Varje år genomför cirka 1100 personer i Sverige ett suicid. Varje suicid föregås av i genomsnitt 10 suicidförsök. Detta orsakar förutom kostnader i form av oerhörda summor pengar för samhället också otroligt mycket lidande för anhöriga. Ambulanssjuksköterskan är många gånger den första resursen i vårdkedjan som den suicidnära kommer i kontakt med. Detta ställer stora krav på bemötandet av patienten men också krav på kunskap om medicinska åtgärder för att rädda personen till livet. Detta arbete avser att studera ambulanssjuksköterskans bemötande och egna upplevelser av mötet med den suicidnära patienten genom att intervjua ambulanssjuksköterskor i Uppsala. Studien visar att få ambulanssjuksköterskor upplever sig ha tillräcklig kompetens för att bemöta den här typen av patienter. Vidare framgår att ambulanssjuksköterskan i mycket stor utsträckning känner en misstro till den vård som patienten erhåller från psykiatrin och att det förekommer stora skillnader i hur ambulanssjuksköterskan resonerar kring sin egen säkerhet i mötet med patienten. Studien visar också att de flesta av ambulanssjuksköterskorna bemöter patienterna enligt POSP-riktlinjerna (Prehospitalt Omhändertagande av Suicidnära Patienter). Patienten skriker ofta efter hjälp i samband med ett suicidförsök och vågar man identifiera syftet med handlingen så möts man ofta med tacksamhet. / Annually around 1100 individuals in Sweden end their lives by committing suicide. Prior to every completed suicide estimate shows that 10 attempts have been made. This results in both high costs for the society and unmeasurable suffering for their relatives. The nurses that are working in the Swedish ambulance system are often the first medical resources with whom the suicidal patient has contact. This means high demands are placed on the nurse both regarding the meeting itself with the patient but also with the medical knowledge that could prove to be lifesaving in an acute situation. This paper seeks to study the professional interaction and the strategies that the nurse uses to help the suicidal patients and their own experiences of the meeting by interviewing nurses working in the Uppsala ambulance service. This study shows that the nursing staff experiences a lack of knowledge in the meeting with the patients and a clear disbelief in the care that the patients receive at the psychiatric ward. Furthermore the study shows that most nurses in the study interact with the patients in accordance with the POSP-guidelines. The patient is often crying for help in connection to a suicide attempt and if the nurse has the courage to identify the purpose with the action one is most often met with gratitude.

The overall aim of the thesis was to describe patient−health-professional interactions in a hospital setting, with a specific focus on the surgical care unit. The thesis consists of four studies and includes both qualitative and quantitative studies. Content analysis and phenomenography were used in the qualitative studies; the quantitative study was an intervention study with a three-phase quasi-experimental design. The findings of study I showed that patient complaints to a local Patients’ Advisory Committee about negative interactions with health professionals most often concerned the perceived insufficiencies of information, respect, and empathy. The findings of study II showed that experiences of negative interactions with health professionals caused long-term consequences for individual patients and reduced patients’ confidence in upcoming consultations. The findings of the phenomenographic study (III) showed that surgical nurses understand an important part of their work in qualitatively different ways, which can be presented as a hierarchy of increasing complexity and comprehensiveness. In the most restricted understanding, surgical nurses focus on the work task, whereas in the others surgical nurses demonstrate increasing degrees of patient-centeredness. Finally, the results of study IV showed that an uncomplicated intervention that invited patients to express their daily questions and concerns in writing (using the ‘Tell-us card’) improved the patients’ perceptions of participation in their care in a surgical care unit. For further implementation of the Tell-us card to succeed, it needs to be prioritized and supported by leaders in ongoing quality improvement work. The value of a patient-focused interaction needs to be the subject of ongoing discussions in surgical care units. Patients’ stories of negative interactions could be used as a starting point for discussions in professional reflection sessions. It is important to discuss and become aware of different ways of understanding professional interactions and relationships with patients; these discussions could open up new areas of professional development. Providing patients an opportunity to ask their questions and express their concerns in writing, and using this information in the patient−health-professional interaction, could be an important step towards improved patient participation.

The overall aim of the present thesis was to investigate experiences of living with multidrug-resistant bacteria (MDRB), using methicillin-resistant Staphylococcus aureus (MRSA) colonization as an illustration, and to develop and validate a tool to describe healthcare personnel’s attitudes towards patients with MDRB. A further objective was to study MRSA-colonized persons’ and healthcare personnel’s experiences of patient-professional interactions and responsibilities for infection prevention. Four empirical studies were conducted. A total of 18 MRSA-colonized persons and 20 healthcare personnel were interviewed regarding their experiences, and a total of 726 RNs responded the MDRB Attitude Questionnaire. The findings revealed the difficulties associated with living with MRSA colonization, which was described as something uncertain, and as an indefinable threat that has to be managed in both everyday life and in contacts with healthcare. Interactions with healthcare personnel were described as unprofessional owing to personnel’s inappropriate behaviour and insufficient information provision. According to the personnel, achieving adequate patient-professional interactions required having knowledge and experiences of MRSA. They also experienced difficulties in providing tailored information to patients. The MRSA-colonized persons described their unwanted responsibility to inform healthcare personnel about the colonization, but also felt responsible for limiting the spread of infection to others. Furthermore, responsibility for infection control was regarded as shared between healthcare personnel and patients. The personnel described such responsibility as a natural part of their daily work, although it was not always easy to adhere to hygiene precautions. The MRSA-colonized persons felt that healthcare personnel have insufficient knowledge of the bacteria and of hygiene precautions. The MDRB Attitude Questionnaire showed that registered nurses do have knowledge deficiencies. The MDRB Attitude Questionnaire has adequate psychometric properties. In conclusion, MRSA colonization constitutes a psychological strain for carriers, and interactions with healthcare personnel resulted in feelings of stigmatization. The present thesis indicates that there is a need to improve healthcare personnel’s knowledge, behaviour and emotional response in relation to patients with MDRB, in order to ensure patient safety and address patients’ needs. The heads of department is responsible for such improvements, and the MDRB Attitude Questionnaire is useful in identifying areas in need for improvement.

Within the helping professions there are contrasting epistemological views regarding the role of the helping professional, which have direct influences on learning support practices. Despite these views, it remains unclear what parents expect when seeking learning support for their children. This qualitative study explored parents’ constructions of the role of the helping professional in learning support. It specifically addressed parents’ expectations of the helping professional, what they value in their interactions with helping professionals as well as their understandings of their own roles in consultation and intervention for learning support. A case study approach was employed to gain access to participants. Specifically, three parents of children attending a school for Learners with Special Educational Needs [LSEN] were included as participants. These parents had had experiences with various helping professionals, both at the school and in private practice settings, in the course of seeking assistance for their children. It was thus thought that they would be able to provide in-depth perspectives as to their ideas of the role of helping professionals who assist children experiencing difficulties due to their exposure and experiences with helping professionals. Initial data collection was undertaken via semi-structured interviews with the participants. A content analysis of the interviews was subsequently employed to elicit affinities for use during a further modified form of Interactive Qualitative Analysis [IQA] with the contributors to the study. In total, fourteen affinities were generated and included Parental expectations, Professional characteristics, The helping process, Parents’ role, Status of the helping professional, Professional approach, Parents’ personal experiences, Parents’ emotions, Assessment, Recommendations, Stigma, a Team approach, parent-professional Interaction and Values. These affinity descriptions were corroborated and expanded on with the participants and the relationships amongst the affinities where then hypothesised by the participants themselves. A central outcome of the study was the research participants’ social representations of helping professionals. These representations comprise the thematic elements representing the participants’ discourse about the role of helping professionals in learning support and provide the participants’ in-depth ideas of the relationships amongst these elements. / Dissertation (MEd (Educational Psychology))--University of Pretoria, 2007. / Educational Psychology / unrestricted

Introduktion: Antibiotikaresistens är ett globalt problem och inkluderar MRSA, meticillinresistenta stafylokocker. Det saknas översiktsstudier som sammanfattar viktiga resultat gällande upplevelser av att bära på antibiotikaresistenta bakterier, främst gällande MRSA-bärare. För att bedriva ett effektivt folkhälso- och smittskyddsarbete är det viktigt att undersöka upplevelser, resurser och strategier kring bärarskapet hos dessa individer. Syfte: Att undersöka hur individer som bär på MRSA upplevde MRSA-bärarskapet ur ett salutogent perspektiv utifrån känsla av sammanhang (KASAM), med avseende på begriplighet, hanterbarhet och meningsfullhet. Metod: En strukturerad litteraturstudie gjordes där 10 vetenskapliga artiklar analyserades genom tematisk analys utifrån ett salutogent perspektiv. Resultat: Elva subteman identifierades och relaterades till tre teman som utgjordes av de främsta komponenterna av KASAM: begriplighet, hanterbarhet och meningsfullhet. Begriplighet beskriver hur individen uppfattar sin situation som MRSA-bärare och utgörs av subtemana ”Pestsmittad, smutsig och invaderad”, ”Chock, rädsla och skam”, ”Utanförskap, ensamhet och stigmatisering”, ”Okunskap, osäkerhet och ett gåtfullt hot” och ”Nuet störs, framtiden påverkas”. Hanterbarhet beskriver hur individen försöker hantera MRSA-bärarskapet och utgörs av subtemana ”Skydda andra från smitta”, ”Söka information” och ”Informera och utbilda vårdpersonal”. Meningsfullhet utgörs av MRSA-bärarnas beskrivningar av vad som ger dem engagemang och motivation och utgörs av subtemana ”Ta kontroll över situationen”, ”Tid, aktivt lärande och reflektion” och ”Goda möten och relationer”. Slutsats: Upplevelsen av MRSA-bärarskapet innebär ofta ett stort lidande för individen med flertalet begränsningar av livet. Att leva med MRSA är att befinna sig på ett kontinuum av salutogenes/patogenes, där möten och relationer med vårdpersonal spelar en avgörande roll för var individens hälsa positioneras. Det finns en outnyttjad salutogen potential i vårdpersonalens möten och interaktioner med MRSA-bärare. / Introduction: Antibiotic resistance is a global problem and includes MRSA, methicillin-resistant Staphylococcus aureus. Reviews summarising important results concerning experiences of being colonised with MRSA are lacking. For efficient public health and infection prevention work, it is important to examine the experiences, resources, and strategies these individuals have regarding colonisation. Aim: To explore how individuals colonised with MRSA experienced this from a salutogenic perspective, based on Sense of Coherence (SOC), with respect to comprehensibility, manageability, and meaningfulness. Methods: A structured literary review was conducted where 10 scientific articles were analysed through thematic analysis from a salutogenic perspective. Results: Eleven subthemes were identified and related to three themes composed from the main components of SOC. “Comprehension” describes how the individual perceives their situation as colonised with MRSA and consists of the subthemes "Plague infected, dirty and invaded", "Shock, fear and shame", "Exclusion, loneliness and stigmatisation", "Ignorance, uncertainty and a mysterious threat" and "The present is disrupted, the future is affected". “Manageability” describes how the individual tries to manage the MRSA colonisation and consists of the subthemes "Protect others from infection", "Seek information" and "Inform and educate healthcare workers". “Meaningfulness” consists of the descriptions of what gives the commitment and motivation and consists of the subthemes "Take control over the situation", "Time, active learning and reflection" and "Good encounters and relationships". Conclusion: The experience of being colonised with MRSA often involves immense suffering for the affected individual. Living with MRSA is to exist on a continuum of salutogenesis/pathogenesis, where encounters and relationships with healthcare professionals play a key role in where the individual's health is positioned. There is an untapped salutogenic potential in healthcare professionals' encounters and interactions with MRSA carriers.

Made available in DSpace on 2014-12-17T15:45:07Z (GMT). No. of bitstreams: 1 RicardoHVM_DISSERT.pdf: 1910228 bytes, checksum: 54c89a3a577f5b8c1d0ee128b06d997d (MD5) Previous issue date: 2014-02-14 / O presente estudo discute a forma??o de Redes Sociais no cotidiano da Estrat?gia Sa?de da Fam?lia, a partir de aportes da teoria sociol?gica sobre redes, intera??es, d?diva e reconhecimento. O objetivo geral ? analisar as redes sociais locais em sa?de a partir da intera??o de usu?rios e profissionais da Estrat?gia Sa?de da Fam?lia na Unidade de Sa?de de Lig?ia, em Natal, RN. Seus objetivos espec?ficos s?o: Mapear as redes sociais locais em sa?de existentes no territ?rio adscrito; Identificar os tipos de intera??es cotidianas entre os sujeitos; Compreender a percep??o dos sujeitos sobre o processo de forma??o de redes sociais a partir das intera??es. Caracteriza-se enquanto pesquisa qualitativa explorat?ria cujos sujeitos foram profissionais e usu?rios vinculados ? referida unidade de sa?de. Para a coleta de dados foram utilizadas entrevistas individuais semiestruturadas e debates em grupos focais, estimulados pela Metodologia de An?lise de Redes do Cotidiano (MARES), pertinente para abordar a complexidade das rela??es sociais e mapear os diferentes conte?dos expressos e as formas de mobiliza??o coletiva. A an?lise dos dados foi realizada atrav?s da T?cnica de An?lise Tem?tica de Conte?do, proposta por Minayo. Os resultados foram interpretados ? luz das Teorias da D?diva (Mauss) e do Reconhecimento (Honneth). Os sujeitos visualizaram: Rede Virtual (28,20%); Rede de Aten??o ? Sa?de (25,64%); Redes de Usu?rios (17,95%); Rede Pessoal (10,26%); Conselho Comunit?rio (10,26%); Escolas (7,69%). Os participantes n?o perceberam os arranjos familiares enquanto Redes Sociais. Os tipos de intera??es sociais identificadas foram: Confronta??o/Negocia??o (41.02%); Harm?nicas (25,70%); Correlativas (17,90%); Definidas pela Organiza??o (15,38%). A forma??o de redes sociais ocorre a partir de intera??es cotidianas entre pessoas, pela articula??o insepar?vel de conte?dos e formas, catalisadas pelo contexto, experi?ncia e cogni??o, valorizando a liberdade, a expressividade e a diversidade dos parceiros de significa??o. Foram encontradas duas categorias, na percep??o dos sujeitos, sobre a forma??o de redes sociais do cotidiano: Di?logo e Encontro. Validamos e recomendamos o uso da metodologia MARES: Na forma??o, para despertar uma vis?o mais tolerante e humana de si e do outro; Na avalia??o qualitativa dos servi?os, por facilitar a reflex?o sobre a pr?tica e (re)organiza??o do processo de trabalho; Na comunidade, para estimular movimentos sociais existentes ou emergentes. A aposta no circuito da d?diva e do reconhecimento rec?proco, durante o tr?nsito nas redes sociais em sa?de, pode ser capaz de tecer uma pr?xis transformadora, pela busca e alcance de confian?a, respeito e estima, nos espa?os de encontro entre usu?rios e profissionais da Estrat?gia Sa?de da Fam?lia