Bakgrund: Under den korta perioden som den perioperativa vården varar ska sjuksköterskor skapa en tillitsfull relation, uppmärksamma behov, lindra oro och förmedla känsla av trygghet. Personcentrerad vård har visat sig vara ett effektivt verktyg för detta. Genom att studera upplevelser av vården hos patienter som har genomgått en sköldkörteloperation kan vården anpassas för att möta patienternas individuella behov. Syfte: Studiens syfte var att utforska och beskriva hur patienter som genomgått en sköldskörteloperation upplever den perioperativa omvårdnaden. Metod: En kvalitativ studie. Semi-strukturerade individuella intervjuer genomfördes med åtta patienter som nyligen genomgått sköldkörtelkirurgi. Datan analyserades genom systematisk textkondensering. Resultat: Studiens resultat visar på att känsla av oro och trygghet genomsyrar upplevelsen av den perioperativa processen hos patienter som har genomgått sköldkörtelkirurgi. Omvårdnaden som patienterna erhåller bidrar till att skapa trygghet och lindra oro. Ett gott bemötande av hjälpsam, lugn och omhändertagande vårdpersonal som ser patienternas behov bidrar till att skapa känslan av trygghet. Patienternas oro kan lindras genom tydlig och individanpassad information som ges under rätt omständigheter. En tillitsfull relation mellan vårdtagaren och vårdgivaren har en positiv inverkan på patienterna och är en viktig faktor för att lindra den perioperativa oron. Slutsats: Kunskap om omvårdnadsåtgärder som skapar trygghet och lindrar oro är betydelsefull och kan bidra till en mer personcentrerad vård. En förändring måste ske och omvårdnaden måste ges ett större utrymme, i första hand för patienternas skull. Strävan efter att minimera lidande och öka tryggheten i samband med den perioperativa vården ska vara en självklarhet. / Background: During the short period of time of the perioperative care, the nurses needs to create a trustful relationship, observe needs, ease anxiety and mediate feeling of safety. The person-centred care had proven to be a good tool to achieve that. By studying the experiences of care in patients who had undergone thyroid surgery, the care can be fitted to encounter the individual needs in patients. Aim: The aim of this study was to explore and describe how patients who had undergone thyroid surgery experience the perioperative care. Method: A qualitative study. Semi structured individual interviews were conducted with eight patients who recently had undergone thyroid surgery. Data were analysed using systematic text condensation. Results: Study results shows that the feeling of anxiety and safety permeates the experience of the perioperative process in patients who had undergone thyroid surgery. The nursing care from calm and caretaking personnel contributes to create safety and to ease suffering. Patients’ anxiety can be eased through clear and individually fitted information that is given under the right circumstances. Trustful relationship between the caretaker and the caregiver is an important factor to ease the perioperative anxiety. Conclusions: Knowledge about nursing actions that creates safety and eases anxiety is meaningful and can contribute to a more person-centred care. A change must take place and the nursing care must be given more space, primarily for the patient's sake. The striving to minimize suffering and increase the security associated with perioperative care should be a matter of course.

Höftkirurgi är ett vanligt ingrepp både som elektivt och akut. Sjuksköterskans arbete inkluderar preoperativ information vilken oftast ges muntligt. Studier visar att smärta ofta är ett problem postoperativt. Tidigare forskning har även kommit fram till att patienter önskar vara välinformerade om det postoperativa förloppet för att kunna vara delaktiga i sin egen vård. Syfte : Syftet var att utifrån aktuell forskning undersöka betydelsen av olika sätt att informera patienter preoperativt avseende smärta och smärtbehandling för patientens postoperativa smärtupplevelse vid höftkirurgi. Metod : En litteraturöversikt gjordes genom att söka artiklar på databaserna CINAHL och PubMed. En granskningsmall användes där valda artiklar kvalitetsgranskades och endast artiklar av minst medelhög kvalitet användes. Arbetet grundas på 17 artiklar som delades in i huvudkategorierna elektiv, akut, information och smärta. Resultat : Ett samband mellan preoperativ information och postoperativ smärta hittades i 13 artiklar. Sambandet visar att den givna informationen skapade förutsättningar för patienterna att hantera den postoperativa smärtan. Vid elektiv kirurgi fanns bättre förutsättningar för patientaktiverande preoperativa utbildningar. Preoperativa individuella strategier identifierades. Slutsats : Merparten av studierna syftar till att preoperativ information används för att kunna minska postoperativ smärta genom att öka patienternas delaktighet och copingförmåga. Då samband hittats hos de flesta av artiklarna i denna litteraturstudie stärker detta sannolikheten att det finns ett samband mellan sjuksköterskans preoperativa information och patientens postoperativa smärtupplevelse. / Hip surgery is a common operation, for both elective and acute approach. Nurses’ duties includes pain prevention and information to the patient. This with the patient always in focus. Studies have shown that it is most common to give the information verbally, and that patients want to know more preoperative about the postoperative phase to be more involved. Aim : The purpose of this literature review was to investigate the importance of nurses’ preoperative information for postoperative pain management. Methods : For the research the database CINAHL and PubMed was used. A review template was used, and only the articles with a medium high score has been used. This work is based on 17 articles which has been divided in main categories that was elective, acute, information and pain. Results : A relationship between preoperative information and postoperative pain was found in 13 of the articles. This connection indicate that the given information provided the patients to manage their postoperative pain. Patients undergoing elective surgery was better prepared and was given more patient activated education preoperative than acute surgery. Preoperative individual strategies was identified. Conclusion: Most of the studies showed that preoperative information is used to reduce postoperative pain by increasing patients’ participation and their ability to cope better. Since a connection was found between most of the articles in this work it increases the likelihood that there is a relationship between nurses’ preoperative information and patients’ postoperative pain experience.

Background: Primary care faces the challenge of developing an easily accessible and effective health care system to meet the needs of the population and to fulfill the care guarantee. Teamwork with satisfactory communication can provide more efficient work and good results for patients. In Gävleborg County, three healthcare centers have started a joint emergency care, where collaboration in teams should optimize resources. Aim: The aim of the this study was to describe district nurses and nurses' experiences of working in the emergency care of primary care. Method: The study had a qualitative approach and a descriptive design. Data were collected using semi-structured interviews and was analyzed with qualitative content analysis. Main result: The interviews resulted in three categories: The teamwork in the emergency care, Changes with a new way of working and Challenges in working with the emergency care. The categories describe district nurses 'and nurses' experiences of a team-based approach where collaboration and accessibility facilitate work and make it effective. The categories also describe challenges in working with the emergency care that led to difficulties in work and shortcomings for the patient. Conclusion: District nurses and nurses in the present study described that the work in primary emergency care was an effective teamwork with satisfactory cooperation and communication between professions. Advantages of the method were accessibility to get advice and support from others and not to be alone. Challenges and difficulties emerged in the work that affected both the working group and the patients. The result in the study give an insight into a common approach of emergency care in the primary care based on the experience of district nurses and nurses. The result in the study can hopefully lead to development and improvement of working methods within emergency care in the primary care.

Bakgrund: Diabetes är en kronisk metabol sjukdom och det finns två sorter. Typ 1 kallas den som orsakas av bristande insulinproduktion. Nordiska riktlinjerna för barn och ungdomar rekommenderar 60 minuter fysisk aktivitet per dag.   Syfte: Syftet med denna litteraturstudie var att belysa vikten av fysisk aktivitet hos barn och ungdomar med typ 1 diabetes samt vilka faktorer som påverkar deras fysiska aktivitet.   Metod: En litteraturstudie innehållande 16 vetenskapliga artiklar som erhållits genom databaserna PubMed och Cinahl. Dessa har granskats, kvalitetsbestämts och sammanfattats. Resultatet har därefter analyserats och presenterats under två huvudteman med tillhörande subteman.   Resultat: Efter granskning av de involverade artiklarna framkommer det att den fysiska aktiviteten är viktig för barn och ungdomar med typ 1 diabetes. Det är viktigt för att de ska ligga på en bra glukosnivå, men även för att motverka exempelvis framtida sjukdomar och övervikt. De hinder som de kan drabbas av är bland annat hypoglykemi men även val av metod för tillförsel av insulin, som kan begränsa dem i vilken form av fysisk aktivitet de kan utföra.   Slutsats: Den fysiska aktiviteten är viktig för barn och ungdomar med typ 1 diabetes och bör ses som en behandlingsmetod. Vården bör vara personcentrerad för att kunna mota de hinder som kan uppstå och för att nå fram till barnen och ungdomarna. / Background: Diabetes is a chronic metabolic disease and there are two types. Diabetes type 1 is known as the one caused by lack of insulin production. A Nordic guideline for children and adolescents recommends 60 minutes of physical activity per day.   Objective: The aim of this study was to highlight the importance of physical activity in children and adolescents with diabetes type 1 and their potential barriers to physical activities.   Method:  In total 16 scientific articles were included after searches in the databases PubMed and Cinahl. The articles were quality audited, summarised and analysed. In total two themes and four subthemes were obtained.   Results: After analysed the involved articles it reveals that the physical activity is necessary for the children and adolescents with diabetes type 1. It’s necessary for keeping the glucose level stabile, but also to prevent future diseases and obesity.  The obstacles that they can suffer are for instance hypoglycaemia, but also the choice of method to take insulin can limit them in what physical activity that they can perform.   Conclusion: Physical activity is important for children and adolescents with diabetes type 1, and should been seen as a treatment method. The healthcare should be person-centred to be able to face the obstacles that may arise and to reach the children and adolescents.

Background Type 2 diabetes demands self-management over time, to maintain health and reduce the risk for diabetes complications. However, despite efforts, many persons with type 2 diabetes are not reaching the treatment targets. In diabetes, person-centred care and group education are recommended. Diabetes specialist nurses (DSNs) working in primary healthcare have an important role in supporting patients with type 2 diabetes in their self-management to adapt to the demands of the disease in everyday life. Therefore, it is important to explore the DSNs’ professional role and their experiences of practising person-centred care. The overall aim of the thesis was to explore the professional role of DSNs in primary healthcare, and to describe their experiences of person-centred diabetes care. Methods The thesis includes three studies with qualitative, and one with a quantitative, approach. Data collection consisted of focus group interviews, individual interviews, observations, and questionnaires. Qualitative content analysis and statistics were used in the analysis. In studies I and II, 29 and 31 DSNs participated, respectively. In study III, 10 DSNs and 44 persons with type 2 diabetes participated. Lastly, in study IV, 10 DSNs participated. Results The results in the thesis showed that DSNs have a complex and multifaceted professional role that entails striving to be an expert, a fosterer, a leader, an executive, and a role model, which they found challenging. The DSNs perceived high job demands, such as decision-making and learning. The thesis also showed that the interaction between DSNs and persons with type 2 diabetes shifted from empowerment to authority struggles during group support sessions based on person-centred care. The experience of person-centred care was described as enriching, but DSNs also expressed ambivalence, related to an altered professional role. Conclusion There is a desire by DSNs to be close to persons with type 2 diabetes, although they have several challenges to fulfil, which makes it difficult to uphold a relation with proximity; thus, distance is also present. Even though person-centred care is recommended in healthcare, and despite DSNs’ efforts to practise PCC, the result of this thesis shows that it also implies an altered professional role for DSNs that has to be addressed. / Diabetes intervention in Västerbotten, DIVA 2

Bakgrund: Vi har idag en stor del inläggningar av patienter på sjukhus som lider av någon form av demenssjukdom. Omvårdnaden av kroppsligt sjuka patienter som har en demensdiagnos är komplex eftersom dessa har speciella behov relaterat till sina kognitiva, funktionella och beteendemässiga förändringar. Denna komplexa vård kan bli svårhanterlig för omvårdnadspersonalen i sjukhusmiljö vilket kan leda till att omvårdnaden blir lidande Syfte: Syftet med litteraturstudien var att beskriva omvårdnadspersonalens syn på och upplevelser av att vårda patienter med demenssjukdomar som är inlagda på sjukhus. Metod: En allmän litteraturstudie gjordes på ett systematiskt sätt, resultatet baserades på åtta kvalitativa originalartiklar Resultat: Resultatet utgår från tre olika huvudkategorier: Omvårdnadspersonalens upplevelse av och syn på sin egen roll i vården av patienter med demenssjukdom, omvårdnadspersonalens upplevelse av och syn på patienter med demenssjukdom och deras behov samt omvårdnadspersonalens upplevelse av och syn på ledningen, organisationen och miljön i relation till patienter med demenssjukdom. Slutsats: Värdigheten och integriteten av personer med demenssjukdom försvinner på sjukhusavdelningarna på grund av att den personcentrerade vården minskar då omvårdnadspersonalen har en stereotyp bild av personer med demenssjukdom, eftersom det finns tidsbrist på avdelningarna, att miljön på avdelningarna inte är optimal för denna patientkategori samt att sjukhusledningarna tar fel beslut och inte har tillräcklig förståelse för situationen på avdelningarna. / Background: We currently have a large proportion of admissions in hospital suffering from some form of dementia. Nursing care of physically ill patients who have a dementia diagnosis is complex because people with dementia have specific needs related to their cognitive, functional and behavioural changes. This complex care can be cumbersome for nursing staff in the hospital setting, this may contribute to that the care may suffer Aim: The aim of this literature review was to describe nursing staffs´ views on and experiences of experiences of caring for patients with dementia who are admitted to hospital. Method: A literature review was done in a systematic way, the result was based on eight quality original articles Results: The results are based on three main categories: Nursing Staff's experiences of and view on their own role in the care of patients with dementia, nursing staff's experiences of and views on patients with dementia and their needs as well as nursing staff experiences of and view on management, organization and the environment in relation to patients with dementia. Conclusion: Dignity and integrity of persons with dementia disappear in hospital departments due to that the person-centred care decreases when nursing staff have a stereotypical image of people with dementia, as there are time constraints on the wards, that the environment of the department is not optimal for this type of patients and that hospitals' management taking wrong decisions and do not have sufficient understanding of the situation on the wards.

Bakgrund: Bröstcancer är den vanligaste cancerformen som drabbar kvinnor. Biverkningarna av behandlingarna är många och påfrestande och kan leda till psykisk ohälsa. Trots en stor chans att överleva påverkas kvinnornas psykiska tillstånd. Detta beror bland annat på grund av den förändrade kroppsuppfattningen efter behandlingarna. När sjuksköterskan arbetar personcentrerat är målet att inkludera och stötta patienten. Syfte: Beskriva vilka faktorer som bidrar till en förändrad kroppsuppfattning efter en bröstcancerbehandling. Metod: En litteraturöversikt som baserats på 15 vetenskapliga artiklar. Resultat: Kvinnornas förändrade kroppsuppfattning kan beskrivas utifrån fyra kategorier och dessa är; synliga kroppsförändringar, faktorer som påverkar den psykiska hälsan, sexualitet, information och stöd. Konklusion: Det fanns flera faktorer till att kvinnornas kroppsuppfattning förändrades efter bröstcancerbehandling. Behandlingens biverkningar påverkade kvinnorna negativt, både fysiskt och psykiskt. Att förlora ett eller båda brösten samt att tappa håret gjorde att den kvinnliga identiteten blev lidande. De fysiska förändringarna påverkade den psykiska hälsan och kvinnorna riskerade att drabbas av depression och ångest. Många upplevde ett missnöje med sin kropp och kände sig mindre attraktiva inför sin partner vilket i sin tur ledde till att de valde att ta avstånd från sexuella aktiviteter. Det fanns ett stort behov av stöd och information från hälso-och sjukvårdspersonalen. / Background: Breast cancer is the most common type of cancer that affects women. The side effects of treatments are many and stressful and may result in mental illness. Even though the chances for surviving are good women’s mental health are affected. This is, for instance, because of the changed body image after the treatments. The nurse’s aim with the personcentered- care is to include and support the patient. Aim: To describe what factors contribute to a changed body perception after breast cancer treatment. Method: A literature review based on 15 scientific articles. Results: Women’s changed perception of her body can be described in four categories, and these are; visible changes of the body, mental health, sexuality, need for support. Conclusion: There were many factors that changed the body image after breast cancer treatment. The side effects of the treatments affected women both physically and psychologically. Losing one or two breasts and hair loss caused the female identity to suffer. The physical changes affected mental health and women were at risk of depression and anxiety. Many experienced a dissatisfaction with their body and felt less attractive to their partner, which in turn led them to distance themselves from sexual activities. There was a great need for support and information from healthcare professionals.

The social work profession requires the accumulation of theory, knowledge, skills and their integration into practice. The department of social work at UNISA trains students according to the person-centred approach (PCA). The question thus arises whether the social workers trained in PCA at UNISA are able to integrate theory into practice in their different areas of employment. Exploring this would give the department of social work an opportunity to re-visit the teaching of PCA and make some improvements if necessary. The qualitative study was conducted with social workers employed in different welfare organizations in Pretoria. The following themes emerged from the analysis: the perceived significance of building relationship with clients, the organizational influence in counselling, unique experiences with regard to colleagues who graduated from other institutions, challenges in handling a conflict or crisis situation, and lastly the nature of statutory cases. The conclusions were drawn and recommendations were presented. / Social Science / M.A. (Mental Health)

Irritable Bowel Syndrome är en vanlig kronisk mag-tarmsjukdom som medför konsekvenser i det vardagliga livet för den som lever med sjukdomen. Än idag är orsaken till sjukdomen okänd, likväl finns inga tydliga riktlinjer för hur den ska behandlas. Syfte: Att belysa upplevelsen av att leva med Irritable Bowel Syndrome. Metod: Studien genomfördes som en systematisk litteraturstudie med induktiv ansats. Resultat: Resultatet baserades på nio kvalitativa vetenskapliga artiklar. Utifrån meningsenheter framkom tre huvudkategorier; Ett begränsat liv, Emotionell påverkan och Behov av förståelse och stöd med tillhörande sex underkategorier; Social isolering, Brist på energi, Rädsla och oro, Frustration, Att inte bli tagen på allvar av hälso- och sjukvårdspersonal och Att förstå och acceptera sin sjukdom. Slutsats: Att leva med Irritable Bowel Syndrome medförde begränsningar i det vardagliga livet. Det handlade både om professionella och privata områden. Att leva med den kroniska sjukdomen påverkade de drabbade individerna emotionellt eftersom de uttryckte att de inte kunde leva ett ”normalt” liv på grund av de oförutsägbara och genanta symtomen. I möten med hälso- och sjukvårdspersonal var det viktigt att ett personcentrerat förhållningssätt användes. Resultatet visade att individer med IBS uttryckte frustration över att inte få information och kunskap om deras sjukdom samt brist på evidensbaserad behandling. Därför behöver forskning bedrivas inom området. / Irritable Bowel Syndrome is a common chronic gastroinestinal disease that has consequenses in the everyday life for persons living with the condition. Still the cause of the disease is unknown, yet there is no clear guidelines how to treat it. Aim: To highlight the experience of living with Irritable Bowel Syndrome. Method: The study was conducted as a systematic literature study with inductive approach. Result: The result was based on nine qualitative scientific articles. Based on meaningful extracts three main categories were formed; A limited life, Emotional impact and The need for understanding and support. Six related subcategories were formed; Social isolation, Lack of energy, Fear and worry, Frustration, Not to be taken seriously by healthcare professionals and To understand and accept the disease. Conclusion: Living with Irritable Bowel Syndrome caused limitations in everyday life. It limited both the professional life and the private life. To live with a chronic disease affected the individuals emotionally because they expressed that they could not live a ”normal” life because of the unpredicable and embarrassing symptoms. In the meeting with healthcare it was important that a person-centered approach was used. The results showed that individuals living with IBS expressed frustration about not getting information and knowledge about their disease and treatment options. Because of this research needs to be conducted about the chronic condition and potential treatments.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / A Abordagem Centrada na Pessoa (ACP), fundada por Carl Rogers, sà pode ser justificada a partir de um conjunto de valores e de uma Ãtica e nÃo somente como uma aplicaÃÃo de tÃcnicas e conhecimentos. AlÃm disto, a partir dos estudos de Figueiredo (1996) fica estabelecida a importÃncia do Ãthos como busca de um lugar para o Outro na constituiÃÃo das psicologias. Naquilo que se refere ao Lugar do Outro na constituiÃÃo da subjetividade, Freire (2002) investiga o lugar para a alteridade nas diversas psicologias modernas e afirma que, na ACP, o lugar para a alteridade radical levinasiana està vacante, assim como nas demais psicologias. O Outro, conforme postulado por LÃvinas (2008 [1961]), à precedente e transcendente ao Eu; nÃo sendo possÃvel totalizÃ-lo e compreendÃ-lo inteiramente, ele apresenta a dimensÃo do estranho na experiÃncia psicolÃgica. Este Outro nÃo à figura tÃo cara para as psicologias como aparenta ser. Por outro lado, Peter Schmid (1999) concebe que a Ãtica à a primeira questÃo a ser pensada quando se trata da ACP, quer de sua teoria, quer de sua prÃtica. Daà que este trabalho objetivou apresentar a obra de Peter Schmid à comunidade brasileira da abordagem rogeriana. A perspectiva deste autor està alicerÃada em um diÃlogo importante com as filosofias do diÃlogo e uma visÃo do humano como radicalmente pessoa, o que oferece outra forma de encarar a alteridade na teoria e prÃtica rogerianas. Tal mudanÃa apresenta uma profÃcua aproximaÃÃo com a filosofia Ãtica de Emmanuel LÃvinas. Como metodologia para o estudo, utilizou-se um quase-mÃtodo inspirado nas filosofias de LÃvinas (2008 [1961]) e Derrida (2008), em que buscamos, entre outras coisas, pÃr à mostra a polissemia dos discursos estudados. Concluiu-se que, apesar da perspectiva formulada por Schmid apresentar divergÃncias com a Ãtica levinasiana, ao fazer releituras dos principais conceitos da ACP, ela apresenta uma maior aproximaÃÃo com aquela e uma nova forma de lidar com a alteridade dentro do arcabouÃo da abordagem rogeriana. Espera-se, com este trabalho, fomentar um maior diÃlogo e produÃÃo acerca do cuidado clÃnico e psicoterapÃutico com a pessoa e o lugar oferecido para a alteridade na psicologia rogeriana. / The Person Centred Approach (PCA), founded by Carl Rogers, can only be justified from a set of values and ethics and not only as an application of skills and knowledge. Furthermore, from studies of Figueiredo (1996), it is established the importance of ethos as a search for a place to the Other in the constitution of psychologies. In what refers to the place of the Other in the constitution of subjectivity, Freire (2002) investigates the place to alterity in several modern psychologies and states that in PCA, the place for Levinasâ radical alterity is vacant, as in other psychologies. The Other, as postulated by Levinas (2008 [1961]), is precedent and transcendent to the I; not being possible to totalize and understand it fully; it shows the dimension of the strange in the psychological experience. This Other is not so dear figure to psychologies as it appears to be. On the other hand, Peter Schmid (1999) conceives that ethics is the first issue to be considered when it comes to PCA, either its theory or its practice. Hence, the present paper aims to present the work of Peter Schmid to the Brazilian community of Rogerian approach. The perspective of this author is grounded in an important dialogue with the philosophies of dialogue and a vision of the human as radically a person, which offers another way to face the alterity in Rogerian theory and practice. Such change presents a fruitful approach to ethical philosophy of Emmanuel Levinas. A methodology for the study, we used an almost-in-method inspired by the philosophies of Levinas (2008 [1961]) and Derrida (2007), in which we seek, among other things, to put on display the polysemy of the studied speeches. We conclude that, despite the divergences among the prospect formulated by Schmid with Levinasian ethics, doing readings of the main concepts of the PCA, it shows a closer relationship with that one and a new way of dealing with the alterity within the framework of the Rogerian approach. With this work, we hope to foment a greater dialogue and production on the clinical and psychotherapeutic care of the person and the place offered to otherness in Rogerian psychology.