Emergency departments (EDs) are often thought of solely as places where life-saving interventions occur. However, EDs are also places where dying patients receive end of life care. Though research examining expert nurse behaviours in care of the dying has been conducted in a variety of care settings, little is known about this topic as it relates to care of the dying adult in the ED. A descriptive exploratory study was conducted with registered nurse experts (n = 6) in two urban EDs in Western Canada. Five expert nurse behaviours deemed essential in care of the dying adult patient in the ED were identified: 1) providing comfort; 2) honouring the personhood of the patient; 3) responding to the family; 4) responding after the death of the patient; and 5) responding to colleagues. These findings contribute to the empirical evidence concerning expert nursing care of the dying.

Hur personlighet och attribut påverkar arbetsprestation har längevarit ett aktuellt forskningsområde inom organisationspsykologin. Vipresenterar i vår studie Anknytningsteori, samt hur anknytningsstilaroch beteenden kan kopplas till arbetsrelaterade situationer ochproblem. Anknytningsteorin försöker förklara människorsinterpersonella relationstendenser. Med hjälp av mätinstrumentetAttachment Style Questionnaire (ASQ) undersöker vi poliser (n=50)och sjuksköterskors (n=83) anknytningsstil för att ge grund för vårahypoteser om yrkesdoktrinens påverkan på fördelningen avanknytningsstilar. Statistiskt säkerställda skillnader existerargrupperna emellan vad gällande anknytningsbeteende där poliseruppmäter högre värden på målinriktade delskalor och sjuksköterskorhögre på relationsbaserade. Sammantaget existerar en skillnad vadgällande den interpersonella personlighetskaraktärenyrkesdoktrinerna emellan. / How personality and personal attributes affects workplaceperformance has long been a hot topic in organizational psychology.We introduce attachment theory in our study and how differentattachment styles and behaviors can be associated to differentsituations and difficulties related to the workplace. The main goal inattachment theory is to explain the interpersonal relationshiptendencies. With the instrument Attachment Style Questionnaire(ASQ) we examine police (n=50) and nurses (n=83) attachment stylesin order to detect whether the line of work affects the distribution ofattachment styles. Statistically significant results were found betweenthe two groups where the police measured higher in the subscalesrelated to goal orientation, and the nurses scored higher in thesubscales related to relationship and approval. There is a significantdifference related to the interpersonal personality characteristicsbetween the two occupations.

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Chapter one reviews the literatures on psychological studies of aggression, problems of aggression within the Social Services and the National Health Service, and nurse-patient communication. A number of issues are raised which are addressed by the current research. In chapter two nurses' theories about what defuses and what aggravates aggression are explored. It was found that nurses believe that by remaining calm, gentle and firm they will defuse both physical and verbal aggression. In the case of physical aggression they believe it to be aggravated by being authoritarian, demeaning and defensive, while in the case of verbal aggression they believe it to be aggravated by becoming angry or attempting to deflect it. In chapter three nurses' real-life experiences of what defuses and what aggravates physical and verbal aggression are compared with their theories. The nurses' experiences largely support their theories. It was also found that there are very few methods for dealing effectively with physical aggression, while there are a relatively large number of methods for dealing effectively with verbal aggression. Moreover, those nurses who believe themselves to be more capable of dealing with aggression suffer fewer emotional after-effects than those nurses who do not. Chapter four examines individual differences between nurses and relates these differences to their ability to recover from the emotional aftermath of aggression. It was found that nurses who are highly stressed and who bottle-up their feelings of anger suffer emotionally after aggressive incidents. In contrast, nurses who are assertive, extravert and who exercise interpersonal control are not so distressed by aggressive incidents. In chapter five nurses' attributions are related to their ability to select effective methods of dealing with aggression as well as their ability to recover from it emotionally. It was found that those nurses who have a tendency to blame themselves are both emotionally vulnerable and less capable of selecting effective methods of responding to aggression. In addition, a new method of measuring attribution was developed and tested, and was found to be preferable to the usual method of measuring attribution. Chapter six presents the two-day aggression training programme. The training was designed to incorporate the findings of the current research as well as theoretical issues. The training was carefully evaluated with a control group, pre-post measures of both subjective and objective change, and a seven week follow-up. The aggression training group was no different to the control group before training, but was different on all measures after training. It was concluded that the training model has been shown to make a significant difference to objective skills and subjective evaluations, and that the causal influence of some of the findings described in chapters two to five has been demonstrated. Chapter seven summarises the findings of the research, explores their theoretical and practical implications, and suggests directions for future research.

Bakgrund: Patienter på en intensivvårdsavdelning är ofta i behov av avancerad medicinsk behandling på grund av sitt livshotande sjukdomstillstånd. Återkommande störningar av sömnen är ett av de vanligaste återkommande klagomålen från patienter vilket bidrar till att perioden upplevs som särskilt svår. Syfte: Att belysa vad vuxna patienter upplever stör sömnen på en intensivvårdsavdelning. Metod: Allmän litteraturstudie där 12 vetenskapliga artiklar ligger till grund för resultatet. Resultat: I analysen av artiklarna framträdde fyra kategorier som alla tillsammans påverkade patientens sömn negativt. Kategorierna var rädsla/oro över att inte bli frisk, smärta från till exempel operationssår, inskränkning av integriteten samt störningar från vårdrelaterade interventioner såsom kontroll av vitalparametrar, munvård och förbandsbyte. Diskussion: Tidigare forskning har påvisat ljus och ljud från apparater som störande för patientens sömn, resultatet från denna studie visar dock att samtal mellan personalen är mer störande. Personalen kan behöva uppmärksamma detta och anpassa samtalsnivån därefter. Genom att informera patienten om vad som händer på intensivvårdsavdelningen kan man öka deras känsla av trygghet. Rutinmässiga vårdrelaterade interventioner skulle kunna samordnas nattetid för att ge patienterna sammanhängande sömn. Slutsats: Personal inom intensivvården skulle behöva uppmärksamma vad patienten upplever stör sömnen under vårdtiden. Ytterligare forskning med kvalitativ ansats behövs där patientens upplevelser sätts i fokus. / Background: Patients in an intensive care unit (ICU) often require sophisticated treatment due to life-threatening conditions, but disturbed sleep has been found to be one of the most reoccurring complaints from patients in intensive care. Purpose: To highlight what adults perceive disturb their sleep in an intensive care unit. Method: General literature review where twelve scientific articles form the basis of the results. Result: When analysed, four categories emerged, which when combined adversely affected patients sleep. The categories were fear/worry about not recovering, pain from e.g. surgical wounds, limitations of integrity caused by being attached to wires and tubes, and disturbance from care related interventions by staff checking vital observations, oral hygiene, wound dressings. Discussion: Previous research has found light and machinery noise disruptive, however, our findings show staff communication levels to be more disturbing. Straff need to be aware of speech noise levels, reminding colleagues when required. Informing patients of ICU activity helps increase patients’ sense of security which when combined with coordinated, care related interventions at night helps with continous periods of sleep. Conclusion: ICU staff need to identify patients concerns regarding perceived sleep disruption. Further research is required where patients perception of sleepdisturbances is in focus.

The lecturer practitioner role in nursing is widely seen as offering hope for the future of nurse education, by overcoming the 'theory-practice gap', and establishing and maintaining effective links at many different levels between education and practice. It is clear, however, that there are a number of issues of concern about the role. These can be summarised as: lack of role clarity about overcoming the theory-practice gap; varying conceptions of the role and unclear job descriptions; and role conflicts and overload, from the conflicting demands of service and education settings Despite current political support for strengthening the links between higher education institutions and practice settings, a new governmental emphasis on the support of students in practice, and a growing in-depth evaluative literature about the role, there is no research examining its systematic development, or measuring and addressing aspects of lecturer practitioners' occupational stress and burnout. Initial project planning work found that lecturer practitioners perceived themselves as 'adding value' to education provision, with personal and professional gains for postholders. However, their key concerns were: absence of role clarity; absence of effective joint review/appraisal;a bsenceo f formal support In, order to develop and address aspects of lecturer practitioners' work roles and their employment position, this action research project was established. Using a spiral methodological framework, and a multi-methods approach to data collection to triangulate the findings, new knowledge about lecturer practitioner roles was uncovered, and employment practices were developed as a result. The project established three new mechanisms, and these outcomes can be summarised as: joint appraisal policies and materials; orientation/induction policies and materials; group support network. In addition, previously validated measures of occupational stress and burnout were used to meas. ure those conceptsi n this group of lecturer practitioners, and the impact of the project. They were found to be generally no more stressed or burnt out than comparable workers, and the project was unable to demonstrate statistically significant differences in beforeand after-scores. Synthesis of quantitative and qualitative findings indicates that these LPs were 'thriving rather than just surviving'.

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Background: The nursing profession involves meetings and situations which can be stressful. The work environment can cause additional stress in the form of time pressure, lack of support from colleagues, management or disgruntled family members and patients. This places the nurse in a position that requires a sharpened ability to handle stress. It can become overwhelming and unmanageable and cause a serious threat to the nurse's health and wellbeing. To handle stress the nurses uses different coping strategies. Aim: The aim of the review was to gain a better understanding of how nurses deal with occupational stress. Method: A systematic literature overview study based on eleven articles, including both qualitative and quantitative studies. Results: Nurses deal with stress in different ways based on their own resources. The results were divided in to seven themes: Seeking social support for emotional expression, Planning and problem solving to reduce stress, Setting boundaries to alleviate stress, Create time and space for recovery, Create time for reflection and guidance, Manage what cannot be affected and Creating distance in order to gain perspective. Conclusion: Perceived stress differs wide between nurses. A great responsibility therefore rests on the nurse herself to learn to manage her stress. The employer can create supportive conditions but the nurse must learn to master their own stress.

Background Sexual health is affected by disease, dysfunction and disability but can also be experienced in spite of illness. To get a deeper knowledge of what the nurse does for the patients the background is written with the support of the holistic care and Katie Eriksson theoretical perspectives health and suffering. Aim The aim of this study is to describe the factors to why nurses do not prioritize patients' sexual health in the nursing care. Method A literature review based on nine qualitative and quantitative studies focusing on the barriers perceived by the nurses to address sexual health. Result The result of this study showed that the barriers were many. Factors related to nurses unwillingness to talk to patients about sexuality and sexual health were difficulties in nurses' psychosocial work environment and lacking competence concerning sexual health. The fact that sexuality is a sensitive subject, factors related to the patient and that it was someone else's responsibility to raise the topic were other factors that made it difficult. Conclusion We conclude that a stressed workplace where there is a lack of time and stress along with a poor education and uncertainty leads to no grasp of the subject and the problem slides between health professionals. Patients' sexual health remains untreated. If sexual health is not involved in the nursing care increases the risk for larger problems and that the patients are exposed to unnecessary suffering.