Bakgrund: Stigmatisering kring människor som har psykiatriska diagnoser är vitt spridd. Det finns forskning som visar att detta också förekommer inom vården och att detta kan påverka den vård patienter med psykiatriska diagnoser får. Dessutom blir olika psykiatriska diagnoser allt mer vanligt förekommande i samhället, därför kommer även patienter med dessa diagnoser bli vanligare. Syfte: Studiens syfte var att belysa hur sjuksköterskor inom den somatiska vården uppfattar bemötandet och omvårdnaden av patienter med en psykiatrisk diagnos. Metod: Studien var en empirisk studie genomförd med en deskriptiv kvalitativ ansats. Det genomfördes 5 halvstrukturerade intervjuer med legitimerade sjuksköterskor från en somatisk avdelning. Materialet som framkom analyserades genom en manifest innehållsanalys. Resultat: Det framkom 4 huvudkategorier med totalt tio underkategorier. Kunskap: kunskapsbrist och förkunskaper, Bemötande: frustration, patientsyn och omvårdnad, Rädsla: undvikande, vaksamhet och ovisshet, Trovärdighet: tilltro och misstro. Slutsats: Tids och kunskapsbrist skapar en frustration vid omvårdnaden av patienter med psykiatriska diagnoser. Kunskapsbristen leder också till en rädsla för hur dessa patienter ska reagera och bete sig, samt för att sjusköterskan inte vet hur hon ska hantera situationen. Detta leder till ett undvikande av patienten och på så sätt till ensämre omvårdnad. / Background: Stigma concerning people with psychiatric diagnoses is widespread. There are studies that show that this also is common in hospital settings. This might affect the care that is provided to patients with psychiatric diagnoses. Psychiatric diagnoses are also increasing in the society which means that the number of patients with psychiatric diagnoses will increase as well. Aim: The aim of this study was to bring some light to how registered nurses working with patient with medical problems experience the care given to patients with psychiatric diagnoses. Method: This is an empirical study using a descriptive qualitative approach. 5 semi-structured interviews were conducted with registered nurses working in a ward for medical problems. The data that was received were analyzed using a manifest content analysis. Results: 4 main categories and 10 under categories emerged. Knowledge: lack of knowledge and pre-knowledge, Response to the patients: Frustration, patient view and care, Fear: avoidance, vigilance and uncertainty, Trustworthiness: trust and distrust. Conclusion: Lack of time and knowledge creates a frustration when caring for patients with psychiatric diagnoses. The lack of knowledge also leads to a fear of how these patients will react and behave, and a fear for not knowing how to handle the situation. This leads to a avoidance of the patients and by that these patients get an inferior care.

Competency-based nurse orientation programs focus on the new nursing graduate and experienced nurse employees' ability to perform skills necessary in a new work setting. The purpose of this project was to develop a learner-focused and competency-based orientation program for new nursing employees at a large urban hospital to enhance patient safety and nurse retention. The Johns Hopkins nursing evidence-based practice model and guideline were used in the selection of articles with higher levels of evidence and research quality for the critical appraisal of literature in support of the program development. The best practices for nursing orientation content and delivery for positive effects on hospital finances, nurse turnover rates, and patient safety were the focus of the literature review. Benner's model of 5 levels of skill development was the theoretical framework for advancing skills of nurses who enter the orientation program with different expertise and skill sets. Nurse orientation materials and processes, comprising a collaborative team approach to orientation and a guideline for preceptor selection, were developed as the essential components for successful orientation at the project hospital. A nursing orientation based on the evidence may provide an infrastructure and operational process for the organization in developing the competencies of all levels of nurses, including experienced nurses transitioning to new units or duties. The social change resulting from the project will be a supportive and seamless transition of nurses into the new practice role and work environment. When implemented, this project is anticipated to increase nurse satisfaction, improve quality of health care delivery, decrease anxiety related to the new nursing role, and improve collegiality among all levels of nurses.

By the year 2025, the nursing workforce shortage will exceed 500,000 registered nurses (RN). Hospitals will primarily experience this loss. The retention of RNs is a critical issue for hospitals, and studies about RNs leaving jobs in hospital nursing are essential to addressing the workforce shortage. Limited data exists about why RNs leave hospital nursing, other than job dissatisfaction. There is limited current data on whether horizontal violence, bullying, and intraprofessional conflict between RNs influence such decisions. This qualitative phenomenological study explored RNs’ experiences of horizontal violence, bullying, and intraprofessional conflict in hospital nursing. Findings suggest behaviors such as alienation, intimidation, sabotage, lack of intellectual respect, and failed professionalism contribute to horizontal violence and intraprofessional conflict among RNs in the hospital workplace. These findings may help develop strategies to educate healthcare teams and hospital administrative staff, and lobby for universal anti-horizontal violence and anti-bullying policies in hospitals. The findings highlight the need for conflict management training for RNs and healthcare workers, to facilitate intraprofessional communication and collaboration, and the need for further research.

Philosophiae Doctor - PhD / The purpose of this research study is to develop and describe a model to enhance the empowerment professional nurses to promote the recovery of people who have been diagnosed with depression. Depression is a prevalent psychiatric disorder that despite its increase worldwide, often goes undetected or inadequately treated. The biomedical model's reductionist and dualistic approach proves to be inadequate for nursing practice to address depression and calls for the examination of a multifaceted holistic approach. A multifaceted holistic approach views disease as having multiple causes that are amenable to multiple therapeutic interventions. Despite research evidence about the effectiveness of such an approach, an in-dept literature search did not reveal the availability of such a model to enhance the empowerment of professional nurses to promote the recovery of people who have been diagnosed with depression. The research question that emerged was: • How can professional nurses in the Western Cape be empowered to promote the recovery of people who have been diagnosed with depression? The assumption is that this question was necessary to address. To realise the purpose of this research study, the following objectives were formulated: • To explore and describe the self reported attributes needed by professional nurses to promote the recovery of people who have been diagnosed with depression. • To explore and describe how these self reported attributes can be facilitated in the work environment. • To propose a model to enhance the empowerment of professional nurses to promote the recovery of people who have been diagnosed with depression. • To develop guidelines for the operationalisation of the model. The theoretical framework for this research study was adopted from the Critical Social Theory. The research design and method used was qualitative, explorative, descriptive and contextual in nature. The research was done in two phases. In phase one the researcher did semi- structured interviews with a purposive and convenient sample of fourteen (14) professional nurses who were working in the Cape Town Metropolitan area and the West Coast.

Bakgrund: I december 2019 började den nya sjukdomen COVID-19 spridas i världen. Människor har påverkats direkt och indirekt av pandemin och sjuksköterskor har en viktig roll på frontlinjen av pandemin. Syfte: Syftet med studien var att beskriva sjuksköterskors erfarenheter av vården av patienter med COVID-19. Metod: En litteraturstudie genomfördes, baserad på nio empiriska artiklar med kvalitativ metod från databaserna CINAHL och PubMed. Artiklarna kvalitetsgranskades och analyserades med en metod från Friberg. Resultat: Vid analysen framtogs tre kategorier, Förändringar inom vården, Konsekvenser för kropp och själ och Strävan efter att ge god vård samt tillhörande nio subkategorier. Sjuksköterskors hälsa påverkades på och utanför arbetet. De behövde arbeta i en omväxlande och pressad situation där informationsläget var osäkert. Arbetet på frontlinjen försvårades och bidrog till bristande patientsäkerhet. Konklusion: Det var påfrestande för sjuksköterskor att arbeta på frontlinjen och möjligheten att ge god vård påverkades. Det behövs en allsidig grundläggande pandemiberedskap, tillräckligt med skyddsutrustning och utbildning för att vara bättre förberedd. Utöver det krävs olika typer av stöd för att minska den negativa påverkan hos sjuksköterskor. / Background: In December 2019, the new disease COVID-19 began to spread around the world. People have been directly and indirectly affected by the pandemic and registered nurses had an important role on the frontlines of the pandemic. Aim: The aim of the study was to describe registered nurses’ experiences of the care for patients with COVID-19. Methods: A literature review was conducted based on nine empirical articles with qualitative methods from the databases CINAHL and PubMed. The quality of the articles was examined and the articles were analyzed with a method from Friberg. Results: During the analysis three categories were identified, Changes in health care, Consequences for the body and soul and The effort to provide good care with nine associated subcategories. The registered nurses’ health was affected at and outside of work. They had to work in various and pressured situations where the state of the information was uncertain. The work on the frontline became more difficult and contributed to a lack of patient safety. Conclusion: It was stressful for registered nurses to work on the frontlines and the ability to provide good care was affected. Versatile and fundamental pandemic preparedness, enough personal protective equipment and education is needed to be better prepared. Besides that, registered nurses need to be offered different types of support to decrease the negative impact on them.

Den vanligaste orsaken till att patienter kommer till akutmottagningarna är på grund av smärta. De största svårigheterna som sjuksköterskor upplever på akutmottagningen är att patienterna erhåller otillräcklig smärtbedömning och smärtlindring. Patienter som är i behov av smärtlindring erhåller inte detta i samma omfattning om de har tolkbehov, vilket kan bero på kommunikationshinder, språkförbistring, oklar vakenhetsgrad, intoxikation, demens eller svårigheter i att beskriva smärtans intensitet, duration och placering. Det ställer krav på att sjuksköterskorna i kommunikationen med dessa patienter är lyhörda och uppmärksamma på patienternas uttryck och hur de beskriver sin smärta.Syftet var att undersöka vilka strategier som sjuksköterskor på akutmottagningar nyttjar vid smärtbedömning av patienter med nedsatt kommunikationsförmåga. Metoden som användes var en kvalitativ, empirisk studie där fyra fokusgruppsintervjuer användes för insamling av datamaterial. Totalt 18 sjuksköterskor från 3 akutmottagningar deltog. Fokusgruppsintervjuerna ljudinspelades, transkriberades och därefter analyserades materialet med hjälp av en kvalitativ innehållsanalys utifrån en induktiv ansats.Resultat presenteras i tre huvudkategorier: Subjektiv värdering, Objektiv triagering och Explicera samt nio underkategorier. Det framkom olika strategier som sjuksköterskor används vid smärtbedömning av patienter med nedsatt kommunikationsförmåga. Beroende på vilken nedsatt kommunikationsförmåga patienter har, krävs det olika tillvägagångssätt för att omhänderta dem på ett optimalt sätt på akutmottagningen. Slutsats var att användandet av specifika anpassade smärtskattningsskalor till patienter med nedsatt kommunikationsförmåga inte används utan andra strategier nyttjas istället. Genom att bruka enskilda eller flera strategier i samband med smärtbedömning kan det generera en förbättrad omvårdnad för patienterna. / Pain is the most common complaint by patients at the emergency department. Nurses experience that the biggest difficulties at the emergency department are patients inadequate pain assessment and pain relief. Patients that are in need of pain relief will not receive this in the same extent if they require interpretation which can derive from communication obstacles, language barriers, uncertain consciousness, intoxication, dementia or difficulties to describe the intensity, duration and localization of the pain. This sets tough requirement on nurses in their communication with these kinds of patients and demands them to be observant and responsive to the patient’s expressions and how they describe their pain.The aim was to examine what type of strategies nurses at emergency department use to assess pain in patients with impaired communication abilities.A qualitative empirical study was chosen as method and four focus group interviews was conducted to collect data. A total of eighteen registered nurses from three different emergency department participated. The focus groups interviews were recorded, transcribed and then analysed with a qualitative inductive analysis method.The result is presented in three main categories: Subjective assessment, Objective evaluation and Explicate followed by nine subcategories. Different strategies emerged that were used by nurses in assessing pain in patients with reduced communication abilities. Depending on what kind of communication impairment the patients have, different courses of action were implemented to take care of the patients in the most favourable way at the emergency department.The conclusion derived in that specific adapted pain assessment scales were not used for patients with impaired communication abilities but rather other strategies were used instead. By using individual or multiple strategies when assessing patients, it may procreate an improvement in the care of the patients.

No description available.

Background In remote areas of the Peruvian Amazon there is a high burden of communicable diseases, limited access to health care and a low distribution of registered nurses. Registered nurses are working with indigenous patients in the area, where traditional medicine and practice is common. In order to strengthen the relation between western and traditional practices, intercultural health has been implemented within the public health care. Aim The aim was to describe registered nurses’ experiences of working with indigenous patients in remote health care settings in Loreto region, Peruvian Amazon. Method A qualitative field study with semi-structured interviews was conducted at four health clinics in Maynas and Mariscal Ramón Castilla province. A qualitative content analysis was used when analyzing the data. Findings Three categories were identified in the analysis; Working environment in a remote area, Providing health care for indigenous patients and Including intercultural health in nursing practice. The participants’ daily work with few colleagues and high demand in remote clinics was described. Experiences of working with intercultural health, as well as opportunities and challenges of working with indigenous patients was found. Conclusion The registered nurses work in an area with a high workload, limited resources and geographic isolation. Intercultural implementations were shown to improve intercultural relations, autonomy and health. Challenges between registered nurses and indigenous patients related to communication and different cultures were described. In order to improve the situation and reach the UN Sustainable Development Goals, infrastructural and socio-economic improvements, more resources and health professionals are necessary.

No description available.

Nurses working in acute care psychiatry experience high rates of violence perpetrated by patients and their perspectives on these experiences are essential to understand this phenomenon. The purpose of this study was to explore psychiatric nurses’ experiences of patient violence in acute care inpatient psychiatric settings. In this interpretive descriptive study, a purposeful sample of 12 nurses were interviewed to understand how they define patient violence and understand their experiences of abuse within the workplace. Using thematic content analysis, a problem, needs and practice analysis was also conducted. Experiencing patient violence had many perceived negative impacts on nurses, patients and the organization. It was often considered to be part of the job and some nurses struggled with the role conflict between one’s duty to care and one’s duty to self when needing to provide care following a critical incident. Power, control and stigma also influenced nurses’ perceptions and responses to patient violence. In their practice, nurses used a wide variety of interventions to stay safe as well as prevent and manage patient violence. Nurses recommended increased education, support and debriefing, and an improved working environment. Future research should explore a consistent definition of violence, barriers to incident reporting and the creation of best practice guidelines specifically related to patient violence. Understanding the perspectives and experiences of nurses in acute inpatient psychiatry leads to greater knowledge of the phenomenon of patient violence and helps to inform the development of future nursing interventions to prevent and to respond to patient violence, as well as support nurses working within the acute care setting. / Thesis / Master of Science in Nursing (MSN)