Bakgrund: Sjuksköterskans roll i vården runt patienten är att vara omvårdnadsexpert. Vårdrelationen mellan patienten och sjuksköterskan är en viktig del av omvårdnaden. I sitt arbete har sjuksköterskan lagar och regler, riktlinjer och styrdokument att förhålla sig till. Omvårdnadsteorier föreslår olika system för hur en god omvårdnad ska bedrivas. Syfte: Att utforska vilka faktorer som påverkar patienters upplevelser av omvårdnad. Metod: Allmän litteraturöversikt. Uppsatsen är baserad på fyra kvalitativa och sex kvantitativa artiklar hämtade från Cinahl Complete, PsycINFO och PubMed. Artiklarna är kvalitetsgranskade och sammanställda efter resultatens likheter och olikheter. Resultat: Resultatet är presenterat i tre huvudkategorier, Demografiska faktorer, Kommunikation och Kompetens. En patient som får tydlig information, blir behandlad som en människa och som bemöts med vänlighet och respekt känner sig trygg och väl omhändertagen. En sjuksköterska som är kunnig och fingerfärdig och kan använda sig av sina personliga resurser för att få en god relation med patienten utstrålar professionalitet och självsäkerhet och har möjlighet att ge god omvårdnad till patienten Diskussion: Resultatet diskuteras utifrån patientupplevelsen, ramen för sjuksköterskeprofessionen och Joyce Travelbees teori om omvårdnadens mellanmänskliga aspekter / Background: The role of the nurse in caring for the patient is to be the nursing expert. The nurse-patient relation is an important part of nursing care. In her work the nurse has laws and regulations, guidelines and control documents to relate to. Nursing theories suggests different systems to carry out good nursing care. Aim: To explore which factors that affect the patient experience of nursing. Method: Literature review. The essay is based on four qualitative and six quantitative articles retrieved from Cinahl Complete, PsycINFO and PubMed. The articles were quality-reviewed and compiled based on their similarities and differences. Results: The result is presented in three main categories, Demographic factors, Communication and Competence. A patient who gets proper information, is treated like a human-being and with kindness and respect, feels safe and well taken care of. A nurse who is well educated and dexterous and who can use his or hers personal resources to get a good relation with the patient, emits professionality and self-confidence and has a possibility to give good nursing to the patient. Discussion: The result was discussed based on the patient experience, the scope of the profession of the nurse and Joyce Travelbee’s nursing theory

Bakgrund: Den organisatoriska och politiska kontexten påverkar hur väl fundamental omvårdnad utförs. Missed nursing care är ett begrepp som, i tidigare forskning, beskriver omvårdnad som uteblir delvis eller fullständigt och orsakas av resursbrist och hög arbetsbörda. Detta leder till en hotad patientsäkerhet. Risken för missed nursing care kan öka i den anestesiologiska kontexten, då det är en högteknologisk miljö med hög produktionstakt. Användningen av begreppet har ökat inom vårdvetenskaplig forskning. Emellertid är missed nursing care ännu inte beskrivet inom anestesiologisk omvårdnad.  Syfte: Begreppsanalysens syfte var att, utifrån den kontextuella dimensionen av Fundamentals of Care, klargöra innebörden av begreppet missed nursing care och hur det kan förstås inom anestesiologisk omvårdnad. Metod: Begreppsanalysen genomfördes enligt Walker och Avants metod.   Resultat: Missed nursing care definieras som en nödvändig omvårdnadsåtgärd som, p.g.a. kontexten och efter en process av klinisk prioritering utelämnas helt, delvis, lämnas oavslutad eller utförs med sämre kvalitet, vid en olämplig tidpunkt eller för sent. Sjuksköterskor hanterar kontextuella brister genom klinisk prioritering, vilket resulterar i att fundamental omvårdnad uteblir. Tidskrävande, icke-monitorerade omvårdnadsåtgärder nedprioriteras, främst inom basal omvårdnad.   Slutsats:  När kontexten tvingar sjuksköterskor att utföra hårdare prioritering uteblir fundamental omvårdnad. Detta får konsekvenser för patientsäkerheten, vilket belyser vikten av högkvalitativ omvårdnad. Anestesiologisk omvårdnad tros utebli enligt liknande mönster som inom övrig omvårdnad.

Recent reforms in the South African health care and educational system were founded in the ideal that the country would produce independent, critical thinkers. Nurses need to cope with diversity in a more creative way, defining their role in a complex, uncertain, rapidly changing health care environment. Learning facilitators are held accountable for finding adequate learning experiences to prepare nursing students for such practice demands so that newly qualified nurses do meet expectations for entry level clinical judgement ability. Quality clinical judgement is therefore imperative as an identified characteristic of newly qualified professional nurses. There is a scarceness of information on the concept of clinical judgement especially within the South African nursing environment. Relevant information in this regard can assist in clarifying the meaning, which will facilitate a common understanding of the concept within the clinical nursing environment. This in turn can lead to the formulation of a teaching-learning strategy to facilitate clinical judgement in undergraduate nursing students, which would be of benefit in the nursing care environment. The objective of this study was addressed in three phases. The first phase of this research analysed the concept of clinical judgement through various data sources and a review of literature to clarify the meaning and facilitate a common understanding through identification of the characteristics and to develop a connotative (theoretical) definition of the concept. The second phase of the research investigated professional nurses‟ understanding of the meaning of clinical judgement, as well as the factors that influence the development of clinical judgement within the nursing environment. During the third phase a conceptual framework for an enabling teaching-learning environment was constructed from a modern day constructivist approach to facilitate clinical judgement. The section included a description and diagrammatic presentation of the framework. The conceptual framework formed the scientific basis from which a teaching-learning strategy for the creation of an enabling teaching-learning environment to facilitate clinical judgement in undergraduate nursing students within the South African nursing environment was synthesised. A qualitative design was used for the study. During the first phase (manuscript 1) an explorative, descriptive qualitative design was used to discover the complexity and meaning of the phenomenon. Multiple data sources and search engines were consulted for the time frame 1982-2013. An extensive concept analysis resulted in a theoretical definition of the concept „clinical judgement‟, a complex cognitive skill to evaluate patient treatment alternatives within the clinical nursing environment. The second phase (manuscript 2) is qualitative in nature and explored professional nurses‟ understanding of clinical judgement, as well as the factors influencing the development of clinical judgement in undergraduate nursing students. The findings emphasised clinical judgement as skill within the nursing environment. This assisted in the development of teaching-learning strategy for the creation of an enabling teaching-learning environment to facilitate clinical judgement in undergraduate nursing students within the South African Nursing environment as the third phase (manuscript 3). Such an environment should impact positively to promotion of autonomous and accountable nursing care. / PhD (Nursing), North-West University, Potchefstroom Campus, 2015

Recent reforms in the South African health care and educational system were founded in the ideal that the country would produce independent, critical thinkers. Nurses need to cope with diversity in a more creative way, defining their role in a complex, uncertain, rapidly changing health care environment. Learning facilitators are held accountable for finding adequate learning experiences to prepare nursing students for such practice demands so that newly qualified nurses do meet expectations for entry level clinical judgement ability. Quality clinical judgement is therefore imperative as an identified characteristic of newly qualified professional nurses. There is a scarceness of information on the concept of clinical judgement especially within the South African nursing environment. Relevant information in this regard can assist in clarifying the meaning, which will facilitate a common understanding of the concept within the clinical nursing environment. This in turn can lead to the formulation of a teaching-learning strategy to facilitate clinical judgement in undergraduate nursing students, which would be of benefit in the nursing care environment. The objective of this study was addressed in three phases. The first phase of this research analysed the concept of clinical judgement through various data sources and a review of literature to clarify the meaning and facilitate a common understanding through identification of the characteristics and to develop a connotative (theoretical) definition of the concept. The second phase of the research investigated professional nurses‟ understanding of the meaning of clinical judgement, as well as the factors that influence the development of clinical judgement within the nursing environment. During the third phase a conceptual framework for an enabling teaching-learning environment was constructed from a modern day constructivist approach to facilitate clinical judgement. The section included a description and diagrammatic presentation of the framework. The conceptual framework formed the scientific basis from which a teaching-learning strategy for the creation of an enabling teaching-learning environment to facilitate clinical judgement in undergraduate nursing students within the South African nursing environment was synthesised. A qualitative design was used for the study. During the first phase (manuscript 1) an explorative, descriptive qualitative design was used to discover the complexity and meaning of the phenomenon. Multiple data sources and search engines were consulted for the time frame 1982-2013. An extensive concept analysis resulted in a theoretical definition of the concept „clinical judgement‟, a complex cognitive skill to evaluate patient treatment alternatives within the clinical nursing environment. The second phase (manuscript 2) is qualitative in nature and explored professional nurses‟ understanding of clinical judgement, as well as the factors influencing the development of clinical judgement in undergraduate nursing students. The findings emphasised clinical judgement as skill within the nursing environment. This assisted in the development of teaching-learning strategy for the creation of an enabling teaching-learning environment to facilitate clinical judgement in undergraduate nursing students within the South African Nursing environment as the third phase (manuscript 3). Such an environment should impact positively to promotion of autonomous and accountable nursing care. / PhD (Nursing), North-West University, Potchefstroom Campus, 2015

BACKGROUND: The child mortality is relatively high in a middle income country such as Ghana. Great achievements have been accomplished in order to reduce the under five mortality rate, likewise reach the millennium development goal to reduce child mortality. The nurses´ role to carry the capacity to face these challenges becomes a great part of their work. AIM: The aim of the study was to illuminate the experiences of nurses caring for ill children in Ghana and to gain a better understanding of the Ghanese perspective of important factors in pediatric care. METHOD: A qualitative method with semi structured interviews was performed. Five interviews were conducted with nurses at one pediatric ward in Ghana. The data was analysed using content analysis, Halldorsdottir´s theory was used as a raster throughout the paper. RESULTS: Two categories were identified and represent the results, Qualities and Strengths and Obstacles. The categories were found to be encompassed by nine subcategories, Feelings, Improvisation, Attitudes, Empowerment, Collaboration, Workload, Difficulties in the Nurse-Patient relationship, Contradictory experiences and Environmental challenges. CONCLUSION: The findings in this study suggest that the nursing care is largely affected by different factors in the nurses’ daily work. This can result in both a positive and negative impact on the nurse, patient and their relationship. CLINICAL RELEVANCE: Describing how nurses experience work in pediatric nursing care can contribute with a better knowledge of important factors in global nursing. / BAKGRUND: Barnadödligheten är relativt hög i ett medelinkomstland som Ghana. Stora framsteg har gjorts för att minska dödligheten, likaså uppnå millenniemålet att minska barnadödligheten. Sjuksköterskornas roll att inneha kapaciteten för att bemöta dessa utmaningar blir en stor del av deras arbete. SYFTE: Syftet med studien var att belysa sjuksköterskors erfarenheter av att vårda sjuka barn i Ghana, samt att få en bättre förståelse av viktiga faktorer i pediatrisk omvårdnad från ett ghanesiskt perspektiv. METOD: En kvalitativ metod med semi strukturerade intervjuer utfördes. Fem intervjuer utfördes med sjuksköterskor på en pediatrisk avdelning i Ghana. Datan analyserades genom en innehållsanalys och Halldorsdottirs teroi användes som ett raster löpande genom rapporten. RESULTAT: Två kateorier identifierades och representerar resultatet Kvalitéer och Styrkor samt Hinder. Kategorierna omfattas av nio subkategorier, Känslor, Improvisation, Attityder, Empowerment, Samarbete, Arbetsbörda, Svårigheter i sjusköterske- och patientrelationen, Paradoxala upplevelser samt Hinder i miljön. SLUTSATS: Resultatet i den här studien föreslår att omvårdnaden till stor del påverkas av olika faktorer i sjuksköterskans dagliga arbete. Detta kan resultera i både en positiv och negativ påverkan för sjuksköterskan, patienten och deras relation. KLINISK BETYDELSE: Genom att beskriva hur sjuksköterskor upplever arbetet inom pedriatitisk vård kan detta bidra till större kunskap om viktiga faktorer inom omvårdnad globalt.

A qualitative, grounded theory study was undertaken to explore and describe how nurses conceptualise spiritual nursing care, and how they integrate spiritual nursing care in practice. An in-depth literature review through concept analysis on the phenomenon was conducted to assist the researcher with theoretical sensitivity and theoretical saturation. In-depth Individual interviews and focus group interviews were conducted to generate data. Interviews were audio-taped and transcribed by the researcher verbatim. Symbolic Interactionism was the philosophical base for the study. Data analysis was done through the use of the NUD*Ist computer soft ware programme version 4.0. The direct quotes of participants were coded and arranged into meaning units for analysis. A constant comparison method of data analysis was applied by following a process of open, axial and selective coding. Tech’s (1990:142-145) eight steps of analysis to analyse textual qualitative data was used until themes, categories and subcategories were identified and developed. Data analysis revealed that nurses had difficulty to differentiate spiritual nursing care from emotional, psychological or religious care. Nurses still felt inadequately prepared educationally on how to integrate spiritual nursing care in nursing practice. A Humane Care Model and practice guidelines were developed to guide nurses in clinical practice on how to provide such care. Recommendations proposed that the matter be taken up by nurse managers, educators and nurse clinicians to guide nurses in this regard. / Health Studies / D. Litt. et Phil. (Health Studies)

The purpose of this study was to evaluate the quality of professional practice by the registered nurses midwives as reflected in clinical nursing care records for postlaparotomy patients in public central hospitals in Malawi. The set process standards by Nurses and Midwives Council of Malawi (NMCM) were addressed in relation to clinical care of post-laparotomy patients. The hypothesis for this study was that the quality of professional practice by the registered nurse midwives as reflected in clinical nursing care of post-laparotomy patients in public central hospitals in Malawi is inadequate and non-compliant with the process standards set by the NMCM. The researcher used quantitative, evaluative, descriptive, contextual survey and participatory observations to collect data. A three-point rating scale consisting of compliance (C) = 1, partial compliance (PC) = 0.5 and non-compliance (NC) = 0.0 was used to evaluate the state registered nurse midwives’ compliance with process standards. The results showed partial compliance with the set NMCM process standards by the state registered nurse midwives in public central hospitals in Malawi. / Health Studies / M.A. (Health Studies)

Bakgrund: I Sverige slutar ungefär 12-13 % av alla kända graviditeter med missfall. De flesta sker innan graviditetsvecka 13 och räknas därmed som tidiga. Många kvinnor upplever att vårdpersonalen inte ger dem det stöd de behöver. Detta kan bero på bristfällig kunskap om den känslomässiga processen vid tidiga missfall. Syfte: Syftet med denna litteraturstudie var att beskriva kvinnors upplevelser i samband med tidiga missfall. Metod: I litteraturstudien har 10 kvalitativa empiriska studier sammanställts och analyserats utifrån Fribergs analysmetod, inspirerad av beskrivande syntes. Artikelsökning utfördes i databaserna Cinahl, Pubmed och SweMed+. Resultat: Upplevelserna vid tidiga missfall innefattar psykiska, existentiella och sociala aspekter samt omvårdnadsrelaterade upplevelser. Missfallet upplevs ofta som en oväntad förlust vilket kan medföra reaktioner som sorg, ifrågasättande av den egna identiteten och skuldkänslor. Många kvinnor känner sig missförstådda av sina anhöriga och att vårdpersonalen inte uppmärksammar deras känslor, upplevelser och behov. Slutsats: Litteraturstudiens resultat visar att kvinnor vill bli bemötta med respekt och förståelse vid tidiga missfall. För att förbättra omvårdnaden av dessa kvinnor krävs personcentrerad omvårdnad som uppmärksammar deras individuella behov, utbildning bland vårdpersonalen samt ytterligare forskning inom området. / Background: About 12-13 % of all recognised pregnancies in Sweden end in a miscarriage. The majority of these occur before gestational week 13 and are therefore classified as early. Many women experience inadequate support from the nursing staff. This could be related to a limited knowledge about the emotional process subsequent to early miscarriages. Aim: The aim of this study was to describe women’s experiences associated with early miscarriages. Methods: In this literature study 10 empirical studies were compiled and analysed with Friberg’s method of analysis, inspired by descriptive synthesis. Article search was performed in the Cinahl, PubMed and SweMed+ databases. Results: The experiences of early miscarriages include psychological, existential and social aspects and experiences connected to nursing care. The miscarriage is often perceived as an unexpected bereavement that can bring about reactions such as grief, questioning of one’s identity and guilt. Many women feel misunderstood by their friends and families and that the nursing staff does not recognize their feelings, experiences and needs. Conclusion: The result of the literature study shows that women want to be met with respect and understanding during the time of early miscarriage. Person centred care that recognise the women’s individual needs, education among the staff and further research in this area is needed to improve the nursing care of these women.

Bakgrund: Det finns 45 miljoner flyktingar i världen. Många flyktingar har svåra upplevelser bakom sig som kan påverka hälsan och de skattar sin hälsa som dålig. Flyktingar möter många hinder när de söker vård. Trots grundläggande rättigheter om bästa uppnåeliga hälsa för alla är vården för flyktingar godtycklig. Syfte: Syftet med litteraturstudien var att beskriva flyktingars erfarenheter av hälso-och sjukvård. Metod: Kvalitativa resultat ur sex kvalitativa och tre mixed-methodstudier kvalitetsgranskades, analyserades och sammanställdes. Sökningar av artiklar gjordes i databaserna PubMed, SocIndex och CINAHL. Manuella sökningar genomfördes även. Resultat: Flyktingar hade olika erfarenheter kring vårdpersonalens bemötande och tillgången till vård. Fyra kategorier identifierades: svårigheter att få vård, kulturkrockar, diskriminerad samt respektfullt bemött. Inom dessa kategorier beskrivs kommunikationssvårigheter, rädsla för deportation, att bli lyssnad på och ekonomiska hinder som faktorer som påverkade vården. Slutsats: Flyktingar upplever att det är svårt att få vård samt att de får sämre vård än medborgare. Resultatet visar att kunskapen om bemötandet av flyktingar behöver utvecklas. Sjuksköterskor kan arbeta för att förbättra flyktingars erfarenhet av vården. / Background: There are 45 million refugees in the world. Many refugees have traumatic experiences that might affect their health and their self-rated health is generaly poor. Refugees encounter many obstacles when they seek care. Despite the fundamental rights of highest attainable standard of health for all people, healthcare for refugees is inconsistent. Purpose: The purpose of this literature review was to examine the refugees’ healthcare experiences. Method: Qualitative results from six qualitative and three mixed-method studies were reviewed for quality, analyzed and summarized. Searches of articles were made in the databases PubMed, SocIndex and CINAHL. Manual searches were also conducted. Results: Refugees had different experiences regarding their treatment by health professionals and in their access to healthcare. Four categories were identified: difficulties in accessing care, cultural clashes, discriminated and respectfully treated. Within these communication difficulties, fear of deportation, being listened to and economic barriers were described as factors that affected the care. Conclusion: Refugees experience difficulties getting care and recieve worse care than citizens. The results show that knowledge around the treatment of refugees needs to be developed. Nurses can work to improve refugees’ experiences of healthcare.

Bakgrund Attention deficit hyperactivity disorder (ADHD) omfattas av tre grupper; (1) en kombinerad typ med både uppmärksamhetsstörning och överaktivitet/impulsivitet, (2) huvudsakligen överaktivitet/impulsivitet samt (3) huvudsakligen uppmärksamhetsstörning. Hos barn erhåller 1 av 20 diagnosen ADHD där pojkar är överrepresenterade. Flickor diagnostiseras oftast i vuxen ålder varför det kan misstänkas att en underdiagnostik förekommer i yngre år. Sjuksköterskor är ofta delaktiga i psykopedagogiska insatser vars syfte är ökad förståelse och att ge strategier till barnet och de personer som finns runt barnet. Sjuksköterskornas erfarenhet av att det är fler pojkar än flickor som erhåller diagnosen ADHD skulle eventuellt kunna leda till att sjuksköterskorna brister i sin förmåga att anpassa omvårdnaden och de psykopedagogiska samtalen efter flickornas behov. Syfte Att undersöka om sjuksköterskor uppfattar att symtombilden och den psykopedagogiska omvårdnaden skiljer sig vid ADHD beroende på barnets/ungdomens kön ur ett genusperspektiv. Metod Fem sjuksköterskor från barn- och ungdomspsykiatriska verksamheter i Sverige intervjuades med stöd av en semistrukturerad frågeguide. Intervjuerna spelades in, transkriberades och analyserades utifrån en kvalitativ innehållsanalys. Resultat I resultatet framkom att det fanns ämnesområden som sjuksköterskorna vanligtvis fokuserade på i de psykopedagogiska samtalen. Sjuksköterskorna beskrev skillnader mellan flickor och pojkar när det handlade om skola, fritidssysselsättning, beteende, relationer och känslor samt i symtombild. Majoriteten av sjuksköterskorna ansåg att samtalen formades efter vad barnen valde att ta upp och påverkades inte av vilket kön barnet hade. Slutsats Sjuksköterskorna upplevde inte att deras förmåga att anpassa omvårdnaden och de psykopedagogiska samtalen påverkades av barnets kön. De anpassade istället omvårdnaden efter barnens och ungdomarnas behov, resurser och intressen. Däremot upplevde sjuksköterskorna att intressen och symtombild ofta skiljde sig beroende på kön. / Background   Attention deficit hyperactivity disorder (ADHD) comprises of three subtypes; (1) a combined type with both inattention and hyperactivity/impulsivity, (2) mainly hyperactivity/impulsivity and (3) mainly inattention. One out of every 20 children is diagnosed with ADHD and boys are diagnosed more frequently than girls. Girls are often diagnosed as adults which could mean that they are underdiagnosed as children. Psychoeducation, which nurses often partake in, is directed towards increasing understanding and giving the necessary strategies for the child and the people surrounding and caring for the child. Nurses´ experience of the fact that more boys than girls are diagnosed with ADHD may possibly lead to deficits in their ability to modulate care and psychoeducation to the needs of the girls. Purpose To explore if nurses perceive the symptomology and the psychoeducational care to be different depending on the sex of the child/adolescent with ADHD from a gender perspective. Method Five nurses working in child and adolescent psychiatric care in Sweden were interviewed using a semi structured interview guide. The interviews were recorded, transcribed and analysed using qualitative content analysis.  Results The results show that there are subject areas that nurses usually focus on during the psychoeducational conversations. The nurses described differences between girls and boys in terms of school, avocation, behaviour, symptomology and relationships and emotions. The majority of nurses considered the conversations to be shaped around what the child wished to discuss and not depending on the sex of the child. Conclusion The nurses did not perceive that their ability to modulate nursing care during the psychoeducational meetings was affected by the child’s gender. Instead they modulated the nursing care according to the children´s or the adolescents needs, resources and interests. However, the nurses experienced that the interests and symptoms of the child or adolescent often differed by gender.