ABSTRACT Background: To serve the patients information and to relieve pain post-operatively is largely the nurse's responsibility. Studies suggest a correlation between the preoperative information and the pain and anxiety. Previous studies suggest that the preoperative information affect the postoperative pain in a positive direction. Aim: The aim of this study was to investigate the correlation between preoperative paininformation, anxiety and pain in patients who have undergone elective and acute orthopedic surgery. A further aim was to see if there was a difference between elective and acute orthopedic surgical wards and also investigate if there were something the patients were missing in the preoperative pain-information. Method: A quantitative survey was conducted with a descriptive correlative design. The study was carried out in two different orthopedic wards in a hospital in Sweden. The study included a total of 27 participants, 12 elective and 15 acute patients. Reslut: The result showed that there is a significant correlation between the patients preoperative anxiety and postoperative pain (r=0,398, N=27, p=0, 04). The result also showed a significant correlation between patient’s postoperative anxiety and postoperative pain (r=0,601, N=27, p=0,001). Patients with high anxiety also had high levels of pain. No significant difference was seen between the elective and acute group, but the elective group estimated the preoperative information higher (M=6, 17) than the acute group (M=4, 53). The study did not show evidence that preoperative information about the pain leads to lower postoperative painscores, however the preoperative information is important so the patient feel well prepared for the operation. A total of 6 (22%) patients did not obtain preoperative pain-information. Conclusion: Anxiety and pain are two factors that affect each other. To be responsive as a nurse and capture anxious patients, as well as alleviate this concern , the postoperative pain would be alleviated . Patients undergoing acute surgery do not receive preoperative information to the same extent as those undergoing elective surgery. To develop a quality document about how and when preoperative information about pain should be given , could ensure that patients are well informed before surgery. To share this information is largely the nurse's role, and it is important as it would lead to increased well-being and less suffering for the patients.

Patient participation is a central theme in health care policy in the United Kingdom (U.K.). Indeed, there is a trend in health care policy and practice towards encouraging patients to participate actively in their care, treatment and the services they use (Department of Health, 1989, 2003; 2004; 2005; 2006; 2008; 2009; 2010; 2011; 2012). Despite the current popularity surrounding such an approach to care, the concept remains elusive. Patient participation in nursing care specifically has not been examined adequately and remains one of the least understood ideas in clinical practice. The contribution that nurses make to this important activity has also not been explored. Furthermore, only a few studies have examined the nature of patient participation in nursing care from the frame of reference of the acute surgical patient (Henderson, 1997; Sahlston et al., 2008 and Larsson et al., 2011). Most studies have targeted clinically distinct patient groups and discrete aspects of patient participation within the context of chronic illness or medical and primary care practice. They are therefore limited by their precision and narrow focus (Cassileth et al., 1980; Haug & Levin, 1981; Vertinsky et al., 1984; Caress et al., 2005; Entwhistle et al., 2004; Collins et al., 2007; S. Parsons et al., 2010). Most have also drawn on positivist epistemologies and derived data from self-completed fixed choice questionnaires. An empirically grounded theory that explains the process of patient participation in surgical nursing care within the empirical world has yet to be published. The purpose of this grounded theory study was to explore the nature of patient participation in nursing care within the context of the acute surgical care setting. Ultimately the aim was to generate a substantive theory that could account for, and explain, the process by which patients’ participate in their surgical nursing care. A qualitative, inductive design, based on the classic grounded theory approach to data collection and data analysis (Glaser & Strauss, 1967; Glaser, 1978) was employed to examine the complex nature or natural history of patient participation within the context of contemporary surgical nursing practice. The informants of the research were patients and nurses on three acute surgical wards in an NHS Trust Hospital. Data were collected through 61 unstructured, audiotaped interviews (47 patients and 14 nurses) and 72 hours of participant observation. The interview and observational data were analysed using the constant comparative method of analysis (Glaser & Strauss, 1967; Glaser, 1978). The analytic process generated a substantive theory, labelled Engaging in Nursing Care. The theory explains how patient participation in nursing care within the acute surgical setting is established, developed, maintained or inhibited. It reveals an evolutionary context-sensitive process, which describes the complex and challenging nature of patient participation in nursing care as experienced by patients and nurses in the pre and post-operative period. Three dynamic phases: Establishing Readiness, Shaping Work and Incurring Rewards and Costs describe how patients engage in their nursing care prior to and after surgery. The phase Establishing Readiness describes the structural, organisational and environmental antecedents of patient participation within the context of the surgical care setting. Shaping Work describes the range and variation in participatory behaviour and the levels at which patients participate in their own nursing care throughout their surgical experience. The phase Incurring Rewards and Costs explains the varied effects of patient participation in surgical nursing care on the individual patient, the nurse and surgical ward performance and resources. A number of recommendations are made to enable nurses, educationalists, health care managers and policy makers to develop substantiated strategies and initiatives for the effective implementation of patient participation in modern surgical nursing practice.

The aim of this study was to investigate the principles and factors underlying the culturally competent nursing care of asylum applicants. Asylum applicants are a highly vulnerable group, whose health is often severely compromised prior to arrival in the UK due to exposure to torture, violence and rape. Although they are entitled to primary health care services whilst their asylum claim is under consideration, their level of welfare support has been significantly eroded over the last decade. An analysis of the nursing literature revealed mainly US notions of cultural competence, which were based on a private health care insurance system rather than a universal health care system of equitable, accessible and non-discriminatory service provision, such as the NHS. A Five Steps Model of cultural competence (Quickfall 2004) was later revised to provide a theoretical framework for this research study. Data for this ethnographic study were collected during 2005-2007 with asylum applicants and community nurses within one Health Board in Scotland, using participant observation, individual, narrative and group interview methods. The data were analysed for their categorical content. The findings are presented as vignettes to highlight cultural competence issues. Three major themes emerge from the study findings, which highlight the intermediary function of community nursing. The provision of equitable, accessible and non-discriminatory services remains pertinent in the 21st century. Secondly, the cross-cultural promotion of health involves a partnership process to ensure effective communication and the negotiation of person centred care. Thirdly, the delivery of socially inclusive services requires the aiding of asylum applicant adaptation to a new host environment. This study contributes to community nursing knowledge in explaining, through synthesis of the literature and study data, a model of cultural competence for the care of asylum applicants. It also provides a set of best practice statements, which require further investigation.

Bakgrund: I Sverige lever idag 160 000 personer med en demensdiagnos. Demens kan ge många olika fysiska och beteendemässiga symtom. Forskning har visat att musik är något som kan trösta och lugna en person. Långtidsmusikminnet har visat sig finnas kvar hos personer med demenssjukdom. Syfte: Att undersöka hur personer med demensdiagnos påverkas av musik. Metod: En litteraturöversikt enligt Fribergs metod där resultatet baserats på elva vetenskapliga artiklar; fem kvalitativa och sex kvantitativa originalartiklar. Databaserna Cinahl och PubMed användes med söktermer som dementia, music, nursing och singing. Resultat: Musik vid måltider kan minska agiterade beteenden. Musik vid morgonomvårdnad kan förbättra kommunikationen mellan vårdpersonalen och personen med demens samt att förståelsen för de dagliga aktiviteterna ökar. Att individuellt lyssna på musik kan minska agitation samt öka kommunikationen med personen med demenssjukdom. Diskussion: Resultatet diskuterades utifrån konsensusbegreppet vårdande, där fokus för diskussionen främst kretsade kring hur musiken kan användas som en omvårdnadsåtgärd. / Background: In Sweden 160 000 people live with a dementia diagnosis today. Dementia can give several behavioral and psychological symptoms. Research has shown that music can comfort and calm a person. Long term music memory has shown to be intact in people with dementia. Aim: To study the impact of music on people suffering from dementia.   Method: A literature review according to Friberg's method where the result is based on eleven scientific articles; five qualitative and six quantitative original articles. Databases used were Cinahl and PubMed with the search terms dementia, music, nursing and singing. Results: Music at mealtime can decrease agitated behavior. Music during morning care sessions can increase the communication between caregiver and people suffering from dementia and also increase the understanding of the everyday activities. Individually listening to music can decrease agitation and increase communication with the person suffering from dementia. Discussion: The results are discussed in relation to the consensus concept caring, where the focus for the discussion was how music can be used as a nursing intervention.

Background: In Namibia there are a lot of different native languages even if the official language is English. Since communication is an important tool for nurses and studies about communication across language barriers mostly is done in western countries, there is need for more knowledge regarding the nurse's experience with language barriers in multilingual and multicultural context, like Namibia. Aim: To describe the experiences of Namibian nurses caring for patients who speak another native language. Method: Qualitative interviews were held with four nurses and one student nurse at Katutura State hospital in Windhoek, Namibia. Results: Two themes with subthemes were identified in the results. The first theme, Establishing the patient-nurse relationship, describes the importance of trust for communication and what the interviewees found important when creating a bond with the patient. The other theme, Establishing the communication, describes the importance of interpretation and how they tackled the language barrier. Conclusion: When meeting a patient with another native language it is of great importance to establish trust with the patient and that interpreters are used. The use of sublingual nurses, who found interpreting to be a natural part of their work, was beneficial.

Bakgrund: Suicid anses idag vara ett stort globalt hälsoproblem då det är en av de vanligaste dödsorsakerna bland unga i åldrarna 15-25 år. I Sverige begår ca 150 unga personer suicid varje år. Syfte: Syftet var att beskriva viktiga faktorer i sjuksköterskans omvårdnad av unga med suicidalt beteende samt att beskriva de inkluderade artiklarnas undersökningsgrupper. Metod: Föreliggande litteraturstudies resultat är en sammanställning av totalt 11 vetenskapliga artiklar, med både kvalitativ och kvantitativ ansats. Artiklarna är hämtade ur databaserna PsycINFO, PubMed och CINAHL och granskade enligt anvisningar i Polit och Beck (2016). Resultat: Sjuksköterskor saknar resurser så som tid och kunskap i hur de ska hantera och bemöta unga med suicidalt beteende för att kunna ge en god omvårdnad. Både patienter och sjuksköterskor vittnar själva om bristande kompetens. Flera patienter beskriver hur viktigt det är att det finns någon där som lyssnar och tar dem på allvar. Slutsats: Det är svårt att peka ut en enskild faktor som den viktigaste i omvårdnaden av unga med suicidalt beteende. Det är tydligt att de identifierade faktorerna är beroende av varandra. Sjuksköterskan bör ha en icke-dömande attityd, ett holistiskt förhållningssätt och sträva efter att bygga en tillitsfull relation. Det är viktigt med utbildning och reflektion för att ökad kompetens samt en anpassad miljö. Tid och suicidscreening är ytterligare faktorer av vikt i omvårdnaden av unga med suicidalt beteende. / Background: Suicide is today recognized as a big global health problem being one of the most common causes of death among young people in the age range of 15 to 25. In Sweden approximately 150 young persons commit suicide every year. Purpose: The purpose of the study was to describe factors of importance in the nursing care of young people with suicidal tendency. The further purpose was to describe the study groups of the selected articles. Method: 11 research articles, of both qualitative and quantitative design, where identified for this literature review searching the databases PsycINFO, PubMed and CINAHL. The articles included where reviewed according to Polit and Beck (2016). Findings: There is a lack of resources, such as time and knowledge, for nurses in how to respond and treat young people with suicidal tendencies, in order to provide good care. Both patients and nurses testify to the lack of skills. Many patients describe how they perceive it positively when there is someone available to listen to them and take them seriously. Conclusion: It is difficult to identify one single factor as the most important in the nursing care of young people with suicidal tendency. It is clear that the factors identified are depending on each other. The nurse should have a non-judging attitude, a holistic approach and should strive to build a trusting relation. It is important with education and reflection to increase the nurse’s skills and with an adapted environment. Further factors of importance in the nursing care of young persons with suicidal tendency are time and suicide screening.

Background: Ostomy surgery refers to surgical procedures that reroute the elimination process of the bowel and alters the usual form of elimination. There are different reasons why a person gets a ostomy, depending on the reason for the surgery. The number of persons living with ostomys in Sweden is unknown. However, the reaction to intestinal diversion surgery can be a devastating experience. Living with a ostomy for a longer period may affect the individual. Nurses are important members of the health care team and have a significant role in caring for patients with ostomy. Aim: The aim was to describe experiences living with a permanent ostomy. Method: A qualitative litterature-based design was used in the study. CINAHL and PubMed databases were used to search qualitative articles. Articles were analyzed and reviewed by the five-step method in Friberg. Results: The result is based on ten qualitative articles. After making the analysis three main themes and nine sub-themes were identified. The three main themes were: the altered body appearance, the changing of daily life and interference with anticipated return to normal. The sub- themes were: fear, anxiety, disgrace and irritated skin, body image, acceptance, independence, daily activities, diet, impact on relationships, supporting, loneliness and isolation. Conclusion: Having a ostomy is a major event and it affects personal self-concept and restricts their lives in various ways. Nurses need to provide education, support advice and referral for specialist help if required to promote health and reduce suffering.

Trata-se de uma pesquisa~ comparativa entre a aplicação do Processo de Enfermagem em sub-programas de saúde materna e os registros habituais no processo das clientes. São conhecidas algumas características da populaçio, tais como: idade, escolaridade, ocupação, residência, cor da pele, estado civil, religião, primeiro contato com o centro de saúde na gestação em curso e paridade. Processo de Enfermagem é um termo aplicado a um sistema de intervenções específicas da enfermagem na saúde das gestantes. Detalhadamente, envolve o uso de método científico, para identificar os problemas de saúde e de enfermagem e consequentemente as necessidades de saúde das gestantes; utilizar estas selecionando as que podem mais efetivamente ser solucionadas pelos cuidados de enfermagem; também inclui planejamento para encontrar essas necessidades, providenciar cuidados (encaminhando os que não dizem respeito à enfermagem) e avaliar os resultados. Os instrumentos de pesquisa foram aplicados a cento e dezenove gestantes (quatro amostras probabilísticas sistematicas chamadas A, B, C e D com 32, 27, 30 e 30 gestantes) que representam 50 por cento da populaçio total de gestantes em cada centro de saúde. Através de uma análise estatística em termos quantitativos utilizando média, moda, desvio padrão, amplitude de variação e em termos qualitativos utilizando qui-quadrado (x2), coeficiente de Yule e amostras emparelhadas (teste de hipóteses) ao nível de significancia de 5 por cento , confirmámos as duas hipóteses formuladas. As principais conclusões foram: 1) A utilização do Processo de Enfermagem permitiu encontrar 1405 problemas de saúde e de enfermagem e nos registros nas fichas havia registrados 223. 2) Depois de encontrar os problemas, identificâmos as Necessidades Humanas Básicas afetadas: as psico-biológicas 1003 vezes e as psico-sociais 1069 vezes. 3) A utilização do plano assistencial permitiu fazer: - 887 orientações de saúde; - 372 supervisões em saúde; - 593 encaminhamentos para consulta médica e instituições ligadas à habitação e saneamento do meio. 4) Parece existir uma associação entre a procura do centro de saúde para seguimento da gestação desde o 1º mês e estar no grupo etário 15-29 anos (ao nível de significancia de 5 por cento ). 5) O papel da enfermagem e principalmente de educador e supervisor de saúde na enfermagem de saúde pública - saúde materna. 6) Este estudo demonstra que o corpo de conhecimentos da enfermagem está discriminado no planeamento das ações de saúde necessárias, de forma a responder à problemática das gestantes. 7) É evidente a importancia da pesquisa em enfermagem como a maior contribuição para encontrar as necessidades de saúde e bem-estar das pessoas. / This is a comparative survey between the application of the Nursing Process on the Maternal Health sub-programmes and the normal registrations in the file card. There are known some characteristics of the population such as: age, scolarity, occupation, residence, skin colour, marital status, religion, first contact with the health care center during pregnancy and offspring. Nursing process is a term applied to a system of characteristic nursing interventions in the health of the pregnant women. In detail, it involves the use of scientific methods for identifying health and nursing problems and, consequently, the health needs of the pregnant women and for using the latter to select those which can most effectively be met by nursing care. It also includes planning to meet those needs, providing the care and evaluating the results. The research instruments were applied to one hundred and nineteen pregnant women (four probabilistic and systematic samples called A, B, C and D with 32, 27, 30 and 30 pregnant women), who represents 50 per cent of the total population of pregnant women. By means of statistical analysis in quantitative terms, utilizing mean, mode, standard deviation, range of scores and, in qualitative terms, utilizing chi-square (x2), Yules\' coefficient and paired samples (hypothesis test - 5 per cent level of significance), we confirmed the two hypothesis formulated. The main research finding were: 1) Through the use of Nursing Process one find 1,405 health and nursing problems, on the other hand through the normal registrations in the file card one finds only 223. 2) After encountering problems, we can identify the Basic Human Needs affected: psycho-biological: 1,003 and psycho-social: 1,069. 3) The use of care planning permits one to deal with the foi lowing: - 887 subjects for health education; - 372 subjects for health supervision; - 593 subjects for guidance, specicilly regarding medical consultations and institutions of basic sanitation and housing. 4) lt seems to exist a significant relationship between the demand for the health care center by women, during the first three months of pregnancy in the 15 to 29 year old age group. 5) The nursing role is mainly health educator and health supervisor of public health nursing - maternal health. 6) This study demonstrates that the body of knowledge nursing is revealed in the planning of necessary health action in arder to answer to the problematics of pregnancy. 7) It is evident the importance of nursing research as a major contribution in meeting people is health and welfare needs.

O presente estudo teve como objetivos conhecer os conflitos éticos relativos a pacientes terminais identificados por enfermeiros das clinicas médica, cirúrgica e pronto socorro adulto de um hospital público e geral; compreender como os enfermeiros tomam as decisões frente a conflitos éticos referentes a esses pacientes e conhecer o que é levado em consideração, pelos enfermeiros, para a tomada de decisão frente a conflitos éticos relacionados a pacientes terminais. Foi feito um estudo exploratório, descritivo e de abordagem qualitativa. Para análise dos dados foi utilizada a análise de conteúdo proposta por Bardin. Foram entrevistados dez enfermeiros de um hospital público e geral do Município de São Paulo. Após a análise, emergiram três categorias e quinze sub-categorias: Categoria 1- A vivência dos enfermeiros em relação ao paciente terminal. Subcategorias: Cuidados como condição essencial para assistência aos pacientes terminais; Postura da família frente ao paciente terminal; Conseqüências da vivência profissional com pacientes terminais; e Postura profissional frente aos pacientes terminais. Categoria 2- Fatores geradores de conflitos éticos em relação ao paciente terminal. Subcategorias: Obstinação terapêutica; Situações administrativas; A quebra do sigilo e desrespeito à privacidade do paciente terminal; Despreparo profissional; e Falta de autonomia do enfermeiro. Categoria 3- Fatores considerados para a tomada de decisão em relação aos conflitos éticos frente ao paciente terminal. Subcategorias: Os aspectos ético-legais; O uso do conhecimento científico; A participação das equipes multiprofissional e de enfermagem; O respeito à autonomia do paciente e da família; A importância do esclarecimento de pacientes e familiares; e A multifatorialidade concorrendo para a tomada de decisão. O estudo evidenciou que os conflitos éticos relativos aos pacientes terminais, vivenciados pelos enfermeiros, emergem de seu cotidiano e são decorrentes de diversos fatores relacionados à assistência, ao gerenciamento e à capacitação dos profissionais. Foi evidenciado, ainda, que os enfermeiros apontam fatores que devem ser levados em consideração no processo de tomada de decisão, mas revelam sua pouca participação nesse processo frente aos conflitos éticos relativos a pacientes terminais. / The present study aims to identify and understand the ethical conflicts related to terminal patients experienced by nurses and are what considered for decision making to cope with these conflicts. The methodology adopted was the qualitative strand, using the content analysis proposed by Bardin. Ten nurses were interviewed in a general hospital in Sao Paulo. After the analysis emerged three categories and fifteen sub-categories: Category 1 - The experience of nurses in relation to the patient terminal. Subcategories: care as an essential condition for assistance to terminally ill patients; Posture family towards the patient terminal; Consequences of professional experience with terminal patients, and professional attitude to patients facing terminal. Category 2 - Factors generators to ethical conflicts in respect to the terminal patient. Subcategory: Therapeutic futility; Situations administrative on generating of conflict; The breaking secrecy and privacy disrespect of the patient terminal; A lack of professional preparation; and lack of autonomy of nurses. Category 3 - Factors considered in the decision-making in relation to the conflicts ethic facing the terminally ill patient. Subcategories: ethical and legal aspects; The use of scientific knowledge; The participation of multidisciplinary teams and nursing staff; The Respect for patient autonomy and family; The importance of clarifying patients and families, and, The multifactorial competing to decision-making. The study showed that ethical conflicts related to the patients, experienced by nurses, emerge from their everyday and are caused by several factors related to assistance, to management and capacitation professional. It was evidenced, also, that the nurses point to factors that must be taken account in decision-making process, but they reveal their little participation in this process front to the ethical conflicts related to terminally ill patients.

Este estudo é o resultado de minha preocupação, como enfermeira, com as mulheres com câncer e que se encontram no momento fora de possibilidade de recursos para cura. Dessa forma, a trajetória deste estudo voltou-se à compreensão do significado do cuidar pela perspectiva destas mulheres. Com esta proposta, optei por realizar uma pesquisa qualitativa, segundo a abordagem fenomenológica, com base nestas questões norteadoras: - Me fale como eu posso cuidar de você. Como você gostaria de ser cuidada? Das descrições das mulheres emergiram as unificações ontológicas analisadas e interpretadas segundo o referencial de Martin Heidegger. Essas unificações possibilitaram desvelar caminhos para a ação do cuidar no processo de morrer que vão além do conhecimento técnico-científico, pois o cuidar implica também empatia, escuta, paciência, zelo, controle da dor, autonomia. Respaldada pela ótica das mulheres, foi-me permitido alcançar o sentido do ser com câncer no processo de morrer, não como algo acabado, mas como um ser de possibilidades, mesmo diante de uma situação factual que é o convívio com a terminalidade existencial. / The present study is a result of my concern, as a nurse, for women with cancer and without any possibilities of resources for a cure. Therefore, the trajectory of this study was focused on the comprehension of the meaning of taking care through those women’s perspective. For this purpose, I chose to make a qualitative survey in a phenomenological approach, based on the following directive questions: “Tell me how I can take care of you. How would you like to be taken care?". From the descriptions given by the women, it came up the ontological unifications analyzed and interpreted according to Martin Heidegger’s reference. Such unifications made it possible to reveal ways to the act of taking care in the dying process that go beyond technical-scientific knowledge, because taking care also goes through empathy, the act of listening to somebody, through patience, zeal, pain control and autonomy. Based on those women’s point of view, I was able to reach the sense of a person with cancer in the dying process, not as a finished thing, but as a person with possibilities in spite of facing a situation based on a fact, which is living with the existential end.