Resultatet belyser följande omvårdnadsinsatser: (1) Att följa riktlinjer, (2) Att implementera åtgärdspaket och (3) Att involvera patienten. Sjuksköterskans följsamhet till riktlinjer påverkades av barriärer och facilitatorer. Åtgärdspaket var en effektiv omvårdnadsinsats. En involverad patient kunde bidra positivt till det förebyggande arbetet. Konklusion: Det finns ett behov av förbättringsarbete och vidare forskning kring hur sjuksköterskan kan arbeta med förebyggande omvårdnadsinsatser i relation till postoperativa sårinfektioner. / Background: Surgical site infections (SSI) are infections that occur within 30 days after surgery. SSIs are one of the most common health care- associated infection. When microorganisms end up in the wound an inflammatory process starts and creates an infection in the wound. SSIs lead to suffering in patients, unfortunately the incidence of SSIs is not decreasing in a desired rate. Aim: To highlight how nurses can work with preventative nursing interventions in relation to surgical site infections. Method: The study was conducted as a general literature study based on the result from ten articles with qualitative, quantitative and mixed methods. The results from the articles were analyzed and summarized into three categories and five subcategories. Results: The result highlights the following nursing interventions: (1) to follow clinical practice guidelines, (2) to implement care bundles and (3) to involve patients. Nurses’ compliance to guidelines was affected by barriers and facilitators. The care bundle implementation was a successful nursing intervention. Involving the patient could contribute to nurse’s preventative work against surgical site infections. Conclusion: There is a need for further quality improvement and research to how nurse’s work with preventative nursing interventions in relation to SSIs.

Bakgrund: Miljontals människor världen över avlider årligen till följd av sepsis. Tidigare forskning har visat att det råder bristande kunskaper bland sjuksköterskor att identifiera, hantera och behandla sepsis därför ansågs behovet av att utbilda dem ytterligare föreligga. Omvårdnad är sjuksköterskans huvudområde. Det innefattar exempelvis ansvar och kunskap i att bedöma patienters hälsotillstånd. Ett septiskt tillstånd kan i ett tidigt skede identifieras genom avvikande vitala parametrar. Speciellt framtagna mätinstrument samt riktlinjer finns att följa, dock krävs det att sjuksköterskorna har kunskapen för hur dessa ska användas. Septiska tillstånd har ett snabbt och negativt sjukdomsförlopp, därför är tidig identifiering och snabba åtgärder viktigt. Syfte: Syftet med denna litteraturstudie var att sammanställa vilka utbildningsinsatser som kan öka sjuksköterskors kunskaper för identifiering av sepsis. Metod: En deskriptiv litteraturstudie med tematisk dataanalys vars resultat har baserats på 13 artiklar med kvantitativ ansats samt en med mixad metod. Huvudresultat: I resultatet framkommer det att samtliga studier använde någon form av muntliga och/eller digitala utbildningar, ”escape room” eller simuleringar som lyckade utbildningsinsatser eftersom det resulterade i ökade kunskaper bland sjuksköterskorna gällande identifiering av septiska tillstånd. Syftet med flertalet av utbildningsinsatserna var att de låg till grund för olika typer av förbättringsarbeten inom varierande vårdkontexter med det gemensamma målet att förbättra vården vid sepsis. Slutsats: För att minska de konsekvenser som uppstår till följd av bristande kunskaper gällande sepsis bland sjuksköterskor, kan olika utbildningsinsatser genomföras inom olika vårdkontexter då det är bevisat att kunskap räddar liv. / Background: Millions of people worldwide die annually as a result of sepsis. Previous research has shown that there is a lack of knowledge among nurses in identifying, managing, and treating sepsis, therefore the need to further educate them was considered necessary. Nursing is the nurse's main area and includes for instance, responsibility, knowledge and the experience of evaluating patients' health conditions. A septic condition can be identified in its early stage through abnormal vital parameters. Specifically developed measurement tools and guidelines are available to follow, but it requires that nurses have the knowledge of how to use them. Septic conditions have a rapid and negative disease progression; therefore early identification and rapid measures are essential. Aim: The purpose of this literature review was to compile educational interventions which could increase the nurses' knowledge of sepsis identification. Method: A descriptive literature review with thematic data analysis, the results were based on 13 articles with a quantitative approach and a mixed method. Result: The results reveal that all studies used some form of verbal and/or digital education, "escape room" scenarios and simulations as successful educational interventions. They all resulted in increased knowledge among nurses regarding the identification of septic conditions. The majority of the studies educational interventions where included in different types of quality improvement projects within different kinds of healthcare contexts, all with the common goal of improve the septic care. Conclusion: To reduce the consequences of inadequate knowledge about sepsis among nurses, different educational interventions can be implemented within different healthcare contexts because knowledge is proven to save lives.

Bakgrund: Demens är ett samlingsbegrepp av symtom som karaktäriserar minnesförlust, beteendeförändringar, förlust av kognitiv förmåga och sociala funktioner som orsakas av hjärnpåverkade sjukdomar. Antalet personer som drabbas av demens kommer att öka då den äldre befolkningen ökar. Musikinterventioner används som vanliga icke-farmakologiska interventioner för att behandla patienter med demens.  Syfte: Syftet var att belysa hur musikinterventioner påverkar patienter med demens ur vårdarens perspektiv.  Metod: En strukturerad kvalitativ litteraturöversikt med inslag av den metodologi som används för systematiska översikter. 7 vetenskapliga artiklar ingick i studien. Resultat: Sex teman identifieras: (1) förbättrat humör, (2) minskad rörlighet på grund av ett ökat fokus, (3) ökad interaktion och kommunikation med andra människor, (4) ökad fysisk rörlighet, (5) att återfå minnen och självuppfattning och (6) att orsaka agitation.Slutsats: Musikinterventioner påverkar patienter med demens både positivt och negativt. Dels kan patienterna få ett förbättrat humör, dels kan de bli irriterade.

The aim of this literature search was to explore the prevalence of obstetric violence and identify nursing interventions that could potentially prevent the mistreatment of pregnant women in the United States healthcare system. Background: The topics of obstetric violence and healthcare disparities have been gaining awareness. Other countries have a larger body of research for obstetric violence compared to the U.S. Methods: CINAHL Plus with Full Text and MEDLINE databases were utilized. Global perspectives were considered in conjunction with the U.S. and specifically Florida. Healthcare disparities in obstetric care were identified, based on race, ethnicity, socioeconomic status, sexuality, disability, weight, and age. Results: There were seven studies related to obstetric violence in U.S. healthcare facilities, none in Florida. These studies found there was obstetric violence in U.S. healthcare facilities, however, it was inconclusive to the degree and rate of mistreatment as well as the effectiveness of any stated prevention strategies. The quality of the reporting limited the generalizability and rate of mistreatment. Discussion: Nursing interventions to obstetric violence were readiness to learn, shared decision-making, empathy, and self-reflection. Nurses can implement these interventions to improve the quality of patient care and prevent violence within the healthcare setting.

This scoping review contains a literature analysis regarding interventions used by health care workers to alleviate guilt in caregivers of patients during end-of-life care. During end-of-life care, many transitions and decisions are made that add to the burden of caregivers. Family caregivers experience many physical, financial, and emotional stressors during the journey of end-of-life care, and this can result in guilt. Feelings of guilt can lead to poorer health outcomes and coping in family caregivers and should be addressed by health providers. In this scoping review, a literature search was conducted using various key terms like "guilt," "hospice," "end-of-life care," "interventions," and "caregivers." The articles that fit the criteria were examined to find tested interventions to alleviate guilt in family caregivers of patients in end-of-life or hospice care. A total of 13 articles were analyzed and divided into three sections, interventions that directly influence guilt, interventions that indirectly influence guilt, and interventions recommended by caregivers and hospice workers. Main themes that emerged for tested and recommended interventions include shared decision making, increased communication with health care providers, increased education on disease process and available options, and an emphasis on caregiver self-care. This research is limited and can provide the framework for future interventions to be tested and applied to the care of family caregivers experiencing guilt while caring for or grieving their loved one.

Syfte: att sammanställa och beskriva arbetsterapeutiska interventioner vid neglekt för vuxna personer med stroke. Metod: en litteraturöversikt av både kvantitativ och kvalitativ metod och granskades och resulterade i 11 studier. Datainsamlingen utfördes genom systematisk litteratursökning i tre databaser inom medicin och hälsa samt med manuella sökningar från databaserna CINAHL, Medline och PubMed. Data analyserades och sammanställdes genom intressanta fynd och kategoriserades i fyra underrubriker baserade på Occupational Therapy Intervention Process Model (OTIPM) interventionsmodeller; kompensatorisk modell, modell för aktivitetsträning, modell för förbättring av personliga- och kroppsliga faktorer samt pedagogisk modell. Resultat: det finns ett begränsat antal arbetsterapeutiska interventioner vid neglekt för personer som drabbats av stroke. Studierna var utförda runt om i världen med varierande intensitet. Interventionerna var till största del utförda inom sjukhusmiljö och det fanns en variation på hur lång tid efter strokediagnos som interventionerna utfördes. Modell för förbättring av personliga och kroppsliga faktorer var en av de vanligaste förekommande interventionerna. Slutsats: är att det finns ett fåtal arbetsterapeutiska interventioner vid neglekt för personer som drabbats av stroke och att det inom svensk sjukvård endast finns ett magert utbud av interventioner som rekommenderas enligt Socialstyrelsen. Fortsatt forskning behövs för att ta fram evidens och mäta effekten av varje enskild intervention för att underlätta det arbetsterapeutiska arbetet och för att Socialstyrelsen ska kunna rekommendera dessa vid det rehabiliterande arbetet vid neglekt för personer som drabbats av stroke. / Purpose: to summarize and describe Occupational Therapy Interventions in case of Neglect for adults with stroke. Method: a literature review using both quantitative and qualitative methods and reviewed resulted in 11 studies. Data was collected through a systematic literature search in three databases within medicine and health and with secondary searches, from the CINAHL, Medline and PubMed databases. Data were analyzed and compiled through interesting findings and categorized into four categories based on the Occupational Therapy Intervention Process Model (OTIPM) Intervention models; Compensatory model, Model for activity training, Model for improvement of personal and physical factors, and Educational model. Results: there are a limited amount of Occupational Therapy Interventions in case of Neglect for people affected by stroke. The studies were carried out around the world with varying intensity. The interventions were mostly carried out in a hospital environment and there were variations in how long after stroke diagnosis the interventions were carried out. Model for the improvement of personal and physical factors was one of the most frequently occurring interventions. Conclusion: there are a limited number different Occupational Therapy Interventions in case of Neglect for people who have suffered a stroke, and that within Swedish healthcare there are only few interventions that are recommended by the National Board of Health and Welfare in Sweden. Further research are needed to produce evidence and measure the effect of each individual intervention to facilitate the Occupational Therapy work and for the National Board of Health and Welfare to be able to recommend those for the rehabilitation work in case of Neglect for people affected by stroke.