Background: Health care professionals are at risk of developing burnout due to the inherently stressful nature of their work. Burnout has been found to compromise the wellbeing of health care professionals and their ability to provide optimal patient care. Job engagement is proposed to be the antipode of burnout and is concerned with occupational well-being. It is hoped that through a better understanding of factors related to job engagement and burnout, occupational well-being of health care professionals and their ability to care for patients can be improved. Systematic review: A systematic review of the literature on burnout and job engagement in physicians and nurses since 2002 identified seven studies. Findings suggest that burnout and job engagement are independent constructs, albeit negatively related. These findings contribute to the current knowledge about the relationships between burnout and engagement dimensions and provide a framework for interventions aimed at increasing occupational well-being among front line medical professionals. Aims: A study was conducted to assess levels of job engagement and burnout and their relationship with turnover intentions and job satisfaction and stress in the entire workforce of a Cancer Centre in the United Kingdom. Participants and procedure: 150 cancer care workers completed a cross-sectional questionnaire entailing the Maslach Burnout Inventory, the Engagement Indicator, measures of job satisfaction, stress, turnover intentions and demographics. Results: Mean scores of emotional exhaustion did not differ from normative data, while lower levels of depersonalisation and lack of accomplishment were found. Furthermore, engagement scores were significantly higher than in the normative sample and the majority reported high levels of job satisfaction and indicated no turnover intentions. Path analysis provided preliminary support for an exploratory model indicating that engagement mediates the relationship between job stress, burnout and job satisfaction and turnover intentions. Implications: It is important that, despite increasing pressure to reduce costs, service planning is mindful of the continuous and long-term process required to maintain and facilitate engagement and job satisfaction, which appear important to the long term retention of staff. Conclusions: Work overload and a perception of being poorly managed and resourced appear to be risk factors for burnout. However, engaged employees with high levels of personal accomplishment may experience job satisfaction and desire to stay in their jobs despite high levels of occupational stress. Further research is required to identify factors predictive of personal accomplishment and job engagement in oncology services.

Sjuksköterskans ansvar är att lindra lidande. Vårdverksamheten och vårdforskningens största utmaningar är att förstå hur lidande bäst kan lindras. Lidande som orsakas av vården kallas vårdlidande. Den systematiska litteraturstudiens syfte var att pröva Katie Erikssons teori om vårdlidande inom omvårdnad. En deduktiv ansats användes vid genomförandet av studien. Studien genererade tolv resultatartiklar som analyserades enligt Erikssons följande kategorier om vårdlidande kränkning av värdighet, fördömelse och straff, maktutövning och utebliven vård. De mest förekommande kategorierna som identifierades utifrån resultatet var kränkning av värdighet och utebliven vård. En ytterligare kategori som framkom benämdes vårdens prioriteringar. Den kan ses som en utveckling av Erikssons kategori utebliven vård. Resultatet bekräftade Erikssons teori om vårdlidande. Rekommendationer för klinisk verksamhet är att patienten ska få möjlighet att utvärdera vården i efterhand, för att skapa en medvetenhet hos vårdpersonalen kring patientens upplevelse. Vidare rekommenderas forskning om vårdens prioriteringar. / Nurses’ responsibility is to alleviate suffering. The main challenge for healthcare organisation and the science of caring and nursing is to understand how suffering could be alleviated. Suffering caused by care is called suffering related to care. The aim of the study was to test and imply Katie Erikssons theory about suffering related to care in nursing. The systematic review was performed with a deductive research method. Twelve articles was analysed according to Erikssons theory about suffering related to care. The theory includes three themes: violating the patients dignity, condemnation and punishment, exert of power and absence of care. The themes that occurred the most in the results were violating the patients’ dignity and absence of care. Another theme was developed through the results was healthcare priorities. The theory can be interpreted as a subtheme to absence of care. Erikssons theory was validated by the results of the study. One implication for clinical practice is to give the patients ability to evaluate their received healthcare. The purpose of the evaluation is to make the health care professionals aware of the patients’ experience. Further research about healthcare priorities are suggested.

Många personer över 65 år lever med smärta. Det ingår i sjuksköterskans arbetsuppgifter att bedöma och utvärdera smärta. Syfte: Syftet med denna litteraturstudie var att genom existerande forskning beskriva vårdpersonals kunskap och attityder till smärtbedömning och smärtskattning i sitt dagliga arbete vid vård av äldre. Metod: I denna litteraturstudie användes sökbaserna Cinahl och Pubmed. Resultat: Resultatet baseras på 10 artiklar, 7 kvantitativa , 2 kvalitativa och en artikel där båda metoderna användes. De faktorer som påverkar smärtskattningen sågs vara erfarenhet och utbildning, utbildning i smärtskattning visade sig öka självförtroendet hos personalen. Även olika hinder, så som kognitiv nedsättning hos patienten och tidsbrist för vårdpersonalen, ligger i vägen för en adekvat smärtskattning. Generellt hade vårdpersonalen en positiv inställning till utbildning inom området smärtbedömning och även en stor intention att smärtskatta och göra detta korrekt. Det kunde ses att vårdpersonalens fördomar och attityder till äldres smärta påverkade smärtbedömningen. Slutsats: Smärtskattning av den äldre patienten är av största vikt för att minska smärta, lidande och andra följdtillstånd som obehandlad smärta orsakar. Med stöd från den samlade litteraturen, anses även att utbildning av personalen är ett mycket viktigt sätt att utveckla och förbättra smärtbedömningen inom vården. / Many people over the age of 65 are living with pain. It’s a part of the nurse profession to assess and evaluate pain. Purpose: The purpose of this literature review was by existing research explore nurses knowledge and attitudes towards pain assessment and pain measurement in the care of elderly patients. Methods: In this literature review the databases Cinahl and Pubmed were used. Results: The results in this study are based on 10 articles. 7 quantitative, 2 qualitative and 1 were both methods was used. Factors that influenced how the patients’ pain was assessed by the health care givers was experience and education, attitudes and different obstacles that made adequate assessments difficult, such as patients having cognitive impairment and lack of time to perform assessment. In general, the caregivers had a positive attitude towards education about pain assessment and a great intention to assess pain correctly. However, it could be shown that negative attitudes and prejudices against pain in the older patient and how it should manifest affected how the pain assessment was performed. Conclusions: Negative attitudes regarding aging that is still exists in our society is affecting the health care of the individual. The authors believe, in support of the reviewed literature, that education is an important way to improve and develop the pain assessment performance.

Bröstmjölk är en komplett näringskälla för det nyfödda barnet. Förutom att tillföra barnet alla näringsämnen hen behöver så ger bröstmjölken energi, bygger upp kroppen samt skyddar det nyfödda barnet mot sjukdomar. Amning är ett samspel mellan mamma och barn som påverkas av många faktorer. För en tvillingmamma är initiering av amning en större utmaning än för en mamma som fött ett barn, då omvårdnaden kring barnen blir dubbel. Syftet med studien var att beskriva tvillingmammors erfarenhet av amningsstöd, dels från vårdpersonal, dels från sociala medier, för att initiera och upprätthålla en fungerande amning. Studien är en intervjustudie med kvalitativ metod. Datamaterial samlades in genom intervjuer av sex utvalda tvillingmammor. Mammorna söktes och valdes ut via en Facebookgrupp. I resultatet framkom två kategorier: Mammans initiativ och Vårdpersonalens engagemang. Resultatet tyder på att de intervjuade mammornas erfarenhet är att vårdpersonal idag saknar den specifika kunskapen om/och förståelse för hur mycket arbete det innebär för en tvillingmamma att få amningen att fungera. Många mammor söker idag den information de inte erhållit via vårdpersonal på annat sätt, oftast via sociala medier. Utifrån den här studien kan vårdpersonal få en ökad förståelse för tvillingmammors behov av extra amningsstöd och information. / Breast milk is a complete food source for the newborn. In addition to supplying the baby all the nutrients it needs breast milk also provides energy, builds up the body and protects the newborn against disease. Breastfeeding is an interaction between mother and child that is affected by many factors. For a twin mother is initiation of breastfeeding more of a challenge than for a mother who gave birth to a child, then care about the children becomes twice.The purpose of this study was to describe the mother of twin´s experience of breastfeeding support, both from health professionals as well as from social media, to initiate and maintain a functional breastfeeding. The study is an interview study of qualitative method. Data material was collected through interviews with six selected twin mothers. The informants were sought and selected through a Facebook group. The results revealed two categories: The mother's initiative and The involvement of health professionals. The result indicates that the interviewed mothers experience is that health professionals today lack the specific knowledge and understanding of how much work it means for a twin mother to get a functional breastfeeding. Many mothers today are using other sources in seeking the information they did not receive by health professionals, mostly through social media. Based on this study, health professionals might gain a greater understanding of the need twin mothers have for more support and information regarding breast feeding twins.

Bakgrund: Övervikt och fetma orsakar idag fler dödsfall än undervikt. Det är ett folkhälsoproblem som ökar över hela världen. Övervikt och fetma leder till såväl fysiska som psykiska problem och besvär för den drabbade. Forskning har visat att patienter med övervikt eller fetma upplever mest stigmatisering i vuxen ålder. Syfte: Syftet med denna litteraturöversikt är att belysa bemötandet av patienter med övervikts- och fetmaproblematik ur patientens och vårdpersonalens perspektiv. Metoder: En litteraturöversikt. Resultat: Det framkom att patienter med högre BMI upplevde negativt bemötande från vårdpersonal, att de inte blev hörda. Patienterna sökte inte gärna vård. Det framkommer att vårdpersonalen hade en negativ attityd till patienter med övervikt eller fetma och ville helst inte vårda dessa. Slutsats: Patienter med övervikt eller fetma är en utsatt patientgrupp i såväl samhälle som inom vården. Patienterna upplever att de inte blir hörda och inte blir tagna på allvar. Vårdpersonal är enig om att vården måste hjälpa dessa patienter, trots det uppger en stor del av vårdpersonal att de inte vill vårda patienter med övervikt eller fetma relaterat till tidsbrist. / Background: Overweight and obesity cause today more deaths than underweight. There is a public health disorder that is increasing worldwide . Overweight and obesity leads to both physical and mental problems and inconvenience for the patient. Aim: The purpose of this study is to highlight the treatment of obese and overweight patients from the patient and the health-care personnel’s’ perspective. Methods: A literature review. Findings: It emerged that patients with a higher BMI experienced negative attitude from medical professionals , that they felt not being listened to and excluded. Patients dreaded to seek care. It appears that healthcare staff had a negative attitude and are not willing to care for overweight or obese patients. Conclusions: Overweight and obese patients are a vulnerable group of patients in both society and in healthcare. Patients feel they are not heard, they will be excluded and not taken seriously. Caregivers agrees that they must help these patients, despite the state a large part of health care workers that they would rather not care for obese patients.

Bakgrund: Psykisk ohälsa är vanligt förekommande hos Sveriges befolkning och räknas till en av folksjukdomarna. Personer med psykisk ohälsa kan drabbas av psykiska eller fysiska besvär och söker sig då till primärvården och kommer där att möta sjuksköterskor och annan vårdpersonal. Syfte: Syftet var att belysa vårdpersonals upplevelse av att bemöta patienter med psykisk ohälsa inom primärvården. Metod: En litteraturöversikt baserad på nio vetenskapliga kvalitativa artiklar genomfördes. Resultat: Två huvudkategorier med fyra subkategorier framkom. Den första huvudkategorin ”Kommunikationens betydelse för bemötandet” bestod av subkategorierna Verbal kommunikation och Icke-verbal kommunikation. Kommunikationen, både den verbala och icke-verbala, mellan vårdpersonal och patient hade stor betydelse för hur det upplevdes att bemöta patienten. Den andra huvudkategorin ”Begränsningar som påverkar bemötandet”, bestod av följande subkategorier: Begränsningar i den egna professionen och Begränsningar i organisationen. Brist på kunskap hos personalen eller brist på resurser i organisationen påverkade personalens möjlighet att bemöta patienten så som var önskvärt. Slutsats: Vårdpersonal behöver ta mer eget ansvar för att tillgodogöra sig ny forskning och information om bemötande och patienters sjukdomar, samtidigt bör staten fortsätta med uppmaningar och uppmuntran till utveckling av sjukvården och fortbildning av personal. / Background: Mental illness is common among the Swedish population and is one of the endemic diseases. People with mental illness can be sticken with psychological or physical inconveniences and then turn to primary health care and will there meet nurses and other health care professionals. Aim: Was to illustrate health care professionals experience of encounter patients with mental illness in primary health care. Method: A literature review was carried out based on nine scientific qualitative articles. Result: Two main categories and four subcategories emerged. The first category ”To experience the meaning of communication to the encounter” consisted of the subcategories Verbal communication and Non-verbal communication. The communication, both verbal and non-verbal, meant a lot for the experience to encount the patients. The other main category: ”To experience limitations that affect the encounter” consisted of following subcategories: Limitations within the own profession and Limitations within the organization. Lack of knowledge within the staff or lack of resources within the organization affected the staffs’ ability to encount patients as desirable. Conclusion: Health care professionals have their own responsibility to utilize new research and information about the encounters with and the diseases of patients. The government should continue to request and encourage to develop the health care.

L1 attrition - which in the context of this study is defined as the decline of any native language skill (or portion thereof) in a healthy bilingual speaker (Ecke, 2004) - has been studied extensively for several decades. However, only few studies have examined the native speech of immigrants who use their L1 for professional purposes, such as language instructors (Isurin, 2007; Major, 1992; Porte, 1999, 2003). Furthermore, no research has been conducted comparing the L1 speech of such individuals with that of individuals who do not use their L1 for professional purposes. This study analyzed and compared L1 speech samples from two populations of German immigrants in the U.S., German Instructors and Other Professionals, and from a monolingual control group in Germany. It was hypothesized that German instructors may be less vulnerable to L1 attrition due to more frequent L1 use, a higher motivation to maintain the L1, and greater identification with the native language and culture. Data elicited through verbal fluency tasks, a film retelling task, a semi-structured interview, and a sociolinguistic questionnaire revealed significant differences between the control group and the two bilingual groups which point to L1 attrition (primarily as an access problem) in the bilingual speakers. The data also revealed significant differences between the German Instructors and the Other Professionals, suggesting that the severity of L1 attrition is not the same for all populations. In addition, a comparison of the two bilingual groups with regard to sociolinguistic variables, and correlations between linguistic measures and sociolinguistic variables also yielded interesting findings which have implications for L1 attrition research as well as L1 maintenance.

This qualitative research study addressed the gap in the literature and lack of clinical guidelines and frameworks for health professionals as they assess and manage risk when balancing the safety and autonomy of community-dwelling older adults. Twelve health professionals were asked in individual interviews how they perceive, identify, assess and treat risk and how they negotiate the safety and autonomy of their clients. Informed by grounded theory methodology, the findings revealed what kinds of decisions health professionals made and how they made them within this clinical context. These findings from the perspective of the health professional contributed to the development of a definition of living at risk, a safety continuum and a conceptual/practice framework to help health professionals, including occupational therapists, make sound clinical decisions as they balance the autonomy and safety of their community-dwelling older adult clients.

Emotional Intelligence (EI) has been viewed as a critical factor influencing students' academic achievement, ability to work, and potential to succeed. Previous research has shown that students with high EI perform better academically than those with low EI, as well as being better equipped for their professional careers. However, despite the acknowledged importance of EI, little work has explored the construct within the context of built environment education and relatively little is known about how built environment curricula should be designed to enhance EI. This research explores the EI levels of built environment undergraduates and its relationship to their specific programmes, and investigates the types of pedagogic interventions which appear to influence EI in a positive way. This research adopts a multimethodological research design and a mixed methods approach, involving a combination of both quantitative and qualitative datasets to explore students' experiences and learning enhancements. These include a questionnaire survey of 420 respondents, a secondary examination of built environment programmes, interviews with construction professionals and 45 in-depth interviews with placement students and other undergraduates. The results reveal that the existing built environment education inhibits students' EI development, but that EI is shown to increase during industrial placements. The results also reveal that EI development differs by the types of programme taken, with students studying on Civil Engineering and Architectural Engineering & Design Management programmes showing a propensity for higher EI scores in comparison with those studying on a Commercial Management & Quantity Surveying programme. An analysis of the modular content of programmes, together with the mode of teaching, learning and assessment used, reveals the types of pedagogic intervention which can enhance EI development. Group work and student-centred learning in particular were found to have a positive effect on EI development. These findings form the basis of recommendations for how current built environment education can be enhanced in a way to develop students' EI. It is suggested that a better understanding of students' EI levels and the ability of such programmes to influence students' EI may help to produce graduates better able to meet the future requirements of the construction industry.

Some sections of the appendices are not available in the electronic copy of this thesis due to their format. The full version is available for consultation at the University of Leicester Library.