MSc (Nursing), Faculty of Health Sciences, University of the Witwatersrand / The purpose of this study was to elicit and compare nurses’ and families’ perception of family needs in intensive care unit. A quantitative non-experimental, comparative and descriptive research design was used to achieve research objectives. Participants (nurses, n= 65; family members, n= 61) were drawn from three intensive care units. Data were collected using a questionnaire developed from the Critical Care Family Needs Inventory (CCFNI). Descriptive and inferential statistics were used to analyze the data. Majority (more than 50%) of both groups agreed with 42 out of 45 family need statements. All the nurses (100%, n=65) agreed with the need ‘to have explanations that are understandable’ while most family members (98%, n=58) agreed with the need ‘to feel that health care professionals care about the patient’. Seven out of ten statements agreed by majority of both groups were similar. Most of these statements were related to assurance and information need categories. In addition, both groups scored high on the two categories, assurance and information. However, family members scored higher than nurses in two categories, assurance and proximity with statistically significant difference (p-value < 0.05). Based on the research findings, it can therefore be concluded that generally there were similarities between nurses’ and families’ perception of family needs. These findings support evidence in literature resulting from previous studies.

Background: Critical-care nurses (CCN) provide end-of life (EOL) care on a daily basis as one in five patients dies while in Intensive Care Units (ICU). CCNs overcome many obstacles to perform quality EOL care for dying patients. Objectives: The purposes of this study were to collect CCNs' current suggestions for improving EOL care and determine if EOL care obstacles have changed by comparing results to data gathered in 1998. Methods: A 72-item questionnaire regarding EOL care perceptions was mailed to a national, geographically dispersed, random sample of 2,000 members of the American Association of Critical-Care Nurses. Nurses were asked for suggestions to improve EOL care. Results: Of the 509 returned questionnaires, 322 (63.3%) had 385 written suggestions for improving EOL care. Major themes identified were ensuring characteristics of a good death, improving physician communication with patients and families, adjusting nurse/patient ratios to 1:1, recognizing and avoiding futile care, increasing EOL education, physicians who are present and "on the same page," not allowing families to override patients' wishes, and the need for more support staff. When compared to data gathered 17 years previously, major themes remained the same, but in a few cases, changed in order and possible causation. Conclusion: Critical-care nurses' suggestions were similar to those recommendations from 17 years ago. Although the order of importance changed minimally, the number of similar themes indicated obstacles to providing EOL care to dying ICU patients continue to exist over time.

Bakgrund: Andelen äldre i befolkningen kommer att öka och som en konsekvens av detta ökar också antalet patienter med bensår. Inom vården av dessa patienter är specialistsjukvårdens roll att sätta in riktade behandlingar för en ökad sårläkning och minska lidandet för patienten. Inom den kommunala hemsjukvården är det distriktssköterskan som har huvudansvaret för patienter med bensår. Samarbete runt dessa patienter är nödvändigt. Syfte: Syftet med studien var att beskriva uppfattningar hos distriktssköterskor inom kommunal hemsjukvård om deras samarbete med specialistsjukvård avseende patienter med bensår. Metod: En kvalitativ ansats med fenomenografisk metod har använts i studien. Datamaterialet bygger på intervjuer som genomfördes med elva distriktssköterskor. Resultat: Ur analysen av datamaterialet framträdde tre beskrivningskategorier; möjligheter att konsultera ger trygghet, bristande förståelse för unika förutsättningar och utveckla ökad samsyn; med åtta uppfattningar. Konklusion: Det som framkommer i studien är hur viktig trygghet, förståelse och samsyn är för att ett samarbete ska uppfattas som positivt. Denna studie visar att det finns potential för förbättring av samarbetet och därmed en ökad förståelse för distriktssköterskornas perspektiv inom omvårdanden av patienter med bensår. / Background: The population of elderly will increase and as a consequence patients with leg ulcers will also increase. In caring for patients with leg ulcers the specialist healthcare uses targeted therapies with the purpose of enhanced wound healing and reduce the suffering for the patient. The district nurse has the main responsibility for patients with leg ulcers in the municipal home care and collaboration around these patients is nessecary. Aim: The aim of this study was to describe the perception of district nurses in the municipal home care of their collaboration with specialist healthcare, regarding patients with leg ulcers. Method: A qualitative approach with a phenomenographic method was used.  The data was collected through interviews with eleven district nurses in municipal home care. Results: Three major description categories emerged; opportunities to consult offers assurance lack of understanding for the unique conditions and procuring a greater consensus; with eight perceptions. Conclusion: This study showed how important assurance, understanding and consensus is for the collaboration to be perceived as positive and that there is potential to improve the collaboration. The study contributes to a better understanding for the district nurses perspective concerning the care for patients with leg ulcers.

A growing interest in evaluating quality of healthcare services has led to several initiatives geared towards quality improvement and increased efficiency by focusing on patient needs and collected evidence. Efforts designed to standardize quality healthcare delivery are difficult because of variation in perspectives and disagreement as to what actually indicates quality healthcare. To help bring more clarity to the topic of quality care this study performed a secondary analysis on data gathered from the ‘provider morale’ section of the ‘Managing Quality in Canadian Hospitals’ project. The purpose of this study was to address how nurses’ perceptions of distress, work place recognition and satisfaction influenced their assessment of quality care in Saskatoon hospitals. The conservation of resources (COR) theory was used as a theoretical framework to guide the development of an understanding of nurses’ perceptions through a focus on occupational distress, recognition, and job satisfaction as a potential means of observing environmental effects on quality of care. This research established that there were significant positive relationships between recognition-quality, satisfaction-quality and recognition-satisfaction; suggesting that recognition and satisfaction can be viewed as work related resources and indicators of nurses’ perceptions of quality care delivery. Significant negative relationships were found between distress-recognition and distress-satisfaction; suggesting that distress levels have an effect on perceptions of nursing work resources. The research findings also indicated that there was a significant difference in how nursing units perceived quality and distress, but no significant difference in perceptions of recognition or satisfaction; suggesting that work place resources have different effects, that there are other resources in play on units which affect perceptions, and that the impact of recognition and satisfaction on quality and distress perceptions differs between nursing units. The results of this study provide nurses, nursing managers, and healthcare organizations with a deeper understanding of how resources and stress processes in work environments effect the perception of quality care delivery.

Bakgrund: Övervikt och fetma är ett växande bekymmer som medför hälsoproblem. En av de vanligaste orsakerna är ohälsosamma levnadsvanor gällande kost och fysisk aktivitet. För att hindra den negativa utvecklingen behövs livsstilsförändring. Därför är distriktssköterskans stöd och vägledning viktigt i arbetet med dessa patienter för att kunna få dem att bli motiverade. Syfte: Syftet var att belysa distriktssköterskors uppfattningar om vad som motiverar patienter med övervikt eller fetma till livsstilsförändring. Metod: En kvalitativ ansats med fenomenografisk metod har använts i studien. Tio distriktssköterskor inom primärvård intervjuades. Resultat: Ur analysen av datamaterialet framträdde fyra beskrivningskategorier: få patienten att reflektera, skapa förtroende, öka patientens förståelse och patienten upplever sig må dåligt med 11 uppfattningar. Konklusion: Resultatet kan bidra till att utveckla och förbättra distriktssköterkans möjligheter att vägleda och ge adekvat stöd till patienter med övervikt eller fetma som behöver livsstilsförändring. Detta möjliggörs av att en förtroendefull relation skapas genom att lyssna på patienten och respektera dennes val. Likaså ökar möjligheterna att vägleda och ge stöd när patientens livsstil synliggörs med hjälp av dennes egna reflektioner på detta. / Background: Overweight and obesity is a growing concern that causes health problems. These conditions are often due to unhealthy dietary habits and lack of exercise. A change in lifestyle is needed to stop this negative development. In order for the patient to become motivated for a lifestyle change requires support and guidance from the district nurse. Aim: The aim of the study was to illuminate district nurses’ perceptions of what motivates patients with overweight or obesity to a change in lifestyle. Method: A qualitative approach with a phenomenographic method was used. Ten interviews were performed with district nurses in primary health care. Results: Four description categories emerged from the analysis: have the patient reflect, to build trust, to increase the patient’s understanding and the patient’s experience of not feeling well with 11 perceptions. Conclusion: The results could contribute in developing and improving the district nurse’s possibilities for giving adequate support and guidance to patients with overweight or obesity in need of a lifestyle change. This is enabled by building trust which requires listening to the patient and respecting their choices. Also making the patient’s lifestyle visible through their own reflections of it enhances the possibilities to give support and guidance.

Introduction/background: Ayurveda is an ancient holistic medical system largely used in India. Complementary and alternative forms of medicine (CAM) like Ayurveda is starting to spread to the western parts of the world. In Sweden, there is an ongoing project of integrating CAM methods in Swedish health care. Research has shown that this has been beneficial for patients and can reduce care costs. Despite the popularity of CAM methods, knowledge of the methods might be deficient among Swedish healthcare staff. Aim: The aim of this study was to examine registered nurses’ perception of the use of ayurvedic medicine compared to western medicine in a hospital in Kerala, India. Method: A qualitative method was used with an inductive design. Data was collected through semi-structured interviews with five registered nurses. A thematic analysis was used to analyze the data. Result: The analysis resulted in three themes: Pros and cons, To combine or not? and Negotiating the use of Ayurveda. Conclusion: Ayurveda can be helpful in treating less critical conditions. Western medicine was seen as more relevant when treating more serious illnesses. Ayurvedic treatments was perceived to take longer and have more side effects. A combination of the two medical approaches was not recommended, however, Ayurveda could work as a complement to western medicine in terms of less acute conditions.

The aim of this study is to analyse the discourses drawn upon by community paediatric nurses in relation to children’s rights to health. The philosophy of Michel Foucault has been used to underpin the analysis of the interviews and exemplars of five experienced community nurses, revealing conflicting power relationships and discourses. Rights are formalised morality and so from a children’s rights perspective, discourses reflect both the moral and ethical positions of the nurses. Children are constructed as developing human beings whose moral status gradually changes and who, through a lack of developmental autonomy, entrust their decision-making to their representatives (parents and caregivers) as their trustees. Rights are correlative with the obligations and duties toward children by both families and society. Society constructs legislative and politically organised structures to govern raising children because children are an intrinsic social concern. Whilst representing society’s interest in children’s rights to health, nurses in the home act as a conduit for multiple governing structures. The nurses in this study construct their “truths” and knowledge about children’s health rights from nursing, medicine, law, education, and social policy. However, the values of individual parents can conflict with universal values for children’s health and wellbeing. Therefore representing society positions nurses as “agents of the state”, a role that potentially holds power over parents and children and leads to the epithet of “the health police”. Within the institution of the family, and in the privacy of the home, there are also mechanisms of power that can resist the mechanisms of the state and its representatives. Therefore the discourse “it takes a village to raise a child” competes with the “my home is my castle” discourse. Nurses negotiate a fine balance between these power relations. Nurses are challenged with using power productively to promote children’s rights whilst respecting the role of parents and families. I argue that children’s rights are central to the moral and ethical work of nurses but that such work is often obscured and invisible. I propose that children’s community nurses are excellent at negotiating networking and connecting at a micro level, but need to create a more sophisticated and cohesive entity at a macro level to become fully political children’s rights advocates.

Bakgrund: Bakgrunden beskriver hur sjuksköterskor bemöter patienter med missbruk och beroende. Den beskriver även vikten av en främjande vårdrelation samt hur patienter med missbruk och beroende önskar bli bemötta av sjuksköterskor inom beroendevård. Syfte: Syftet var att beskriva sjuksköterskors uppfattningar av att vårda patienter med missbruk eller beroende med fokus på bemötandet i vårdrelationen. Metod: Fem sjuksköterskor, yrkesverksamma inom beroendevård, intervjuades. Materialet analyserades med kvalitativ innehållsanalys. Resultat: Resultatet läggs fram genom två kategorier, Sjuksköterskors beskrivningar av hur de förhåller sig till patienter med missbruk eller beroende.  Denna kategori har fem subkategorier. Den andra kategorin är Sjuksköterskors önskan att göra gott för patienter med missbruk eller beroende.  Denna kategori har två subkategorier. Resultatet visar att sjuksköterskor ibland kan bidra till stigmatisering av patienterna. Resultatet visar även att sjuksköterskorna önskar bekräftelse, både yrkesmässig och personlig. Diskussion: Resultatet diskuteras utifrån Ida Jean Orlandos interaktionsteori samt övrig relevant litteratur. Diskussionen kretsar kring hur sjuksköterskornas förhållningssätt på olika sätt får konsekvenser för vårdrelationen. / Background: The background describes how nurses treat patients with substance abuse and addiction. It also describes the importance of promoting caring relationship and how patients with substance abuse and addiction wish to be treated by nurses in addiction care. Aim: The aim was to describe nurses' perceptions of caring for patients with substance abuse or addiction, with a focus on the hospitality of the caring relationship. Method: Five nurses, professionals in addiction care, were interviewed. The material was analyzed using qualitative content analysis. Results: The results are presented in two categories, Nurses' descriptions of how they relate to patients with substance abuse or dependence. This category has five subcategories. The second category is the Nurses' desire to do good for patients with substance abuse or dependence. This category has two subcategories. The results show that nurses sometimes may contribute to the stigmatization of patients. The result also shows that the nurses want confirmation, both professional and personal. Discussions: The results are discussed from Ida Jean Orlando interaction theory and other relevant literature. The discussion revolves around how nurses´ approach in different ways has implications on the caring relation.

The aim of this study is to analyse the discourses drawn upon by community paediatric nurses in relation to children’s rights to health. The philosophy of Michel Foucault has been used to underpin the analysis of the interviews and exemplars of five experienced community nurses, revealing conflicting power relationships and discourses. Rights are formalised morality and so from a children’s rights perspective, discourses reflect both the moral and ethical positions of the nurses. Children are constructed as developing human beings whose moral status gradually changes and who, through a lack of developmental autonomy, entrust their decision-making to their representatives (parents and caregivers) as their trustees. Rights are correlative with the obligations and duties toward children by both families and society. Society constructs legislative and politically organised structures to govern raising children because children are an intrinsic social concern. Whilst representing society’s interest in children’s rights to health, nurses in the home act as a conduit for multiple governing structures. The nurses in this study construct their “truths” and knowledge about children’s health rights from nursing, medicine, law, education, and social policy. However, the values of individual parents can conflict with universal values for children’s health and wellbeing. Therefore representing society positions nurses as “agents of the state”, a role that potentially holds power over parents and children and leads to the epithet of “the health police”. Within the institution of the family, and in the privacy of the home, there are also mechanisms of power that can resist the mechanisms of the state and its representatives. Therefore the discourse “it takes a village to raise a child” competes with the “my home is my castle” discourse. Nurses negotiate a fine balance between these power relations. Nurses are challenged with using power productively to promote children’s rights whilst respecting the role of parents and families. I argue that children’s rights are central to the moral and ethical work of nurses but that such work is often obscured and invisible. I propose that children’s community nurses are excellent at negotiating networking and connecting at a micro level, but need to create a more sophisticated and cohesive entity at a macro level to become fully political children’s rights advocates.

The purpose of the study was to explore the perceptions nurses have regarding PHC in rural communities in Kasoa, Ghana.The study was carried out in Kasoa in the Central Region of Ghana. The data were collected purposively using individual in-depth interview; the data were analysed using thematic data analysis approach. A total of 24 nurses were interviewed. This sample size was attained at saturation. The population for this study included all the nurses irrespective of category, qualification and experience and who are working in the PHC facilities in Kasoa rural areas. The categories of nurses were registered general nurses, enrolled nurses, midwives and community health nurses. The thematic analysis yielded 5 themes as follows: Participants’ interpretation of the meaning of Primary Health Care.The participants further perceived health education and patients’ rights provided at PHC facilities as helpful in achieving health outcomes. The participants had the perception that the provision of outreach services seems to be acceptable to communities and there are referral systems at PHC facilities, which are well-structured, clear and acceptable. The participants also perceive the CHPS zones as helpful to provide PHC services / Health Studies / M.A. (Public Health)