Tidiga missfall är vanligt förekommande och det kan ha stor psykisk påverkan på kvinnan. Hon kan känna sig deprimerad och uppleva sorg en längre tid efter missfallet. Studier har visat att kvinnor behöver stöd och samtal för att lättare kunna hantera sorgen. Barnmorskan arbetar utefter en personcentrerad vård där kvinnans fysiska och psykiska behov står i centrum. Barnmorskans roll är att finnas där för kvinnan och hjälpa henne i sorgeprocessen. Kvinnor kan ha olika tankar om vad som är bäst för henne vid missfallet och behovet av stöd kan se olika ut. Vården vid missfall bedrivs på olika sätt i olika delar av Sverige. Syftet med studien är att belysa kvinnors upplevelse av stöd från vårdpersonal i samband med tidigt missfall. Metoden som använts är en kvalitativ innehållsanalys med en induktiv ansats. Sju kvinnor från olika delar av Sverige har intervjuats. Studien resulterade i fem kategorier: Övergivenhet, Bekräftelse, Ovisshet, Trygghet och Maktlöshet med temat; En variation av känslor som påverkar helhetsupplevelsen. Det finns en tydligare plan i vården för de kvinnor som haft upprepade missfall än de som haft enstaka missfall. Det var en skillnad mellan dessa grupper när det gäller vilket stöd de fått. Trots att vårdpersonalen är medveten om missfallets påverkan på kvinnan så upplever kvinnorna att de inte fått det individanpassade stöd som de önskat. Barnmorskan bör i större utsträckning ha ansvaret för kvinnor som genomgår missfall då detta ligger inom deras profession, sexuell och reproduktiv hälsa. Alla kvinnor bör få en mer jämlik vård när vården är personcentrerad redan vid första missfallet. / Early miscarriages are common, and it can have a major psychological impact on a woman. She may feel depressed and experience grief for a long time after. Studies have shown that women need support and interlocution to more easily handle the grief. The midwife work according to a person-centered care where the woman's physical and psychological needs are central. The midwife role is to be there for the woman and help her in the grieving process. Women may have different ideas about what is best for her at her miscarriage and the need for support can take different forms. Care for miscarriage is conducted in different ways in different parts of Sweden. The purpose of the study is to highlight women's experiences of support from health professionals in connection with early miscarriage. The method used is qualitative content analysis using an inductive approach. Seven women from different parts of Sweden were interviewed. The study resulted in five categories: Abandonment, Confirmation, Uncertainty, Confidence and Powerlessness with the theme; A variety of feelings that affect the overall experience. There is a clearer plan of care for women with recurrent miscarriages than for those with a single miscarriage. There was a difference between these groups in terms of the support they received. Although the care staff is aware of the miscarriage impact on the woman, the experiences of the women were that they did not receive the individualized support they required. The midwife should to a greater extent be responsible for women undergoing miscarriage when this is within  their profession, sexual and reproductive health. All women should get a more equitable care if the care is person-centered at the first miscarriage.

Bakgrund: För den individen som har diabetes typ två, som är en kronisk sjukdom medför sjukdomen planering och struktur för att få en vardag i välmående tecken att fungera. Det förutsätter att individen reglerar egenvården i form av följsamhet i behandlingsplan och upprättande av en hälsosam livsstil som har betydelse för individens upplevelse av livssituationen. Egenvård är ett förekommande begrepp inom diabetesvården som ställer både krav på individen men även anhöriga och sjuksköterskan i form av förståelse och att ge stöd vid behov. Syfte: Att beskriva individers upplevelser av att leva med diabetes typ två. Metod: Litteraturöversikt med 14 artiklar utifrån kvalitativ metod med induktiv design analyserades med hjälp av Fribergs femstegsmodell. Resultat: Att leva med diabetes typ två innefattade upplevelser av hanterbarhet och känslor av maktlöshet. Sjukdomen ställer krav på nya livsstilsvanor och förutsätter ett positivt sätt att tänka och prioritet av hälsan. Socialt stöd från omgivning som anhöriga, bekanta och sjuksköterska vid bristande egenvårdskapacitet var värdefullt för att kunna hantera sjukdomen och uppleva hälsa. Rädsla och oro fanns hos individer inför att hamna i utanförskap till omgivningen och för sjukdomsförsämring. Slutsats: Kontroll upplevdes genom kunskap och stöd från omgivning samt förståelse och när sjuksköterskan bekräftade personens livssituation. / Background: For the individual with diabetes type two, which is a chronic disease causes the need of planning and structure to experience health in daily life. It assumes that individuals regulate their own health care in terms of adherence to the treatment plan and the establishment of a healthy lifestyle that is important for the individual's experience of life situation. Self-care is a common concept in diabetes care that places both the demands on the individual but also the family and the nurse in the form of understanding and to provide support if necessary. Purpose: To describe individual's experiences of living with diabetes type two. Method: Literature review of 14 articles of qualitative method with inductive design and were analyzed with help of Friberg five-step model. Results: Living with diabetes type two included the experiences of control and feelings of powerlessness. The disease requires new lifestyle habits, and assumes a positive way of thinking and priority of health. Social support from the surroundings as relatives, acquaintances and nurse at the lack of self-care capacity was valuable to be able to manage the disease and experience health. Fear and anxiety were in individuals face of exclusion to the environment and disease progression.Conclusion: Control was perceived through knowledge and support of the environment and understanding and when the nurse confirmed the person's life situation.

A impotência, como uma das possíveis respostas psicossociais ao adoecer, caracteriza uma necessidade de cuidado de enfermagem. A descrição dos indicadores dessa resposta em pacientes pós-operados por insuficiência coronariana e disfunção valvar foi o núcleo do presente estudo. Os objetivos foram: descrever a impotência quanto à freqüência, intensidade e características definidoras, comparar a impotência (freqüência e intensidade) e o “locus de controle" entre os pós-operados por insuficiência coronariana e disfunção valvar, verificar a existência de associação entre impotência e o “locus de controle" nessa amostra. A coleta de dados foi feita por entrevista com base em dois instrumentos: o primeiro construído especificamente para este estudo, para avaliar a impotência, e o segundo foi a Escala de Locus de Controle da Saúde de WALLSTON, K.A; WALLSTON, B.S; DEVELLIS (1978). Houve um julgamento quanto à presença e intensidade do diagnóstico impotência. As dimensões avaliadas pela Escala de Locus de Controle foram: interno, externo e acaso. Esses procedimentos foram realizados junto a 75 doentes, sendo 45 com insuficiência coronariana e 30 com disfunção valvar, sendo 62,7% do sexo masculino; idade média de 57,2 anos; escolaridade média de 6,4 anos; tempo médio de pós-operatório à coleta dos dados de 7,5 dias. Dos 75 pacientes, 44 apresentaram impotência (leve=20; moderada= 15 e intensa= 9). Das 17 características definidoras estudadas, 12 foram significativamente mais freqüentes em nível de 5% de significância nos doentes com impotência. As proporções de impotentes nos dois grupos de pacientes com insuficiência coronariana e disfunção valvar foram semelhantes, não havendo diferenças estatisticamente significantes (p=0,848). Os pacientes pós-operados coronarianos acreditavam mais em fatores internos como fonte de controle dos que os pacientes de disfunção valvar (“locus" interno p=0,001; internalidade total p=0,002) Não houve associação entre impotência e “locus de controle" em nível de 5%, sugerindo que as dimensões de “locus de controle" não são atributos isolados essenciais do conceito de impotência. Os resultados deste estudo permitiram estabelecer outras questões de pesquisa e corroboram a importância do desenvolvimento do conhecimento sobre as respostas psicossociais do doente em situações médico-cirúrgicas. / Powerlessness as one of the possible psychosocial responses of illness, characterizes a necessity for nursing care. The description of the indicators of this response in post-operative patients with coronary insufficiency and valve dysfunction was the core of this study. The objectives were: to describe powerlessness (frequency and intensity), and the “locus of control" between the post-operated patients for coronary insufficiency and valve dysfunction, and to verify the existence of association between powerlessness and the “locus of control". The data were obtained by means of interviews based on two tools: the first one was organized specifically for this study to assess powerlessness, and the second was the “Locus of Control Health Scale" of WALLSTON, K.; WALLSTON, B.S; DEVELLIS (1978). The presence and intensity of powerlessness was judged by the author. The “locus of control" dimensions assessed were: internal, external and chance. These procedures were carried out on 75 patients of which 45 had coronary insufficiency and 30 had valve dysfunction; 62.7% were male with mean age of 57.2 years; average schooling of 6.4 years; mean post-operative data collection time of 7.5 days. Of the 75 patients, 44 presented powerlessness (low=20; moderate=15; severe=9). Of the 17 defining characteristics studied, 12 were significantly more frequent (p0.05) for powerless patients. The proportion of powerlessness in the two groups (coronary insufficiency and valve dysfunction) were similar (p=0.848). The post-operated coronary patients believed more in internal factors than the patients with valve dysfunction (“internal locus" p=0.001; “total internality" p=0.002). There was no association between powerlessness and “locus of control" (p0.05), thus suggesting that the dimensions of “locus of control" are not, in essence, isolated attribute of the concept of powerlessness. The results of this study permitted further questioning of research and corroborated the importance of knowledge development on psychosocial responses of patients in medical-surgical situations.

La question des implications sociales et environnementales des activités économiques et de leur gestion ou gouvernance traverse aujourd’hui largement le champ académique des sciences de gestion. Pour autant, le potentiel transformateur de cette RSE continue largement de poser question. Les auteurs nourrissant une analyse critique de cette dernière arguent que, plus qu’une transformation ou qu’une démocratisation des espaces de régulation de problématiques sociales et environnementales devenues transnationales, la RSE serait à resituer dans une analyse des rapports de force à l’œuvre. A défaut d’inclure les différents intérêts en présence, la RSE prendrait finalement la forme d’un pouvoir discursif offrant au contraire le maintien et la perpétuation de pratiques et asymétries de pouvoir inchangées, et marginalisant les opposants ou témoins susceptibles de contrevenir à cette continuité. Inscrit dans le courant des perspectives critiques en management, ce travail doctoral s’est donné pour projet de venir comprendre et mettre au jour les rouages et procédés permettant l'édification d’une puissance industrielle à même de fermer les issues en sa défaveur et d’assurer les conditions de sa propre perpétuation. Ce travail accorde en particulier une place centrale aux implications et aux marges de l’histoire, offrant de considérer les moyens dévolus à la mise en impuissance des contestations et tentatives de remise en cause de cet ordre dominant, et dans le conteste de politiques de RSE. Quelles modalités, mécanismes ou boîtes noires viennent sous-tendre le processus de légitimation des entreprises vis-à-vis des externalités sociales et environnementales qu’elles produisent ? Quelles techniques ou technologies du pouvoir viennent-elles mobiliser pour se constituer en macro-acteurs légitimes ? Comment permettent-elles leur maintien et leur renouvellement en dépit des conflits, des contestations et des dénonciations venant les remettre en cause ? Pour permettre l’analyse de ces différents points, une étude exploratoire fut réalisée et prolongée de l’étude du cas Weda Bay Nickel, projet minier développé par la multinationale française Eramet dans une lointaine Indonésie. Inscrite dans une posture constructiviste pragmatique, la démarche qualitative adoptée cherchait à comprendre et à déconstruire ce projet minier, présenté comme exemplaire en matière de RSE et pourtant largement contesté, par la recension systématique des documents produits et publiés à son sujet, la réalisation d’interviews auprès de diverses parties prenantes (N=41), ainsi qu’une ethnographie de trois semaines principalement effectuée dans la baie de Weda, et plus largement dans la province indonésienne des Moluques du Nord, constituant le théâtre de son implantation.Inscrit dans la tradition des postures analytiques descriptives et narratives, ce travail doctoral propose une mise en récit processuelle du cas offrant de caractériser le contexte de fabrication d’une puissance WBN et de mettre au jour sa transformation d’hypothèse spéculative en projet de développement ne pouvant plus qu’advenir, produit des contingences de l’histoire, de la nécessité de retour sur investissement auto-générée et d’un réseau d’intérêts bien compris. Par ailleurs, la mise en impuissance des contestations, révoltes et mobilisations s’étant faites jour à son encontre sera également étudiée, de sorte qu’elle se voit reconnaître sa place de produit des échecs successifs subis par une contestation bien réelle et active. Aussi, plus qu’un pendant inéluctable de la puissance, l’impuissance collective des acteurs s’étant opposés au projet minier WBN se présentera comme un construit, le produit d’une fabrique où les pouvoirs de cadrage et de contrainte des partisans de la mine apparaissent finalement moins empreints d’une quête de légitimation, qu’apparentés à un processus d’écrasement vécu comme indiscutable et irréversible par les parties prenantes sans pouvoir. / The academic field of organization studies has paid, in the past several years, a growing attention to the social and environmental impacts of economic activities, to their management as well as their governance. The idea of a corporate social responsibility (CSR) came to materialize and embody the commitment of corporations against unsustainable activities, even if the voluntary or constrained character of this phenomenon remains a matter of debate. Additionally, the prospects of CSR in terms of concrete transformations leading to more sustainable and democratic practices are still questioned. Critical scholars of CSR have, more recently, tackled these issues by pointing to the need for bringing power struggles back in the study of CSR. Although CSR principles aim at managing a multiplicity of stakeholders, critical scholars have highlighted that CSR practices took shape as a discursive power designed for maintaining and enforcing existing practices and power asymmetries, thanks to a marginalization of protestors and those trying to threaten their continuity.This doctoral project is precisely drawing upon such critical perspectives on CSR in order to understand comprehensively the political mechanisms according to which a corporate power manages to rise so as to counter potential protests and secure its own perpetuation. More particularly, this project devotes a significant attention to the implications of such corporate power on powerless stakeholders, highlighting the specific means implemented to manufacture powerlessness, starting from the following research questions: what are the modalities, mechanisms and black boxes upon which the legitimation process of corporations’ social and environmental impacts relies? What are the techniques and technologies of power designed and implemented by corporations in order to do so? How do they manage to maintain and renew their power in the face of struggles, contests and denunciations trying to challenge it?The design of this doctoral project relied on two different stages: an exploratory study of a multiplicity of CSR discourses articulated within and around a political CSR arena of the mining industry ; an in-depth case study of Weda Bay Nickel, i.e. a mining project undertaken by a French multinational corporation, Eramet, in far-off Indonesia. The methodological background of the doctoral project draws upon pragmatic constructivism and qualitative methods in order to comprehend and deconstruct the paradox according to which the Weda Bay Nickel case is at the same time praised for its exemplariness and fiercely contested. Data collection consisted in a systematic inventory of published data, interviews with a multiplicity of stakeholders (N = 41), as well as a period of three weeks ethnography in the Indonesia North Maluku region, where the mining deposit is located. Data analysis was conducted following a descriptive narrative approach, allowing for the production of a narrative which starts from the context of manufacture of corporate powerfulness, from a mere object of geological then financial speculation to a project of development that must be achieved, thanks to historical contingencies, return-on-investment self-fulfilling imperatives, as well as the forging of a coalition of interests. The narrative continues to portray the manufacture of powerlessness of protesters, rebellions and social movements, highlighting that the failure to contest corporate power cannot be associated to a powerlessness per se. Accordingly, the manufacture of powerlessness is shown to be of a socially constructed nature, relying on the implementation of framing and coercive forms of power by the corporation and its allies. Framing and coercion being the cornerstones of a policy that seems to go far beyond a search for legitimation. Instead, they can be subsumed into the idea of a domination process, experienced as non-disputable and non-reversible by the powerless stakeholders.

Un nombre croissant de professionnels qui pratiquent l'éducation thérapeutique du patient s'interrogent sur leurs pratiques et considèrent qu'une éducation qui vise seulement une meilleure compliance ou adhésion au traitement par la transmission d'informations en rapport avec la maladie et le traitement est inefficace et fortement réductrice de la personne malade. Ces professionnels considèrent que dans le cadre de la relation de soins, les patients doivent avoir une place pour exprimer leurs préférences et leurs réticences, ce qu'ils espèrent pour eux et ce qui est difficile pour eux dans leur vie de tous les jours, afin de participer au choix des modalités de leur traitement, qui acquiert alors un statut de traitement « proposé » et «négocié », plutôt que «prescrit» par le médecin. Une telle relation de soins, qui s'appuie sur un patient-sujet, s'inspire d'une philosophie humaniste qui affirme le droit à l'auto-détermination de chaque individu et qui reconnaît à chaque personne la capacité et le désir d'être l'acteur de sa vie. Dans une telle perspective, la finalité de l'éducation est de permettre aux patients d'exercer un meilleur contrôle sur leur vie, et pas seulement sur leur maladie et leur traitement. Il est courant d'utiliser le terme de « empowerment » pour désigner ce processus par lequel une personne malade, au départ d'une situation ou d'un sentiment d'impuissance (powerlessness), augmente sa capacité à identifier et satisfaire ses besoins, résoudre ses problèmes et mobiliser ses ressources, de manière à avoir le sentiment de contrôler sa propre vie. Afin de mieux comprendre dans quelle mesure les soignants peuvent effectivement contribuer à l'empowerment des patients atteints de maladie chronique, la signification de l'empowerment du patient a été explorée par une double approche : 1. exploration de la signification de l'empowerment en tant qu'expérience vécue par des patients atteints de maladie chronique : 40 entretiens qualitatifs semi-dirigés ; 12 maladies représentées ; méthodes d'analyse inspirées de la phénoménologie et de la théorisation ancrée (grounded theory). 2. exploration de la signification de l'empowerment en tant que concept utilisé à des fins de recherche ou de pratique : revue de littérature portant sur 55 articles scientifiques parus entre 1995 et 2006 ; analyse qualitative de contenu. Alors que les résultats de la revue de littérature présentent les finalités de l'empowerment comme étant essentiellement la capacité de participation dans la relation de soins et un sentiment de maîtrise quant à l'adoption et au maintien de comportements d'auto-soins, l'analyse des entretiens montre que les situations ou sentiments d'impuissance à partir desquels un processus d'empowerment est susceptible d'émerger dépassent largement ces questions. En effet, les personnes malades expriment souvent être ou avoir été confrontées à des sentiments d'insécurité et de rupture d'identité, qui ont été (ou non) à l'origine d'un processus de transformation personnelle, au cours duquel un effort de dissociation identitaire visant à développer ou maintenir un sentiment de maîtrise était accompagné d'un travail de réconciliation identitaire, marqué par la capacité de "lâcher prise" et une recherche de sens, visant à acquérir un plus grand sentiment de cohérence.

Bakgrund: Känslor av maktlöshet kan påverka sjuksköterskors engagemang och ansvar för patienter. Sjuksköterskor har i sin profession ansvar för patienters omvårdnad och vill hjälpa patienter att bli friska. När sjuksköterskor inser att målet inte kan fullföljas kan känslor av maktlöshet uppstå. Syfte: Att beskriva sjuksköterskors upplevelser och erfarenheter av maktlöshet vid vård av patienter. Metod: Litteraturstudie med kvalitativ ansats. Baseras på 12 vetenskapliga artiklar. Resultat: Av analysen framkom att sjuksköterskor upplever maktlöshet i olika vårdsammanhang. Fyra rubriker identifierades: otillräcklighet, frustration, rädsla och förlorad kontroll. Diskussion: Maktlöshet har diskuterats utifrån två påståenden: Höga krav har visat sig ge känslor av maktlöshet hos sjuksköterskor. När läkare inte lyssnar på sjuksköterskor känner de sig maktlösa. Konklusion: Maktlöshet är negativt laddat och kan ge konsekvenser för den enskilda sjuksköterskan och omgivningen. Ytterligare forskning om fenomenet maktlöshet samt strategier för att minska dessa känslor bör uppmärksammas. / Background: Feelings of powerlessness can affect nurses’ commitment and responsibility for patients. In their profession the nurses’ has responsibility for the patients and wants to help the patients get well. When the nurses’ realize that the goal can’t be achieved a sense of powerlessness can occur. Aim: Was to describe nurses’ experiences of powerlessness when caring for patients. Method: A literature review with a qualitative approach. The study was based on 12 scientific articles. Result: From the analysis four categories of nurses’ experiences of powerlessness emerged. They were: inadequacy, frustration, fear and lack of control. Discussion: Powerlessness has been discussed based on two statements: It has been shown that high demands give feelings of powerlessness among nurses’. When physicians don’t listen to the nurses’ they feel powerless. Conclusion: Powerlessness is a negative feeling and can give consequences for the nurse and the surrounding people. Further research about the phenomenon of powerlessness is needed and strategies to reduce those feelings.

A impotência, como uma das possíveis respostas psicossociais ao adoecer, caracteriza uma necessidade de cuidado de enfermagem. A descrição dos indicadores dessa resposta em pacientes pós-operados por insuficiência coronariana e disfunção valvar foi o núcleo do presente estudo. Os objetivos foram: descrever a impotência quanto à freqüência, intensidade e características definidoras, comparar a impotência (freqüência e intensidade) e o “locus de controle” entre os pós-operados por insuficiência coronariana e disfunção valvar, verificar a existência de associação entre impotência e o “locus de controle” nessa amostra. A coleta de dados foi feita por entrevista com base em dois instrumentos: o primeiro construído especificamente para este estudo, para avaliar a impotência, e o segundo foi a Escala de Locus de Controle da Saúde de WALLSTON, K.A; WALLSTON, B.S; DEVELLIS (1978). Houve um julgamento quanto à presença e intensidade do diagnóstico impotência. As dimensões avaliadas pela Escala de Locus de Controle foram: interno, externo e acaso. Esses procedimentos foram realizados junto a 75 doentes, sendo 45 com insuficiência coronariana e 30 com disfunção valvar, sendo 62,7% do sexo masculino; idade média de 57,2 anos; escolaridade média de 6,4 anos; tempo médio de pós-operatório à coleta dos dados de 7,5 dias. Dos 75 pacientes, 44 apresentaram impotência (leve=20; moderada= 15 e intensa= 9). Das 17 características definidoras estudadas, 12 foram significativamente mais freqüentes em nível de 5% de significância nos doentes com impotência. As proporções de impotentes nos dois grupos de pacientes com insuficiência coronariana e disfunção valvar foram semelhantes, não havendo diferenças estatisticamente significantes (p=0,848). Os pacientes pós-operados coronarianos acreditavam mais em fatores internos como fonte de controle dos que os pacientes de disfunção valvar (“locus” interno p=0,001; internalidade total p=0,002) Não houve associação entre impotência e “locus de controle” em nível de 5%, sugerindo que as dimensões de “locus de controle” não são atributos isolados essenciais do conceito de impotência. Os resultados deste estudo permitiram estabelecer outras questões de pesquisa e corroboram a importância do desenvolvimento do conhecimento sobre as respostas psicossociais do doente em situações médico-cirúrgicas. / Powerlessness as one of the possible psychosocial responses of illness, characterizes a necessity for nursing care. The description of the indicators of this response in post-operative patients with coronary insufficiency and valve dysfunction was the core of this study. The objectives were: to describe powerlessness (frequency and intensity), and the “locus of control” between the post-operated patients for coronary insufficiency and valve dysfunction, and to verify the existence of association between powerlessness and the “locus of control”. The data were obtained by means of interviews based on two tools: the first one was organized specifically for this study to assess powerlessness, and the second was the “Locus of Control Health Scale” of WALLSTON, K.; WALLSTON, B.S; DEVELLIS (1978). The presence and intensity of powerlessness was judged by the author. The “locus of control” dimensions assessed were: internal, external and chance. These procedures were carried out on 75 patients of which 45 had coronary insufficiency and 30 had valve dysfunction; 62.7% were male with mean age of 57.2 years; average schooling of 6.4 years; mean post-operative data collection time of 7.5 days. Of the 75 patients, 44 presented powerlessness (low=20; moderate=15; severe=9). Of the 17 defining characteristics studied, 12 were significantly more frequent (p0.05) for powerless patients. The proportion of powerlessness in the two groups (coronary insufficiency and valve dysfunction) were similar (p=0.848). The post-operated coronary patients believed more in internal factors than the patients with valve dysfunction (“internal locus” p=0.001; “total internality” p=0.002). There was no association between powerlessness and “locus of control” (p0.05), thus suggesting that the dimensions of “locus of control” are not, in essence, isolated attribute of the concept of powerlessness. The results of this study permitted further questioning of research and corroborated the importance of knowledge development on psychosocial responses of patients in medical-surgical situations.

Partner violence is a recognized phenomenon in Sweden. Unfortunately, sibling violence does not seem to be noticed at all. Thoughts regarding whether there is any reason to differentiate between violence between adults and violence between siblings arose, which is why the purpose of the study is to compare differences between sibling violence and violence between adults. In summary, the results show that both violence between adults and sibling violence is a normalized violence in society, even though sibling violence seems to be even more normalized. In addition, the results show as in previous research that all forms of violence, such as physical, psychological, material and latent violence, are found in both sibling violence and partner violence. Even though, there is some disagreement about how they should be named. Finally, the essay shows how violence arises as a result of powerlessness, which is why the importance of defining violence based on the function of the action has been identified as necessary.

Bakgrund: Venös insufficiens är en kronisk sjukdom som kan orsaka venösa bensår. Livssituationen för patienter med venösa bensår förändras när de tvingas förhålla sig till symtom från såret såsom smärta, klåda, sårvätska och odör, samt till en långvarig läkeprocess med besvärande kompressionsbehandling. Av kliniska riktlinjer framgår att sjuksköterskan skall omhänderta patienten ur ett helhetsperspektiv, men sjuksköterskor har i tidigare studier uppgivit att de saknar nödvändiga kunskaper för att möta personen bakom såret. Syfte: Att beskriva patienters upplevelser av att leva med venösa bensår. Metod: Studien utformades som en kvalitativ litteraturstudie. Resultat: Patienter med venösa bensår kan uppleva skam för rinnande sårvätska, skrymmande bandage och odör. Sårrelaterad smärta leder till fysiska begränsningar, som i kombination med skam, oro och osäkerhet ger patienterna en begränsad tillvaro. Den långa och osäkra läkeprocessen leder till känslor av hopplöshet, sorg och maktlöshet. Slutsats: Begränsningarna som patienterna upplever kan leda till social isolering och nedsatt fysisk aktivitet. Maktlöshet, sorg och hopplöshet kan leda till en sämre hälsa. Ovanstående konsekvenser av den förändrade livssituationen kan i sin tur påverka sårläkningen negativt. Sjuksköterskan kan ge stöd till patienten genom att använda humor, skapa mötesplatser och tillämpa empowermentstrategier. Klinisk betydelse: Patienter kan uppleva ett bättre bemötande när sjuksköterskan har en god förståelse för de besvär som såren orsakar. Förståelsen kan även vara till hjälp när sjuksköterskor planerar stödåtgärder till patientgruppen. / Background: Venous insufficiency is a chronic disease that can cause venous leg ulcers. Living conditions of patients with venous leg ulcers are changed when they need to adapt to wound symptoms such as pain, itching, exudate and odour, as well as a prolonged healing process with disturbing compression therapy. Clinical guidelines show that nurses should have a holistic approach to patient care, but in previous studies nurses have indicated lack of necessary skills to meet the person behind the wound. Purpose: To describe patients' experiences of living with venous leg ulcers. Method: The study was designed as a qualitative literature study. Results: Patients with venous leg ulcers may experience shame for running exudate, bulky bandages and odour. Wound pain leads to physical limitations, which in combination with shame, anxiety and uncertainty gives patients a restricted life. The long and uncertain healing process results in feelings of hopelessness, sadness and powerlessness. Conclusion: Limitations that patients experience may lead to social isolation and reduced physical activity. Powerlessness, sadness and hopelessness may lead to poor health. The above consequences of the changed life conditions may in turn influence wound healing. Nurses can provide patients support by using humour, creating meeting places and applying empowerment strategies. Clinical significance: Patients may experience better treatment when nurses show a good understanding of the problems that wounds cause. Understanding can also be helpful when nurses plan measures to support the patient group.

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