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Bakgrund: Diabetiska fotsår, ”Diabetes foot ulcer” (DFU) är ett globalt hot mot personer med diabetes på grund av de komplikationer som kan uppkomma som en efterföljd av diabetes. Neuropati är en vanlig följdsjukdom till diabetes vilket medför risken för DFU. Neuropati orsakar nedsatt känsel i underben och fötter vilket kan medföra att patienten inte känner föremål i skorna som skaver och trycker mot fötterna som kan orsaka DFU. Syfte: Syftet med litteraturstudien var att beskriva sjuksköterskors preventionsstrategier för att reducera utvecklingen av fotsår hos patienter med diabetes. Metod: Denna studie genomfördes som en beskrivande litteraturstudie baserat på 12 vetenskapliga artiklar som bestod av fyra kvalitativa och åtta kvantitativa artiklar. Huvudresultat: Resultatet visade att sjuksköterskor är i behov av ökad kunskap genom sårvårdsutbildning efter kandidatexamen. Det framkommer att sjuksköterskornas kunskaper har en stor roll i behandlingen av DFU varav patienternas egenvårdsförmåga lyfts fram för att tillsammans finna de rätta strategierna för varje patient i sin DFU behandling. Slutsats: Fördjupad kunskap inom preventionsstrategier att reducera utvecklingen av DFU hos patienter med diabetes skulle kunna komma både patienter, sjuksköterskor och svensk hälso- och sjukvård till nytta. Kunskapen om preventionsstrategier hos sjuksköterskor i arbetet av DFU varierade inom hälso-ochsjukvårdsverksamheter världen över. Det finns flera strategier att arbeta vidare med som sjuksköterska i förebyggandet av DFU. Två viktiga aspekter inom preventionsstrategier är ökad utbildning för grundutbildade sjuksköterskor inom sårvård av DFU.Patientutbildning inom egenvård i förebyggande av komplikationer av DFU är en viktigstrategi i sjuksköterskans yrkesroll för att kunna bidra med goda förutsättningar och hälsofrämjande vård. / Abstract Background: Diabetic foot ulcer (DFU) is a global threat to people with diabetes due tothe complications that can arise as a result of diabetes. Neuropathy is a common secondary result of diabetes which carries the risk of DFU. Neuropathy causes decreased sensation in the lower legs and feet which can cause the patient not to feel objects in the shoes rubbing and pressing against the feet which can cause DFU. Aim:The purpose of the literature study was to describe nurses' prevention strategies for reducing the development of foot ulcers in patients with diabetes. Method: This study was conducted as a descriptive literature study based on 12 scientific articles consisting of four qualitative and eight quantitative articles. Main results: The results showed that nurses are in need of increased knowledge through wound care training after thebachelor's degree. It appears that the nurses 'knowledge has a major role in the treatmentof DFU, of which the patients' self-care ability is highlighted in order to jointly find theright strategies for each patient in their DFU treatment. Conclusion: Advanced knowledge of prevention strategies to reduce the development of DFU in patients with diabetes could benefit both patients, nurses and Swedish health care. The knowledge of prevention strategies among nurses in the work of DFU varied in health care activitiesworldwide. There are several strategies to continue working with as a nurse in the prevention of DFU. Two important aspects in prevention strategies are increased training for undergraduate nurses in wound care at DFU. Patient education in self-care in the prevention of complications of DFU is an important strategy in the nurse'sprofessional role in order to be able to contribute with good conditions and health promoting care.

Bakgrund: Patienter riskerar att försämras i sitt tillstånd på grund av olika faktorer. Sjuksköterskan har en viktig roll i att upptäcka, bedöma och initiera åtgärder för en patient som försämras i sitt tillstånd. Sjuksköterskans kompetens består av kunskap, färdigheter och erfarenheter. Sjuksköterskan ska arbeta för att säkerställa patientsäkerheten inom vården. Syfte: Syftet var att belysa hur sjuksköterskans kompetens kan påverka patientsäkerheten vid försämring av patientens tillstånd. Metod: En litteraturstudie genomfördes genom att söka i relevanta databaser. Elva artiklar valdes ut och bearbetades med inspiration från innehållsanalys. Resultat: Fyra kategorier med tillhörande underkategorier framkom. Huvudkategorierna var: Från sjuksköterskestudent till nyutbildad sjuksköterska, Den yrkeskompetenta sjuksköterskan, Samverkan i vårdteam och Arbetsmiljöns betydelse. Nyutbildade sjuksköterskor upplevde att de hade brist på erfarenhet i att hantera patienter som försämras i sitt tillstånd. Erfarenhet och kontinuitet framkom som betydande för att upptäcka och hantera försämring i patientens tillstånd. Samarbete ökade patientsäkerheten men det förekom brister i kommunikationen mellan läkare och sjuksköterska. Slutsats: Litteraturstudien påvisade att sjuksköterskans kompetens påverkar patientsäkerheten vid försämring av patientens tillstånd. Mer forskning behövs för att undersöka hur detta kan tillämpas inom vården. / Background: Nurses have an important role in recognizing and responding to patient deterioration. Nursing competence includes knowledge, skills and experience. The nurse must work to ensure patient safety in healthcare. Aim: The aim of this study was to illustrate how nursing competence affects patient safety during patient deterioration. Method: A literature study was undertaken by searching relevant databases. Eleven articles were selected and analyzed with inspiration from content analysis. Results: Four main categories with associated subcategories emerged. The main categories were From nursing student to newly graduated nurse, The professional and competent nurse, Teamwork and The importance of the working environment. Newly graduated nurses felt they lacked experience when dealing with patient deterioration. Experience and continuity played an important role for nurses when dealing with deterioration. Team collaboration increased patient safety, but there were shortcomings in communication between nurses and doctors. Conclusion: The literary study showed that nursing competence affects patient safety when a patient deteriorates. Further research is needed to establish how this information can be applied in healthcare.

Bakgrund: Varje år får omkring 300 barn i Sverige cancer. När ett barn får ett cancerbesked drabbas hela familjen. Tiden efter diagnos är en jobbig period för alla inblandade. Vardagen förändras och känslor av besvikelse, ilska och sorg kan tränga sig på. På sjukhuset spelar sjuksköterskan en central roll i omvårdnaden och konfronteras oundvikligen med familjen och deras känslor. Syfte: Att beskriva sjuksköterskans upplevelse av att bemöta en familj i sorg när deras barn får en cancerdiagnos. Metod: Semistrukturerade intervjuer med fyra sjuksköterskor genomfördes vid två olika sjukhus. Insamlad data sammanställdes och bearbetades utifrån en kvalitativ innehållsanalys. Resultat: Tre teman identifierades utifrån sjuksköterskans upplevelser: Sjuksköterskans roll, Familjens känslomässiga berg- och dalbana och Uppmärksamma de unika mötena. Slutsats: Cancer förknippas med döden. Däremot förekommer inte sorg bara vid död. Som sjuksköterska är det viktigt att inte gå in i familjens sorg, utan istället, genom god kommunikation och information, stärka familjen och ge dem hopp. Familjen är en viktig del i omvårdnaden av sjuka barn. Genom att involvera familjen i vårdandet skapas en helhet vilket ger familjen ett inre lugn. / Background Every year, about 300 children in Sweden are diagnosed with cancer. When a child gets a cancer diagnosis it affects the whole family and it is a difficult time for everyone involved. The everyday life changes and feelings of disappointment, anger and grief can be presented. At the hospital, the nurse plays a central role in the care and is inevitably confronted by the family and their feelings. Aim: To describe the nurse’s experience of caring for a family in grief when their child gets a cancer diagnosis. Method: Semi-structured interviews with four nurses were conducted in two different hospitals. Collected data were compiled and processed by using a qualitative content analysis. Results: Three themes were identified by the nurse's experiences: The nurses’ role, The families emotional rollercoaster, and Notice the unique meetings. Conclusion: Cancer is associated with death. Grief however, does not only apply death. As a nurse it is important to avoid going into the family's grief, but instead, through good communication and information, provide them with strength and hope. The family is an important part in the care of sick children. By involving the family, a sense of wholeness and inner calm is created.

Background: In the Republic of the Congo, malaria is a major cause of death, in particular among children. Therefore, malaria prevention is of high priority. Registered nurses have an important role in illness prevention in sub-Saharan Africa, especially through education of the population. To improve malaria prevention, it is important to understand how registered nurses experience the preventive work. Objective: The objective of this study was to examine the experiences of registered nurses working with malaria prevention in the Republic of the Congo. Method: A qualitative method was used. Semi-structured interviews with six registered nurses in the Republic of the Congo were conducted. Qualitative content analysis was used to analyse the interviews. Findings: Three categories were identified in the analysis: preventive interventions are necessary, possibilities in malaria prevention and difficulties in malaria prevention. The registered nurses experienced that preventive interventions, such as different methods of avoiding mosquito bites, are necessary because malaria affects the entire population in Congo. The registered nurses experienced educating and informing the patients as a possibility in malaria prevention and a lack of resources as a difficulty. Conclusion: The registered nurses experienced education and information as an effective way to communicate preventive interventions against malaria. However, the registered nurses sometimes experienced incomprehension among the patients, which could be improved by adapting the information to the individual. A difficulty that the registered nurses experienced was a lack of resources on many levels. An increased access to resources would lead to improvements in malaria prevention.

Background Globally pressures ulcers are commonly seen as hospital acquired injuries with negative consequences for the persons such as pain, suffering and also incurring high costs for society. Preventing the occurrence of pressure ulcers is an important part of nursing care and a professional responsibility for registered nurses. Person-centered care is one of the core competencies for registered nurses. Involving the person in their care and increasingthe person’s knowledge about preventive strategies, person-centered care is of great value in the prevention of pressure ulcer. Aim The aim of this study was to describe registered nurses’ experiences of preventing theoccurrence of pressure ulcers in persons receiving care in a hospital setting in Peru. Method A qualitative method was used with semi-structured interviews which were conducted at a hospital in Peru. Seven registered nurses participated in this study. The data was analyzed with a qualitative content analysis. Findings The findings of this study are presented under three categories formed during the data analysis: Incorporating pressure ulcer prevention into general nursing care, recognition of the need to develop knowledge about pressure ulcers and awareness of professional responsibilities in nursing care. Conclusion Providing nursing care, following closely hospital guidelines, provides a systematic way to prevent the occurrence of pressure ulcers in persons receiving hospital care. It is important that the nurse includes the person in the care process. The registered nurses underlined the importance of education in prevention strategies.

Bakgrund Smärta är en subjektiv upplevelse och smärtbehandling bör därför utformas olika beroende på individens smärtupplevelse. Att lindra lidande och smärtbehandla alla patienter där behovet finns är en del av sjuksköterskans arbetsuppgifter. Smärtbehandling hos patienter med ett samtidigt opioidberoende kan upplevas problematiskt och som ett hinder i vårdandet av denna patientgrupp. Sjuksköterskors attityder till att smärtbehandla opioidberoende patienter kan grunda sig i egna erfarenheter och personliga åsikter där attityden kan påverka mötet med patienter och vårdandet av dessa. Syfte Syftet var att belysa sjuksköterskors attityder till smärtbehandling för opioidberoende patienter. Metod Icke systematisk litteraturöversikt användes som metod för att besvara syftet med stöd av 17 vetenskapliga artiklar. Artikelsökning genomfördes i PubMed och CINAHL Complete. Resultat Genomförd litteraturöversikt visade att sjuksköterskor hade negativa attityder till att vårda och smärtbehandla opioidberoende patienter. Sjuksköterskor upplevde problematik kring tillit och partnerskap i uppbyggandet av god vårdrelation då patienten var opioidberoende och ansåg att mötet med dessa patienter kunde bli hotfullt och påverkat av manipulativt beteende. Sjuksköterskors tidigare erfarenheter och personliga inställning till missbruk påverkade vårdandet. De upplevda problemen gällande att smärtbehandla opioidberoende patienter ofta grundade sig i kunskapsbrist hos sjuksköterskor. Kunskapsbristen genererade otrygghet i beslutsfattande, bemötande och vårdande av patienter med opioidberoende och samtidig smärta. De sjuksköterskor som hade mer erfarenhet av patientgruppen tenderade uppleva mer positiva attityder och en känsla av säkerhet gällande både bemötande och smärtbehandling. Sjuksköterskor beskrev vikten av god och formell utbildning och behov av organisatoriskt stöd i vårdandet. Slutsats Litteraturöversiktens resultat tyder på att sjuksköterskor brister i sin utbildning gällande vårdandet av patienter med missbruk i samband med smärtbehandling. Sjuksköterskornas kunskap och erfarenhet ligger till grund för hur omvårdnaden och mötet med patientgruppen utformas. Framtagna riktlinjer och stödmodeller krävs på en organisatorisk nivå för vårdande av missbrukande patienter i samband med smärtbehandling. / Background Pain is a subjective experience. Relieving suffering and treating all patients where the need arises is a part of the nurse's duties. Pain treatment for patients with concomitant opioid dependence can be experienced as problematic. The nurse's attitudes towards treating opioid dependent patients may be based on individual experiences and personal opinions, where their attitude can influence the meeting with patients and their care. Aim The aim was to explore nurses’ attitudes to pain treatment for opioid dependent patients. Method Non-systematic literature review was used as a method to answer the purpose with the support of 17 scientific articles. The article search was performed in PubMed and CINAHL Complete. Results The literature review showed that nurses had negative attitudes towards caring for and treating opioid dependent patients. Nurses experienced problems with trust and partnership when the patient was opioid dependent and considered that interactions with these patients could be threatening and influenced by manipulative behavior. Nurses' previous experiences and personal attitudes towards addiction affected the care. Problems regarding pain treatment of opioid dependent patients were often based on a lack of knowledge, which generated insecurity in decision making, treatment and care of the patient group. Nurses who had more experience of the patient group tended to experience more positive attitudes and a sense of security regarding both care treatment and pain treatment. Good and formal education and need for organizational support in care of the patient group were indicated. Conclusions The results indicate that there is a lack of training among nurses in the care of addicted patients in connection with pain treatment. The nurses' knowledge and experience form the basis of how the nursing and meeting with the patient group looks like. Developed guidelines are required at an organizational level for addicted patients in connection with pain treatment.

There are around 90 000 deaths annually in Sweden, it is not unusual for nurses to encounter death in their work. Death can evoke many strong emotions; it is therefore of great importance that nurses’ can cope with their emotions. The aim of this study was to explore nurses' experiences in coping with their own emotions from patient deaths in inpatient care. The study was conducted as a literature-based study based on qualitative research. Ten articles from the databases Cinahl and PubMed, published 2013-2023 in English were included. The articles were analyzed using Friberg’s (2022) five step process. Two main themes were identified: coping strategies in case of death and aspects influencing the coping of emotions. The results showed that nurses coped with their emotions using different coping strategies which could be divided into three subthemes: coping with emotions through practical problem-solving, coping with emotions through distraction and coping with emotions by changing perspective. The results also showed that cultural and religious aspects affected the nurses coping, in both positive and negative ways. Some nurses found ways to cope with their emotions after they had gained experience within the field of deaths, while other nurses didn’t and expressed a feeling of not having enough knowledge about how to cope with their emotions. Therefore, nurses need education on how to cope with their feelings that occur in difficult situations such as deaths. / I Sverige dör omkring 90 000 personer årligen. Sjuksköterskor som jobbar inom slutenvården kan stöta på både oväntade och förväntade dödsfall i sitt arbete och behöver därför kunna hantera känslor som uppstår i samband med dödsfall. I studien beskrivs olika lagar och föreskrifter att förhålla sig till när ett dödsfall inträffar. För att hantera känslor som uppstår kan olika copingstrategier tillämpas, dessa kan delas in i tre grupper; problemfokuserade, emotionsfokuserade och meningsskapande copingstrategier. Sjuksköterskors ansvar kring dödsfall handlar om att respektfullt omhänderta patienten och anhöriga på ett professionellt sätt. Sjuksköterskor ska även förhålla sig till International Council of Nurses (ICN) etiska kod för sjuksköterskor. ICN:s etiska kod beskriver principer och värderingar vilket sjuksköterskor bör följas för att främja hög kvalitet, säkerhet och omsorg i vården. Syftet med denna studie var att undersöka sjuksköterskors erfarenheter kring hantering av egna känslor vid dödsfall av patienter inom slutenvården. Resultat visade att de flesta sjuksköterskor hanterade sina känslor genom att tillämpa olika copingstrategier, vilka var; att hantera känslor genom praktiska lösningar på problemet, att hantera känslor genom avledning och att hantera känslor genom att ändra perspektiv. Religiösa och kulturella aspekter visade sig påverka sjuksköterskors hantering av känslor, det underlättade för vissa och försvårade för andra. En annan aspekt som påverkade hanteringen var sjuksköterskors tidigare erfarenheter, där resultatet visade att en längre erfarenhet oftast underlättade för hanteringen. I resultatet framkom det att de flesta sjuksköterskor uttryckte en känsla av att de inte hade nog med kunskap i hur de skulle hantera känslor som uppstod vid dödsfall. Detta examensarbete genomfördes som en litteraturbaserad studie med grund i befintlig kvalitativ forskning, där tio vetenskapliga artiklar valdes ut. Baserat på resultatet kunde slutsatsen dras om att det fanns en brist i sjuksköterskors kunskap om hur de skulle hantera sina egna känslor. Konsekvenserna av att detta kunde påverka patienters omvårdnad negativt och orsakade problem såsom utmattningssymtom för sjuksköterskor.

Background: Sweden has developed to a country with great ethnic variation. Previous research shows that knowledge about the patient’s ethnicity is important for the quality and it’s the nurse’s responsibility to ensure that the patient gets god care regarded what ethnicity the patients belong to. Research shows that patients with different ethnicity then the majority has a larger ability to develop illness. Purpose: To describe nurse’s experiences of caring for patients with different ethnicity. Method: A systematic literature review with descriptive syntheses. Results: The result showed that communication barriers, ethnic collision and lack of recourses is the greatest challenge for nurses to provide transcultural care. But at the same time nurse’s experienced that they evolved in a professional level when they experienced that their awareness of the importance of ethnicity as a key too holistic acre. That knowledge got better when they cared for patients with another ethnicity. Conclusion: Nurse’s experienced that it’s challenging to provide god care to patients with different ethnicity. Knowledge of transcultural care is an important key to holistic care. The nurse’s experienced that more knowledge about transcultural care and more recuses in form of time, education and access to professional interpreter as important elements to reach the goal to provide good and individualized care.

Este estudo foi de natureza qualitativa e utilizou como referencial teórico o Interacionismo simbólico e metodológico a Teoria Fundamentada em Dados. Objetivou-se desenvolver um modelo de cuidado espiritual para os pacientes e seus familiares no enfrentamento de situações de adoecimento. O estudo foi realizado em Hospital Universitário do sul do Brasil, com seis enfermeiras e quatro técnicas de enfermagem, com um ano ou mais de experiência na área de atuação e que estavam exercendo suas atividades. Para coleta dos dados utilizou-se uma entrevista semiestruturada do tipo intensivo e um grupo de expertise, com quatro participantes para validação do Modelo, no período de março a maio de 2016. Os preceitos éticos foram seguidos e obtidas as assinaturas de todas as participantes no Termo de Consentimento Livre e Esclarecido. A coleta e análise dos dados ocorreram de forma concomitante de acordo com o método. Na análise dos dados aplicaram-se as etapas da Teoria Fundamentada em Dados que prevê a codificação inicial, focalizada, axial e teórica. Os significados, pressupostos, ações e resultantes identificados a partir das experiências e vivências das participantes no cuidado aos pacientes e seus familiares foram descritas nas categorias Situando a espiritualidade no seu viver e as subcategorias “Reconhecendo a espiritualidade como uma necessidade e complemento” e “Caminhando na espiritualidade”. Exercitando a espiritualidade na vida e as subcategorias “Praticando a espiritualidade ao seu modo”, “Percebendo a espiritualidade como uma opção de vida”, “Respeitando as crenças do outro”, “Encontrando a espiritualidade na maneira de agir e pensar”. Percebendo o papel da equipe de enfermagem no cuidado espiritual e as subcategorias “Advogando os direitos do paciente e em prol da profissão”, “Conversando sobre espiritualidade”, “Preparando a equipe de enfermagem”, “Cuidando no processo e morte e morrer”, “Limitando o cuidado pelas crenças pessoais, organizacionais e religiosas”. Identificando as manifestações das necessidades espirituais e as subcategorias “Identificando as formas de enfrentamento do sofrimento” e “Acontecendo: o momento de atender as necessidades”. Colocando a espiritualidade como prioridade no cuidado e as subcategorias “Acolhendo os pacientes e familiares”, “Utilizando práticas integrativas”, “Rezando com o paciente”, “Confortando por meio da espiritualidade” e “Continuando a acreditar todos os dias”. A integração destas categorias possibilitou identificar a categoria central Ressignificando o adoecimento e o desenvolvimento do modelo de cuidado espiritual. Além disso, foi desenvolvida uma versão prática do modelo. O estudo originou uma compreensão e interpretação conceitual e prática sobre o tema espiritualidade na enfermagem e foram delineadas as conexões entre a equipe de enfermagem e os pacientes e familiares no momento do cuidado espiritual. / This study was a qualitative approach, which used the theoretical symbolic interactionism and the Grounded Theory as methodological benchmarks. The purpose was to develop a spiritual model of care for patients and their relatives when confronting situations of illness. The study was conducted in a University Hospital in the south of Brazil and involved six nurses and four certified nurse practitioner, whose had one year or over of experience in the operating area and were performing their activities. In order to collect data, we used semi-structured interviews of intensive type and an expertise group, composed of four participants, with sights to validate the Model, during the period between March and May 2016. The ethical precepts were followed, and then we obtained the signatures of all participants in the Free and Informed Consent Form. The collection and analysis of data took place concomitantly in line with the method. When analyzing data, we applied the steps of the Grounded Theory, which foresees the initial, focused, axial and theoretical coding. The meanings, assumptions, actions and outcomes identified from the experiences and backgrounds of the participants in the care of patients and their relatives were described in the categories “Situating the spirituality in your daily life” and the subcategories “Recognizing the spirituality as a need and complement” and “Walking in the spirituality”. “Exercising the spirituality in life” and the subcategories “Practicing the spirituality in my own way”, “Perceiving the spirituality as a life choice”, “Respecting the beliefs of others”, Finding the spirituality in the way of acting and thinking”. “Perceiving the role of the nursing team in the spiritual care” and the subcategories “Advocating the patient’s rights and for the promotion of the profession”, “Talking about spirituality”, “Preparing the nursing team”, “Caring for in the process of death and dying”, “Limiting care through the personal, organizational and religious beliefs”. “Identifying the manifestations of the spiritual needs” and the subcategories “Identifying the ways of confronting the suffering” and “Happening: the time to meet the needs”. “Placing the spirituality as a priority in the care” and the subcategories “Welcoming the patients and relatives”, “Using integrative practices”, “Praying together with the patient”, “Comforting through the spirituality” and “Continuing to believe every day”. The integration of these categories has enabled us to identify the central category “Resignifying the illness”, as well as to develop a spiritual care model. In addition, we have developed a practical version of the model. The study gave rise to a practical and conceptual understanding and interpretation about the issue of spirituality in nursing, and then we drew up the connections between the nursing team and the patients and their relatives at the time of the spiritual care.