Thèse numérisée par la Division de la gestion de documents et des archives de l'Université de Montréal

Bakgrund: En del patienter som vårdas inom slutenvårdspsykiatrin ses av sjuksköterskor svårare att vårda. Dessa patienter riskerar få en sämre vård än andra patienter. Genom att belysa sjuksköterskors egna förklaringsmodeller till varför patienterna uppfattas som svåra kan fokus riktas mot en utsatt patientgrupp inom den svenska slutenvårdspsykiatrin. Syfte: Att beskriva sjuksköterskors egna uppfattningar om varför patienter upplevs som svåra att vårda inom den slutna psykiatriska vården. Metod:Fem intervjuer med sjuksköterskor arbetandes inom slutenvårdspsykiatrin genomfördes. Intervjuerna var semistrukturerade och en intervjumall användes för att beröra studiens frågeområden. De transkriberade intervjuerna analyserades med hjälp av en kvalitativ innehållsanalys. Resultat:Fem olika kategorier framträdde ur materialet vilka återspeglade de intervjuade sjuksköterskornas förklaringar till varför en patient uppfattas som svår inom den psykiatriska slutenvården: Patientens negativa beteenden, omständigheter kring patienten, personalens känslor, personalens beteenden, dåligt anpassad vårdorganisation samt lätta patienter. Diskussion: Det finns många paralleller mellan patienter som uppfattas som svåra och en icke fungerande vårdrelation mellan sjuksköterska och patient. En modell presenteras som beskriver hur patienter i den slutna psykiatriska vården uppfattas som svåra utifrån ett sjuksköterskeperspektiv.

Bakgrund: Behovet av palliativ vård ökar i kapp med en åldrande befolkning och kraven på sjuksköterskornas kompetens ökar därefter. Den palliativa vården bedrivs bäst i samråd med patienter och anhöriga och anses vara mångsidig och komplex. Sjuksköterskan beskrivs ha en avgörande roll för hur den palliativa vården bedrivs och upplevs, där kommunikation är ett av de viktigaste verktygen. Samtidigt rapporteras det om sjuksköterskors bristande kunskap inom ämnet.  Syfte: Syftet med denna litteraturstudie var att undersöka sjuksköterskors upplevelse av att kommunicera med patienter och anhöriga inom palliativ vård. Metod: Studien är en litteraturöversikt med kvalitativ ansats. Datainsamlingen gjordes med hjälp av ett strukturerat sökschema i databaserna PubMed och Cinahl. Artiklarna granskades med hjälp av SBU:s granskningsmall för kvalitativ forskning. Efter kvalitetsgranskning återstod 12 artiklar som analyserades med en innehållsanalys och sedan utgjorde resultatet. Resultat: Tre huvudteman framkom efter gjord innehållsanalys, Kommunikationens deltagare, Kommunikationens kontext samt Organisatoriska faktorer.Konklusion: Kommunikation upplevs av sjuksköterskor som ett komplicerat och känslomässigt krävande område där det råder kunskapsluckor. Upplevelserna påverkas av utbildning, erfarenhet, arbetsplats och vilka som deltar i kommunikationen. Sjuksköterskor behöver erbjudas mer stöd och utbildning för att känna sig trygga i sin kommunikation och därmed kunna erbjuda den bästa möjliga omvårdnaden. / Background: The need for palliative care increases in line with an aging population and the demands on nurses' skills increase accordingly. Palliative care is best conducted in consultation with patients and relatives and is considered to be versatile and complex. The nurse's role regarding how palliative care is practiced and experienced is described as crucial, where communication is one of the most important tools. However, at the same time, nurses' lack of knowledge on the subject is reported.Aim: The purpose of this literature study was to investigate nurses' experience of communicating with patients and relatives in palliative care.Method: The study is a literature review with a qualitative approach. The data collection was done using a structured search schedule in the PubMed and Cinahl databases. The articles were reviewed using the SBU's review template for qualitative research. After quality review, 12 articles remained which were then analyzed with a content analysis and formed the result.Results: Three main themes emerged from the content analysis, The communication participants, Context and type of communication and Organizational factors.Conclusion: Communication is perceived by nurses as a complicated and emotionally demanding area where there is a gap in knowledge. The experiences are affected by education, work and personal experiences, workplace and the communications participants. Nurses need more support and training to feel confident in their communicative abilities and thus be able to offer the best possible care.

Bakgrund: En god hälsa kräver ett psykiskt så väl som fysiskt välbefinnande. De goda fysiologiska effekterna av fysisk aktivitet har länge uppmärksammats och ny forskning pekar även på flertalet psykologiska vinster. Det är dessutom allmänt känt att en stillasittande livsstil kan leda till en rad olika sjukdomar och försämrat hälsotillstånd. Patienter med psykisk ohälsa som vårdas under tvång har begränsade möjligheter till aktivitet och ett minskat självbestämmande gällande upprätthållandet av en god fysisk hälsostatus. Syfte: Syftet med denna studie är att undersöka yrkesverksamma sjuksköterskors erfarenheter av fysisk aktivitet för patienter som vårdas inom psykiatrisk tvångsvård. Metod: Designen var en empirisk intervjustudie med kvalitativ ansats. Sjuksköterskor yrkesverksamma inom psykiatrisk tvångsvård intervjuades. Analysen av insamlad data gjordes av det manifesta innehållet i intervjuerna. Resultat: Studien resulterade i sex kategorier; Den goda vårdrelationen, Hinder inom tvångsvården, Sjuksköterskans inställning, Sjuksköterskans ansvar och Individanpassad aktivitet Slutsats: Sjuksköterskor inom psykiatrisk tvångsvård hade en positiv inställning till fysisk aktivitet men hinder och svårigheter såväl inom organisationen som relaterat till patienternas sjukdomstillstånd försvårade arbetet med tillfredställandet av en god fysiskt hälsostatus. / Background: Good health requires a mental as well as physical well-being. The good physiological effects of physical activity have long been recognized and new research also points to several psychological gains. It is well known that a sedentary lifestyle can lead to a variety of diseases and conditions. Patients with mental illness who are cared for under compulsory institutional care have limited opportunities for activity and a decreased self-determination regarding the maintenance of a good physical health status. Aim: To investigate registered nurses' experiences of physical activity for patients with mental illness who are cared for under compulsory institutional care. Method: The design was an empirical interview study with a qualitative approach. Nurses working in psychiatric compulsory institutional care were interviewed. The analysis of the gathered information was made of the manifest content of the interviews. Results: The study resulted in six categories; The good nurse- patient relationship, obstacles in compulsory institutional care, nurses attitudes, nurses’ responsibility and individualized activity. Conclusion: Nurses in psychiatric compulsory institutional care had a positive attitude towards physical activity, but the obstacles and difficulties both within the organization as well as the patients' medical conditions, complicated the process of satisfying the patients physical health status.

This dissertation reports on the lived experiences of four child psychiatric nurses. The territory of child psychiatric nursing is explored in this investigation through the punctuation of many voices within this field of study. The methodology of the investigation is descriptive phenomenology and Colaizzis’ steps in descriptive phenomenology (map) are used to discover and describe the different template theories (the territory) that are unique to each of the four child psychiatric nurses who were interviewed. Following this, a story is punctuated, which is referred to as the structural synthesis. It is the heartbeat of the investigation. The dissertation concludes by reflecting on the paradox of how the invisibility of the child psychiatric nurses allowed for the visibility of the dissertation and encourages the reader to ask pivotal questions about the important role of the child psychiatric nurse, working as part of a multidisciplinary team, in order to improve patient care. / Psychology / M.A. (Clinical psychology)

Transcultural nursing refers to the provision of nursing care to patients whose values, beliefs and life-style differ from those of the nurse. To enable nurses to honour their ethical obligation to provide quality care, they must have the necessary knowledge to nurse patients across cultural boundaries. This study was conducted to determine the nurse's knowledge of and attitudes towards the culturally different patient. A questionnaire was used to collect the data. Although nurses see it as a challenge to nurse patients from different cultures, it was found that they do not have the necessary knowledge to provide culture-sensitive care. Other factors, such as the nurse's attitude towards culturally different patients, communication problems, mistrust, prejudice and a lack of understanding of cultural uses and traditions, contribute to the lack of culture-sensitive care. The nursing profession should pay attention to these problems. / Health Studies / Van Tonder, Sally / M.A. (Nursing)

Introdução: Calor humano (calidez em espanhol) é um atributo de grande importância na saúde, mas pouco estudado. Não existe um conceito universalmente aceito sobre calor humano, quais os fatores que o compõem ou como medi-lo. Os objetivos do estudo foram identificar os comportamentos e fatores de calor humano, construir definição desse construto e uma escala para medí-lo. Método: Estudo metodológica para construir e validar uma escala. Foi desenvolvido em três fases, de acordo com o proposto por Pasquali. Na fase de procedimentos teóricos foram identificados na literatura e por meio de entrevistas a 23 pacientes e 25 enfermeiras, comportamentos representativos de calor humano em enfermagem. Na fase empírica, esses comportamentos foram testados junto a pacientes internados. A fase analítica foi a identificação de fatores e das propriedades psicométricas. Resultados: A escala foi testada em 476 pacientes de instituições públicas e privadas. A análise psicométrica foi realizada utilizando o método de factores comuns, eixos principais e a rotação oblíqua. A Análise Fatorial Exploratória identificou 5 fatores e 35 itens e o Alfa de Cronbach testo a confiabilidade. Os fatores foram: F1-Conexão- relação não-verbal para o outro ( =0,943), F2-Empatia ( =0,909), F3- Conexão- relação verbal para o outro ( =0,914), F4- Inclusão ( =0,858) e F5- Confiança ( =0,852). O Alfa Cronbach total foi 0,93. O Índice de Tucker Lewis foi de 0,901. É possível obter-se escore por fator e total da ECAE e quando mais alto o escore, maior o calor humano. Após as fases teórica, empirica e analítica do estudo o conceito de calor humano foi estabelecido como O calorhumano é a capacidade de estabelecer e manter um relacionamento próximo e acolhedor que demonstre por meio de comportamentos verbais e não verbais, conexão e relacionamento com os outros, empatia, inclusão e confiança, de modo que, para o outro, significa uma experiência agradável. Conclusão: Construíu-se a Escala de Calor Humano em Enfermagem (ECAE), propos-se o conceito de calor humano em enfermagem e chave de escore para medir esse fenômeno. Trata-se de contribuição original que pode ser útil na clínica, ensino e pesquisa para a avaliação das competências interpessoais em enfermagem. / Introduction: Warmth is an important attribute in health care; however, it is a scarcely studied phenomenon. There is no universally accepted concept of warmth, component description and/or measurement. The purposes of this research were to identify behaviors and factors associated with warmth, build a definition of this construct and a scale to measure it. Method: Methodological study about the building and validation of a measurement scale, developed in three phases, as proposed by Pasquali. In the theoretical phase, behaviors associated with warmth in nursing were identified by reviewing the literature and interviewing 23 patients and 25 nurses. In the empirical phase, these behaviors were tested with inpatients. In the analytical phase, factors and psychometric properties were identified. Results: The scale was applied to 476 patients of public and private institutions. The psychometric analysis was performed using the common factor method, main axes and oblique rotation. The Exploratory Factor Analysis identified 5 factors and 35 items, and Cronbachs Alpha measured reliability. The factors were: F1 - Non-verbal connection-relationship with the other (=0.943), F2 - Empathy (=0.909), F3 - Verbal connection-relationship with the other (=0.914), F4 - Inclusion (=0.858) and F5 - Confidence (=0.852). The total Cronbachs Alpha was 0.93. The Tucker-Lewis index was 0.901. It is possible to obtain a score by factor and by total, and the higher the score, the higher the human warmth. After the theoretical, empirical and analytical phases of the study, the construct was established as warmth is the ability to establish and maintain a close, welcoming relationship that demonstrates, through verbal and non-verbal behaviors, connection and relationship with the other person, empathy, inclusion and confidence, so that it finally means a pleasant experience for the other person. Conclusion: The Nursing Warmth Scale (ECAE) was developed, and a concept of warmth in nursing and a measurement scale were proposed. It is an original contribution that may be useful in clinical practices, teaching and research for the evaluation of interpersonal skills in nursing.

This thesis researches the phenomenon ‘caring relationship’. The empirical studies in this thesis were carried out in China with the aim to describe the caring relationship in China through the lifeworld experiences of professional caregivers and patients. The result of this study will later on relate to a study of Swedish caring relationships. For this phenomenological study 9 patients, 10 medical and healthcare workers and 4 nursing tutors were interviewed. They were from 5 different medical and care units from two hospitals, one private clinic and a nursing school in Southern China. This study shows that caring relationship in China has many layers. Embedded in the basic interpersonal relationship is a ‘relationship of need’. The relationship carries a goal: to help the patient to restore a personal harmonic existence and regain the responsibility for their health. The relationship is temporary and normally ends when the goal is achieved. The relationship is initiated by the patients need for help. The two main actors in the caring relationship are the patient and the caregiver with their roles as care seeker and care provider. This study shows that to become a patient is a process of diminishing the natural ordinary self which makes the person feel vulnerable. Caregivers take a leading role which carries responsibility. They feel an obligation to use all their knowledge and resources for the benefit of the patients. They teach them how to live and how to stay healthy. A main function in the caring relationship is the transfer of knowledge. The caregivers feel the need to create a dialog to get access to the patients’ unique knowledge about themselves so that the caregiver’s general knowledge of health and care can be applied to the individual. Through the informal chats they share the patient’s experiences, emotions and history. It creates en opportunity for the interpersonal relationship to grow deeper and for the patient and the caregiver to meet as fellow human beings. In the Chinese caring relationship the patient’s family is included. It is considered to be every contributor’s duty to be responsible for oneself and for others. Mutual understanding and respect in a caring relationship are important in getting the patient back into balance.

<p>This thesis researches the phenomenon ‘caring relationship’. The empirical studies in this thesis were carried out in China with the aim to describe the caring relationship in China through the lifeworld experiences of professional caregivers and patients. The result of this study will later on relate to a study of Swedish caring relationships.</p><p>For this phenomenological study 9 patients, 10 medical and healthcare workers and 4 nursing tutors were interviewed. They were from 5 different medical and care units from two hospitals, one private clinic and a nursing school in Southern China.</p><p>This study shows that caring relationship in China has many layers. Embedded in the basic interpersonal relationship is a ‘relationship of need’. The relationship carries a goal: to help the patient to restore a personal harmonic existence and regain the responsibility for their health. The relationship is temporary and normally ends when the goal is achieved.</p><p>The relationship is initiated by the patients need for help. The two main actors in the caring relationship are the patient and the caregiver with their roles as care seeker and care provider. This study shows that to become a patient is a process of diminishing the natural ordinary self which makes the person feel vulnerable. Caregivers take a leading role which carries responsibility. They feel an obligation to use all their knowledge and resources for the benefit of the patients. They teach them how to live and how to stay healthy.</p><p>A main function in the caring relationship is the transfer of knowledge. The caregivers feel the need to create a dialog to get access to the patients’ unique knowledge about themselves so that the caregiver’s general knowledge of health and care can be applied to the individual. Through the informal chats they share the patient’s experiences, emotions and history. It creates en opportunity for the interpersonal relationship to grow deeper and for the patient and the caregiver to meet as fellow human beings.</p><p>In the Chinese caring relationship the patient’s family is included. It is considered to be every contributor’s duty to be responsible for oneself and for others. Mutual understanding and respect in a caring relationship are important in getting the patient back into balance.</p>

This dissertation reports on the lived experiences of four child psychiatric nurses. The territory of child psychiatric nursing is explored in this investigation through the punctuation of many voices within this field of study. The methodology of the investigation is descriptive phenomenology and Colaizzis’ steps in descriptive phenomenology (map) are used to discover and describe the different template theories (the territory) that are unique to each of the four child psychiatric nurses who were interviewed. Following this, a story is punctuated, which is referred to as the structural synthesis. It is the heartbeat of the investigation. The dissertation concludes by reflecting on the paradox of how the invisibility of the child psychiatric nurses allowed for the visibility of the dissertation and encourages the reader to ask pivotal questions about the important role of the child psychiatric nurse, working as part of a multidisciplinary team, in order to improve patient care. / Psychology / M.A. (Clinical psychology)