The overall aim of this thesis is twofold: first, to develop and validate questionnaires that could be used for investigating relationships between perceptions of conscience, moral sensitivity and burnout and second, to describe patterns of self-comfort used to ease stress and illuminate meanings of living with a troubled conscience. The thesis comprises five studies and is based on both quantitative and qualitative data. In study I, a questionnaire was constructed to assess perceptions of conscience; the Perceptions of Conscience Questionnaire (PCQ). This 15 item-questionnaire was distributed to 444 care providers. Statistical analyses of responses showed sufficient distribution and a stable six factor solution congruent with reviewed literature. The six factors were labelled: ‘the voice of authority’, ‘warning signal’, ‘demanding sensitivity’, ‘asset’, ‘burden’ and ‘depending on culture’. The findings suggest that the PCQ is a valid questionnaire. The aim of study II was further development of an existing questionnaire assessing care providers’ moral sensitivity, enabling its use in various care contexts. The revised nine-item questionnaire, the Moral Sensitivity Questionnaire Revised version (MSQ-R), was distributed to 278 care providers with various professional backgrounds. Statistical analyses of responses showed sufficient distribution and a three-factor solution congruent with reviewed literature. The three factors were labelled: ‘sense of moral burden’, ‘sense of moral strength,’ and ‘sense of moral responsibility.’ The findings suggest that MSQ-R is valid for use in various healthcare contexts. In study III, the PCQ, the MSQ-R and the Maslach Burnout Inventory (MBI) were distributed to a population of psychiatric care providers (n=101) to investigate relationships between perceptions of conscience and moral sensitivity and levels of burnout. The hierarchical cluster analysis shows two clusters with Pearson’s r >.50. Cluster A comprising items such as: being sensitive, interpreting and following the voice of conscience that warns us against hurting other or ourselves and developing as human beings was labelled ‘experiencing a sense of moral integrity’. Cluster B comprising items such as: feeling inadequate, doing more than one has strengths for, feeling always responsible, having difficulties to deal with wearing feelings, perceiving that conscience gives wrong signals and express social values, having to deaden one’ conscience, were all related to scores of the MBI subscales emotional exhaustion (EE) and depersonalisation (DP). Cluster B was labelled ‘experiencing a burdening accountability’. The results show that levels of ‘experiencing a burdening accountability’ are closely related to levels of being at risk of burnout. The aim of study IV was to describe patterns of self-comforting measures used to ease stress. The written accounts of 168 care providers and healthcare students were analysed by means of qualitative content analysis. The findings disclose two dimensions: an ability to use early learned measures to take care of oneself (ingression) and an ability to feel intimately related to life, other human beings and universe or God (transcendence). The findings provide valuable knowledge about self-comfort as a coping strategy. The aim of study V was to illuminate meanings of living with a troubled conscience. Ten psychiatric care providers, respondents of study III with various perceptions of conscience were interviewed. The interviews were interpreted using a phenomenological - hermeneutical method. The findings show that one meaning of living with a troubled conscience is being confronted with inadequacy and struggling to view oneself as ‘good enough.’ The comprehensive understanding indicates that inadequacy, both one’s own and that of organization one represents, infuse feelings of shame rather than feelings of guilt. Shame concerns one’s identity and need of reconciliation. Conclusions: The results reveal two ways of encountering a troubled conscience. One is being unable to interpret the ethical demand from a troubled conscience. This is indicated by connections between levels of moral burden and levels of burnout. The other way is being able to interpret the ethical demand and using one’s troubled conscience to develop practical wisdom. This means facing shame of feeling inadequate, reconciling images of the ideal self and self-contempt, and becoming realistic about what one can do. In this process comfort seems to be a mediator of reconciliation.

The aim of this study was to obtain better knowledge about teenagers' physical capacity and physical activity. The study group consisted of 301 students in upper secondary school, 191 students in practical education (74 girls and 117 boys) and 110 students in theoretical education (57 girls and 53 boys). The adolescents were 16-19 years old and lived in southern Sweden. The study comprised three parts: a questionnaire, seven physical tests (one test to predict maximal oxygen uptake, three strength tests, two flexibility tests and one balance test) and information on each pupil's grades. Pupils in practical education for occupations like industrial- and building workers, mechanics, assistant nurses and hairdressers, all of which are occupations involving physical effort, had lower physical capacity than pupils in theoretical education among both girls and boys. A correlation was found between physical capacity and grades.

Neck pain has the potential to result in altered afferent input to the central nervous system which may thereby result in altered sensorimotor integration and eventually further disability. One “at risk” population for neck pain may be university students, particularly given the growing use of laptop computers in the university setting. This thesis presents two pilot studies which aim to develop and assess instruments to use as screening tools for risk factors associated with neck pain. The first study explores the environment in which university students utilize their laptop computers and the relationship to known risk factors for neck pain. A new questionnaire, The Student Laptop Use and Neck Pain Risk Questionnaire (SLUNPRQ) was created to measure the presence of risk factors known to increase the risk of developing neck pain. This questionnaire was piloted for reliability using test- retest measures. Results indicated that the SLUNPRQ had good reliability based on Cohen’s Kappa scores. A modified questionnaire was developed based on questions with either low reliability or ambiguous answers and is ready for further testing. The second study sought to determine if dual somatosensory evoked potential (SEP) ratios changed with long term chiropractic care. This was part of the overall goal of finding neural markers that could identify those who are at risk for developing neck pain. This study sought to determine the feasibility of using dual SEPs to evaluate changes in neural markers of sensorimotor integration after 12 weeks of chiropractic care and demonstrated that dual SEPs shows potential as a marker to screen individuals at risk of neck pain as the SEP markers showed improvement after long term chiropractic care. / UOIT

Introduction: Physical and verbal violence within the health care sector, especially towards nurses, is a problem that have been reported from many countries worldwide.  Aim: The aim of this study was to examine workplace-related violence, and its outcomes, experienced by Tanzanian nurses in a tertiary hospital facility. Method: This was a descriptive, retrospective, cross-sectional study.  The study was carried out in patient wards in a tertiary hospital facility. 54 nurses’ working at a hospital in Tanzania with regular contacts with patients were asked to return a questionnaire, comprising 17 questions with fixed-alternative answers. Results: Of the 32 participants (59% response rate), 16 nurses reported having experienced physical or verbal violence. The most common type of violence was “verbal threat/aggression” (n = 11) and the most common source of aggression was from “patient relative/visitor” (n = 9). Conclusion: The main findings of this study confirmed that workplace-related violence towards nurses’ did occur in the hospital where the study took place. The results are supported by existing research and literature that workplace-related violence is a worldwide problem. Education and awareness regarding violence prevention as a part of nursing education could help preventing workplace-related violence. / Introduktion: Våld i fysisk eller psykisk form är inom hälso- och sjukvårdssektorn, speciellt riktat mot sjuksköterskor, ett problem som rapporterats från flertalet länder över hela världen. Mål: Målet med denna studie var att utforska arbetsplatsrelaterat våld och upplevda utfall av dessa hos sjuksköterskor på ett referenssjukhus i Tanzania. Metod: Detta var en deskriptiv, retrospektiv, tvärsnittsstudie. Den utfördes på vårdavdelningar på ett referenssjukhus. 54 sjuksköterskor med regelbunden patientkontakt som arbetade på KCMC tillfrågades om att fylla i en enkät innehållandes 17 frågor med valbara alternativ.  Resultat: Utav de 32 deltagarna (59% svarsfrekvens) hade 16 sjuksköterskor rapporterat att ha upplevt psykiskt eller fysiskt våld. Majoriteten av sjuksköterskorna rapporterade typen av våld som verbalt (n = 11) och den vanligaste källan av våld var patientens närstående (n = 9). Slutsats: De huvudsakliga fynden från denna studie var att våld riktat mot sjuksköterskor på arbetsplatsen förkom på sjukhuset där studien utfördes. Resultaten i denna studie stämmer överens med redan existerande forskning och stöder teorin om att detta fenomen är globalt. För att förhindra arbetsplatsrelaterat våld bör utbildning rörande våldsprevention ingå i sjuksköterskors utbildning.

För att anhöriga och personer med afasi ska kunna etablera en fungerande vardag harkunskap om och förståelse för afasi visat sig viktig. I tidigare studier har anhöriga tillpersoner med afasi visat sig sakna relevant kunskap om och förståelse för afasi som debehöver för att etablera en fungerande vardag. Logopediska insatser som är riktadedirekt till anhöriga är relativt ovanliga i Sverige. Syftet med denna studie är att utifråndata från litteratur och intervjuer utforma frågor, så kallade item, som på ett tillförlitligtsätt kan mäta kunskap om och förståelse för afasi hos anhöriga till personer med afasi.Tre fokusgrupper bestående av anhöriga till personer med afasi, personer med afasi ochlogopeder användes för insamlande av intervjudata. Intervjudatan analyserades genomkvalitativ innehållsanalys. Från analysen framställdes sju kategorier med tillhörandeunderkategorier. Kategorierna låg till grund för utformningen av item. Sammanlagt har140 stycken item utformats. Dessa item var av två typer; item bestående av en 6-gradigLikert-skala och item av typen Multiple Choice. Vidare indelades item beroende påvilka svar som kan erhållas . Item med önskvärda svar( typ A) och situations- ochindividberoende item (typ B) som syftar till att ligga till grund för samtal mellananhörig till person med afasi och logoped.. De kategorier och item som studienresulterat i uppvisar samstämmighet med tidigare studier som fokuserat på anhöriga tillpersoner med afasi. Samstämmigheten tyder på att de item som inkluderas i ett framtidaformulär har möjlighet att kunna mäta av kunskap och förståelse hos anhöriga tillpersoner med afasi. För att framtagna item ska kunna resultera i det tilltänkta formuläretkrävs ytterligare validering, reliabilitetstestning och urval. / Previous studies have shown that significant others to persons with aphasia are in needof increased knowledge and understanding of aphasia. The knowledge andunderstanding for aphasia has shown to be crucial to significant others in terms ofpsychosocial well-being and to be able to establish a satisfying everyday life. PresentSpeech-language pathologist services in Sweden tend to have limited involvement ofsignificant others to persons with aphasia. This study aims to design a number ofquestions, items, which will be able to measure the knowledge and understanding ofaphasia for significant others of persons with aphasia. The items result from literaturestudies and semi-structured interviews with significant others to persons with aphasia,persons with aphasia and speech-language pathologists. Transcripts from interviews areanalyzed through content analysis. The study results in 140 items presented in sevencategories, each with a number of sub-categories. Two types of items are designed:items in the form of a 6-point Likert Scale and items in the form of Multiple Choice.The items are also divided depending on whether the answer is knowledgde-based (typeA) or to be used as material for discussion (type B). The categories and items from thisstudy are consistent with previous research. To transform the items into a completequestionnaire, further validation, testing of reliability and selection is needed.

Study Design: A blinded, prospective diagnostic test study was conducted.<p>Objectives: To assess the inter-tester reliability of clinical examination items for carpal tunnel syndrome (CTS), to assess the validity of individual clinical test items and self-report measures for the diagnosis of CTS and to assess the accuracy of an optimum test item cluster for the diagnosis of CTS.<p>Study Rational: Examination of the diagnostic validity of various clinical tests for the diagnosis of CTS has shown mixed results and the reliability of many of these tests has not been determined. The majority of the diagnostic validity research for CTS has examined tests individually which is in contrast to clinical practice where the results of multiple tests are combined as part of the clinical reasoning process in order to formulate a differential diagnosis: the test item cluster, derived through logistic regression, is proposed as a means to integrate the validity of multiple tests. Methods: 37 subjects (74 hands) were recruited from a convenience sample of consecutive patients referred to for electrodiagnostic (EDX) testing due to upper extremity symptomatic complaints. Subjects underwent EDX testing followed by completion of self-report questionnaires and a standardized clinical examination by examiners blinded to EDX results. Diagnostic validity was determined for both general and restricted CTS classification groupings. <p>Results: Out of 18 clinical test items, 12 had reliability coefficients (i.e. ICC or Kappa) of .40 or greater. There were 10 clinical exam and self-report items that were found to have likelihood point estimates above 2 or below 0.50 for the general diagnostic classification and 6 items had acceptable validity for the restricted classification. The test item cluster (TIC) derived for the general classification included hand numbness and symptom reproduction with the upper limb neurodynamic test 1. The TIC derived for the restricted classification included hand numbness and the overall score of the symptom component of the Bringham Carpal Tunnel Questionnaire. The 95% confidence intervals for most likelihood ratio point estimates were wide. <p>Conclusions: The TICs for both classification groupings did not yield improved diagnostic validity beyond that found with the single best test item (hand numbness). The value of the single best test item hand numbness was in a negative response. Further investigation is required to validate the TIC and the single best test item and to improve the point estimate precision.

Background: There is an unacceptable delay in diagnosis of axial Spondyloarthritis (axSpA) especially in its early stages among patients with inflammatory bowel disease (IBD). Objective: to develop a sensible and reliable questionnaire to identify undetected axSpA among IBD patients. Methods: Candidate items for the questionnaire were selected on 3 domains (IBD, inflammatory back symptoms, and extra-axial features). Sensibility of the Toronto axSpA Questionnaire (TASQ) was assessed leading to drafting 18 items. Test-retest reliability study was conducted among 77 patients with established IBD and axSpA and kappa agreement coefficients were calculated for items. Results: The TASQ was developed using multiple steps of sensibility assessment resulting in 16 items. Kappa coefficients ranged from 0.81 to 1.00 for all items indicating almost perfect agreement. Conclusion: TASQ is a newly developed, sensible and reliable questionnaire that should facilitate identification and referral of IBD patients to rheumatologists and should avoid delay in diagnosis of axSpA.

Background: There is an unacceptable delay in diagnosis of axial Spondyloarthritis (axSpA) especially in its early stages among patients with inflammatory bowel disease (IBD). Objective: to develop a sensible and reliable questionnaire to identify undetected axSpA among IBD patients. Methods: Candidate items for the questionnaire were selected on 3 domains (IBD, inflammatory back symptoms, and extra-axial features). Sensibility of the Toronto axSpA Questionnaire (TASQ) was assessed leading to drafting 18 items. Test-retest reliability study was conducted among 77 patients with established IBD and axSpA and kappa agreement coefficients were calculated for items. Results: The TASQ was developed using multiple steps of sensibility assessment resulting in 16 items. Kappa coefficients ranged from 0.81 to 1.00 for all items indicating almost perfect agreement. Conclusion: TASQ is a newly developed, sensible and reliable questionnaire that should facilitate identification and referral of IBD patients to rheumatologists and should avoid delay in diagnosis of axSpA.

Background: Health-Related Quality of Life (HRQOL) can be negatively affected in patients living with arrhythmias and many patients experience a pronounced symptom burden. The arrhythmia can cause both uncertainty and limitations, including interference with work, reluctance to perform and plan for leisure activities and leading to self-imposed restrictions in daily life situations. There are patients striving to find strategies to manage the arrhythmia and for some this can become the focus in their lives. Treatment options are often a choice between pharmaceuticals and radiofrequency ablation (RFA) where RFA is an option for many arrhythmia-patients to be cured. In the care of arrhythmia-patients it is of great importance to combine objective examinations with patient-reported outcomes (PROs) to achieve patient’s own experiences of treatment efficacy and arrhythmias interference in daily life situations. Aims: The overall aims of this thesis were to assess symptom burden and HRQOL in patients with arrhythmias and to develop and validate an arrhythmia-specific questionnaire, suitable for most arrhythmia-patients. Design and Methods: Studies I and II were single-centre studies including patients referred for RFA, with two different arrhythmia diagnoses. Assessments of patient-reported outcomes (PROs) concerning HRQOL were performed using two questionnaires, SF-36 and EQ-5D (I-II). Further, patients were asked some disease-specific questions (I). Study I describes assessments before the RFA treatment and Study II the follow-up assessments at three and twelve months after RFA. Patients’ scoring of HRQOL was compared to age and gender matched reference groups before and after RFA (I-II). Studies III and IV describe the development and validation of a disease-specific questionnaire ASTA (Arrhythmia-Specific questionnaire in Tachycardia and Arrhythmia) assessing symptom burden and HRQOL. Studies III and IV were multicentre studies. Patients planned for DC-conversion, AF patients seeking emergency care and those with different forms of arrhythmias referred for RFA were included. Results: Patients scored significantly lower HRQOL in seven of SF-36’s eight scales compared to the age and gender matched reference groups before RFA treatment. Frequent arrhythmia attacks had a great negative impact on HRQOL, and female gender and older age were factors contributing to worse HRQOL (I). Treatment with RFA restored the patients’ HRQOL. Most positive effects were seen at three months follow-up. One year after treatment patients and the matched reference group scored their HRQOL to a similar level, assessed with SF-36 and EQ-5D index (II). The validated ASTA questionnaire was found to have good psychometric properties. Construct validity was confirmed with sufficient levels of item-total correlations in the ASTA symptom burden scale and HRQOL scales. The dimensionality of the ASTA HRQOL scale was established with confirmatory factor analysis, supporting a physical and a mental subscale. The internal consistency, demonstrated with Cronbach’s alpha (α), was satisfactory for the ASTA symptom burden scale and the ASTA HRQOL scales, varying from α 0.79 to α 0.91 (III-IV). Conclusions and clinical implications: The studies in this thesis confirmed how negatively affected the arrhythmia-patients can be with a pronounced symptom burden and impaired HRQOL. Treatment with RFA was demonstrated to restore the patients HRQOL to an equal level of that of the matched reference group. PROs are important to take into consideration in the care of arrhythmia-patients, to achieve the patients’ subjective experiences of their daily life situation. To the best of our knowledge ASTA is the first arrhythmia-specific questionnaire assessing symptom burden and HRQOL, suitable for most arrhythmia forms. The newly validated ASTA questionnaire can be an important contribution to assessment of PROs in arrhythmia-patients.

Die Befragung „Ist-Stand der OP-Textilienversorgung in deutschen Krankenhäusern“, die eingebettet ist in das Forschungsvorhaben „Evaluierung von OP-Textilien nach hygienischen, ökologischen und ökonomischen Kriterien“, hat zum Ziel, den gegenwärtigen Stand der OP-Textilienversorgung zu erfassen. Für die Befragung, die sowohl web-basiert als auch postalisch im Zeitraum 11/2008 bis 02/2009 durchgeführt worden ist, wurden vorab alle Krankenhäuser und Kliniken in Deutschland kontaktiert, um den jeweiligen Ansprechpartner für die Beschaffung von OP-Textilien zu erhalten. Der Fragebogen gliedert sich in drei Teile: Abschnitt A: OP-Textilien mit den Unterabschnitten Allgemeines, Ausschreibung von OP-Textilien, OP-Mäntel, OP-Abdeckungen, OP-Kit-Packs, Ökonomische Analyse der OP-Textilienversorgung und Ökologische Bewertung der OP-Textilienversorgung; Abschnitt B: Umweltschutz im Krankenhaus und Abschnitt C: Angaben zum Krankenhaus. Zu den zentralen Ergebnissen der Befragung zählen, dass das Kriterium Versorgungssicherheit das wichtigste Kriterium bei der Ausschreibung ist, gefolgt von Zuverlässigkeit und Reinigungsqualität; dass sowohl Einweg-OP-Mäntel als auch -OP-Abdeckungen häufiger angewendet werden als Mehrweg-Textilien; dass der Tragekomfort der Mehrweg-Mäntel als deutlich besser eingestuft wird als der der Einweg-Mäntel. Ein ähnliches Ergebnis zeigt sich bei der Umweltfreundlichkeit von OP-Mänteln und OP-Abdeckungen. Weiterhin zeigte die Untersuchung, dass eine ökonomische Bewertung bisher häufiger vorgenommen wurde als eine ökologische Bewertung. Bei ökonomischen Analysen, die in den meisten Fällen durch ein krankenhausinternes Team durchgeführt wurden, wurden weitestgehend die Anschaffungskosten/ Miet- bzw. Leasingrate als Kriterium herangezogen. Im Rahmen der ökologischen Bewertung sind vor allem Kriterien wie schadstoffarmer Abfall, geringe Umweltbelastung und wenig schädliche Stoffe von Bedeutung. Insgesamt wird der Umweltschutz tendenziell als wichtig eingeschätzt, wobei die am häufigsten vertretenen Umweltschutzmaßnahmen die Beachtung von Umweltkriterien bei der Beschaffung, die/der Umweltbeauftragte/r und die Zertifizierung nach ISO 14001 sind.