Recente profusão de novos papéis profissionais do enfermeiro e mudanças nas práticas da enfermagem têm sido descritas mundialmente e exercem impacto no tipo de cuidado provido e nas formas de sua provisão. O interesse deste estudo é a ideia de papel clínico, que, apesar de ser uma expressão comumente usada no cotidiano, é pouco explorada em termos conceituais. Este estudo teve como objetivo desenvolver o conceito de papel clínico do enfermeiro. A Metodologia de Análise Qualitativa de Conceito foi aplicada em suas três fases: Identificação dos Atributos, Verificação dos Atributos e Identificação das Manifestações do Conceito. Na primeira fase, os atributos abstratos e universais do conceito foram identificados, utilizando-se a Análise Crítica da Literatura, que resultou no estudo de 24 publicações. Na segunda fase, aplicou-se a Teoria Fundamentada nos Dados para verificar os atributos do papel clínico na experiência do enfermeiro. Nessa fase, realizou-se estudo com sete enfermeiros assistenciais do Hospital Universitário da Universidade de São Paulo. Os dados foram coletados por entrevistas abertas, que foram analisadas e interpretadas em categorias inter-relacionadas, com a derivação de um modelo teórico da experiência do papel clínico do enfermeiro. Na terceira fase, os dados das fases anteriores foram comparados e integrados, possibilitando a proposição teórica do conceito. Os resultados da análise evidenciaram que papel clínico do enfermeiro é um processo psicossocial resultante da interação do enfermeiro com o paciente, com o contexto e consigo mesmo. Autonomia clínica configurou-se como elemento central da interação do enfermeiro com o paciente na experiência do papel clínico. O significado da experiência do papel clínico foi expresso no empoderamento do enfermeiro pelo exercício da autonomia clínica, que mostra o alcance de resultados manifestados na própria interação do enfermeiro com o paciente, consigo mesmo ou com o contexto. Os dados indicaram ter o paciente como o centro do cuidado, ter finalidades e intencionalidade como atributos principais do papel clínico. O desempenho do papel clínico requer que o enfermeiro tome posse da autonomia clínica, que a exerça nas interações e nas ações junto ao paciente e se perceba empoderado por esse exercício. Papel clínico é uma competência que se articula como uma forma de poder, mediado pela autonomia clínica. A autonomia clínica concede ao enfermeiro o poder de pensar, de imaginar, de planejar o cuidado e de influir na saúde do paciente. A análise do conceito do papel clínico contribuirá para reflexões sobre as dimensões envolvidas na prática e no ensino de enfermagem e para informar não só as políticas de ensino e de práticas profissionais, mas também as políticas de saúde. / Recent profusion of new professional roles of the nurse and changes in the practice of nursing have been worldwide described and have an impact on the type of care provided as well as on the forms of its provision. The interest of this study is the idea of the clinical role, which inspite of being a commonly used daily expression, is little explored in conceptual terms. This study has had as an objective the development of the concept of the clinical role of the nurse. The Methodology of Qualitative Analysis of Concept has been applied in its three phases: Identification of the Attributes, Verification of the Attributes and Identification of the Manifestations of the Concept. In the first phase, abstract and universal attributes of the concept have been identified using Critical Analysis of Literature, which resulted in the study of 24 publications. In the second phase, Grounded Theory has been applied to verify the attributes of the clinical role in the nurses experience. In this phase, a study has been carried out with seven assistential nurses from the São Paulo Universitys Hospital. Data has been collected by open interviews, which has been analysed and interpreted in interrelated categories, deriving to a theorical model of the nurses clinical roles experience. In the third phase, the data of the previous phases were compared and integrated, permitting the theorical proposition of the concept. The results of the analysis have proved that the nurses clinical role is a psychosocial process resulting from the interaction of the nurse with the patient, with the context and with himself. Clinical autonomy has configured as a central element in the interaction of the nurse with the patient in the clinical roles experience. The significance of the clinical roles experience has been expressed in the empowerment of the nurse through the exercise of clinical autonomy, which shows the range of achieved results shown in the nurses interaction with the patient, with himself or with the context. Data has indicated to have the patient as the center of attention, to have purposes and intentions as the main attributes of the clinical role. The performance of the clinical role requires that the nurse takes lead of the clinical autonomy, exercises it during interactions and actions with the patient and feels empowered by this exercise. The clinical role is an ability which, through clinical autonomy, is articulated as a form of power. Clinical autonomy concedes the nurse the power to think, to imagine, to make care plans and to influence the patients health. The analysis of the clinical roles concept will help to have reflections about the dimensions involved in the practice and teaching of nursing and to inform, not only the educational and professional practices politics, but health politics as well.

No description available.

Telecare has been an approach to care that, internationally, has experienced a generally rapid development during the last ten years. There are many examples of successful pilot projects where ICT applications have been used in the care of elderly: for improved remote consultation with health professionals, to improve the communication and support of the elderly person’s social network, and as intelligent sensors intended to improve the safety of the elderly person. Despite these successes, implementation has been slow. This research project was set up to provide additional knowledge on some of the important questions regarding quality and implementation aspects of the use of ICT application on the care of frail elderly persons. The overall aim of the research project is to illuminate reasoning and experiences of using applications of telecare for frail elderly persons. The research project comprised five studies that were conducted using qualitative research methods. Four of them were carried out within the framework of three telecare projects. Different qualitative research approaches such as content analysis, phenomenological hermeneutics and conversational and discourse analysis were used, in accordance with the research questions of each study. The experiences revealed in the findings of the studies indicate that it is possible to have communication of good quality via videoconferencing with frail elderly persons, even those that have mild or mid-level dementia, provided the conditions are right. Technical limitations of the videoconferencing media in transferring communication cues and the limitations on what the camera can expose place special demands on those communicating with the frail elderly and on the general setting. On the other hand, these limitations on the context of interaction in some situations also seem to be an advantage for demented elderly persons and contribute to increased attention. One example of meaningful remote communication with frail elderly persons was family members’ videophone conversations with their demented relatives when they were placed in nursing homes or homes for respite services. This communication gave new possibilities of being involved in caring for, and of maintaining a relationship with, their demented relative. An introduction of teleconsultations in the care of frail elderly persons will, according to the experiences recorded, affect the professional role and the practical spheres of involved health professionals. The perceptions and experiences of participating health personnel indicate that in order for ICT applications to become valuable assets in the care of frail elderly persons they have to be part of a care alternative that is viewed by all concerned as the best alternative, as a whole, for all affected parties. Further research is needed in order to confirm or refute the findings of this thesis and in order to further broaden our understanding of the use of ICT applications in the care of frail elderly persons. This could facilitate a development of ICT applications suitable for the care of frail elderly persons and their introduction into regular care activities, to the benefit of both the frail elderly persons and their carers.

Background: Female circumcision or female genital mutilation is a tradition that is carried out mainly in Africa. The intervention refers to that part of- or all of the girl’s external genital organs are removed.  Aim: The study's purpose was to highlight the consequences of female circumcision in the encounter with western health care. Method: A systematic literature reviews was performed as a method. Twelve articles were selected for the study and these were sought in Chinal, PubMed and PsycINFO. Analysis and interpretation was done according to qualitative content analysis, inspired by Lundman and Granheim. Eriksson, Birkler, Dahlberg and Segersten’s nursing theory was used as background in the discussion. Results: The analysis process resulted in six categories: laws and guidelines, offence, communication, knowledge, vulnerability and nursing. The results showed that offence occur extensively against genitally mutilated women and the exposure of these women. The results also showed a strong need for knowledge, laws and guidelines. Conclusions: Health care professionals need to have a basic knowledge of female circumcision and clear guidelines to ensure good care. The nurse should also keep themselves updated of new research and search for knowledge to improve their care.

Bakgrund: Psykisk sjukdom utgör en fjärde del av Sveriges sjukdomsbörda men fördomar mot personer med psykisk sjukdom är ingen ovanlig företeelse i dagens samhälle. Patienter med psykisk sjukdom har lika rätt till en god vård som alla andra. En grundutbildad sjuksköterska ska kunna vårda dessa patienter. Det framkommer dock att patienter med psykisk sjukdom inte har lika förutsättningar och hälsoutfall som patienter utan psykisk sjukdom. Patienterna upplever ett behov av trygghet och förtroende för sina vårdare men sjuksköterskor visar en tendens att agera annorlunda mot dessa patienter. Syfte: Att beskriva sjuksköterskors inställning till att vårda patienter med psykisk sjukdom i den somatiska slutenvården. Metod: En litteratursökning har genomförts för att skapa en översikt över vetenskapliga artiklar om grundutbildade sjuksköterskors inställning till vårdandet av patienter med psykisk sjukdom inom den somatiska vården. Åtta vetenskapliga artiklar, fyra kvantitativa och fyra kvalitativa, har analyserats och ligger till grund för resultatet. För sökningen användes databasen PubMed. Resultat: Resultatet tyder på att de negativa inställningarna till psykisk sjukdom överväger över de positiva. De framträdande orsakerna är framförallt brist på kunskap och erfarenhet, arbetsmiljöns påverkan, föreställningar om patienters beteende, negativa känslor såsom rädsla, frustation och ilska samt uppfattningen att vården av patienter med psykisk sjukdom inte ingår i yrkesrollen hos somatiska sjuksköterskor. De få positiva inställningar som framkommit grundar sig på faktorer som tillräcklig kunskap, goda erfarenheter, en anpassad arbetsmiljö och en holistisk syn på omvårdnad där även vård av patienter med psykisk sjukdom ingår. Diskussion: I resultatdiskussionen resoneras det kring hur sjuksköterskans arbete försvåras av de faktorer som beskrivs ligga bakom de negativa inställningarna. Sjuksköterskor behöver mer stöd i form av arbetsmiljöfaktorer som tid, bemanning och anpassning av vårdutrymmen. Utifrån den teoretiska referensramen beskrivs hur vårdrelationen påverkas av sjuksköterskors inställning och vad detta innebär för den vård patienter med psykisk sjukdom får inom somatiken. Förståelse för patienten är en viktig förutsättning för en bra vårdrelation. När vårdrelationen inte fungerar riskerar mötet mellan patienten och sjuksköterskan bli negativt och på så sätt skapas det negativa vårderfarenheter för både patienten och sjuksköterskan. / Background: Mental illness makes up a quarter of Sweden's disease burden but prejudice against people with mental illness is not an unusual phenomenon in today's society. Patients with mental illness have the same right to good health care as everyone else. General nurses with no specialist training should be able to care for these patients. It appears, however, that patients with mental illness do not receive health care under the same conditions and do not have the same health outcomes as patients without mental illness. These patients experience a need for security and trust in their caregivers but nurses show a tendency to act differently towards these patients. Aim: To describe nurses' stance on caring for patients with mental illness in somatic inpatient care settings. Method: A literature review has been made of scientific articles on general nurses' stance on caring for patients with mental illness in somatic care. Eight scientific articles, four quantitative and four qualitative, have been analysed and provide the base for the results. PubMed was used as database. Result: The results indicate that negative attitudes outweigh positive attitudes. The revealed causes of negative attitudes are mainly lack of knowledge and experience, work environment factors, preconceptions about patients' behaviour, negative emotions such as fear, frustration and anger, as well as the perception that caring for patients with mental illness is not part of the work of somatic care nurses. The few positive attitudes that have emerged are based on factors such as knowledge, good experience, an adjusted work environment and a holistic view of nursing care, which includes the care of patients with mental illness. Discussion: In the result discussion it is reasoned about how nurses’ work is being complicated by the factors described as causing negative attitudes. Nurses need more support in terms of work environment improvements such as more time, better staffing and adjusted care settings. The theoretical framework is used to clarify how the nurse-patient relationship is affected by nurses' attitudes and what implications this has on the care these patients received within somatic health care. Being understood is important for patients as a premise for a good nurse-patient relationship. With a dysfunctional nurse-patient relationship there is a risk for the nurse-patient encounter to be negative, which in its turn creates negative health care experiences for both patients and nurses.

Patienter med missbruksproblem upptar mycket av hälso- ochsjukvårdens platser och resurser. Det är därmed viktigt attsäkerställa att dessa patienter får god vård och belysa vilkafaktorer som kan inverka på omvårdnaden. Syftet var att belysasjuksköterskors attityder gentemot patienter medmissbruksproblem samt att beskriva hur mötet mellansjuksköterskor och dessa patienter ser ut. Det användes 17vetenskapliga artiklar som grund för detta arbete varav 11 varkvantitativa och sex var kvalitativa. Det framkom attsjuksköterskor ofta uppvisade negativa attityder gentemot patientermed missbruksproblematik och detta inverkade på omvårdnadenav patienterna. Det förekom även stigmatisering, stereotypiseringoch moralisering av patienter med missbruksproblem vilket leddetill att dessa patienter många gånger fick sämre vård.Sjuksköterskans omvårdnadsarbete ska präglas av etisktförhållningsätt och en humanistisk människosyn vilket försummasom negativa attityder gentemot patienter med missbruksproblemfår inverka på vården. Mer kvalitativ forskning gällandesjuksköterskors attityder gentemot patienter medmissbruksproblem efterfrågas. Dessutom krävs det merundervisning i sjuksköterskans grundutbildning och meryrkesrelaterad utbildning på sjuksköterskans arbetsplats gällandeomvårdnaden av patienter med missbruksproblem. / Patients with substance abuse problems occupy much of the bedsand resources of the health care. Therefore, it is important toensure that these patients receive proper care and highlight thefactors that may affect that care. The purpose of this literaturestudy was to illuminate nurses’ attitudes towards patients withsubstance abuse problems and describe the character of themeetings between nurses and these patients. As the basis for thispaper, 17 research articles were used, of them 11 articles werequantitative and six were qualitative. It was found that nurses oftenexhibited negative attitudes towards patients with substance abuseproblems and that this had an impact on the nursing care of thesepatients. Stigmatization, stereotyping and moralization of thesepatients were also detected and this often led to substandard care.Nursing care is characterized by an ethical approach and ahumanistic view that is overlooked if the negative attitudes ofnurses towards patients with substance abuse problems are allowedto affect care. More qualitative research on nurses’ attitudestowards patients with substance abuse problems is prompted.Furthermore, it is required more education in the undergraduatenursing schools and more occupational education at nurses’workplace about nursing care of patients with substance abuseproblems.

SAMMANFATTNING Bakgrund: Delaktighet och inflytande i samhället är ett målområde som Folkhälsomyndigheten (2015) lyfter fram som förutsättning för folkhälsan. I sjukvården ska patientlagen (SFS 2014:821) stärka patientens ställning och främja patientens delaktighet, integritet och självbestämmande. En intention är att utveckla en säkrare vård tillsammans med patienten. Begreppet patientdelaktighet är inte entydigt definierat enligt tidigare studier och forskare skriver det är bara den enskilda patienten som kan avgöra om delaktighet uppnåtts rörande den egna omvårdnaden.  Syfte: Att beskriva vad patienter upplever påverkar delaktighet i vården vid en thoraxkirurgisk vårdavdelning. Metod: Deskriptiv kvalitativ design med semistrukturerade intervjuer som omfattade sju patienter vilka genomgått öppen hjärtkirurgi. Analysarbetet genomfördes med kvalitativ innehållsanalys. Resultat: Det som påverkar upplevd delaktighet i vården bestod av underlättande och begränsande faktorer. Interaktion med och stöd av personalen samt möjligheten att välja grad av delaktighet underlättade. Begränsande var att inte ha kunskap och de medicinska bedömningarna, det fanns ett kunskapsgap mellan informant och professionen, den sjukvårdspersonal informanterna mötte och hade kontakt med under vårdtiden. För att minska den begränsande faktorn kunskap var skriftlig och muntlig information viktig. De medicinska bedömningarna accepterade informanterna helt och fullt. Professionens kunskap och medicinska bedömningar gav trygghet. Slutsats: Resultatet visar förutsättningar, underlättande och begränsande faktorer, som beskriver hur informanterna upplever vad som påverkade patientdelaktighet i vården i samband med öppen hjärtkirurgi. Stor vikt läggs vid stöd av personal, vid patientinformation och svar på frågor från professionen. / ABSTRACT Background: Participation and influence in society is a target area that Folkhälsomyndigheten (2015) highlighted as vital for public health. In medical care shall Patientlagen (SFS 2014: 821) strengthen the position of patients and promote patient involvement, integrity and self-determination. The intention is to develop safer care together with the patient. The concept of patient participation is not clearly defined in previous studies, and it is only the individual patient, which can determine whether participation is reached regarding their own care. Purpose: To describe what patients experience affects participation in care at a thoracic surgery ward. Method: Descriptive qualitative design with semi-structured interviews involving seven patients who underwent open heart surgery. The analysis was conducted using qualitative content analysis. Results: There affecting perceived participation in the care consisted of facilitating and constraining factors. Interaction and support of the staff and the ability to choose the degree of participation facilitated. Limitation was not to have the knowledge and the medical assessments; there was a knowledge gap between the informant and the profession, the medical staff informants met and had contact with during the hospital stay. To reduce the limiting factor knowledge was written and verbal information important. The medical assessments accepted the informants completely. The profession´s knowledge and medical assessment gave security. Conclusion: The results show potential, facilitating and constraining factors, describing how the informants experience what affected patient participation in care associated with open heart surgery. Emphasis is placed on the support of the staff, the patient information and answers to questions from the profession.

The general aim of the present thesis was to develop a theory on caring and uncaring encounters within nursing and health care from the patient's perspective. Results of an analysis of two phenomenological studies (paper I), as well as research findings from five other phenomenological studies (papers II-VI), were used to develop the theory. Caring and uncaring can be conceptualized on a continuum symbolizing five basic modes of being with another, which, for example, involves a neutral mode of being with another, where the individual is perceived as neither caring nor uncanng. There are two major metaphors in the theory, that of the bridge, symbolizing the openness in communication and the connectedness experienced by the recipient of care in an encounter perceived as caring. The other metaphor is the wall, which symbolizes negative or no communication, detachment and lack of a caring connection, experienced by the recipient in an encounter perceived as uncaring. In the theory the importance of professional caring within nursing and health care is proposed, essentially involving competence, caring, and connection. The above-mentioned 'bridge' is developed through mutual trust and the development of a connection between the professional and the recipient. This connection is a combination of professional intimacy and a comfortable distance of respect and compassion -- professional distance. On the other hand, uncaring involves perceived indifference and incompetence, creating distrust, disconnection and the above-mentioned 'wall' of negative or no communication. The recipient of professional caring is influenced positively. Theconsequences, which are an increased sense of well-being and health, can be summarized as empowerment. Uncaring, however, has the negative consequences of decreased sense of well-being and health, which can be summarized as discouragement. Empowerment and discouragement in this context are defined as subjective experiences of the recipients of care. The importance of seeing the recipient in his or her inner and outer contexts is emphasized in the theory. The inner context involves perceived needs, expectations, previous experiences and sense of self, which in the perspective of the recipient of nursing can be summarized as both a sense of vulnerability and the need for professional caring. The perceived hospital environment comprises the recipient's outer context. It is concluded that nurses and other health professionals can, by theirprofessional caring or lack of it, be powerful sources of empowerment ordiscouragement to those whom they are pledged to serve. / <p>Papers, included in the Ph.D. thesis, are not registered and included in the posts from 1999 and backwards.</p><p>The following papers included in the Ph.D. Thesis are removed due to copyright restrictions.</p><p>Paper I: Halldirsdottir, S. l 991. Five basic modes of being with another. In Gaut, D.A., &amp; Leininger, M.M., (eds) <em>Caring: The compassionate healer</em>. NationalLeague for Nursing, New York, 37-49.</p><p>Paper II: Halldirsdottir, S. &amp; Hamrin, E. 1997. Caring and uncaring encounters'vvithin nursing and health care: From the cancer patient's perspective. <em>Cancer Nursing</em> April, 20(2):120-128.</p><p>Paper III: Halldirsdottir, S. &amp; Hamrin, E. 1996b. Experiencing existentialchanges: The lived experience ofhaving cancer. <em>Cancer Nursing</em>, 19(1), 29-36.</p><p>Paper IV: Halldirsdottir, S. &amp; Karlsd6ttir, S.I. 1996a. Empowerment ordiscouragement: Women's experience of caring and uncaring encounters during childbirth. <em>Health Care for Women lnternational</em>, 17( 4).</p><p>Paper V: Halldirsdottir, S. &amp; Karlsdottir, S.I. i 996b. Journeying through labourand delivery: Perceptions of women who have given birth. <em>Midwifery</em> 12(2).</p><p>Paper VI: Halldirsdottir, S. 1996a. The lived experience of health: Aphenomenological case study. (on the day of the defence date the status of this article was <em>Submitted</em>. <strong>Published later:</strong> Halldorsdottir, S. 2000. Feeling empowered: A phenomenological case study of the lived experience of health.  In B. Fridlund and C. Hildingh (eds),  <em>Qualitative methods in the service of health </em>(pp. 82-96).  Lund: Studentlitteratur.</p>

Bakgrund: Lagen om psykiatrisk tvångsvård och Lagen om rättspsykiatrisk vård ger rätt att vårda patienter mot deras vilja. I psykiatrisk vård förekommer specifika omvårdnadsåtgärder som bältesläggning, tvångsmedicinering och avskiljning. Dessa väcker många känslor och kräver att sjuksköterskan arbetar med hänsyn och respekt. Relationen är en central del inom psykiatrisk omvårdnad och ska baseras på tillit och empati. Syfte: Att belysa sjuksköterskors uppfattning om tvångsåtgärders inverkan på omvårdnadsrelationen. Metod: Semi-strukturerade intervjuer med hjälp av en intervjuguide genomfördes med yrkesverksamma sjuksköterskor på en psykiatrisk klinik. Data bearbetades med en kvalitativ manifest innehållsanalys. Resultat: Studien resulterade i sex kategorier; professionellt förhållningssätt, vårdande samtal, tillitsfull relation, tvång som maktmedel, sjuksköterskans uppfattning av patientens känslor och sjuksköterskans känslor. Slutsats: Tvångsåtgärder väckte flera känslor hos sjuksköterskan. Med hjälp av ett professionellt förhållningssätt och vårdande samtal skapades en tillitsfull relation med patienten. Detta medförde att tvångsåtgärderna inte hade en negativ inverkan på omvårdnadsrelationen. / Background: The Compulsory Psychiatric Care Act and the Forensic Psychiatric Care Act gives the right to treat patients involuntarily. Specific nursing interventions in the form of restraint, coerced medication and seclusion occur in psychiatric care. These evoke a lot of emotions and require that the nurse work with consideration and respect. The nurse-patient relationship is an essential part within psychiatric nursing and should be based on trust and empathy. Aim: To illuminate nurses perception of coercive measures impact on the nurse-patient relationship. Method: Semi-structured interviews with the help of a topic guide were conducted with nurses on a psychiatric clinic. The data were processed through a qualitative manifest content analysis. Results: The study resulted in six categories; professional approach, caring dialogue, trusting relationship, coercion as an instrument of power, the nurse´s perception of patients emotions and the nurse´s emotions. Conclusion: Coercive measures raised several emotions within the nurse. With the use of a professional approach and a caring dialogue a trusting relationship was created with the patient. This meant that coercive measures didn't have a negative impact on the nurse-patient relationship.

Thesis (Ph. D.)--University of Virginia, 2007. / Includes bibliographical references. Also available online through Digital Dissertations.