Bakgrund: Palliativ vård bygger på ett förhållningsätt som innebär att öka livskvalitén för både patienten och dess närstående. Palliativ vård handlar om god symtom kontroll och lindring. Den palliativa vården i hemmet lägger stort ansvar på de närstående, inte bara när det kommer till kontrollera symtomen men att organisera vården för patienten 24 timmar/dygnet. Sjuksköterskan måste se patienten och närståendes livssituation för att ge bra stöd i hemmet. Syfte: Syftet med denna studie var att belysa närståendes erfarenheter av att vårda den sjuke palliativt i hemmet. Metod: Som metod valdes en litteraturbaserad studie. Datamaterialet bestod av nio kvalitativa vetenskapliga artiklar. Resultat: Tre kategorier identifierades såsom: Ny roll, behov av hjälp från kunniga och behålla det egna livet med sex underkategorier. Närståendes erfarenheter, att ha ett stort ansvar är svårt och krävande men även meningsfullt. Brist på stöd från sjukvården påverkar närståendes förmåga att vårda den sjuke. Slutsats: När närstående vårdar den sjuke i hemmet är tiden både tung och meningsfull. Det beror på vilket stöd och information de får från sjuksköterskorna samt om de själva får möjligheten att distansera sig till vårdandet för att behålla det egna livet.

The thesis considers an understudied form of third party peacemaking, namely peacemaking interventions with kin-state involvement. The main research question this thesis seeks to analyse is how local actors, their kin-states and third party peacemakers interact within the context of a peacemaking intervention for power-sharing in deeply divided societies. The literature on third party peacemaking largely neglects the role of kin-states in peacemaking, while in the literature on power-sharing the role of external actors, including kin-states, remains understudied. This thesis aims to address these gaps by investigating the recent peacemaking interventions for power-sharing with kin-state involvement in Cyprus, Bosnia and Northern Ireland. The findings of the case studies are combined and assessed through the use of a five-level analytical framework, which includes the local actors level; the local actors-third party peacemaker level; the local actors-kin-state(s) level; the third party peacemaker-kin-state(s) level; and the kin-states level. The analysis identifies a number of conditions pertinent to each of these levels which affect peacemaking interventions for power-sharing in deeply divided societies with kin-state involvement. There are two main original contributions of this thesis to the above mentioned literatures. First, it proposes a typology of kin-state involvement in peacemaking, which categorises kin-state involvement into four roles: promoter; quasi-mediator; power-broker; and enforcer. Second, through the use of game theoretical analysis, more specifically a nested games approach, it illustrates how the interaction between local actors, their kin-states and third party peacemakers can be modelled in the context of a peacemaking intervention for power-sharing. The empirical and theoretical conclusions of this study indicate that kin-state involvement in third peacemaking interventions is more complex and fluid than widely assumed.

No description available.

Purpose: To test whether a psycho-educational program affects mental wellbeing in persons treated for colorectal cancer and their next-of-kin. Design: A prospective, longitudinal, randomized controlled trial. Setting: Surgical clinic at a university hospital in Sweden. Sample: 105 colorectal cancer patients and 71 next-of-kin were allocated to a psycho­educational program or to standard care. Methods: Mental wellbeing was evaluated with the Mood Adjective Check List and The Hospital Anxiety and Depression Scale at baseline and at 1, 6, and 12 months. The program consisted of seven meetings, including lecture and time for reflection with other patients/next­of-kin. Main Research Variable: Overall mood, activity, calmness, pleasantness, anxiety, and depression. Findings: The psycho-educational program increased overall mood, calmness, and pleasantness among patients after one month but had no effect on activity, anxiety, or depression. The program had no effect on the overall mood, activity, calmness, pleasantness, anxiety, or depression among next-of-kin. Conclusion: The psycho-educational program had a short-term effect on overall patient mood, calmness, and pleasantness but not on next-of-kin. Implications for Nursing: A psycho-educational program including lecture and time for reflection can be used with a colorectal cancer patient population to improve some aspects of their mental wellbeing.

This thesis is an ethnography of Palestinian political factions in Lebanon through an immersion in the daily life of homes. It explores the nature of factions and faction membership from the vantage point of those who form their very basis. It asks how did Palestinian political factions, which are clearly made of people, come to be seen as autonomous bodies that are studied as a whole and spoken of in the singular (‘Fatah did this’ and ‘Hamas declared that’). Through a detailed account of the everyday practices of Palestinian refugees I problematise the underlying conceptualization of factions in the academic literature as bounded structures defined by their respective ideologies. I explore how factions appear in the daily life of Palestinian refugees in Lebanon; how Palestinians join factions; how their relationship evolves over time; how they demand, and at times obtain, aid; how and whether they participate in events organized by factions; and how factionalism affects their understandings of what factions are. This ethnographic approach reveals that what binds Palestinian refugees to factions is not the ideology or regional or international alliances of the factions. For example, young Palestinians do not join a faction based on whether it is Islamic, Marxist, or nationalist; rather they do so based on where they have friends or family, and sometimes depending on which faction has the closest youth centre to their home. In fact, it is those personal relationships, including those developed with other faction members that keep Palestinians affiliated to factions. Factions appear as a loose network of people held together by different degrees of trust and cohesion. Yet my work does not dismiss the fact that factions also appear as structures, as coherent entities. On the contrary, in the second part of this thesis, I trace another set of practices, that of aid distribution, criticism, physical representation, and factionalism, to show how factions metamorphose from loose networks based on interpersonal relations into impersonal structures defined by ideology. An examination of the everyday practices and representations of Palestinian political factions reveals how those structures come into being, how that operation creates and maintains a certain configuration of power in Palestinian society, and how factions remain the center of political life in the face of widespread condemnation.

Bakgrund: Sjuksköterskor behöver möta närstående till personer som vårdas palliativt. Sjuksköterskan kan skapa meningsfulla relationer med närstående och använda denne som en resurs för patienten. Närståendestöd är en av hörnstenarna inom den palliativa vården. Sociala relationer är en av de 6 S:n som används vid personcentrerad palliativ vård, då närstående kan tillföra fler dimensioner till patientens livsberättelse. Syfte: Syftet med denna litteraturstudie var att beskriva sjuksköterskans erfarenheter av att möta närstående till patienter inom palliativ vård. Metod: Metoden var en litteraturöversikt där tolv vetenskapliga artiklar inkluderades. Artiklarna hämtades från databaserna CINAHL Complete och Pubmed och analyserades med hjälp av Fribergs analysmetod. Resultat: Två teman identifierades: yttre och inre förutsättningar för sjuksköterskan. Yttre förutsättningar för sjuksköterskan delades in subteman såsom tidens betydelse, vårdmiljöns inverkan och när närstående har en annan åsikt. I inre förutsättningar för sjuksköterskan framkom sjuksköterskans förmåga att involvera närstående, sjuksköterskans förmåga att utveckla sin kompetens i mötet med närstående, kommunikationens betydelse och förutsättningar att skapa teamarbete. Diskussion: Med de 6 S:n som teoretisk utgångspunkt har litteraturöversiktens resultat diskuterats utifrån bakgrund och annan relevant litteratur. Närstående behövs i vården kring patienten men det är inte alltid som närståendes vilja är densamma som patientens eller vårdgivarens. För att sjuksköterskan ska kunna använda närstående som en resurs krävs tydlig kommunikation och stöd från sjuksköterskan i arbetet mot ett gemensamt mål för palliativ vård. / Background: Nurses need to face next of kin to people who receive palliative care. The nurse can create meaningful relationships with the next of kin and can use them as a resource for the patient. Support for the next of kin is a cornerstone in palliative care. Social relations are one of the 6 S:s used for person-centered palliative care when next of kin can add more dimensions to the patient's life story. Aim: The purpose of this study was to describe nurses' experiences in meeting next of kin to patients in palliative care. Method: The method was a literature review where twelve scientific articles were included. Articles were taken from the databases CINAHL Complete and Pubmed and analyzed using analysis of Friberg. Results: Two themes were identified: external and internal conditions for the nurse. External conditions for the nurse divided into subthemes such as time significance, the care environment impact and when the next of kin has a different opinion. The internal conditions for the nurse came up as the nurse's ability to involve next of kin, nurses' ability to develop their skills in the meeting with next of kin, the importance of communication and the ability to create teamwork. Discussion: With the 6 S:s as a theoretical basis, this literature review has been discussed from the basis of the background and other relevant literature. Next of kin are needed in the health care around the patient but it is not a guarantee that the next of kin`s wishes is the same as the wishes of the patients or the caregivers. For the nurse to use next of kin as a resource it requires clear communication and support from the nurse in the work towards a common goal of palliative care.

The theory of dyadic intrastate conflict cause and resolution containing transnational ethnic kin is under development. One of the things current research share is the focus on the cases where conflict erupts, or where conflict resolution fails, and its causes. The aim of this study is to try to contribute and develop the generalizing theory. The focus on the study rests on the impact that state apparatus characteristic has on risk for conflict. The research builds on theoretical framework from the consociational theory. The subject is of relevance both for the field of peace and conflict research as theory development, and for policy makers. The study has resulted in two observations. First, it supports the claim of consociational theory that enhanced presence of its nine favorable factors diminishes the risk for intrastate tension and violence. Second, it proposes that a successful decentralization is the possible key explanatory characteristic of state apparatus that decreases risk for dyadic intrastate conflict. The causal mechanism here being heightened credibility and legitimacy of constitution because of increased trust and lowered fear of further ethnic discrimination. It is necessary to verify these results before further theory development can be done.

Nära patienten i samband med hjärt- eller lungtransplantation finns ofta anhöriga. Anhöriga upplever påfrestningar och har ett kunskapsbehov i samband med transplantationen. Liksom patienten är anhöriga sårbara och det är av betydelse att undersöka anhörigas upplevelser, det kan medföra att anhöriga bättre förbereds för den påfrestning transplantationen innebär. Litteraturstudiens syfte var att undersöka upplevelsen av att vara anhörig i samband med hjärt- eller lungtransplantation. Studien genomfördes som en allmän litteraturstudie och analysen gjordes med stöd av hermeneutisk metod. Resultatet visar att anhörigas stöd till patienten var en akt av kärlek som medförde att anhöriga bland annat försakade vänner och förändrade det dagliga livet. Transplantationen innebar en väntan och mycket känslor för anhöriga, allt från glädje när samtalet om att det var dags för transplantation kom, till oro för att patientens tillstånd efter transplantationen kunde försämras igen. Anhöriga upplevde brist i tillgängligheten från vården gällande information, uppmärksamhet och stöd i sin roll. I litteraturen är omvårdnadsprocessen relaterat till anhörigas upplevelser i samband med hjärt- eller lungtransplantation bristande, därför är framtida forskning betydelsefull för att skapa ytterligare evidensbaserad kunskap till omvårdnadsprocessen om anhörigas upplevelser. / Next of kins are often close to patients in heart- or lung transplantation. In connection with transplantation next of kins experience strain and has a need for knowledge. Like patients next of kins are vulnerable and it is important to explore next of kins’ experiences, this to better prepare for the burden of transplantation. The aim of the study was to explore the experience of being a next of kin in connection with heart- or lung transplantation. The study was conducted as a general literature study and the analysis was guided by a hermeneutic method. The results show that next of kin’s support for the patient is an act of love resulting in sacrificed relationships with friends and changes in their daily lives. The transplantation generated waiting and a lot of feelings for next of kins, such as joy when the call came about transplant, and later on after the transplantation worries that the patient’s condition would worsen again. Furthermore, next of kins experienced lack of availability from the health care services regarding information, attention and support in their role. In the literature the nursing process regarding next of kins’ experiences in heart- or lung transplantation is inadequately described, therefore it is of importance that future research creates new evidence based knowledge.

This study bridges the gap in literature about the impact of extended family relationships on young adult depression and self-esteem. A sample of 304 undergraduate students between the ages of 18 and 21 at the University of Kentucky was recruited to complete an online survey about their immediate and extended family relationships and their mental health. The largest predictor of self-esteem and depression in early young adults is perceived social support from the family of origin, which is also moderately correlated with perceived support from extended family members. This indicates that extended family support collaborates with family of origin support to benefit self-esteem and depression levels. Depression also decreases through more positive interactions with extended family members. Males benefited less than females from extended family relationships, as evidenced by the result that closer extended kin relationships were the second largest predictor of more depressive symptoms in males. These findings inform therapists about effective ways of conducting therapy with college students and support the use of Bowen family systems therapy.

Aim: The overall aim of the thesis was to illuminate the meanings of intensive care units’ patient rooms as a place of care for critically ill patients and their loved ones. Moreover, it was aimed to develop photovoice as a data collection method for research in ICU context. Methods and materials: Data has been collected using photovoice methodology in combination with research interviews for all three empirical studies. In total 37 people participated. Nine patients, fourteen loved ones and fourteen nurses from three ICU settings. Study I examined the perspective of loved ones, for this purpose a phenomenological hermeneutic method rooted in the philosophy of Ricoeur was chosen. Study II and III examined patients’ respectively nurses’ perspective. Both studies are phenomenologically orientated guided by a reflective lifeworld approach rooted in continental philosophy. Study IV is a theoretical paper focusing on employing photovoice as a data collection method in ICU context. Main findings: The tone and touch of caring is vital for how ICU patient room is materialized for patients. The interior design and furnishing has a great impact on the wellbeing of the loved ones and also the support they can offer the critically ill patient. One major finding is that the ICU patient room is a taken for granted place for health care providers and the impact of it upon caring, patients’ and loved ones wellbeing is not reflected over. It also seems unclear who is responsible for the environment of ICU once it has been built. The environment of ICU affects nurses’ ability to care for the patients and their family in a genuine way and to promote their wellbeing during a fragile time in life. Conclusions: There is an urgent need to translate research findings into clinical practice in order to improve the environment of ICU patient rooms. There is also need of further research and policies for transforming the hostile environment of the patient rooms to a healing environment more conductive to people’s recovering process. / <p>Akademisk avhandling som för avläggande av filosofie doktorsexamen vid Linnéuniversitetet försvaras vid offentlig disputation, 13 juni 2014, klockan 14.00 i sal Wicksell, Hus K, Växjö</p>