Psykisk ohälsa är ett växande folkhälsoproblem och förutspås vara den största sjukdomsbördan i världen år 2030. Första vårdkontakten för patienter med psykisk ohälsa är vanligtvis sjuksköterskor i telefonrådgivning inom primärvård. Sjuksköterskor i telefonrådgivning upplever att de bland annat saknar erfarenhet, kunskap samt rätt verktyg för att ge adekvat rådgivning när de möter patienter med psykisk ohälsa. Det är därmed relevant att undersöka sjuksköterskans upplevelse av att bedöma psykisk ohälsa vid telefonrådgivning inom primärvården. Sex sjuksköterskor med olika lång erfarenhet av arbete i telefonrådgivning intervjuades. Dataanalysen genomfördes med hjälp av Elo och Kyngäs kvalitativa innehållsanalys med en induktiv ansats. Två kategorier framträder i resultatet, ”att känna sig otillräcklig” samt ”att känna sig otrygg” följt av 7 subkategorier. Det finns behov av psykiatrisk specialistkompetens inom primärvården för att möta behoven relaterat till psykisk ohälsa i samhället. Sjuksköterskan känner sig otillräcklig vid bedömning av psykisk ohälsa i telefonrådgivning, vilket belyser vikten av tillgång till spetskompetens på arbetsplatsen. / Mental illness is a public health problem that is predicted to be the biggest burden of disease in the world by the year 2030. Telenurses in primary care are usually the first to encounter patients with mental illness. Telenurses feel that they lack experience and knowledge or the right tools to provide adequate care when they encounter mental illness. It is thus relevant to further research the nurses experience of assessing mental illness through telenursing in primary care. Six nurses with different lengths of experience in working in primary care telenursing were interviewed and the collected data were analyzed using Elo and Kyngäs qualitative content analysis with an inductive approach. Two categories appeared in the result, “to feel inadequate” and “to feel insecure” followed by seven subcategories. Feelings of inadequacy and insecurity emerged when facing mental illness and the conclusion of this study highlights the importance of access to expertise in the workplace, such as a psychiatric nurse.

Background The word cancer is a term used to describe about 200 different diseases. Cancer patients often receive palliative care, where the purpose is to relive suffering and promote quality of life. Previous research shows that nurses often have a negative approach towards cancer, especially because the lack of knowledge and insecurity in how to communicate with these patients. Aim The aim of this study was to describe nurses' experiences of caring for patients with cancer receiving palliative care in a hospital ward. Method The method used in this study was a literature review based on qualitative studies. Fourteen articles were analysed according to Friberg's (2006) qualitative content analyse in five steps for literature-based studies. Results The result showed that nurses have mixed feelings about meeting patients with cancer in a palliative phase. They had feelings of inadequacy and they felt a great responsibility, many nurses experienced feelings of gratitude towards working with palliative patients with cancer. Nurses also expressed that communication and a trusting relationship with the patients were important. The nurses often felt that they didn't have enough time to give the care that the patients deserved because of a high workload. Conclusion Patients with cancer in a palliative phase are a complex area. Nurses may experience providing care to patients in palliative care as emotionally stressful. To be able to provide high quality care trusting relationships were essential between nurses and patients. Patients with cancer are in need of support from the nurse, but the nurses experienced that time is not enough.

SAMMANFATTNINGBakgrund: Hjärtsvikt är i Sverige en folksjukdom där cirka 200 000 personer beräknas lida av symtom och lika många till lever utan några symtom. Under de nästkommande 25 åren beräknas inläggningar att öka med 50% då prevalensen av hjärtsvikt ökar på grund av befolkningstillväxten, åldrande och den ökade förekomsten av samsjuklighet. Sjuksköterskeledda hjärtsviktsmottagningar inom primärvården verkar vara effektiva för att tillhandahålla högkvalitativ personcentrerad vård och därmed minska behovet av sjukhusvård. Personcentrering är en process att ta tillvara patientens resurser med hänsyn till individens förutsättningar och hinder. Ett partnerskap som bygger på ömsesidig respekt, är jämbördig och inbjuder till delaktighet och att vårdtagaren får den information som behövs för att kunna fatta rätt beslut. Syfte: Att belysa sjuksköterskors erfarenheter av hur de arbetar utifrån ett personcentrerat förhållningssätt med personer med hjärtsvikt i primärvården.Metod: En kvalitativ semistrukturerad intervjustudie med induktiv ansats där nio sjuksköterskor deltog som arbetade på hjärtsviktsmottagningar. En kvalitativ innehållsanalys användes och det teoretiskt ramverk utgick från ett personcentrerat förhållningssätt. Resultat: Innehållsanalysen resulterade i fyra huvudkategorier holistisk människosyn, individuellt bemötande, partnerskap och delegering av läkemedel. Slutsats: I resultatet framkom att alla sjuksköterskor ansåg sig lyssna till personens berättelseoch att de utgick delvis från en helhetssyn, men det fanns brister i att tillgodo se de existentiella behoven. De tyckte sig erbjuda individanpassad vård och behandling efter personens förutsättningar och behov och de upplevde att det var en viktig del i arbetet att motivera till delaktighet i egenvård samt kunskap och förståelse om sjukdomen. Sjuksköterskorna önskade bli bättre på att inkludera anhöriga. Få sjuksköterskor hade delegering av läkemedel och några få tyckte att det hade betydelse för omhändertagandet. / ABSTRACTBackground: In Sweden, heart failure is a common disease, where approximately 200,000 people are estimated to suffer from symptoms and the same number live without any symptoms. Over the next 25 years, admissions are projected to increase by 50% as the prevalence of heart failure increases due to population growth, aging and the increased prevalence of comorbidities. Nurse-led heart failure clinics in primary care appear to be effective in providing high-quality person-centred care and thereby reducing the need for hospitalisation. Person-centredness is a process of making use of the patient's resources, taking into account the individual's conditions and obstacles. A partnership that is based on mutual respect, is equal and invites participation and that the care recipient receives the information needed to be able to make the right decision.Aim: To shed light on nurses' experiences of how they work based on a person-centred approach with people with heart failure in primary care.Method: A qualitative semi-structured interview study with an inductive approach in which nine nurses who worked in heart failure wards participated. A qualitative content analysis was used and the theoretical framework was based on a person-centred approach.Results: The content analysis resulted in four main categories: holistic view of people, individual treatment, partnership, delegation of medicines.Conclusion: The results showed that all nurses considered themselves to listen to the person's story and that they partly started from a holistic view, but there were shortcomings in satisfying the existential needs. They seemed to offer individually tailored care and treatment according to the person's conditions and needs, and they felt that it was an important part of the work to motivate participation in self-care as well as knowledge and understanding of the disease. The nurses wanted to be better at including relatives. Few nurses had delegation of medicines and a few thought it was important for care.

Bakgrund: Diabetes Mellitus är en samling av kroniska sjukdomar, som påverkar kroppensförmåga att hantera blodsockernivån. I Sverige uppskattas att cirka 470 000 människor liderav sjukdomen. Det mest effektiva sättet att förebygga diabetes sena komplikationer är attpatienten själv bedriver en god egenvård. Sjuksköterskans roll i diabetesbehandling är av storbetydelse, då de stödjer och handleder patienter att bedriva god egenvård. Syfte: Syftet meddenna litteraturstudie var att undersöka sjuksköterskors erfarenhet av patienters följsamhet tillegenvårdsråd vid diabetes typ 2. Metod: Studien har genomförts som en kvalitativlitteraturstudie baserat på tio artiklar som har hämtats från databaserna CINAHL ochPubMed. SBU:s granskningsmall har använts för kvalitetsgranskning. Analysen gjordesutifrån metoden som är för kvalitativ innehållsanalys. Resultat: Resultatet presenteras utifråntre kategorier: Sociokulturella aspekters betydelse, Förutsättningar inom vården ochSjuksköterskans kunskap. Ur dessa skapades även tio underkategorier: Religiöst tankesätt,Kulturellt tankesätt, Stöd från anhöriga, Egenvård och delaktighet, Samverkan i team medandra vårdprofessioner, Resurser och stöd, Personcentrerad vård, Erfarenhet, Utbildning,Sjuksköterskornas metod att förmedla kunskap Slutsats: Sjuksköterskor upplevde att etteffektivt samspel mellan sjuksköterskor och övriga professioner, ökade deras motivation ochsjälvförtroende i diabetesbehandlingen för både patienter och sjuksköterskor. Vidare framgårdet att hänsyn till patienters sociokulturella aspekter och bruk av ett personcentrerattillvägagångssätt är avgörande faktorer i patientens följsamhet till sjuksköterskors rådgivning / Background: Diabetes Mellitus is a collection of chronic diseases which affect the body’sability to regulate the blood sugar level. In Sweden alone, there are approximately 470 000diagnosed patients. The most effective method to counteract and treat the disease is for thepatient in question to establish proper self-care practices. The nurse plays a central role in thediabetes treatment since the nurse supports and guides the patient to conduct a good self-careroutine. Aim: This literature review aims to investigate nurses’ experience of patientcompliance to self-care advice regarding diabetes type 2. Method: The study has beenconducted as a literature review of ten articles, where a qualitative approach has been used tocompile a result. The articles have been collected from the databases CINAHL and PubMed.Further, the quality of the studies has been examined with the help of SBU’s review templatefor qualitative studies. The analysis was conducted by the method presented in qualitativecontent analysis. Result: The result was presented from three categories: The importance ofsociocultural aspects, Conditions in the care and the nurses’ knowledge. From thesecategories a total of ten subcategories were used: Religious mindset, Cultural mindset,Support from relatives, Self-care and participation, Cooperation in teams with othercare-professions, Resources and support, Personcentred care, Experience, Education and thenurses’ method to convey information. Conclusion: Nurses experienced that an effectiveteamwork with the other involved professions increased their motivation and self-confidenceand made the diabetes treatment easier for both patients and nurses. Further, it was clear thatconsideration to the patients’ sociocultural aspects and using a patient-centered approach arecrucial factors that affect patients’ adherence to the nurses’ advice.

The HIV/AIDS epidemic is described as a crisis by the Global Report (UNAIDS 2004:13). Swaziland¡¦s King Mswati III also declared the HIV/AIDS epidemic as a disaster when the HIV/AIDS prevalence rate increased from 3.9% in 1992 to 42.6% in 2004 (MOHSW 2004:3). In responding to the increasing numbers, the Government of Swaziland established various programmes; one of them being the Voluntary Counselling and Testing (VCT) services to meet societal needs. The MOHSW designed guidelines to be utilized when training nurses to be pre and post HIV test counselors (TASC 2003:2). The period of training ranges between 1 to 2 weeks, after which they are deployed to the VCT centres where nurses provide counseling and testing, treatment of opportunistic infections and distributing antiretroviral drugs. Much research has been done in Swaziland on HIV/AIDS however; there is insufficient knowledge on the impact of HIV/AIDS on nurses working at the VCT services. The objectives of the study were to: ,,« Explore and describe the experiences of nurses working in the VCT services. ,,« Explore and describe the experiences of clients receiving VCT services. ,,« Design and develop an empowerment programme for nurses working in the VCT services in Swaziland. ,,« Formulate and describe guidelines for the implementation of the programme. In this qualitative study, the exploratory descriptive and contextual methodology was utilized to look into lived experiences of nurses and clients. This was done within the adaptation of the intervention Design and Development genre proposed by Rothman and Thomas (1994). Data was collected through purposive sampling and analysed according to Tesch¡¦s methods (Tesch 1990:890) The study revealed one major theme; constant experience of stress that was related to psychological and physical factors (categories). Nurses identified the complexity of HIV/AIDS, shortage of staff, lack of social support, lack of a supportive working environment, and a need for staff development under psychological factors. Clients identified stigma and discrimination. Constant exhaustion and development of medical conditions were identified as physical factors that led to constant experience of stress. Conclusions drawn from the data analysis revealed that nurses were stressed and felt disempowered at working in the VCT services. An empowerment programme was designed and developed to enable these nurses to deal with issues and VCT services for rendering quality care and enjoy the work they do. Guidelines were formulated to implement the empowerment programme. The study concluded with the identification of limitations and recommendations for future endeavours. / Health Studies / D.Litt. et Phil.

The HIV/AIDS epidemic is described as a crisis by the Global Report (UNAIDS 2004:13). Swaziland¡¦s King Mswati III also declared the HIV/AIDS epidemic as a disaster when the HIV/AIDS prevalence rate increased from 3.9% in 1992 to 42.6% in 2004 (MOHSW 2004:3). In responding to the increasing numbers, the Government of Swaziland established various programmes; one of them being the Voluntary Counselling and Testing (VCT) services to meet societal needs. The MOHSW designed guidelines to be utilized when training nurses to be pre and post HIV test counselors (TASC 2003:2). The period of training ranges between 1 to 2 weeks, after which they are deployed to the VCT centres where nurses provide counseling and testing, treatment of opportunistic infections and distributing antiretroviral drugs. Much research has been done in Swaziland on HIV/AIDS however; there is insufficient knowledge on the impact of HIV/AIDS on nurses working at the VCT services. The objectives of the study were to: ,,« Explore and describe the experiences of nurses working in the VCT services. ,,« Explore and describe the experiences of clients receiving VCT services. ,,« Design and develop an empowerment programme for nurses working in the VCT services in Swaziland. ,,« Formulate and describe guidelines for the implementation of the programme. In this qualitative study, the exploratory descriptive and contextual methodology was utilized to look into lived experiences of nurses and clients. This was done within the adaptation of the intervention Design and Development genre proposed by Rothman and Thomas (1994). Data was collected through purposive sampling and analysed according to Tesch¡¦s methods (Tesch 1990:890) The study revealed one major theme; constant experience of stress that was related to psychological and physical factors (categories). Nurses identified the complexity of HIV/AIDS, shortage of staff, lack of social support, lack of a supportive working environment, and a need for staff development under psychological factors. Clients identified stigma and discrimination. Constant exhaustion and development of medical conditions were identified as physical factors that led to constant experience of stress. Conclusions drawn from the data analysis revealed that nurses were stressed and felt disempowered at working in the VCT services. An empowerment programme was designed and developed to enable these nurses to deal with issues and VCT services for rendering quality care and enjoy the work they do. Guidelines were formulated to implement the empowerment programme. The study concluded with the identification of limitations and recommendations for future endeavours. / Health Studies / D.Litt. et Phil.

Background: Demands to be cared for and die at home are increasing nowadays. The holistic approach of palliative care is to emphasize on alleviating physical and psychological distresses and psychosocial support to patients and their families. The nurses have a significant role in promoting palliative care as guidelines of The National Board of Health and Welfare and The World Health Organization (WHO). Aim: To describe nurses' experiences and perceptions in providing palliative care to adult patients at home. Method: A general literature review of ten scientific articles were retrieved from CINAHL and MEDLINE. The collected data were analysed systematically before processing into the result. Results: Three themes and seven subthemes are identified. Three themes describe: supporting patients and their families, improving work efficiency and organizational factors. Seven subthemes present nurses’ experiences in handling psychosocial and emotional issues, strengthen empowerment, building relationships, interprofessional collaboration, self-development, workload and lack of time, and organization support. Conclusion: The results indicate the importance of increasing knowledge and skills in providing the holistic palliative home care for patients and their families. Organizations' supports and effective interprofessional collaboration are fundamental attributions in promoting adequate palliative care. / Bakgrund: Allt fler väljer att vårdas och dö hemma vilket medför ett ökande palliativt vårdbehov i hemmet. Holistiskt förhållningsätt av palliativ sjukvård fokuserar på att lindra fysiskt, psykiskt symtom och existentiellt stöd till patienter och deras familjer. Sjuksköterskor har en viktig roll i att främja palliativ omvårdnaden utifrån vägledningen av Socialstyrelsens och Världshälsoorganisationen (WHO). Syfte: Att beskriva sjuksköterskors erfarenheter och upplevelser av palliativ vård av vuxna patienter i hemmet. Metod: En allmän litteraturöversiktstudie genomfördes på tio vetenskapliga artiklar som hämtades från databaserna CINAHL och MEDLINE. Insamlad data analyserades systematiskt innan de bearbetades för resultaten. Resultat: Tre huvudteman och sju underteman har identifierats. De tre huvudteman beskriver upplevelser av: stöd till patienter och deras familjer, förbättring av arbetseffektiviteten och organisationsfaktorer. De sju underteman beskriver hur sjuksköterskor hanterar psykosociala och emotionella frågor, förstärkande av empowerment, hur man bygger upp en vårdrelation, interprofessionellt samarbete, självutveckling, arbetsbelastning och tidsbrist samt organisationsstöd. Slutsats: Resultaten pekar på angelägenheten i att förbättra vårdpersonalens kunskap och färdigheter i att sörja för holistiskt palliativ hemsjukvård av patienter och deras familjer. Organisationsstöd och goda interprofessionella samarbeten är en förutsättning för att förbättra kvaliteten i den palliativa sjukvården.

Bakgrund: Sjuksköterskor har ansvar att tidigt identifiera försämrade patienter på vårdavdelningar och kontakta den mobila intensivvårdsgruppen (MIG) för konsultation. Studier har visat att patienter med ökat vårdbehov kan vistas på vårdavdelningar som inte har adekvata personal- och övervakningsresurser. Dessa otillräckliga resurser och att vårda flera patienter samtidigt innebär en stressande arbetssituation. Samarbetet i team mellan intensivvårdssjuksköterskan och sjuksköterskan är avgörande för atten MIG konsultation ska fungera. Syfte: Syftet var att belysa sjuksköterskans upplevelse av samarbetet med intensivvårdssjuksköterskan vid en MIG konsultation. Metod: Studien genomfördes med en kvalitativ ansats med semistrukturerade intervjuer. Intervjuerna analyserades med induktiv innehållsanalys. Åtta sjuksköterskor på vårdavdelningarintervjuades. Resultat: Analysen utmynnade i fyra underkategorier, två kategorier och ettövergripande tema. Det övergripande temat beskrev en sista utväg som innebar att MIG finnssom ett stöd och en trygghet för sjuksköterskorna på vårdavdelningarna. Hur samarbetet med intensivvårdssjuksköterskan upplevdes berodde på många faktorer som bemötande, förståelseför arbetssituationen och respekt för sjuksköterskans kunskap. Hur samarbetet fungerade med intensivvårdssjuksköterskorna berodde på hur sjuksköterskorna blev bemötta vid MIG-konsultationerna. Slutsats: Oftast är samarbetet i team mellan sjuksköterskor och intensivvårdssjuksköterskor positivt. Dock kan svårigheter förekomma vilka grundade sig i intensivvårdssjuksköterskornas nedlåtande attityder. Intensivvårdssjuksköterskorna behöver ha förståelse för sjuksköterskans arbetssituation och ha rimliga förväntningar på dem. / Background: Nurses have a responsibility to early identify deteriorated patients in the general wards and contact the mobile intensive care group (MIG) for consultation. Studies have shown that patients with increased care needs may be in a ward that does not have the adequate staff and monitoring resources. These insufficient resources and nurses multiple patients at the same time implies a stressful work situation. Collaboration in teams between the intensive care nurse and the nurse is crucial for a MIG consultation to work. Aim: To illuminate the nurse's experience of collaboration with the intensive care nurseduring a MIG consultation. Method: Eight individual, semi-structured interviews with nursesworking at four care wards were analysed using inductive qualitative content analysis.Results: The analysis result was presented in four sub-categories, two categories and one theme. The overall theme a last resort described that MIG was there to support the nurses andit was safe to have the MIG at the hospital. How the collaboration with MIG was experienced depended on intensive care nurses´ attitude towards the nurses, such as their understanding of the nurses´ work situation and respected the nurses´ knowledge. How the collaboration worked with the intensive care nurses depended on how the nurses were treated at the MIG-consultations. Conclusion: Most nurses has a positive experience of working with the intensive care nurse, but there were difficulties with the team collaboration. However, difficulties may arise which are based on the condescending attitudes of the intensive care nurses. The intensive care nurses must understand the nurses' work situation and have reasonable expectations of them.