Key Aim: The purpose of this study was to examine complex concerns and challenges encountered by counselling and psychotherapy trainers, and support them to deliver a consistent, relationship-centred learning approach within Higher Education (HE). Background: Counselling and psychotherapy training is central to regulating practice, however, studies conceptualising trainers’ concerns and challenges in the United Kingdom (UK) are sparse. Literature generally evaluates trainer challenges from a professional competence and/or gatekeeping perspective. Little evidence exists identifying problems connected with ‘professionalisation’. Aims and Objectives: The aim was to evaluate trainers’ multidimensional unease that can hinder working relationships. The intention was to: explore difficult patterns of behaviour and group dynamics in the ‘training alliance’; explore trainers’ perceptions and experiences when confronted with gatekeeping issues; collaboratively develop strategies to enhance trainers’ learning experience; examine the processes needed to sustain these strategies; and identify the lessons learnt to inform practice, education, and research. Approach and Methods: A qualitative, co-operative inquiry approach enabled trainers to question their situated and propositional knowledge, reconcile professional challenges, allay concerns about individual fitness to practice, and provide alternative responses to students, peers, and managerial hierarchies in HE and professional bodies. This approach has a political and social element, according with personal desire to make change. Thematic analysis uncovered new insights, expanded or modified principles and re-examine accepted interpretations during 8 inquiry sessions with 5 experienced trainers, and 3 associated workshops. A primarily iterative and inductive process of immersion, involved reflexive engagement, and sharing of data with trainer/practitioners. Findings: 6 overarching themes were identified: Trying to Make Sense of Significant Events; Negotiating Conflict and Incongruity in Training Groups; Navigating Inherent Challenges within Counsellor Training Teams; Teaching as a Never-Ending Challenge; Organisational Constraints and Challenges; and Contemplating Individual Connection in a Collaborative Context. Discussion and Conclusion: Findings supported previous research suggesting trainers require training, and that trainers’ concerns and challenges are interlinked; beginning with interpersonal challenges that subsequently impact on trainers’ professional and intra-personal sense of identity. Co-operative inquiry can benefit programme teams in terms of the co-construction of trainers’ realities and dynamic negotiation of meaning. Co-researchers’ knowledge and confidence in responding to potential conflict in training was enhanced. To achieve the best outcome, this knowledge needs implementing in practice; programme team involvement is a prerequisite, and support is required by professional bodies and HE to ensure ethical training practice in the face of student disgruntlement, management demands in HE and from professional accrediting bodies.

A realização deste estudo se pauta no fato de que, até o momento, não se tem conhecimento da existência de algum instrumento de abordagem quantitativa que identifica e avalia competências de enfermeiros que atuam em setores de oncologia. Dessa forma, a construção e a validação de uma ferramenta com esta finalidade poderá contribuir para a organização desses serviços, visando a identificação de potencialidades e desafios a serem percorridos por esses profissio- nais, em busca do desenvolvimento profissional e consequentemente, a melhoria na assistência ao paciente oncológico. O estudo teve como objetivo geral descrever o processo de construção e validação semântica de um instrumento para avaliação de competências de enfermeiros que atuam em oncologia. Pesquisa metodológica, realizada em duas etapas: fase teórica, composta por planejamento e seleção dos referenciais teórico-metodológicos; observações diretas, não participantes das atividades desenvolvidas por enfermeiros de uma unidade oncológica; cons- trução de domínios e itens do instrumento; validação de face e conteúdo e análise semântica realizada por enfermeiros da área. Posteriormente, temos a fase empírica que engloba o piloto. Quanto a construção e validação dos itens do instrumento, utilizou-se a ferramenta formulários Google Docs Off line, disponibilizado por meio eletrônico. Na análise semântica o instrumento foi facilmente compreendido pelos participantes, assim o instrumento ficou composto por 30 itens de competências para o enfermeiro oncológico. Foi submetido ao teste piloto com 61 en- fermeiros, predominantemente do sexo feminino, idade entre 31 e 35 anos, tempo de conclusão da Graduação entre cinco e 10 anos e experiência em oncologia acima de cinco anos. O ins- trumento demonstrou satisfatória consistência interna dos itens com alfa de Cronbach de 0,75, sendo denominado de Questionário de Avaliação de Competências de Enfermeiros que atuam em Oncologia (QACEO). A contribuição do estudo reside em descrever cada etapa do processo metodológico, bem como, disponibilizar um instrumento apropriadamente testado, que visa identificar as competências de enfermeiros que atuam na oncologia / This study is guided in the fact that, until this moment, has no knowledge of the existence of a quantitative approach instrument that identifies and evaluates skills of nurses working in on- cology sectors. Thus, the construction and validation of a tool for this purpose can contribute to the organization of these services for the identification of potentialities and challenges to be followed by these professionals in search of professional development and consequently the im- provement in patient care oncological. The study aimed to describe the process of construction and semantic validation of an instrument for evaluating skills of nurses working in oncology. Methodological research, performed in two steps theoretical phase, consisting of planning and selection of the theoretical and methodological references; direct observations, not participa- ting in the activities developed by nurses in an oncology unit; construction domains and items of the instrument; face validity and content and semantic analysis performed by nurses from the area. Subsequently, we have the empirical phase which includes the pilot. The construction and validation of the instrument items, used the Google Docs Forms Off line tool, available electronically. In the semantic analysis the instrument was easily understood by the partici- pants, and the instrument was composed of 30 items of competencies for oncology nurses. It was submitted to the pilot test with 61 nurses, predominantly female, aged between 31 and 35 years of graduation completion time between five and 10 years and experience in oncology over five years. The instrument showed satisfactory internal consistency of items with 0.75 Cron- bach\'s alpha, being denominated Nurses Competencies evaluation questionnaire of working in Oncology (QACEO). The contribution of the study is to describe each step of the methodolo- gical process, as well as provide an appropriately tested instrument, which aims to identify the competencies of nurses working in oncology

<p>Syftet med studien har varit att undersöka hur arbetsterapeuter går till väga för att genomföra en informationsöverföring till alla personliga assistenter hos en brukare samt hur arbetsterapeuter anser att informationsöverföringen till personliga assistenter fungerar. En kvalitativ ansats valdes och informationen inhämtades via intervjuer med 9 arbetsterapeuter i öppenvården i Västmanlands och Gävleborgs län. Resultatet visar att: det är få av arbetsterapeuterna som tycker att informationsöverföringen fungerar riktigt bra. Flertalet anser att det är lättare att nå fram och få en bra kommunikation med de personliga assistenterna om de är intresserade och insatta i sitt arbete. Arbetsterapeuterna beskriver att informationsöverföringen sker utifrån varje enskilt fall och hur många som är närvarande beror på vad som arbetsterapeuten vill informera om. Valet av tillvägagångssätt och hur många som man träffar inom gruppen beror mycket på vad ärendet handlar om och vilken kompetensnivå som de personliga assistenterna har. Att nå fram till alla i gruppen med information är svårt, eftersom de personliga assistenterna oftast jobbar på olika tider. Det är också svårt att veta vilka som tar eller får del av informationen då det inom vissa grupper ofta byts personal. Det är nästan uteslutande arbetsterapeuten som tar initiativ till uppföljning genom att ringa och fråga hur det har gått. Författarna kan konstatera att arbetsterapeuterna är flexibla, arbetar med både offensiv och defensiv informationsöverföring beroende på de personliga assistenternas kunskapsnivå. I sitt informationsgivande förhållande till de personliga assistenterna använder sig de flesta arbetsterapeuterna av den induktiva principen (Christensen och Jensen 2004) genom att utgå ifrån det enskilda ärendet i informationsöverföringsstillfället. Vid framtida studier av ämnet bör även de personliga assistenternas bild av informationsöverföringsprocessen delges för att ge en bredare bild av processen.</p>

Aims: The overall aim of this thesis was to explore and describe radiographers‟ professional competence based on patients‟ and radiographers‟ experiences and to develop a context-specific instrument to assess the level and frequency of use of radiographers‟ professional competence. Methods: The design was inductive and deductive. Both qualitative and quantitative methods were used. The data collection methods comprised interviews (Studies I-II) and questionnaires (Studies III-IV). The subjects were patients in study I and radiographers in studies II-IV. In study I, 17 patients were interviewed about their experiences of the encounter during radiographic examinations and treatment. The interviews were analysed using qualitative content analysis. In study II, 14 radiographers were interviewed to identify radiographers‟ areas of competence. The critical incident technique was chosen to analyse the interviews. Studies III and IV were based on a national cross-sectional survey of 406 randomly selected radiographers. Study III consisted of two phases; designing the Radiographer Competence Scale (RCS) and evaluation of its psychometric properties. A 42-item questionnaire was developed and validated by a pilot test (n=16) resulting in the addition of 12 items. Thus the final RCS comprised a 54-item questionnaire, which after psychometric tests was reduced to 28 items. In study IV, the 28-item questionnaire served as data. The level of competencies was rated on a 10-point scale, while their use was rated on a six-point scale. Results: In study I, the female patients‟ comprehensive understanding was expressed as feelings of vulnerability. The encounters were described as empowering, empathetic, mechanical and neglectful, depending on the radiographers‟ skills and attitudes. Study II revealed two main areas of professional competence, direct patient-related and indirect patient-related. The first focused on competencies in the care provided in close proximity to the patient and the second on competencies used in the activities of the surrounding environment. Each of the two main areas was divided into four categories and 31 sub-categories that either facilitated or hindered good nursing care. In study III the analysis condensed the 54-item questionnaire in two steps, firstly by removing 12 items and secondly a further 14 items, resulting in the final 28-item RCS questionnaire. Several factor analyses were performed and a two factor-solution emerged, labelled; “Nurse initiated care” and “Technical and radiographic processes”. The psychometric tests had good construct validity and homogeneity. The result of study IV demonstrated that most competencies in the RCS received high ratings both in terms of level and frequency of use. Competencies e.g. „Adequately informing the patient‟, „Adapting the examination to the patient‟s prerequisites and needs‟ and „Producing accurate and correct images‟ were rated the highest while „Identifying and encountering the patient in a state of shock‟ and „Participating in quality improvement regarding patient safety and care‟ received the lowest ratings. The total score of each of the two dimensions had a low but significant correlation with age and years in present position. The competence level correlated with age and years in present position in both dimensions but not with the use of competencies in the “Nurse initiated care” dimension. Conclusion: This thesis has shown that professional competence is important in the encounter between patient and radiographer. It has also demonstrated that radiographers‟ self-rated professional competence is based on nursing, technological and radiographic knowledge. From a radiographer‟s perspective, „Nurse initiated care‟ and „Technical and Radiographic processes‟ are two core dimensions of Radiographer Competence Scale. The 28-item questionnaire regarding level and frequency of use of competence is feasible to use to measure radiographers‟ professional competence.

Syftet med studien har varit att undersöka hur arbetsterapeuter går till väga för att genomföra en informationsöverföring till alla personliga assistenter hos en brukare samt hur arbetsterapeuter anser att informationsöverföringen till personliga assistenter fungerar. En kvalitativ ansats valdes och informationen inhämtades via intervjuer med 9 arbetsterapeuter i öppenvården i Västmanlands och Gävleborgs län. Resultatet visar att: det är få av arbetsterapeuterna som tycker att informationsöverföringen fungerar riktigt bra. Flertalet anser att det är lättare att nå fram och få en bra kommunikation med de personliga assistenterna om de är intresserade och insatta i sitt arbete. Arbetsterapeuterna beskriver att informationsöverföringen sker utifrån varje enskilt fall och hur många som är närvarande beror på vad som arbetsterapeuten vill informera om. Valet av tillvägagångssätt och hur många som man träffar inom gruppen beror mycket på vad ärendet handlar om och vilken kompetensnivå som de personliga assistenterna har. Att nå fram till alla i gruppen med information är svårt, eftersom de personliga assistenterna oftast jobbar på olika tider. Det är också svårt att veta vilka som tar eller får del av informationen då det inom vissa grupper ofta byts personal. Det är nästan uteslutande arbetsterapeuten som tar initiativ till uppföljning genom att ringa och fråga hur det har gått. Författarna kan konstatera att arbetsterapeuterna är flexibla, arbetar med både offensiv och defensiv informationsöverföring beroende på de personliga assistenternas kunskapsnivå. I sitt informationsgivande förhållande till de personliga assistenterna använder sig de flesta arbetsterapeuterna av den induktiva principen (Christensen och Jensen 2004) genom att utgå ifrån det enskilda ärendet i informationsöverföringsstillfället. Vid framtida studier av ämnet bör även de personliga assistenternas bild av informationsöverföringsprocessen delges för att ge en bredare bild av processen.

Bakgrund: Specialistsjuksköterskans kompetens är en fördjupning av de kunskaper och förmågor som erhållits i grundutbildningen. Behovet av specialiserade sjuksköterskor ökar men då arbets-uppgifterna mellan grund- och specialistutbildade sjuksköterskor inte skiljer sig nämnvärt åt kan detta få till följd att specialistsjuksköterskorna lämnar det kliniska arbetet. Den specialistkompetens som efterfrågats riskerar därmed att försvinna. På denna grund, och som ett led i att förtydliga specialistsjuksköterskans roll i psykiatrisk slutenvård, är det av intresse att uppmärksamma hur specialistsjuksköterskan uppfattas och vilka förväntningar som finns på dennes kompetens. Syfte: att beskriva läkares uppfattningar av specialistsjuksköterskans kompetens i psykiatrisk vård. Metod: Åtta kvalitativa semistrukturerade intervjuer analyserades med en fenomenografisk ansats. Resultat: Huvudresultaten sammanfattades i fem kategorier: Specialistsjuksköterskans roll är otydlig och osynlig; Specialistsjuksköterskan utför särskilda arbetsuppgifter; Specialistsjuk-sköterskan besitter fördjupad kompetens; Specialistkompetens leder till personlig utveckling samt Specialistsjuksköterskan är en ambassadör. Slutsats: Det behövs en ökad förståelse för specialist-sjuksköterskans kompetens. För att detta ska kunna ske efterfrågas en tydligare beskrivning av vad det innebär att arbeta som specialistsjuksköterska på en psykiatrisk slutenvårdsavdelning. / Background: The competence of the specialised nurse is a development of the knowledge and skill obtained in the elementary nursing education. The need for specialised nurses increases but as the work tasks of specialised and general nurses do not differ considerably, this may lead to the specialised nurses leaving the clinical area of work. The requested expertise will then be at risk of disappearing. On these grounds and as a way of clarifying the role of the specialised nurse in psychiatric in-patient care, it is of interest to observe how the specialised nurse is perceived and what the expectations of her competence are. Aim: to describe doctors' conceptions of the competence of the specialised nurse in psychiatric in-patient care. Method: Eight qualitative semi-structured interviews were analysed using a phenomenographic approach. Results: The main findings were summarised in five categories: The role of the specialised nurse is unclear and unseen; The specialised nurse executes special tasks; The specialised nurse possesses in-depth competence; Specialist skill leads to personal development and finally The specialised nurse is an ambassador. Conclusion: There is a need for an increased understanding of the competence of the specialised nurse in psychiatric in-patient care. In order for this to happen a clearer descripton of what it entails to work as a specialised nurse in in-patient care is requested.

Syftet var att undersöka hur sjuksköterskor, inom hemsjukvården, uppfattar sin egen kompetens och sitt behov av stöd i relation till sina arbetsuppgifter. Metoden är en enkätstudie. Enkäten förmedlades via e-post. Urvalet utgjordes av 131 sjuksköterskor inom hemsjukvården i en större stad i Mellansverige, varav 15 av sjuksköterskorna deltog i studien. Resultatet visar att den egenuppfattade kompetensen hos deltagarna var hög och majoriteten av de sjuksköterskor som medverkade känner sig trygga i att arbeta självständigt och att utföra sitt uppdrag som sjuksköterska inom hemsjukvården. Stödet från sjuksköterskekollegor anses som viktigt, dock önskas mer tid eller möjlighet att diskutera patienters vårdproblem. Att ha en bra arbetsrelation med sin läkare upplevs som mycket viktigt hos deltagarna. Majoriteten önskade ett mer omfattande samarbete med läkaren. Slutsatsen är att sjuksköterskorna inom studien uppfattade sin egen kompetens som bra och samtliga känner sig bekväma med att jobba självständigt. Att ha bra arbetsrelationer med kollegor och läkare är mycket viktigt för studiedeltagarna däremot anser några deltagare att de inte alltid kan räkna med sina sjuksköterskekollegor i svåra situationer. Majoriteten av sjuksköterskorna önskade ett mer omfattande samarbete med läkaren. Urvalet i studien var litet och bortfallet var stort, därför behövs en mer omfattande studie inom området. / Aim: The purpose of this study was to describe registered nurses (RNs) perceptions of their competence within the municipal elderly care and their need of support in relation to their job assignment. Method: A questionnaire survey. The questionnaire was delivered electronically as an email. The sample consist of 131 RNs within the municipal elderly care in a large city in the middle of Sweden. 15 of the RNs engaged in the study. Results: The RNs perceive their competence as high and the majority feel secure to perform their job assignment. The support from their nurse colleagues is considered important, however more time and opportunities to discuss care issues is desirable. A good labour relation with the physician is considered important among the respondents. The majority wishes a better physician-nurse teamwork. Conclusion: The RNs perceive their competence as good and the majority feel secure to perform their job assignment independent. A good labour relation with the colleagues and physician is considered important. However some RNs doesn’t believe that they can count on their colleagues in difficult situations. The majority of the RNs desires increased teamwork with the physician. Future interventions are needed with larger sample and a lesser falling off.

Bakgrund: Arbetet på en intensivvårdsavdelning ställer stora krav på de nyutbildade intensivvårdssjuksköterskornas kompetens. Den första tiden i yrket innebär att i socialiseringsprocessen förvärva de kunskaper och färdigheter som krävs i yrket. Nyutbildade intensivvårdssjuksköterskors kompetens anses inte motsvara vårdens kompetenskrav. Syfte: Syftet med studien var att beskriva nyutbildade intensivvårdsjuksköterskors uppfattningar om sin yrkeskompetens. Metod: Studien genomfördes med kvalitativ metod och intervjuer valdes som datainsamlingsmetod. Tio deltagare medverkade i studien. Intervjuerna analyserades efter en modifierad variant av Graneheim och Lundmans kvalitativa innehållsanalys. Resultat: I resultatet framkom två huvudkategorier. I den första huvudkategorin framkom att de nyutbildade intensivvårdsjuksköterskorna kontinuerligt utvecklade sin yrkeskompetens. Utvecklingen främjades av positiva attityder till yrket, användning av tidigare erfarenheter och kollegialt stöd. I den andra huvudkategorin framkom att de nyutbildade intensivvårdssjuksköterskorna uppfattade att de hade bristande kliniska erfarenheter, det var svårt att införliva sig med den nya yrkesrollen och det var svårt att prioritera. Slutsats: Nyutbildade intensivvårdssjuksköterskor är inte helt förberedda för det kommande yrket. De har goda teoretiska kunskaper men saknar färdigheter i de praktiska momenten. Resultatet bekräftas av tidigare studier och Benners beskrivning av vad som karakteriserar sjuksköterskan som novis. / Background: The work in a critical care unit is posing great demands on the newly graduated critical care nurses competence. During the first episode in the profession a process of socialization occurs, where the newly graduated acquire the knowledge and skills needed in the profession. The newly graduated critical care nurses competence is not considered to meet the caregiver’s demands. Purpose: The purpose of this study was to describe the newly graduated critical care nurses perceptions of their competence. Method: The study was conducted with a qualitative approach. Interviews were used as datacollection method. Ten participants were included in the study. Interviews were analyzed after a modified variant of Graneheim and Lundman’s qualitative content analysis. Results: The results revealed two main categories. The first major category revealed that the newly graduated critical care nurses continuously developed their skills. The development was promoted by positive attitudes to the work, use of past experiences and collaboration. The major second category revealed that the newly graduated critical care nurses perceived a lack of clinical experiences, difficulties to incorporate themselves with the new professional role and difficulties with priority. Conclusion: The newly graduated critical care nurses are not entirely prepared for the future profession. They have good theoretical knowledge but lack in practical skills. The result is confirmed by previous studies and Benner’s description of what characterizes the nurse as a novice.

Surgical processes are a complex function of a number of inter-related factors that include individual skills, team working and operating theatre environment. Individual skills can be divided to technical and non-technical skills. This distinction between technical and non-technical skills is rather recent in the healthcare literature. There are studies made about assessing non-technical skills performed in the operating theatre but studies made to assess theatre nurses‘ technical skills have been lacking until recently. The aim of this study is to evaluate clinical applicability of a newly developed observation tool in different contexts and through observing describe similarities or differences between theatre nursing. The observations in the present study are structured with a newly developed observational tool that is developed to assess technical skills of a theatre nurse. The two authors of this study performed the data collection simultaneously at different operation departments. The present study makes evident that the technical skills required of a theatre nurse are considerably different in two different countries. Therefore, it is difficult to use an observational tool without modifying it according to local routines. / Kirurgiska processer består av ett antal komplext inbördes relaterade faktorer som inkluderar individuella färdigheter, teamarbete och miljön i operationssalen. Individuella färdigheter kan delas till tekniska och icke-tekniska färdigheter. Denna åtskillnad mellan tekniska och icke-tekniska färdigheter är ganska ny i omvårdnadslitteraturen. Det har genomförts studier där man har bedömt icke-tekniska färdigheter som utförs i operationssalen men studier för att bedöma operationssjuksköterskans tekniska färdigheter har saknats fram till nyligen. Syftet med denna studie är att utvärdera den kliniska tillämpligheten av ett nyutvecklat observationsverktyg i olika kontext och genom att observera kunna beskriva likheter eller skillnader mellan tekniska färdigheter. Observationerna i den aktuella studien är strukturerade med ett nyutvecklat observationsverktyg som är utvecklad för att bedöma en operationssjuksköterskas tekniska färdigheter. De två författarna till denna studie genomförde datainsamlingen samtidigt på olika operationsavdelningar. Den aktuella studiens resultat visar att de tekniska färdigheterna som krävs av en operationssjuksköterska är betydligt olika i två olika länder. Därför är det svårt att använda ett observationsverktyg utan att anpassa det enligt de lokala rutinerna.

Thèse de doctorat : Sciences économiques et sociales : Göteborgs universitet : 2006. / Résumé en anglais. Bibliogr. p. 213-221.