The overall aim of this thesis is to describe perception of conscience, stress of conscience (stress related to troubled conscience) and burnout, to explore their relationships and to illuminate meanings of the lived experience of troubled conscience in one’s work among registered nurses (RNs) and nurse assistants (NAs) in municipal residential care for the elderly. The thesis comprises four studies; studies I-III are based on questionnaire data from 50 RNs and 96 NAs and study IV is based on interview data from 6 RNs and 6 NAs selected from the participants in the questionnaire study. Questionnaire data was analysed with multivariate statistics (I-III). Narrative interviews were interpreted with a phenomenological hermeneutic method (IV). Study I showed two relationships explaining a noteworthy amount of the shared variance by themselves (25.6% and 17.8%). One relationship was shown between having to deaden one’s conscience in order to keep working in healthcare and stress of conscience related to external demands which was interpreted as having to deaden one’s conscience in order to be able to collaborate with co-workers. The other relationship was shown between having to deaden one’s conscience in order to keep working in healthcare and stress of conscience related to internal demands which was interpreted as having to deaden one’s conscience in order to be able to feel like a good healthcare professional. Study II showed a relationship between stress of conscience and burnout (43.6% explained variance) indicating that experiences of shortcomings and of being exposed to contradictory demands are strongly related to burnout. The relationship between perceptions of conscience and burnout (33.9% explained variance) indicated that having to deaden one’s conscience in order to keep working in healthcare is strongly related to burnout. Study III showed that both RNs and NAs perceived conscience mainly as an asset and a guide and not as a burden in their work. Lack of time and high demands of work influencing home life were the situations related to the highest stress of conscience for both RNs and NAs. The predictive pattern for RNs was interpreted as RNs showing sensitivity to expectations and demands and NAs using their conscience as a guide in their work. Study IV showed that meanings of the RNs’ lived experience of troubled conscience in their work are of being trapped in feelings of powerlessness and a sense of being inadequate. They feel they are failing to live up to expectations from residents and their families, colleagues and themselves because of feelings of powerlessness, cowardice and incompetence. Meanings of NAs’ lived experience of troubled conscience in their work are a sense of being hindered in providing the level of care they would like to provide because of pre-determined conditions and by feelings of being inadequate. They are betraying the residents and themselves by accepting perceived inadequate working conditions and through their own perceived sense of cowardice and negligence. The conclusion of these studies is that stress of conscience is related to burnout among RNs and NAs in municipal residential care for the elderly. Experiences of inadequacy, powerlessness and feelings of being hindered are shown in situations where they have troubled conscience. When the norms of others and/or the pre-determined conditions do not correspond to their own values and norms it may result in the feeling that they cannot perceive themselves as good healthcare professionals.

Socialstyrelsen beskriver en kommande brist på operationssjuksköterskor i Sverige, samtidigt visar statistik av antal ansökningar till specialistutbildningen att färre sjuksköterskor väljer inriktningen operationssjuksköterska. I litteraturen beskrivs operationssjuksköterskans yrke som dolt för utomstående, och det kan vara en orsak till det låga intresset att välja yrket. Syftet med denna pilotstudie var att beskriva sjuksköterskors uppfattningar om operationssjuksköterskans yrke. Studien är genomförd med kvalitativ induktiv ansats som en intervju med öppen ingångsfråga. Data är analyserat med manifest innehållsanalys. I resultatet framkom tre kategorier, Osynligt och lågt värderat, Medlem i teamet och Praktiskt arbete. Resultatet stämmer överens med tidigare utförd forskning. En större studie är av värde för att få en djupare förståelse av skillnader i uppfattningar. Kunskap om uppfattningen kan underlätta rekrytering av operationssjuksköterskor. Specialistkompetens på operationsavdelningarna ökar förutsättningarna för patienter att få en säker perioperativ omvårdad / National Board of Health and Welfare describes an upcoming shortage of perioperative nurses in Sweden, and statistics show that the number of nurses applying to specialized training in the perioperative field is declining. In the literature, the perioperative nursing profession is described as non-visible to people in general, and that may be a reason for the lack of interest in choosing the profession. The purpose of this pilot study is to describe nursesʹ perceptions of the perioperative nursing profession. The study was conducted using qualitative inductive approach as an interview with open entry question. Data was analyzed by manifest content analysis. The results revealed three categories; Invisible and low valued, Member of the team and Practical work. The result is consistent with prior research conducted. A larger study is of value to obtain a deeper understanding of differences in perceptions. Knowledge of these perceptions may facilitate the recruitment of perioperative nurses. Specialized competence at the surgical departments increases the chances for patients to receive a safe perioperative care.

Bakgrund: Delegering av hälso- och sjukvårdsuppgifter från legitimerad sjuksköterska till icke-legitimerad personal är vanlig. Tidigare forskning har visat att delegering kan leda till att sjuksköterskans roll blir otydlig. Syfte: Att undersöka hur sjuksköterskors professionsutövning påverkas av att delegering till icke-legitimerad personal förekommer. Metod: Tio vetenskapliga artiklar studerades enligt metod för kvalitativ innehållsanalys. Resultat: Tre huvudteman framstod: ”Sjuksköterskor och inflytande”, ”Sjuksköterskor och interaktion” samt ”Sjuksköterskor och säkerhet”. Sjuksköterskor tyckte om att dela med sig av sin kunskap och uppskattade den avlastning som delegering kunde innebära. Emellertid uttryckte sjuksköterskor i en majoritet av studierna förlust av kontroll i samband med delegering. Många sjuksköterskor brast också i delegeringskompetens. Konklusion: Delegering kan försämra sjuksköterskors helhetssyn och kontroll över omvårdnadssituationen, vilket kan försvåra för dem att ta sitt fulla omvårdnadsansvar. Det finns också brister i sjuksköterskors kunskaper och färdigheter i att delegera. Impliktioner: Sjuksköterskor behöver delta mer i den patientnära omvårdnaden. Delegeringarna bör minska, och sjuksköterskor behöver återta sitt ansvar för omvårdnaden. Sjuksköterskor behöver också mer utbildning och träning i konsten att delegera. Ytterligare forskning kring delegering är nödvändig, särskilt i Sverige. / Background: Delegation of health care tasks from registered nurse to non-licensed personnel is common. Earlier research has shown that delegation can lead to blurring of the nurse’s role. Aim: To examine how the existence of delegation to non-licensed personnel influences the professional work of registered nurses. Method: Ten scientific articles were studied using content analysis. Results: Three major themes emerged: “Nurses and influence”, “Nurses and interaction” and “Nurses and safety”. Nurses enjoyed sharing their knowledge and appreciated the relief that delegation could entail. However, in a majority of the studies nurses expressed loss of control associated with delegation. Many nurses also showed lack of competence with regard to delegation. Conclusion: Delegation can diminish nurses’ holistic view and control of care situations, which may make it difficult for them to take full responsibility for the care. There is also a lack of knowledge and skill concerning delegation among nurses. Implications: Nurses need to participate more in direct patient care. Delegations should be fewer, and nurses need to reclaim their responsibility for nursing. Nurses also need more education and training in the art of delegating. Further research on delegation is necessary, especially in Sweden.

Nemažai Europos Sąjungos valstybių narių įmonių yra suinteresuotos savo registruotos buveinės perkėlimu į kitą valstybę narę. Įmonei sėkmingai perkėlus savo registruotą buveinę į kitą valstybę, keistųsi įmonei taikytina teisė. Esant teisinei galimybei įmonei nutraukti savo veiklą įsikūrimo valstybėje be įmonės likvidavimo, bei įsikurti kitoje valstybėje, įmonė išlaikytų savo juridinį statusą, o visas įmonės turtas ir prisiimti įsipareigojimai tiesiogiai pereitų naujoje valstybėje įkurtai įmonei. Darbe yra analizuojama įmonės registruotos buveinės perkėlimo galimybė Europos Sąjungos valstybių narių tarptautinės privatinės teisės atžvilgiu, bei jų vidaus materialinės teisės atžvilgiu. Taip pat analizuojama Europos Teisingumo Teismo jurisprudencija ir jos įtaka tokio perkėlimo galimybei bei aptariama alternatyvi įmonės registruotos buveinės perkėlimo galimybė remiantis antriniais Europos Sąjungos teisės aktais. / Many companies in European Union are interested in the possibility to transfer their registered offices to another country. Doing that would lead to a change in the applicable law. If a company is allowed to dissolve in its country of incorporation without the liquidation, and to incorporate in the new state, the company would maintain its legal status and all of it‘s assets and liabilities would be passed to a company incorporated in the new state. This paper analyzes the possibility of such transfer according to European Union member states private international law and substantive law provisions. It also analyzes the jurisprudence of the European Court of Justice and it's influence on possibility of such transfer. The indirect possibility of such transfer, according to European Union secondary law, is also disscused.

Bakgrund: Att bli förälder är en omvälvande och stor förändring i livet och det är vanligt att bli nedstämd den första tiden som förälder. Oftast går det över ganska snabbt efter förloss-ningen men 10-20 procent av alla nyblivna mödrar mår fortsatt dåligt en längre tid och drab-bas av en förlossningsdepression. På grund av känslor som skam och skuld undviker många mödrar att söka vård och därför blir förlossningsdepression ofta oupptäckt och odiagnostise-rat.Syfte: Att beskriva mödrars upplevelser vid förlossningsdepression samt att beskriva upple-velsen av stödet från sjuksköterskan. Syftet var vidare att beskriva de inkluderade artiklarnas urvalsmetod och undersökningsgrupp.Metod: En beskrivande litteraturstudie baserad på 15 vetenskapliga artiklar med kvalitativ ansats. Databaserna PsycINFO och Cinahl användes till litteratursökningen.Huvudresultat: Vanliga upplevelser hos mödrar med förlossningsdepression var rädsla, skuld och ökad sårbarhet för att hantera förändringar. Mödrarna beskrev en frustration kring stödet och rådgivningen som gavs från sjuksköterskan samt deras attityder. Mödrarna beskrev en önskan om att sjuksköterskan skulle lyfta fram och synliggöra förlossningsdepression.Slutsats: Mödrar med förlossningsdepression lever i en känslomässig berg- och dalbana. På grund av skam och dåligt bemötande från sjuksköterskan undviker många mödrar att söka hjälp och de som försöker söka hjälp vet oftast inte var de kan vända sig. Sjuksköterskan ska enligt mödrarna ha ett empatiskt bemötande och vårda relationen mellan dem för att skapa trygghet i vården. / Background: Becoming a parent is revolutionary and a huge change in life and it is normal to become depressed the first time as a parent. The feelings often disappear after giving birth, but 10-20 percent of all new mothers continues to feel depressed for a long time and can result in a postpartum depression. Because of feelings such as shame and guilt many mothers avoid seeking care and therefore postpartum depression often become undiscovered and under-diagnosed. Aim: To describe mothers' experiences at postpartum depression and to describe the experi-ence of support from the nurse. The aim was also to describe the included articles selection method and study group. Method: A descriptive literature study based on 15 scientific articles with qualitative approach. The databases PsycInfo and Cinahl were used for the literature research. Main Results: The most common experiences of mothers with postpartum depression were fear, sense of guilt, increased vulnerability to manage change. The mothers described the frus-tration surrounding the support and advice given by the nurse. What created the most frustra-tion were the poor availability and the nurse's condescending attitude. The mothers described a desire that the nurse would highlight and make postpartum depression more visible. Conclusion: Mothers with postpartum depression lives in an emotional rollercoaster. Because of the feeling of shame and poor treatment from the nurse many mothers avoid to seek help and those who try to seek help often do not know where to turn. According to the mothers the nurse should have an empathetic approach and cherish the relationship between them to create safety in care.

Kentucky has a health crisis and most of the causes can be linked to diet, smoking and physical activity. Vegetarian and vegan diets have numerous benefits for many diet related health problems such as obesity, heart disease, Type 2 diabetes and certain cancers. There has been limited research on vegetarians and vegans in the United States and none in Kentucky. This study used an anonymous electronic survey to examine the different characteristics, behaviors, experiences and opinions of adult vegetarians and vegans in Kentucky. Results were compared to statistical data reported on the general population of Kentucky. Calculated body mass index (BMI) from self-reported height and weight showed 36% of vegetarians and 21% of vegans to be overweight or obese compared to 67% of the general Kentucky population being overweight or obese. The impact on BMI due to type of plant based diet (vegetarian or vegan) was found to be of greater significance (p=0.0030) than that of exercise. Reports from both groups indicated that they may be underserved by health care professionals. These findings have important implications for dietitians, dietetics education programs and health care providers concerned with high rates of obesity and chronic diseases.

The media has highlighted a proposed link between a gluten free diet (GFD) and weight loss. However, research related to weight gain and a GFD for persons with celiac disease (CD) has shown the opposite effect. A GFD is the only known treatment for persons with CD. If a patient with CD consumes a diet high in GF processed foods, weight management may be difficult to achieve. Participants with self-reported CD completed a modified GF food frequency questionnaire (FFQ) to assess typical dietary consumption of whole grains, sweets, fruits, vegetables and regular soda. Additionally, body mass index (BMI) and exercise were assessed. The results of this study found that whole grain, fruit and vegetable intakes were low among celiac patients. Additionally, BMI was on the high end of the normal weight range. The results of this study indicate that a greater emphasis should be placed on nutritional quality when counseling patients with CD. Registered dietitians should focus their diet counseling sessions with CD patients on a nutritious naturally GF diet in order to better manage weight.

The purpose of the study was to evaluate demographic, pre-admission, and academic variables of nursing students to identify the best predictors of success on the NCLEX-RN. A convenience sample of 237 students from Indiana Wesleyan University comprised the population for the study. User-oriented evaluation provided the conceptual framework for the study.Multiple regression analyses were used to determine relationships between the variables and success on the NCLEX-RN. Relationships were studied between variables and scores on the NCLEX-RN prior to 1988 (NCLEX 1) and success on the NCLEX-RN for the total sample (NCLEX 2).Demographic variables included age, race, marital status, and the number of semesters required to complete the program. The findings of the study evidenced no significant relationship between demographic variables and NCLEX-RN scores (NCLEX 1).Pre-admission variables included high school grade point average, Scholastic Aptitude Test math and verbal scores, advanced placement credit, and college credit prior to admission. Pre-admission variablesaverage, and scores on the National Comprehensive Nursing Achievementaccounted for 19% of the variance in scores on the NCLEX-RN.Academic variables included grade point averages in science courses, humanities courses, nursing courses, at the end of each year of study, scores on National League for Nursing Achievement Tests, and the Mosby Assess Test. Grade point averages in physical and biological sciences, in sophomore nursing courses, at the end of the freshman year, and scores on the Mosby Assess Test had a significant relationship with scores on the NCLEX-RN. Scores on the Mosby Assess Test accounted for 25% of the variance in NCLEX-RN scores. The highest prediction equation, accounting for 49% of the variance of NCLEX-RN scores, included a weighted linear composite of Scholastic Aptitude Test math scores, Mosby Assess Test scores, junior nursing course grade point League for Nursing Test.Multiple regression analyses of all variables with success on the NCLEX-RN for the total population (NCLEX 2) demonstrated no significant relationships. All findings were communicated to faculty at Indiana Wesleyan University applying the theoretical framework chosen for the study. / School of Nursing

It is a well-known fact that nurses generally work in challenging circumstances. Within the South-African context, a developing country, factors such as shortages of staff, lack of training and crowded hospitals are common occurrences. Large amounts of South-African-born nurses leave the country, or even the profession, with the hope of better career opportunities. The nurses that are left behind, automatically experience more pressure as their already heavy workload increases further. Staff shortages, which is a general problem in the nursing profession, is a great contributing factor to stress, as nurses sometimes need to work outside their scope of practice. A so-called "multi-skill" setup is then created, such as the Level-Two hospital where this research was conducted, where staff members did not necessarily receive formal training to carry out the tasks that are required from them. Multi-tasking from them then results in the nurse having to divide her attention. The above mentioned circumstances cause a great deal of stress for the nurse working within this setup. The aim of this research was to explore and describe the experience of nurses working in the multi-skill setup, as well as to explore and describe the nurses' view of effective coping mechanisms within the multi-skill setup, and to suggest guidelines for enhancing the emotional well-being of the nurse within the multi-skill setup. A purposive sample was conducted according to a list of inclusion criteria. The sample constituted of registered nurses, enrolled nurses, as well as enrolled nursing assistants employed at the particular Level-Two hospital in Gauteng. Semi-structured interviews were used in order to collect the richest data possible. Each of the interviews was recorded on digital compact discs, so that it could be transcribed verbatim. Data saturation was reached after ten interviews and the researcher analyzed the data, together with an independent co-coder. Consensus was reached between the researcher and the co-coder with regards to their individual analyses. Four main categories, each with their own sub-categories, were identified and discussed together with a literature control; namely; the experience of the multi-skill setup as positive, the experience of the multi-skill setup as negative, personal coping mechanisms within the multi-skill setup, as well as suggestions for the enhancing of the emotional well-being of the nurse within the multi-skill setup. Recommendations were formulated by the researcher relating to nursing research, nursing education, as well as to nursing practice. / Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2009.

It is a well-known fact that nurses generally work in challenging circumstances. Within the South-African context, a developing country, factors such as shortages of staff, lack of training and crowded hospitals are common occurrences. Large amounts of South-African-born nurses leave the country, or even the profession, with the hope of better career opportunities. The nurses that are left behind, automatically experience more pressure as their already heavy workload increases further. Staff shortages, which is a general problem in the nursing profession, is a great contributing factor to stress, as nurses sometimes need to work outside their scope of practice. A so-called "multi-skill" setup is then created, such as the Level-Two hospital where this research was conducted, where staff members did not necessarily receive formal training to carry out the tasks that are required from them. Multi-tasking from them then results in the nurse having to divide her attention. The above mentioned circumstances cause a great deal of stress for the nurse working within this setup. The aim of this research was to explore and describe the experience of nurses working in the multi-skill setup, as well as to explore and describe the nurses' view of effective coping mechanisms within the multi-skill setup, and to suggest guidelines for enhancing the emotional well-being of the nurse within the multi-skill setup. A purposive sample was conducted according to a list of inclusion criteria. The sample constituted of registered nurses, enrolled nurses, as well as enrolled nursing assistants employed at the particular Level-Two hospital in Gauteng. Semi-structured interviews were used in order to collect the richest data possible. Each of the interviews was recorded on digital compact discs, so that it could be transcribed verbatim. Data saturation was reached after ten interviews and the researcher analyzed the data, together with an independent co-coder. Consensus was reached between the researcher and the co-coder with regards to their individual analyses. Four main categories, each with their own sub-categories, were identified and discussed together with a literature control; namely; the experience of the multi-skill setup as positive, the experience of the multi-skill setup as negative, personal coping mechanisms within the multi-skill setup, as well as suggestions for the enhancing of the emotional well-being of the nurse within the multi-skill setup. Recommendations were formulated by the researcher relating to nursing research, nursing education, as well as to nursing practice. / Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2009.