Introduktion: Patienter med HIV/AIDS upplever diskriminering och stigmatisering i sjukvården. Att mötas av diskriminering och stigmatisering påverkar livet för de smittade i form av att de upplever social isolering, depression och post traumatisk stress. Stigmatisering och attityder har ett samband. Sjuksköterskans attityder kan påverka patienten negativt i form av diskriminering och stigmatisering. Syfte: Syftet med studien var att beskriva sjuksköterskors attityder till patienter med HIV/AIDS och även att beskriva vad som orsakar dessa attityder. Metod: En deskriptiv litteraturstudie har genomförts. Artiklar söktes i databasen Cinahl. Resultatet baserar sig på 13 vetenskapliga artiklar som har analyserats genom att söka efter mönster. Huvudresultat: Sjuksköterskan har undvikande, hänvisande och dömande attityder till patienter med HIV/AIDS. Dessa attityder leder till kränkande åsikter och kränkande handlingar. Attityderna orsakas av bristande kunskap om HIV/AIDS samt otillräcklig erfarenhet av att vårda patienter med HIV/AIDS. Attityderna orsakas vidare av rädsla för att bli smittad samt av rädsla för samhällets åsikter om sjukdomen.  Sjuksköterskans attityder orsakas även av patientgruppen som både anses krävande och givande. Slutsats: Fördjupad kunskap gällande ICN:s etiska kod är nödvändig. Vidare är det viktigt att omvårdnaden grundar sig på en värdegrund. Behovet av fortsatt forskning är angeläget för att bedriva god omvårdnad av patienter med HIV/AIDS. / Introduction: Patients with HIV / AIDS experience discrimination and stigmatization in health care. To be faced with discrimination and stigma affects the lives of those infected as they experience social isolation, depression and post-traumatic stress. Stigma and attitudes are related. Nurses' attitudes can affect the patient negatively through discrimination and stigmatization. Purpose: The purpose of this study was to describe nurses' attitudes towards patients with HIV / AIDS and also to describe what causes these attitudes. Method: A descriptive study was carried out. Articles were searched in the Cinahl database. The result is based on 13 scientific articles that have been analyzed by searching for patterns. Main results: The nurse has avoiding, referring and judgmental attitudes towards patients with HIV / AIDS. These attitudes lead to offensive opinions and offensive acts. These attitudes are caused by lack of knowledge about HIV / AIDS and insufficient experience in the care of patients with HIV / AIDS. Attitudes are futher caused by the fear of being infected, and by the fear of society´s opinion of the disease. The nurses' attitudes are also caused by the patient group, because they are considered both challenging and rewarding. Conclusion: Better understanding regarding the ICN:s code of ethics is necessary. Furthermore, it is important that care is based on a underlying philosophy of nursing. The need for continued research is necessary to provide good care of patients with HIV / AIDS.

SAMMANFATTNINGBakgrund: När människan åldras så förändras inte bara kroppens utseende utan också dessnutritionsbehov. Äldre personer som är i kontakt med vården upplever att de inte får denhjälp de behöver med att anpassa nutritionsvården till sina individuella behov ochförutsättningar. När nutritionsvården inte kan anpassas till patienternas individuella behovså föreligger det risk för försämrad hälsa och ett ökat lidande. Patienterna upplever inte attsjuksköterskorna uppmärksammar deras upplevelser av nutritionsvården. Syfte: Syftet meddetta examensarbete är att beskriva sjuksköterskors upplevelser av att tillgodose äldresnäringsbehov. Metod: En kvalitativ litteraturstudie med induktiv ansats används för att fåfram sjuksköterskornas upplevelser. De vetenskapliga artiklarna analyseras enligt Evans(2002). Resultat: Resultatet visar att sjuksköterskorna efterfrågar mer utbildning omnutritionsvård för att utveckla sina kunskaper och därigenom kunna säkerställa en god ochsäker vård för de äldre patienterna. Sjuksköterskorna kan känna stolthet men även skam överderas egen insats av att utföra nutritionsvård. Slutsatser: Fortsatta studier kring patientersoch sjuksköterskors upplevelser behövs där deras svar ställs mot varandra för att tydligareupptäcka eventuella problem. Med tanke på att den äldre befolkningen ökar så behövs merkunskap om nutrition till de äldre personerna i samhället.Nyckelord: Kunskap, nutritionsvård, patient, samarbete, sjuksköterska / ABSTRACTBackground: As the human being comes of age, change appears not only in the physicalappearance but also in its nutritional requirements. Elder people who are in contact withhealth care feel that they do not get the help they needed to adapt nutritional care to theirindividual needs and circumstances. When nutritional care cannot be adapted to patients’individual needs, there are risks of impaired health and increased suffering. The patients donot experience that nurses notes their experiences of nutritional care. Aim: The purpose ofthis study is to describe nurses’ experiences of meeting the nutritional needs of the elderly.Method: A qualitative study of inductive approach is used to get nurses’ experiences. Thescientific articles are analyzed according to Evans (2002). Results: The results shows thatnurses want more education on nutritional care to develop their skills and thereby ensure agood and safe care for elderly patients. The nurses can feel pride but also shame related totheir own effort to perform nutritional care. Conclusions: Further studies on patients’ andnurses’ experiences are needed where their responses are set against each other in order tomore clearly identify possible problems. Given that the elderly population increases, morenutritional knowledge is needed for the elderly people in the community.Keywords: Cooperation, knowledge, nurse, nutritional care, patient

Introduction: Diabetes type 1 is a common chronic disease in children and adolescents. The disease affect, not only the child, but also the parents in their everyday life. The specialist diabetic nurse has a huge responsibility in supporting the parents to feel confident in managing the child’s diabetes. Aims of the study: To investigate how parents of children with diabetes type 1 perceive the care given from the specialist diabetic nurse and what wishes they have concerning the care they receive. Design and methods: Searches for studies in electronic databases were conducted between January 2013 and march 2013. A literature review containing 16 studies was compiled. Both qualitative and quantitative studies were used and analyzed according to Friberg (2006). Findings: Several parents had a positive view of the diabetic care they had received from the specialist diabetic nurse. Great knowledge, expertise in diabetic care and ability to inform the family in a proficient way were considered as important by the parents. To receive knowledge regarding diabetic care the parents preferred to be given practical education from the nurse, but also appreciated to get written information. The parents would have liked to get more emotional support during the time of the diagnosis, especially in forms of counseling and encouragement. They also whished that caregivers would have been more eager to prepare them in managing the disease outside the hospital.  Conclusions: The majority of the parents had an optimistic experience of the care they had received from the specialist nurse in diabetic care. To prepare the family for a life with diabetes it’s necessary with adequate education, encouragement and emotional support from the specialist diabetic nurse.

Aim: The aim of this study was to describe the nurse’s work at an emergency department trough a perspective of caring. Method: A literature review has been made of twelve studies published between the years of 2002 – 2012. The focus of all the studies was on Swedish emergency departments.   Results: The researchers found four themes that they choose to use as a way of describing the nurses work in the emergency room as detailed as possible. These themes were: ‘The emergency room’, ‘the nurse’s job assignments at an emergency department’, ‘the patient’s experiences’ and ‘lifeworld and communication’. This study shows that it is problematic for the nurses to give a caring nursing. The emergency department is more focused on medicine than caring, as there are certain parameters to follow as a nurse at an emergency department.  Lack of time and manpower has been a consistent factor in this study to explain the inability to give good caring at the emergency department. Conclusion: High workload leads to short time with each patient. This leads to a lack of patient care in the emergency room. In the short meetings with patients, important information could get lost and this could lead to inferior nursing. This study shows that some nurses developed strategies to make a fast and correct assessment of the patient. Other nurses developed strategies to make the patients feel more comfortable. Examples were to make eye contact, touch the patient in a comforting way and take the time to really listen to the patient during the short time they had with each patient.

“Power” is a concept that has been discussed by nurse scholars and leaders within the nursing literature. The literature surrounding power concurs that power is necessary within the practice of nursing so that nurses are able to support patients and move the profession of nursing forward. There is a scarcity of research, however, regarding nurses’ perception of power within their own practices. Advanced practice nurses (APNs) are in positions in which they apply graduate education, specialized knowledge, and expertise to improve health care outcomes. Therefore, a qualitative study using an interpretive hermeneutic phenomenological approach was undertaken to discover APNs’ lived experience of power within their practices. In-depth, tape-recorded interviews were conducted with eight APNs from a large tertiary care facility. All of the participants agreed to a follow-up interview to review the summary of the study results. van Manen’s (1990) approach was used to analyze the data by subjecting the transcripts to a thematic analysis and reflective process. The overarching theme of the interviews is “building to make a difference” and the APNs’ perceived that this happened by “building on,” building with,” and “building for.” The APNs built on their knowledge and expertise, built with others in relationships and built for the capacity to make a difference. Power was a part of the everyday practices of these APNs and was described as “soft power,” a power that they shared to bring about change for the better. This shared power was reflected back on them resulting in increased power within their practices, a process described by the APNs as power creep.

Abstract   Emma Bergdahl Obstacles and opportunities among occupational health nurses when implementing healthy eating habits. C thesis in Public Health. Faculty of Health and Occupational Studies. University of Gävle. Autumn 2012   Objective: The purpose of this study was to investigate which obstacles and opportunities nurses within occupational health find when trying to implement healthy eating habits among the employees in their respective company. Another objective was to see if the nurses worked according to the Guidelines, issued by the National Board of Health and Welfare. Method: The study was a quantitative study and conducted among nurses in central Sweden. A web survey was distributed to nurses who chose to participate. The response rate was 66 percent. The results were compiled in Excel since the characters and results are displayed in the form of figures, text and quotes. Results: The results showed that the most common obstacles found by nurses when trying to implement healthy eating habits among workers, were lack of motivation, lack of time and finances of companies. The opportunities were motivation, cooperation with other actors and adequate knowledge in the field. Healthy eating habits received low priority among the nurses. Conclusion: Motivation will always be necessary in order to change lifestyle or habits. Therefore, a high priority must be to work more with how to motivate those individuals who may not be so inclined to make a change.

Nurse empowerment is a well-researched area of nursing practice yet the quality of work environments continue to be eroded, and interactions between nurses and nurse managers continue to be fragile. Power is integral to empowerment, yet the exercise of power between nurses and their managers have been under-investigated in the nurse empowerment literature. To advance our knowledge in the empowerment literature, the study explored the process of how power is exercised in nurse-manager relationships in the hospital setting. Strauss and Corbin’s (1998) grounded theory methodology informed the study. Multiple qualitative fieldwork methods were utilized to collect data on staff nurses about how the manager’s role affected their ability to do their work. The researcher conducted semi-structured interviews and participant observations with 26 participants on three units within a tertiary hospital in Western Canada. Seeking connectivity was the basic social process in which nurses strive to connect with their manager to create a workable partnership in the provision of quality patient care while responding to the demands in the organizational context. Conditions, actions, and consequences formed the theory of seeking connectivity as an extension of nurse empowerment theory. The overarching finding is that the manager plays a critical role in modifying the work environment for nurses and as such, nurses seek connection with their manager to accomplish their work. Institutional policies and practices combined in various ways to influence nurses’ thinking and shaped their actions. The first pattern of the process was characterized by the absence of meaningful engagement with the manager. Power was held over nurses restricting discussions with the manager, and nurses employed a variety of resistance strategies. In the second pattern of the process when managers provided guidance, advocated for nurses, and engaged nurses as collaborators, nurses were better able to problem solve and make decisions with the manager to positively influence patient outcomes. The theory of seeking connectivity is the explanatory framework emerging from the study that reveals how power is exercised in social relations between nurses and managers. Seeking connectivity is a recursive process that continues to evolve. The results of this study advance nurse empowerment primarily from a structural perspective and secondarily from a critical social perspective, suggesting nurses’ perceptions and abilities shape their work role and are foundational to promoting change through collective action. Study implications for research, practice and policy are addressed.

Patient satisfaction is a key outcome measure being examined by researchers exploring the relationships between patient outcomes and hospital structure and care processes. Only a few non-generalizable studies, however, have explored the relationship of nurse staffing and patient satisfaction with nursing care in emergency departments of hospitals. This dissertation aims to address that gap. Using more than 182,000 patient satisfaction surveys collected over a five-year period from 153 emergency departments (EDs) in 107 hospitals throughout Ontario, this study explores the relationship between nurse staffing and patient perceptions of nursing care in a range of Canadian ED settings, including urban and rural, community and academic, and small and large healthcare institutions with varying sizes and case mix. Using an established conceptual framework for investigating the relationship between nurse staffing and patient outcomes, nineteen nurse staffing variables were initially investigated. Ultimately, however, only five staffing variables were used in the multi-level regression analyzes. These five variables included registered nurse (RN) proportion, RN agency proportion, percent full-time nurse worked hours, RN worked hours per patient length of stay and registered practical nurse (RPN) worked hours per length of stay. Emergency department case mix index, patient age and gender, hospital peer group, size, wait times, cleanliness of the emergency department, physician courtesy, and year of measurement were controlled to account for their effect on the relationship between nursing staffing and patient satisfaction in the ED. The study revealed a subset of six patient satisfaction variables representing the overall variation in patient satisfaction with nursing care in the ED. Although RN proportion and RPN worked hours per length of stay were found to have a statistical association with patient satisfaction in the ED, the association was weak and not administratively actionable. Interpersonal and environmental factors such as physician and nurse courtesy, ED cleanliness and timeliness, however, were areas which hospital administrators should consider since they were highly associated with patient satisfaction in EDs.

Organizational restructuring and reform in the health care system has impacted the ability of Clinical Nurses (CNs) to participate in and influence decision making that affects the delivery of patient care. Clinical nurses maintain and advocate a professional responsibility to practice according to specific standards, policies and procedures, and to meet the needs of the patient and family members. Clinical nurses participation in decision making at the patient, unit and administrative levels recognizes their abilities and skills as professionals; however, CNs continue to experience a limited role in the decision making and control over nursing practice at all of these levels.<p> The literature overview examines control over nursing practice including how this complex concept is difficult to define and undervalued within the CNs professional practice environment. It is evident in the literature that control over nursing practice is important to the CNs professional practice environment ultimately affecting job satisfaction, recruitment/retention, and patient outcomes. Control over nursing practice is explored in relation to internal and external factors that affect the professionalism of the CN. Internal factors are those that are more closely related to the CNs scope of practice and include professionalism (influence in decision making including policies and procedures, collegial relations, and professional development), CN satisfaction (workload, scheduling, health, safety and security concerns, supportive management, and opportunities for leadership), safe quality patient care (staffing, education, and specialization), empowerment, and autonomy. The external factors are outside the immediate scope of the CN yet directly and indirectly affect the CNs control over nursing practice including health care restructuring, organizational influence, work environment models (shared governance and magnet hospital environments), and nursing leadership. <p>This study provided CNs employed in the provincial hospitals in Saskatchewan an opportunity and a voice to share their perceptions of who governs their professional practice environment including control over nursing practice. This mixed method descriptive survey design used Hess Index of Professional Nursing Governance ([IPNG], 1998) along with five questions geared to elicit qualitative responses to study the perceptions of who governs CNs professional practice environment including control over nursing practice in provincial hospitals in Saskatchewan. Section one of the IPNG contains a demographic section including information on age, gender, nursing education, and employment information. The second section of IPNG consists of 86 questions that are further divided into six subscales asking respondents to indicate who has control over nursing practice in a number of areas within their particular health facility. The six subscales include Subscale I Professional control relating to who has control over professional practice in the organization, Subscale II Organizational influence examining who participates in governance activities within the organization, Subscale III Organizational recognition identifying who controls nursing personnel and related structures, Subscale IV Facilitating structures indicating who determines and participates in governance decisions within the organization, Subscale V Liaison exploring who influences the resources that support professional practice, and Subscale VI Alignment identifying who sets and negotiates conflict within the organization. These questions are rated on a 5 point Likert scale according to the following response possibilities: 5 = staff nurses only; 4 = primarily staff nurses with some nursing management/administration input; 3 = equally shared by staff nurses and nursing management/administration; 2 = primarily nursing management/administration with some staff nurse input; 1 = nursing management/administration only. Section three the qualitative questions, contained one closed ended and four open ended questions that provided CNs an opportunity to share a more personal perspective regarding their perceptions of control over nursing practice in their work environment. These questions included: 1. What does control over nursing practice mean to you? 2. How could control over your practice be changed significantly? 3. Do you feel you have enough control over practice in your work environment? 4. What limits your control over practice in an area that interests you? and What enables your control over practice in an area that interests you? <p>The total population of 1804 CNs in provincial hospitals in Saskatchewan was invited to participate in this study. One hundred and seventy two CNs (9.53%) responded to this study, including 118 from Saskatoon (11.8%) and 54 from Regina (6.7%). The descriptive data provides data on gender and average age of CNs that is similar to Canadian Institute for Health Information ([CIHI], 2006) and Health Canada (2006a). A greater number of CN respondents indicated their basic nursing education was a diploma and more CNs had attained a baccalaureate degree as their highest level of education when compared to the CIHI data. Twice as many CNs indicated having specialty certification and a higher number were working full time in comparison to the CIHI data. The quantitative data obtained from the IPNG subscales indicates CNs perceive limited control over nursing practice and this is by in large held mainly by nursing management/administration (1) and nursing management with some staff nurse input (2). The subscale results include Professional control (M = 1.72), Organizational influence (m = 2.13), Organizational recognition (M = 1.73), Facilitating structures (M = 1.82), Liaison (M = 2.1), and Alignment (M = 2.1). Overall, the results from the IPNG subscales provide scores of less than 3 on the Likert scale indicating CNs perceive limited control over nursing practice in their professional practice environment. There were no significant differences within the provincial hospitals or between the health regions regarding CNs perceptions of control over nursing practice. In their qualitative responses, CNs provided information related to both the internal and external factors as discussed in Chapter Two. Clinical nurses indicate they face many challenges regarding control over practice including lack of influence in decision making in issues related to policy and procedure, quality patient care, staffing ratios, self-scheduling, and educational opportunities. They also identified external factors affecting their control over nursing practice including a lack of support by management in relation to decision making, a lack of provision of and access to an adequacy of resources, and a lack of communication and collaboration. Many CNs indicated their only influence in decision making was related to direct patient care. Clinical nurses described that being valued, supported, and recognized for their experience and education in decision making positively affects control over nursing practice and more specifically, quality patient care. <p> Study results offer government officials, practitioners, regulatory bodies, researchers, administrators, educators, nurses, the public, professional association, employers, unions, and any other stakeholders information that provides an opportunity to increase their awareness and understanding of the impact that control over nursing practice has for CNs in their practice environment. If stakeholders are serious in their attempts to recognize CNs concerns regarding control over nursing practice in their work environment, the results from this study will provide information facilitating change in the CNs control over nursing practice. Ultimately, this affects the CNs professionalism and ability to provide quality patient care.

Patient satisfaction is a key outcome measure being examined by researchers exploring the relationships between patient outcomes and hospital structure and care processes. Only a few non-generalizable studies, however, have explored the relationship of nurse staffing and patient satisfaction with nursing care in emergency departments of hospitals. This dissertation aims to address that gap. Using more than 182,000 patient satisfaction surveys collected over a five-year period from 153 emergency departments (EDs) in 107 hospitals throughout Ontario, this study explores the relationship between nurse staffing and patient perceptions of nursing care in a range of Canadian ED settings, including urban and rural, community and academic, and small and large healthcare institutions with varying sizes and case mix. Using an established conceptual framework for investigating the relationship between nurse staffing and patient outcomes, nineteen nurse staffing variables were initially investigated. Ultimately, however, only five staffing variables were used in the multi-level regression analyzes. These five variables included registered nurse (RN) proportion, RN agency proportion, percent full-time nurse worked hours, RN worked hours per patient length of stay and registered practical nurse (RPN) worked hours per length of stay. Emergency department case mix index, patient age and gender, hospital peer group, size, wait times, cleanliness of the emergency department, physician courtesy, and year of measurement were controlled to account for their effect on the relationship between nursing staffing and patient satisfaction in the ED. The study revealed a subset of six patient satisfaction variables representing the overall variation in patient satisfaction with nursing care in the ED. Although RN proportion and RPN worked hours per length of stay were found to have a statistical association with patient satisfaction in the ED, the association was weak and not administratively actionable. Interpersonal and environmental factors such as physician and nurse courtesy, ED cleanliness and timeliness, however, were areas which hospital administrators should consider since they were highly associated with patient satisfaction in EDs.