SAMMANFATTNING Inledning och bakgrund Demenssjukdomar ökar i vårt land och dessa innebär funktionsnedsättningar i en varierande grad och på olika plan under sjukdomsprocessen. Demenssjukdomarna påverkar hela livssituationen för den som är drabbad men också för de närstående. Trots att flera personer har samma demenssjukdom kan deras symtombild variera. Det handlar om kognitiva, somatiska, beteendemässiga och psykologiska funktionsnedsättningar. Dessa nedsättningar kan bli ett hot mot personens identitet. För att ge en personcentrerad omvårdnad krävs stora kunskaper hos omvårdnadspersonalen både om demenssjukdomen men också om personen som finns bakom demenssjukdomen. En levnadsberättelse kan här bli ett verktyg och få en betydelse i den dagliga omvårdnaden och i den specifika omvårdnadssituationen i demensvården. Problemområde Antalet äldre personer ökar i vårt samhälle och därmed också risken att drabbas av demenssjukdomar. Det finns idag inget bot mot demenssjukdomar och därav blir omvårdnaden otroligt viktig. Vid demenssjukdomar förloras en del viktiga kognitiva förmågor hos de som drabbas vilket ställer stora krav på omvårdnaden och utformningen av densamma. Ett problem i omvårdnaden av personer som är drabbade av demenssjukdom kan vara hur omvårdnadspersonalen tolkar och förstår den demensdrabbade så att de kan anpassa sig efter deras behov. Större kunskaper om personens liv, vanor samt betydelsefulla händelser i livet ger omvårdnadspersonalen verktyg för att kunna erbjuda en personcentrerad omvårdnad. Föreliggande studie kan bidra med ökad kunskap av levnadsberättelsen som ett verktyg för en förbättrad personcentrerad omvårdnad av denna sårbara patientgrupp. Syfte Studiens syfte var att beskriva upplevelsen av att använda levnadsberättelsen som ett verktyg i en personcentrerad omvårdnad vid demenssjukdom.   Metod Data har inhämtats från åtta intervjuer på ett äldreboende där demenssjuka bor och dessa har analyserats utifrån en kvalitativ innehållsanalys. Informanter i studien var sex undersköterskor och två sjuksköterskor. Resultat I resultatet presenteras fem kategorier och tio subkategorier som framkom i analysen av intervjuerna. Kategorierna presenteras enligt följande: personcentrerad vård, lära känna, levnadsberättelsen som verktyg, levnadsberättelsen som dokument och närståendes olika uppfattningar om innehåll i levnadsberättelsen. Subkategorierna presenteras enligt följande: personen bakom sjukdomen, närvarande personal, vardagliga och specifika omvårdnadssituationer, ökad förståelse, brister i levnadsberättelsen, att inte bli utlämnad, personliga och levande, dokumentation, delaktighet och påverkan. Slutsats Levnadsberättelsen är ett verktyg och en grund att använda i den personcentrerade omvårdnaden vid demenssjukdom menar de flesta av informanterna i studien. För att kunna använda den i en ännu större utsträckning krävs att detaljerna också dokumenteras och följes upp kontinuerligt. Dessa detaljer får personalen vetskap om i samband med att dagligen vara närvarande i omvårdnaden av de demenssjuka samt i sina relationer med närstående. Tolkningar och förståelse av demenssjukas behov bidrar då till att omvårdnadspersonalen kan anpassa sig efter den drabbades behov i en personcentrerad omvårdnad. Det finns också en betydelse om närstående varit delaktiga vid upprättandet av levnadsberättelsen och när i tiden som berättelsen tecknades ned. Närstående till demensdrabbade kan även påverka innehållet i levnadsberättelsen då de kan ha olika uppfattningar kring vad som ska stå i denna. Klinisk tillämpbarhet: Det finns ett behov att se över dokumentet som används till levnadsberättelsen. Vidare måste betydelsen av levnadsberättelsen i den dagliga personcentrerade omvårdnaden förankras hos både närstående och omvårdnadspersonal. Medvetenheten och betydelsen om dess användning blir här viktig. Skapandet av lämpligt dokumentationsställe för kontinuerlig dokumentation får också en stor roll i den dagliga omvårdnaden. / ABSTRACT Introduction and background Disease related to dementia is increasing in Sweden and this implies disabilities of varying degree and at differing levels during the process of the disease. Changes in life situations result from dementia related disease, not only for the sufferer but also for their close relations and friends. Symptomatology can vary amongst individuals who have been given the same diagnosis: cognitive, somatic, behavioural and psychological disabilities are included. These disabilities may threaten the individual’s identity. In order to provide patient-centred care for these individuals, care providers require both in-depth knowledge about dementia and also about the individual who has been afflicted. A tool which may be useful in the daily care of individuals with dementia and also in specific care situations is the use of ”life story”. Problem area The number of older persons is increasing in our society and with it, the risk of being affected by dementia. Since there is, as yet, no cure for dementia, care is of central importance.. Important cognitive functions can be lost as a result of dementia and thus, care and the deliverance of care must be carefully planned. Care providers’ interpretation and understanding of each individual is important, as is adaptation of care to individual needs.  Knowledge of the individual’s life, habits and important life events is implemental in the use of life story for the provision of person-centred care. The present study may allow more understanding of the use of life story as a tool for improved person-centred care for this vulnerable group. Aim The aim of the present study is to describe the experience of using life story as a tool in person-centred care of individuals with dementia. Method Data was collected in eight in-depth interviews with nurses and nurses' assistants at a home for persons suffering from dementia. The data was analysed using qualitative content analysis. Results Five categories and ten sub-categories emerged from the analysis of the interviews. The categories are as follows: person-centred care, getting to know, life story as a tool, life story as documentation and relatives’ different perceptions of the content of life stories. The sub-categories were as follows: the person behind the disease, attendant staff, everyday and specific care situations, increased understanding, flaws in life stories, to not be shown up, personal and alive, documentation, participation and influence. Conclusion Most of the informants in this study felt that life stories were a tool which provided a grounding to use in person-centred care of individuals with dementia. In order to use the tool to a greater extent, details should be documented and followed up continually. Care providers are given knowledge about these details through daily participation in care of the dement individual and through relationships with relatives. Interpretation and understanding of the needs of the individual contributes to deliverence of care adjusted to individual needs. It is of importance that relatives participate in the formation of the life story and also to document when it was drawn up. Close relatives to individuals suffering from dementia may also effect the content of the life story through differing perceptions about what should be documented. Clinical implications There is a need to revise documentation of life stories. It is important that the use of life story and its importance in deliverence of person-centred care is established with both relatives and care providers. Awareness of the usefulness of life story is important here. Establishment of a place for continual documentation of life stories is important in daily care of individuals with dementia.

Abstract This interpretative grounded theory study describes and analyses the actual lived experiences of project members who worked in a three year long inter-organisational information system (IOIS) project. The IOIS project was a Nordic project which spanned four user organisations (Alpha, Beta, Gamma and Delta), two suppliers (Eta and Zeta), two national organisations (Lambda and Kappa), a research organisation (Epsilon) and a Ministry who funded the project. The project was carried out between 2004 and 2006. The data was elicited by means of in-depth interviews (narrative stories), observations of project meetings, diaries, project memoranda and emails sent by project members to each other during these years. Other secondary data (the data from previous projects) was also analysed. Feelings and emotions as a research object are acknowledged to be a very demanding research area. The terms ‘feelings’ and ‘emotions’ are partly used interchangeably in this study, though these concepts are also partly distinguished in this study: feeling is what is felt, and emotion is what is shown; feeling is classified as a subjective experience whereas emotion involves emotional performance where social conventions have a significant role. The Glaserian grounded theory method was used as the technique for theory building. Three core categories were identified: Governance, Power and Emotions. There were also relationships between categories: Governance contributed to issues related to Power which in turn impacted on Emotions and vice versa. The categories not only defined the nature of the core theme but also formed a connection between themselves. The emergent category Emotions demonstrates that emotions influence structure and that emotions are intimately linked to social structures of power, and shows that ‘inequality’ is an essential part of that theme. This study shows that emotions have a remarkable role in the work of an IOIS, and that they have an affect on decisions. The study also finds that feelings and emotions are the basis of action (Power), and that emotions easily trump the intellect. At a higher level of abstraction, the scaling up process produced one core theme: Emotions of Control, and this study builds a substantive theory of Emotions of Control. / Tiivistelmä Tämä tulkitseva grounded teoria tutkimus kuvaa ja analysoi kolmivuotisen, organisaatioiden välisen tietojärjestelmäprojektin jäsenten kokemuksia tietojärjestelmäprojektista. Organisaatioiden välinen tietojärjestelmäprojekti oli Pohjoismainen hanke, joka koostui neljästä käyttäjäorganisaatiosta (Alpha, Beta, Gamma, Delta), kahdesta toimittajasta (Eta, Zeta), kahdesta kansallisesta organisaatiosta (Lambda, Kappa), tutkimusorganisaatiosta (Epsilon) ja ministeriöstä, joka rahoitti projektin. Projekti toteutui vuosina 2004 – 2006. Aineisto saatiin syvähaastatteluiden (narratiiviset tarinat), projektitapaamisten havainnoimisen, päiväkirjojen, projektimuistioiden ja projektijäsenten toisille lähettämien sähköpostien avulla. Toissijaista aineistoa (aineistoa edellisistä projekteista) analysoitiin myös. Tunnetilat ja emootiot tutkimuskohteena on tunnistettu hyvin vaativaksi tutkimusalueeksi. Englanninkielisiä termejä ’feelings’ ja ’emotions’ on osittain käytetty keskenään vaihtokelpoisina käsitteinä ja osittain toisistaan erotettuina tässä tutkimuksessa. Termi ’feeling’ kuvaa enemmän, mitä tunnetaan, ja termi ’emotion’ puolestaan, mitä näytetään. Termi ’feeling’ on täten enemmän henkilökohtainen kokemus, kun termi ’emotion’ käsittää enemmän tunteiden näyttämistä. Sosiaalisilla sopimuksilla on merkittävä rooli tunteiden näyttämisessä. Glaserilainen grounded teoria menetelmää hyödynnettiin teorian muodostuksen menetelmänä. Tutkimuksessa identifioitiin kolme pääkategoriaa: hallinto, valta ja tunteet. Kategorioiden välillä ilmeni suhteita: hallinto vaikutti valtaan, valta vuorostaan vaikutti tunteisiin ja päinvastoin. Kategoriat eivät ainoastaan määrittäneet ydinteeman luonnetta, vaan muodostivat yhteyden keskenään. Tunnekategoria osoittaa, että tunteet vaikuttivat projektin rakenteeseen, ja että tunteet ovat läheisesti yhteydessä myös vallan sosiaalisiin rakenteisiin. Tutkimus osoittaa, että tunteilla on merkittävä rooli organisaatioiden välisen tietojärjestelmäprojektin työskentelyssä, ja että tunteet vaikuttavat päätöksenteossa. Tutkimus osoittaa myös, että tunteet ovat toiminnan perustana, ja että tunteet vievät helposti voiton järjeltä. Korkeamman tason käsitteellistäminen tuotti yhden pääteeman, kontrollin tunteet, ja tämä tutkimus rakentaa teemasta substantiivisen teorian.

The thesis tracks the possibilities of working with education problems through using a book in kindergarten. The theoretical part sums up knowledge about the socialization of a child, social development of a preschool age child, about moral development, about social rules and social education of children in kindergartens. Further, it sums up knowledge about children's literature, especially about genres which present rules and norms of behavior. Furthermore, it sums up knowledge about suitable methods which can be used to work with educational stories. These are RWCT methods, reading strategies, methods of emotional education and methods of dramatic education. The practical part of the thesis is based on the mixed research. The objective of the quantitative part was to find out from teachers the most common education problems at children in kindergartens, using which methods can be worked with children's literature in mediation of these problems to children and specific proven titles of the children's literature. The objective of qualitative part of the thesis was to create a possibility to work with education problems on the basis of work with a book using methodical material aimed at children from 5 to 6-7 years. Classes were designed on the basis of RWCT methods, reading strategies, emotional...

Text in English / The Student Self-Empowerment and Enrichment Programme (SSEEP), formed a resourceful context for this study, which was action-oriented and experience-based. The aim of the SSEEP was to disseminate knowledge, and to create a domain for dialogue that facilitated connection with others and created spaces for the telling and sharing of stories. The philosophy which informed this study was that individuals interpret their experiences and make sense thereof through narratives or stories, which are socially constructed through language. Qualitative research methods were used to interpret the data. Facilitators' and students' experiences in the SSEEP were recorded in field notes, and photographs and 'memory boxes', which were analysed using a hermeneutic method. Personal interviews with four students were analysed using narrative analysis. The purpose of this study was to identify the processes, themes and meanings that contribute to the enhancement of students' personal resources. Facilitators and/ or students co-constructed alternative stories to ones that thwarted their growth, or subjugated them, which led to the creation of new realities that individuals could 'perform', and to recreating themselves in new ways. They could not but be changed by the encounter, and moved from the anonymity of silence to the healing of affirmation through narrative. The promotion of healing, the provision of support or education, and improvement of self-understanding and personal efficacy, were goals that seemed to have been attained. It was also hoped that personal growth would bring life-enhancing contributions to other contexts as well, such as the students' personal, family and community contexts. The guidelines proposed in this study could be of value to those who wish to become involved at grassroots level in designing and implementing their own programmes in the tertiary-education context. They are particularly relevant within present day South Africa taking the diversity of the population into account. / Psychology / D. Litt. et Phil. (Psychology)

Text in English / The Student Self-Empowerment and Enrichment Programme (SSEEP), formed a resourceful context for this study, which was action-oriented and experience-based. The aim of the SSEEP was to disseminate knowledge, and to create a domain for dialogue that facilitated connection with others and created spaces for the telling and sharing of stories. The philosophy which informed this study was that individuals interpret their experiences and make sense thereof through narratives or stories, which are socially constructed through language. Qualitative research methods were used to interpret the data. Facilitators' and students' experiences in the SSEEP were recorded in field notes, and photographs and 'memory boxes', which were analysed using a hermeneutic method. Personal interviews with four students were analysed using narrative analysis. The purpose of this study was to identify the processes, themes and meanings that contribute to the enhancement of students' personal resources. Facilitators and/ or students co-constructed alternative stories to ones that thwarted their growth, or subjugated them, which led to the creation of new realities that individuals could 'perform', and to recreating themselves in new ways. They could not but be changed by the encounter, and moved from the anonymity of silence to the healing of affirmation through narrative. The promotion of healing, the provision of support or education, and improvement of self-understanding and personal efficacy, were goals that seemed to have been attained. It was also hoped that personal growth would bring life-enhancing contributions to other contexts as well, such as the students' personal, family and community contexts. The guidelines proposed in this study could be of value to those who wish to become involved at grassroots level in designing and implementing their own programmes in the tertiary-education context. They are particularly relevant within present day South Africa taking the diversity of the population into account. / Psychology / D. Litt. et Phil. (Psychology)