Bakgrund: När en person drabbas av cancer förändras hela ens livsvärld. Bristande kunskap ger en känsla av att inte få grepp om situationen och därför är det viktigt att sjuksköterskan ger en god omvårdnad med fokus på helhet och kommunikation. Syfte: Syftet med litteraturstudien var att beskriva patienters upplevelser av sjuksköterskans bemötande vid cancerbehandling på sjukhus. Metod: En litteraturstudie som bygger på tio kvalitativa artiklar. Resultat: Genom analys hittades tre huvudkategorier: Vikten av bred kunskap hos sjuksköterskan, Vikten av en bra vårdrelation och Vikten av ett bra omhändertagande som gynnar patientens välbefinnande och viljan att vara delaktig. Metoddiskussion: Att det inte hittades så många artiklar inom ämnet beror på att det mest finns forskning som är ur sjuksköterskans perspektiv. Förförståelsen bekräftades och författarna fick mer insikt i hur viktigt det verkligen är med tvåvägskommunikation. Resultatdiskussion: Patienten vill känna ett intresse från sjuksköterskans sida och en bra relation mellan dessa två uppstår då god kommunikation finns. / Background: When a person suffers from cancer their entire world changes. A lack of knowledge creates a feeling of not being able to adequately grasp the situation, which is why it is important that the nurse provides decent caregiving with emphasis on entirety and communication. Purpose: The purpose of the literature study was to describe patients' experiences of the nurse's approach in relation to cancer treatment at hospital. Method: A literature review that is based on ten qualitative articles. Result: Through analysis, three main categories were found: The importance of wide knowledge by the nurse, The importance of a good nursing relationship and The importance of good caretaking that benefits the patient's well-being and their will to participate. Method of discussion: The reason, as to why there were not many articles found on the subject matter, is due to the fact that there is more research conducted from the nurse's perspective. The preunderstanding was confirmed and the authors get more insight in how important two-way communication is. Discussion of result: The patient wishes to feel involvement from the nurse and a good relationship between the two arises when good communication exists

Eskom Holdings SOC Limited (referred to as Eskom), a public state owned company, is required to continually demonstrate environmental duty of care and report on its environmental performance. In furthering its commitment to sustainable development and in line with environmental compliance of its activities, Eskom is planning to have the Distribution Division certified against the International Organisation for Standardization (ISO) 14001:2004 environmental management system (EMS) standard by 2014. In general, management review may quickly turn into a dry review of the items on the agenda, done only to show an auditor the review was held. As such, the aim of this study was to assess the effectiveness of management reviews as one of the key continual improvement elements of the ISO 14001:2004 environmental management system within Eskom Distribution: Western Region. This research has been designed to take place in three stages. These stages are planning, execution and publication, and preparing the dissertation for marking. The research methodology included a literature study on various national and international articles and journals on EMSs that relate to environmental performance. The databases of Eskom Distribution: Western Region ‒ i.e. the management review presentation results for the 2008/09, 2009/10 and 2010/11 financial years, key significant environmental aspects for the Technical Service Centres (TSCs) and Minor/Major Engineering Works (MEW), key performance indicators (KPIs), Risk Audit System (RAS) results, and results of the external EMS audit conducted from 23–25 April 2007 were used for this research. Questionnaires were sent to the TSCs’ senior supervisors and Safety, Health, Environment and Quality (SHEQ) management. An analysis of the questionnaires completed by the TSC senior supervisors showed that all the participants have seen an improvement in environmental performance due to annual management reviews, except TSC11, who have not seen management review results. It can be concluded from the results of the SHEQ management questionnaires that an improvement (continual improvement as per the ISO 14001 requirement) was observed. The improvements were identified through improved processes, improved gap analysis, increased environmental awareness, and addressing risks. Most of the ISO 14001:2004 requirements for the management review for all financial years covered in this study were met. In terms of the objectives, targets and KPIs, Eskom Distribution: Western Region performed effectively and most of the outcomes were implemented according to the recommendations. Further, based on the external audit conducted from 23 to 25 April 2007, it is clear that Eskom Distribution: Western Region conformed to the minimum requirements of the ISO 14001:2004 EMS. Their management reviews also met all requirements of the ISO 14001:2004 relating to management review. This was proven by minutes of previous meetings that covered all the necessary issues that were audited. Thus, the existence of management reviews contributed towards ensuring that the ISO system was scrutinised and improved where it worked, and that aspects that did not work well were removed. / M. Environmental Management, North-West University, Potchefstroom Campus, 2014

This thesis makes two significant contributions to the advancement of knowledge within crime prevention. The first of these is to evaluate the success of repeat victimisation prevention interventions. Interventions across four crime types are assessed herein, and the context-mechanisms-outcome configurations examined. The second contribution of this thesis is to assess two techniques of meta-evaluation: systematic reviews and realist syntheses. Each of these techniques is used in turn to assess the repeat victimisation prevention interventions. The contribution of each technique to the knowledge pool is then discussed, and the question of whether they are complementary or contradictory approaches answered. The thesis is framed in the context of evolutionary epistemology, which is the philosophy underpinning both approaches to meta-evaluation addressed herein. The thesis starts, with an examination of: firstly, how the evaluation methods in question have evolved, and the background to their scientific worth; and secondly, how situational crime prevention measures have evolved over time. The thesis then examines the two competing approaches for their contribution to the evaluation ecosystem by using both to assess repeat victimisation prevention interventions. Finally, the last section poses the question of whether it is survival of the fittest, or whether co-existence or adaptation could be the key to survival for these two meta-evaluative methodologies. Repeat victimisation prevention is revealed as an effective way of reducing crime, with a need for further research to apply the principle across further crime types. A requirement is identified for a greater breadth and depth of information to be included in future crime prevention evaluations. The systematic review is shown to be a useful way of assessing the overall effectiveness of the interventions, whilst the realist synthesis fills in the detail of why some interventions work and others fail. It is concluded that both approaches to meta-evaluation have useful contributions to make, and that a third way incorporating the best elements from each method should be developed.

Currently, many educators are focusing on the development of Web-based material and the quality of such material needs to be evaluated. Expert review, as a formative evaluation method, is an important method to evaluate the material prior to release. Other studies have described the use of Subject-Matter Experts (SMEs) and also domain students, with enough knowledge in the subject area, as a way of enhancing the quality of the reviewed material. In addition to the SMEs and domain students a lecturer and graduate student, both in the subject discipline area, were used to review Web-based lectures on Advanced Computer Architectures. Both additional reviewers had sufficient knowledge of the discipline. The research investigates three main hypotheses: I) whether a review conducted by domain reviewers (SME and domain student) or discipline reviewers improves the quality of material, 2) whether using discipline reviewers improves the quality of the material more than domain reviewers and 3) whether there are differences in the quality of the material resulting from students' and lecturers' review. Five versions of the material were developed and used as inputs to an experiment that was designed to test the hypotheses by using questionnaires and tests. In summary, the findings of the research were that: SME reviewer and discipline reviewers were effective in producing higher quality than the unreviewed material. However, rather interestingly, the domain student was shown to be the least effective in enhancing the material. The investigation also found that there was no significant difference in the quality of the material resulting from students' and lecturers' review. Furthermore, it was found that the media used to present the material was more useful when the quality of that media was perceived to be high. Finally 90% of the subjects were willing to study Web-based lectures as part of the course.

Background: Traditional psychosocial treatments have been adapted for use with individuals with bipolar affective disorders due to the limited prophylactic nature of pharmacotherapy and the recognition of the role of psychosocial factors in the course of this disorder. Psychosocial interventions that include a prodromal monitoring and management component have been empirically shown to be an effective adjunct to medication for the treatment of bipolar disorder. Aims: There is a deficit of quantitative research that examines the impact of individualrelated (e.g. age, self-efficacy), disorder-related (e.g. time since diagnosis, experience of prodromal symptoms) and treatment-related (e.g. level of psychosocial input) factors on individuals’ ability to manage this disorder via the use of prodromal monitoring. The current research aimed to investigate factors that are associated with the identification and management of prodromal symptoms. Method: Participants completed five self-report measures in order to provide information on their experience of prodromal symptoms, current mood state, general self-efficacy, view of social support from significant others, and demographic and clinical-related variables. The data were collected from 101 participants, 58 of whom were female. The sample consisted of individuals with a diagnosis of bipolar disorder type I and II. Results: Univariate and bivariate analyses were used to explore the relationship between individual, disorder, and treatment-related variables associated with participants’ experience of bipolar disorder. Variables that were significantly associated with participants’ perception of their ability to identify and manage prodromes were further investigated using ordinal logistic regression analyses. The results indicated that general self-efficacy and prodromal-specific help from significant others were associated with an increase in participants’ perception of their ability to identify manic and depressive prodromal symptoms. General self-efficacy was also associated with participants’ view of their ability to manage cognitive and behavioural prodromes. Experience of prodromal symptoms (e.g. consistency of symptoms experienced, type of prodrome experienced) was associated the participants’ perception of their ability to identify and manage prodromes. In general, disorder-related variables (e.g. time since diagnosis, mood state, diagnosis type, and number of episodes experienced) were not significantly associated with the participants’ view of their ability to identify and manage prodromal symptoms. Individual-related variables such as gender and age, however, were associated with prodromal identification. Conclusion: The results indicated the need to consider constructs such as general selfefficacy and experience of prodromal symptoms (e.g. consistency of symptoms, types of prodromes experienced, and ability to recognise prodromes when they first present) when helping patients to learn how to identify and manage prodromal symptoms. In addition gender differences and the role of help from significant others were highlighted as variables that should be considered when using prodromal monitoring approaches with patients with bipolar disorder. Limitations of the research are reviewed in relation to the methodology used. Clinical implications and directions for future research are considered.

Female sexual pain is a common problem affecting women worldwide yet remains a poorly researched area of women’s sexual health. Dyspareunia and vaginismus are two types of sexual pain disorder each having psychological and physical health consequences for women and their partners. Part 1: A literature review of the qualitative research literature exploring women’s experiences of sexual pain disorders and their treatment was conducted adopting a narrative synthesis approach. Searches of psychological and medical electronic databases highlighted the paucity of research exploring women’s experiences of sexual pain disorders. Ten studies met the inclusion criteria for the review. The type of qualitative method and quality varied. Findings highlighted the complexity of women’s experiences of sexual pain. Positive experiences of treatment identified alternative benefits of treatment in addition to the traditional outcome of vaginal penetration and penetration without pain. Existing literature has focussed on dyspareunia, and further research is needed on vaginismus. Part 2: The research study used an Interpretative Phenomenological Analysis (IPA) of women’s experiences of vaginismus. Three women were interviewed about their experiences of vaginismus and the treatment they received. Interview transcripts were analysed using IPA. The findings identified the complexity of experiencing vaginismus, the struggle the women faced when trying to make sense of their vaginismus and the wider impact of these experiences on their identity. The findings highlight the value of psychological therapy with this client group and of the need to raise awareness amongst primary care professionals whom women with vaginismus are likely to consult in the first instance. Part 3: A critical appraisal of the research process is presented with focus on the experience of conducting qualitative research as a trainee clinical psychologist. A discussion of the findings is presented in the context of critical reflections on both the strengths and limitations of the study.

Systematic reviews and meta-analyses have been a central pillar of evidence-based practice and policy-making in healthcare over recent years. Traditionally, this has focused on effectiveness evidence from trials.. There is increasing understanding, however, that other study designs also provide essential information and this has led to interest in developing ways to review and synthesis such evidence. Qualitative research has unique potential to illuminate the patient experience. This research has three aims: 1) To review and compare the proposed methods of systematic review and synthesis of qualitative research. 2) To develop and assess two methods of systematic review and synthesis of qualitative research. 3) To compare these two methods and suggest how they might be used in a policy-making context. In addressing these aims, this thesis substantially contributes to debates about the purpose and practice of systematic review and synthesis of qualitative research, particularly in the context of health technology assessment and related pOlicy-making. I undertake a unique critical comparison of the methods suggested for reviewing and synthesising qualitative research, based on their approach to key stages of systematic review. This is used to produce a comprehensive framework for good practice~ I use the framework in two systematic reviews, one about heavy menstrual bleeding using meta-ethnography, and one about hysterectomy using meta-study. These two reviews allow a comparison of the two methods, and in particular explore the impact of expanding the meta-ethnography approach through meta-study, which adds explicit steps to assess the impact of study methodology and theory on findings. The ability of meta-study to unpack the procedures and theories that produce particular findings is key and illuminates the importance of theory in systematic reviews of qualitative research. Through the two systematic reviews, my thesis also contributes to understanding of these reproductive health topic areas through the creation of new insights and concepts from the synthesis. The synthesis of heavy menstrual bleeding studies produced a detailed patient illness model based on women's experiences. In addition, it allowed an understanding of elements that contribute to women's certainty or uncertainty about whether or not their periods could be seen as problematic and requiring medical help. This helps to establish the limitations of the medical model for doctors, as well as women who suffer from heavy menstrual bleeding. The synthesis of hysterectomy studies produced a detailed description of the journey that women make to, and through, hysterectomy, based on their experiences. I also created a theoretical framework, which shows that hysterectomy needs to be understood in the context of personal, physical experiences, together with sociocultural forces that affect the way in which hysterectomy is experienced, and that the interaction of these micro- and macro-concerns mediate through, and affect, relationships with key other people. Methodology affected the research questions posed and the conclusions of research. Comparing the two methods of review and synthesis showed the importance of taking account of the methods and theories that produce research findings. However this additional detail may be at the expense of certainty and requires additional resources.

Inledning Deloitte gjorde 2013 en granskning av Jönköpings kommun som visade på att rutiner saknades avseende omprövning av nyttjandeperiod för materiella anläggningstillgångar. Detta skulle kunna innebära att det även finns brister i kommunala bolag, varför en jämförelse mellan kommunala och privata bolag görs. Syfte Syftet med studien är att förklara och analysera sambandet mellan ägaridentitet och omprövning av nyttjandeperiod för materiella anläggningstillgångar i svenska fastighetsbolag. Metod Studien har en deduktiv ansats och en kvantitativ forskningsstrategi. En tvärsnittsdesign har gjorts där datan samlats in i form av sekundärdata genom granskning av årsredovisningar. Datan, som utgörs av ett slutgiltigt urval om 405 bolag, har kompletterats med kvalitativa intervjuer med fem revisorer. Slutsats Den statistiska analysen visar ingen signifikans för sambandet mellan omprövning av nyttjandeperiod och ägaridentitet. Det som dock verkar påverka benägenheten att ompröva nyttjandeperiod är vilken revisionsbyrå bolaget anlitar. Bolag som anlitar Deloitte eller en annan revisionsbyrå än Big 4 är mer benägna att ompröva nyttjandeperiod än bolag som anlitar övrigarevisionsbyråer. / Introduction An inspection of Jönköping’s municpality made by Deloitte in 2013 showed a lack of routines regarding reviewing of useful life for tangible fixed assets. This could imply a lack of routines in municipal corporations as well, and because of this a comparison is made between municipal and private corporations. Purpose The aim of this study is to explain and analyze the relationship between owner identity and reviewing of useful life for tangable fixed assets in Swedish real estate corporations. Method The following is a quantitative study based on a deductive approach and a cross-sectional design. Data has been collected as secondary data through examiniation of annual reports. The data, which consists of a final selection of 405 corporations, has been complemented through qualitative interviews with five auditors. Conclusion The statistical analysis shows no significant relationship between reviewing of useful life and owner identity. However, a factor that seems to affect the propensity to review useful life is depending on which audit firm the corporation uses. Corporations that use Deloitte or another audit firm than Big 4 tend to review useful life to a greater extent that those who use other audit firms.

The aim of this research programme was to explore ehealth technology in pharmacy practice in Scotland and, by doing so, contribute original knowledge to this area. Strategists worldwide believe technology has the potential to promote quality, safety and efficiency in healthcare. This has been reflected in national ehealth policies designed to support collaborative working between medical and non-medical healthcare practitioners and, more recently, the whole health and social care team. A meta-narrative systematic review was conducted to explore and contextualise research related to healthcare professionals’ views of the adoption of ehealth technologies to support shared care. Findings indicate the importance of organisational development and training for core and optional ehealth services with pharmacists particularly under-represented in ehealth research. Socio-technical systems theory and the computer supported cooperative working framework were adopted to explore healthcare practitioners’ perceptions of ehealth in relation to integrated care. Findings from the review indicate ehealth research continues to focus on doctors and nurses. No ehealth application was perceived to be an unqualified success with the socio-technical gap still evident. Multiple case studies were conducted to develop explanatory theory around the digital literacy experiences, education and training related needs of pharmacy staff in the NHS Grampian area. Digital literacy levels were self-reported as basic with mixed views on the need for formal education and training. Findings indicate organisational and social factors may act as restraining forces against implementation of technology in pharmacy and associated digital literacy training. A final theory testing, systematic review was conducted into digital literacy training experiences of pharmacy staff applying Kirkpatrick’s four level model. It found a lack of evidence of specific, measurable digital literacy levels but indications that suggest digital literacy should be included in pharmacy education at all levels and career stages. This research provides novel insight into ehealth and digital literacy in pharmacy practice. Combined ehealth, education and pharmacy research has been demonstrated to be an under-researched area therefore these findings contribute original knowledge.

Bakgrund: Hjärtsvikt kan vara ett påfrestande tillstånd och är vanligt bland den äldre befolkningen. Behandlingen består utöver medicinska åtgärder till stor del av egenvård för den drabbade. Personen måste därför ta mycket eget ansvar, vara väl informerad och ha bra stöd ifrån vården, vilket kräver att vården måste vara personcentrerad. Syfte: Att ur ett patientperspektiv beskriva upplevelsen av att leva med hjärtsvikt och hur det påverkar livskvaliteten. Metod: En Litteraturöversikt med litteratur hämtad från databaserna CINAHL, PubMed, PsycINFO och Web of Science. Resultat: Personerna med hjärtsvikt upplevde många olika besvär, både fysiska, psykiska och sociala som påverkade deras dagliga liv i olika omfattning. Situationen gick att lära sig leva med och det var möjligt att uppleva livskvalitet. Många ville lära sig mer men en del var inte medvetna om att de hade hjärtsvikt.. Slutsats: Livet med hjärtsvikt kan innebära stora påfrestningar och påtvingade förändringar både fysiskt, psykiskt och socialt. Men det finns möjlighet att leva ett tillfredsställande liv och känna god livskvalitet. Kontakten med sjukvården är både en tillgång såväl som en källa till frustration. Upplevelserna bör beaktas för att sjuksköterskan ska kunna ge både vård och stöd som är individanpassad och som främjar personens egna resurser samt egenvårdsförmåga. / Background: Heart failure can be a trying and distressing condition, common among the elderly population. Apart from the medical measures, treatment involves a lot of self-care. Healthcare professionals need to provide education and support, since this involves the patient taking a great deal of personal responsibility. With this in mind, healthcare needs to be person-centered. Aim: To describe, from a patients’ perspective, the experience of living with heart failure and how it affects quality of life. Method: A literary review, with studies collected from databases CINAHL, PubMed, PsycINFO and Web of Science. Results: The findings show that people with heart failure experienced many different issues, physical, social and mental, which had an impact on their daily life. Despite this, it was possible to come to terms with the situation and experience quality of life. The will to learn more about the condition was common although many were not aware of their diagnosis. Conclusion: Living with heart failure can be trying and mean forced alterations to physical, mental and social aspects of life. However, it is possible to live a satisfying life and experience good quality of life. Having access to healthcare is both an asset as well as a source of frustration. Nurses need to be aware of these experiences in order to be able to provide patient-centered care and support the patient’s resources and self-care abilities.