Bakgrund När barn är inneliggande på sjukhus så deltar ofta föräldrarna i omvårdnaden enligt vårdfilosofin familjecentrerad omvårdnad. Detta är oftast positivt både för föräldrar och barn men det kan även leda till svårigheter i mötet mellan föräldrar och vårdpersonal eftersom de ska dela på omvårdnadsansvaret. För att föräldrar ska känna sig trygga i detta bör vårdpersonalen uppmuntra deras egenmakt. Genom att föräldrarna upplever mötet positivt kan ett partnerskap mellan vårdpersonal och föräldrar skapas. Syfte Syftet var att belysa hur föräldrar till barn som är inneliggande på sjukhus upplever mötet med vårdpersonalen. Metod Studiedesignen var en litteraturöversikt som baserades på 21 vetenskapliga originalartiklar med både kvalitativ och kvantitativ ansats. Databaserna PubMed och CINAHL användes för datainsamling och artiklarna inhämtades genom att sökord kombinerades ihop i sökblock. Artiklarna har kvalitetsgranskats utifrån Sophiahemmet Högskolas bedömningsunderlag för vetenskaplig klassificering och kvalitet. En integrerad dataanalys genomfördes. Resultat Resultatet sammanställdes i fyra huvudkategorier; relationsskapande möten, information i mötet, roller i mötet samt känslor och behov i mötet. Resultatet visade till exempel att föräldrarna fann det betydelsefullt att vårdpersonalen var förtroendeingivande, visade respekt och kunde fungera som guider. Andra viktiga förmågor var att kunna kommunicera och delge information på ett anpassat sätt och att de kunde hjälpa föräldrarna att hitta och känna sig trygga i sin roll samt hjälpa dem att hantera sina känslor. Slutsats Föräldrar upplevde att kvaliteten på mötet med vårdpersonalen i hög utsträckning kunde påverka deras känsla av egenmakt och hur de kunde hantera sina känslor. Genom att mötet anpassas efter deras önskemål och förutsättningar kan föräldrarna öka sin delaktighet i omvårdnaden och på så sätt kan ett gynnsamt partnerskap etableras. / Background When children are hospitalized, parents often participate in the care, in accordance with the nursing philosophy of family-centered care. This is usually beneficial for both parents and children, but it can also lead to difficulties in the encounter between parents and healthcare professionals as they share the responsibility of care. To make parents feel secure in this, healthcare professionals should encourage their empowerment. By ensuring that parents have a positive experience when interacting with healthcare professionals, a partnership between healthcare professionals and parents can be established. Aim The aim was to highlight how parents to hospitalized children experience the encounter with the healthcare professionals. Method The study design was a literature review which was conducted, based on 21 scientific original articles with both qualitative and quantitative approaches. The databases PubMed and CINAHL were used for data collection, and articles were retrieved by combining keywords in search blocks. The articles were assessed for quality based on the evaluation criteria from Sophiahemmet Högskola for scientific classification and quality. An integrated data analysis was performed. Results The results were compiled into four main categories: relationship-building encounters, information in the encounter, roles in the encounter, and emotions and needs in the encounter. The results showed, for example, that parents found it significant that healthcare professionals were trustworthy, showed respect, and could serve as guides. Other important abilities included being able to communicate and provide information in an appropriate manner and helping parents find and feel secure in their roles, as well as assisting them in managing their emotions. Conclusions Parents experienced that the quality of the encounter with healthcare professionals could affect their sense of empowerment and how they could manage their emotions. By adapting the encounter to their preferences and circumstances, parents can increase their participation in caregiving, enabling a beneficial partnership to be established.

Bakgrund: Substansbrukssyndrom drabbar människor över hela världen. Tidigare forskning har visat att hälso- och sjukvårdspersonal upplevde att de hade en negativ inställning till patienter med substansbrukssyndrom. Hälso-och sjukvårdspersonal har också rapporterats ha fördomar mot denna patientgrupp. Det har även visats att patienter med substansbrukssyndrom behandlades annorlunda än andra patienter. Patienter med substansbrukssyndrom vårdas på många olika avdelningar, vilket gör att den grundutbildade sjuksköterskan kan möta dessa patienter inom olika vårdinstanser. Syfte: Syftet med litteraturstudien var att belysa vilka erfarenheter patienter med substansbrukssyndrom hade av mötet med hälso- och sjukvårdspersonal. Metod: En litteraturstudie baserad på tolv vetenskapliga artiklar med kvalitativ studiedesign. Artiklarna hämtades från databaserna Cinahl, Pubmed och Psychinfo. Artiklarna analyserades enligt metod beskriven av Friberg (2017). Resultat: Två teman identifierades: Positiva upplevelser samt Negativa upplevelser. Utifrån dessa genererades fyra subteman: Professionellt bemötande, Terapeutisk allians, Oprofessionellt bemötande och Inadekvat vård. Konklusion: Patienterna hade både positiva och negativa erfarenheter av möten med hälso- och sjukvårdspersonal. Vid positiva upplevelser beskrevs ett fördomsfritt och accepterande bemötande samt att hälso- och sjukvårdspersonal skapade en anknytning till patienten och gjorde patienten delaktig i vården. Vid negativa erfarenheter skildrades bemötandet som fördomsfullt, dömande och stigmatiserande. Hälso- och sjukvårdspersonal upplevdes ofta ha bristande kunskaper inom beroendemedicin. Patienter med substansbrukssyndrom upplevde att de fick sämre vård än patienter utan substansbrukssyndrom. Hälso- och sjukvårdspersonal behöver ha kunskap inom beroendemedicin samt ett professionellt och fördomsfritt bemötande för att kunna ge patienter med substansbrukssyndrom en god och likvärdig vård som andra patienter. / Background: Substance use disorder affects people all over the world. Previous research showed that health care professionals had a negative attitude towards patients with substance use disorder. They also had prejudices against this patient group. Patients with substance use disorder were treated differently than other patients. They are cared for in many different wards, which means that the undergraduate nurse can meet these patients in different care institutions. Aim: The purpose of the literature study was to illustrate the experiences of patients with substance use disorder meeting health care professionals. Method: A literature study based on twelve scientific articles with qualitative study design. The articles were retrieved from the databases Cinahl, Pubmed and Psychinfo and were analyzed according to Friberg (2017). Result: Two themes were identified: Positive experiences and Negative experiences. Based on these, four subthemes were generated: Professional attitude, Therapeutic alliance, Unprofessional attitude and Inadequate care. Conclusion: Patients had both positive and negative experiences of meetings with health care professionals. In positive experiences, an open-minded and accepting attitude was described and health care professionals created a connection to the patient and involved patients in the care. In negative experiences, the attitude was portrayed as prejudiced, judgmental and stigmatizing. Healthcare professionals often had a lack of knowledge in addiction medicine. Patients with substance use disorder experienced that they received inferior care than patients without substance use disorder. Healthcare professionals need to have knowledge in addiction medicine as well as a professional and open-minded attitude to be able to give patients with substance use disorder a good and equivalent care as other patients.

<p>Primary care multi-disciplinary teams were central to recent reform plans for Canadian primary care, in response to limited resources and increasing demands. Health Information Technology was also an integral part of those plans as supporting infrastructure for the modernization of healthcare services, facilitating coordination, collaboration and access to services. As provider-centric Health Information Technology matures, attention turns to the patient. The hallmark of patient-centered applications is the electronic Personal Health Record System (PHR). These systems have grown beyond simple repositories of personal health information, extending to a range of information collection, sharing, self-management and exchange functions.</p> <p>The implementation of PHRs in primary care multi-disciplinary teams involves many stakeholders including patients, physician, allied health professionals and support staff. There is significant literature on physician and patient perspectives on all PHR functions. However, little attention has been given to the other stakeholders: allied health professionals and support staff.</p> <p>In this study, we explored the views of Allied Health Professionals (AHPs) and support staff, working in a primary care clinic adopting a patient-centered, multi-disciplinary model called the Family Health Team (FHT) model. Participants provided their insight on benefits, concerns and recommendations regarding the implementation of MyOSCAR, a PHR, at their clinic. Qualitative data was collected through semi-structured one-on-one interviews that were analyzed to extract common themes and summarize participant views. Process diagrams were produced to highlight opportunities for improvement of current work processes through the integration of MyOSCAR functions.</p> <p>As more teams are created in primary care and they attempt to implement new technologies, it is important to get a complete picture of all stakeholder views. This is the first study that focuses on the views of AHPs and support staff, contributing to the literature on PHR implementations. Findings from this study can contribute to future PHR implementations by informing planning and implementation.</p> / Master of Science (MSc)

The purpose of this dissertation was to test the utility of theories across the development, implementation, and evaluation of three nationwide knowledge translation (KT) interventions in the physical disability community. Using a theory-based evaluation guided by the Theory of Planned Behaviour (TPB), Study 1 evaluates the effectiveness of an evidence-based, continuing education module designed to increase emergency health care professionals’ (HCPs) knowledge and use of clinical practice guidelines for managing patients with spinal cord injury (SCI) who present with autonomic dysrefexia. Findings suggest that behaviour change theory should be integrated into the intervention to change theory-based determinants of behaviour, and that information about intervention implementation may help explain observed outcomes. Study 2 examined the use of theory across three phases of research in the Canadian Paralympic Committee’s Changing Minds, Changing Lives (CMCL) intervention. Study 2.1 describes the restructuring of the CMCL curriculum to include research evidence and theory. Study 2.2 evaluates the short- and long-term effects of the CMCL intervention on HCPs’ social cognitions for discussing leisure-time physical activity (LTPA), and explores key implementation variables that predict changes in HCPs’ social cognitions. Overall Study 2 results suggest that: (1) using a KT framework and integrating stakeholders throughout intervention development increases the likelihood that interventionists will adopt and implement the intervention, and (2) real-world implementation is important to understanding intervention effectiveness. Study 3 examines the effectiveness, and its implementation correlates, of Get in Motion (GIM), a nationwide, LTPA-enhancing telephone counseling service for adults with SCI. Study 3 furthers our understanding of the relationship between implementation and effectiveness, and suggests key implementation ingredients that could be targeted in future refinements of GIM. Together, the dissertation studies contribute to our understanding of how to use theory when developing, implementing, and evaluating behaviour change interventions targeting HCPs and other end-users in the physical disability community. / Dissertation / Doctor of Philosophy (PhD)

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The Swedish labour market is one of the most gender segregated in Europe, and despite the extensive legislation on gender equality and discrimination, the health gap between working women and working men are continually increasing. This thesis has two purposes. First, to analyse how the work-related health gap between women dominated workplaces and maledominated workplaces are challenged, problematized and/or consolidated through workenvironment policy discourses. Second, to analyse health experiences from preschool professionals and eventual effects on this group created by the policy representations. The analytical tools have mainly been provided through a WPR-approach and the material has been policy documents and interviews with preschool professionals. The results show that there is an inconsistency with how the problem is formulated and who is thought to be responsible for the problem in between the policy levels. Also, the problem representations had effects on the preschool professionals who were caught in between rationalities. Finally, the results confirm policy as a product of social, political and historical context as well as its ability to shape identities and expand or restrict the room for manoeuvre of groups and individuals.

Yes / Recent advances in virtual technologies have allowed the investigation of simulated moral actions in aversive moral dilemmas. Previous studies have employed diverse populations to explore these actions, with little research considering the significance of occupation on moral decision‐making. For the first time, in this study we have investigated simulated moral actions in virtual reality made by professionally trained paramedics and fire service incident commanders who are frequently faced with and must respond to moral dilemmas. We found that specially trained individuals showed distinct empathic and related personality trait scores and that these declined with years of experience working in the profession. Supporting the theory that these professionals develop resilience in moral conflict, reduced emotional arousal was observed during virtual simulations of a distressing dilemma. Furthermore, trained professionals demonstrated less regret following the execution of a moral action in virtual reality when compared to untrained control populations. We showed that, contrary to previous research, trained individuals made the same moral judgements and moral actions as untrained individuals, though showing less arousal and regret. In the face of increasing concerns regarding empathy decline in health care professionals, we suggest that the nature of this decline is complex and likely reflects the development of a necessary emotional resilience to distressing events.

Background: Discrimination against women occurs throughout society but is particularly problematic in healthcare situations as it affects the right to health and access to healthcare. Nurses play a crucial role in protecting patients’ integrity and advocating for social justice and equality. Aim: To describe women's experiences of discrimination in contact with healthcare professionals. Method: The study design consists of a qualitative literature review. Data analysis was conducted using Braun and Clarke's thematic analysis method (2006). Results: The analysis resulted in three main themes and five subthemes. The main themes identified were: Being powerless and vulnerable, Imbalance in power relations between patients and healthcare professionals, and Reduced access and participation in healthcare. Subthemes: Not being heard or taken seriously, Feeling powerless, Being belittled and devalued leads to a sense of dehumanization, Healthcare professionals' actions lead to shame and blame and The complexity of intersectionality. Conclusions: The study demonstrates extensive discrimination where women experience, they are not taken seriously or listened to. Discrimination results in women having poorer health outcomes. Suggestions for further research: To get a deeper understanding of why discrimination still occurs and how it can be avoided in the future. / Bakgrund: Diskriminering mot kvinnor förekommer i hela samhället men är särskilt problematiskt i vårdsituationer eftersom det påverkar rätten till hälsa och tillgång till sjukvård. Sjuksköterskan har en viktig roll i att värna patientens integritet och agera för att främja social rättvisa och jämlikhet. Syfte: Att beskriva kvinnors upplevelser av diskriminering i kontakt med hälso- och sjukvårdspersonal. Metod: Studiens design består av en kvalitativ litteraturöversikt. Dataanalysen gjordes utifrån Braun och Clarkes tematiska analysmetod (2006). Resultat: Analysen resulterade i tre huvudteman och fem subteman. De huvudteman som identifierades var: Att vara maktlös och sårbar, Obalansen i maktrelationen mellan patient och hälso- och sjukvårdspersonal och Försämrad tillgång och delaktighet i vården. Subteman som identifierades var: Att inte bli hörd eller tagen på allvar, Känslan av maktlöshet, Att bli förminskad och nedvärderad leder till en känsla av avhumanisering, Sjukvårdspersonalens agerande leder till skam och skuldbeläggande och Intersektionalitetens komplexitet. Slutsatser: Studien visar på en omfattande diskriminering där kvinnor upplever att de inte blir tagna på allvar eller lyssnade på. Diskrimineringen resulterar i att kvinnor får sämre förutsättningar till god hälsa. Förslag på fortsatt forskning: Fördjupa förståelsen kring varför diskriminering fortfarande förekommer och hur det kan undvikas i framtiden.

This qualitative study addresses a gap in horizontal crisis management research regarding the way collaboration plays out in practice in times of crisis. It is empirically focused on public actors in Kalmar County and takes aim at complementing earlier critical studies around power displacement and recapture in the realm of crisis collaboration to unearth impediments to interagency collaboration. An interview is carried out with duty officers and crisis management officers in four organizations with key tasks in the institutional crisis management system on the regional and local level, and the ambition is toshed light on how collaboration might be affected by formal, as well as informal, imbalances given that the organizations involved belong to different policy subsystems. It uses earlier theories regarding mandate, clusivity and trust as a point of departure, and asks: what impediments arise when actors from different political subsystems engage in interagency crisis collaboration in Kalmar County? The empirical analysis shows, surprisingly, a stark contrast to earlier stories from around the institutional crisis management system that described dysfunctional and asymmetric crisis collaboration.

The integration of work and family continues to be a challenge for women and men of the academy (Gatta & Roos, 2004). Much of the research on worklife balance in the post-secondary education setting focuses on the lives of instructional faculty (Bailyn, 2003; Bassett, 2005; Drago et al., 2006; Drago & Williams, 2000; Gatta & Roos, 2004; Massachusetts Institute of Technology, 1999; Ward & Wolf-Wendel, 2004). There is also a need to understand how university administrators juggle the demands of work and personal life. The primary purpose of this phenomenological inquiry was to make meaning of the lived experiences of mid-level student affairs administrators by examining worklife balance. A secondary purpose was to gather administrator perceptions of their environment to gain insight into infrastructures that may promote or hinder worklife balance efforts. Respondents consisted of 30 mid-level student affairs administrators from an array of post-secondary institutions across the United States. Data were generated from semi-structured telephone interviews and two projection exercises. Findings suggest that mid-level student affairs administrators describe their worklife experiences as driven by a shortage of time. Administrators maintain that time is a limited resource that causes difficulty when juggling competing worklife demands. Their involvement in multiple, interdependent roles is rewarding but presents ongoing personal and professional challenges. Administrators report that shortage of time, coupled with the demands of multiple roles impacts personal well-being and career satisfaction. Mid-level student affairs administrators also identified environmental infrastructures that promote and/or hinder worklife efforts in the context of several cultural dynamics. Formal and informal support mechanisms such as policies, programs and resources, effective supervision and campus support networks assist administrators in mitigating worklife challenges. This is in contrast to expectations, behaviors, and values that reinforce unhealthy workplace norms. In addition, the lack of organizational policies and programs and poor supervision also hindered worklife efforts. / Ph. D.