<p>Uppskattningsvis lever 24 miljoner personer med en demenssjukdom idag, en siffra som förväntas öka. En demenssjukdom innebär ett lidande för personer med demens eftersom de som drabbas får svårigheter att sköta sitt dagliga liv. En demenssjukdom innebär också ett lidande för anhöriga. Över hela världen utför anhöriga den största delen av omvårdnaden för personer med demens. Anhöriga till personer med demens bär ofta ett stort ansvar och upplever sig psykiskt belastade, övergivna och i behov av stöd. Syftet med den här studien var att undersöka sjuksköterskors stöd till anhöriga som vårdar personer med demens. Studien genomfördes som en litteraturöversikt där 14 vetenskapliga studier granskades och analyserades. Huvudfynden visar att sjuksköterskorna gav både individbaserat och gruppbaserat stöd genom individuella behovsbedömningar, emotionellt och socialt stöd, samt stöd genom undervisning och information. Oavsett vilken typ av stödåtgärd som användes tycktes uppmärksamheten på och engagemanget för anhöriga vara det viktigaste stödet. De olika typerna av stödåtgärderna ledde till att anhöriga fick ökade färdigheter i omvårdnaden och till att anhörigas psykiska hälsa förbättrades. Det sågs att det är en viktig del i sjuksköterskornas arbete att uppmärksamma anhörigas behov, vara medvetet närvarande i mötet med dem och visa ett aktivt engagemang för dem.</p> / <p>Approximately 24 million people are living with a dementia disease today, a number which is expected to increase.  A dementia disease entails suffering for persons with dementia because they experience difficulties in their daily life. A dementia disease also entails suffering for the relatives. All over the world the relatives are largely responsible for the caring of persons with dementia. Relatives to persons with dementia often carry a great deal of responsibility and a feeling of psychological burden, abandonment and they are in need of support. The aim of this study was to investigate how nurses can support the relatives caring for persons with dementia. A literature review was used where fourteen scientific articles were investigated and analyzed. The main findings showed that nurses gave both individually based and group based support through individual needs assessment, emotionally and social support, as well as support by teaching and information. Irrespective of the type of intervention it was the nurses´ attentiveness on and their commitment for the relatives that was the most important support. The different types of interventions resulted in that the relatives gained increased caring potential and experienced improved mental health. It was noticed that an important part of nurses´ work is to be attentive to the relatives´ needs, being consciously aware in the meeting with them and showing an active attentiveness for them.</p>

Bakgrund och problem: Självbestämmanderätt är en grundprincip i socialtjänstlagen och ska genomsyra allt socialt arbete. Socialtjänstlagen gör ingen skillnad på friska eller sjuka människor, vilket kan skapa dilemman för biståndshandläggare vid behovsbedömning. Syfte och frågeställningar: Studiens syfte är att uppnå en förståelse kring hur bistånds-handläggare arbetar med självbestämmanderätt och inflytande vid behovsbedömning. Studiens frågeställningar är följande: Hur ser biståndshandläggare på äldres självbestämmanderätt när det finns en bristande insikt i de egna behoven? Hur hanterar biståndshandläggare anhörigas inflytande? Metod: Studien är influerad av en kvalitativ och kvantitativ metodblandning och består av en vinjett besvarad av 24 biståndshandläggare, samtliga arbetande utifrån socialtjänstlagen inriktat mot äldreomsorg. Det insamlade empirimaterialet från biståndshandläggarna har bearbetats genom en tematisk analys. Resultat och slutsatser: Resultatet visar att biståndshandläggare menar att den äldre har självbestämmanderätt trots bristande insikt i sina egna behov. Biståndshandläggarnas utsagor visar att den moraliska aspekten att göra gott för den äldre väger tyngre än dennes självbestämmanderätt. Resultatet visar att anhöriga har ett stort inflytande och spelar en viktig roll vid behovsbedömning.

The overall aim of the present thesis was to study post-resuscitation care of cardiac arrest (CA) patients treated with target temperature management 33°C with a focus on evaluation of two prognostic tools: variations in cerebral venous saturation and acute magnetic resonance imaging (MRI) findings on the brain post-CA. An additional aim was to investigate patients’ neurological outcome and relatives’ experiences 6 months after the event. Paper I describes the cerebral oxygen saturation of blood obtained from a jugular bulb (SjvO2) catheter The results showed that patients with poor outcome tended to have higher SjvO2values,but this difference was only significant at 96 and108 hours post-CA. The main findings of Paper II were that patients with good outcome displayed a pathological pattern mainly in the frontal and parietal lobes on MRI of the brain. Patients with poor outcome had an extensive pathological pattern in several brain regions. Furthermore, very low apparent diffusion coefficient (ADC) values were associated with poor outcome regardless of brain region. Paper III investigated physical and cognitive function over time, between one month and 6 months post-CA, as well as d life satisfaction at 6 months. The results showed that impairment in physical and cognitive function is common in CA survivors but tends to decrease over time. Despite a severe illness, which has impaired the physical and cognitive functions, satisfaction with life as a whole was reported by 70% of CA survivors. In Paper IV, relatives described their experiences 6 months after a significant others CA. The analysis resulted in three themes reflecting relatives’ everyday life 6 months after the event: Difficulties managing a changed life situation, Feeling like I come second and Feeling new hope for the future. In conclusion, the results of the present thesis have increased our understanding of the two prognostic tools that were investigated; they have generated new and revealed aspects that should be taken into account during prognostication and assessing neurological outcome of this group of patients. The thesis has also shown that the healthcare needs to improve its routines for follow-ups and information provision to both patients and their relatives.

Bakgrund: Att vara närstående till en person med psykossjukdom kan vara komplicerat, påfrestande och smärtfyllt. Närstående förväntas kunna hantera sin vardag med familj och arbete samtidigt som de fungerar som omsorgsstöd för den sjuke. Den närstående är en av tre parter i vårdandet, patienten, de närstående och vårdpersonalen. För att underlätta för de närstående måste vården sträva efter en relation som bygger på tillit för att underlätta situationen för de närstående. Syfte: Syftet är att beskriva hur vårdpersonal kan vara stöd till närstående som lever nära en person med psykossjukdom. Metod: Metoden är en litteraturstudie med granskning av vetenskapliga artiklar om närståendes upplevelser av att leva nära en person som lider av psykossjukdom samt vårdpersonalens insatser som är till stöd för de närstående. Resultat: Resultatet visar att närstående har varierande upplevelser att av att leva nära en person med psykossjukdom som att det är viktigt för personalen att förstå närståendes upplevelser så att de kan få en bredare kunskap om patientens sjukdom och därmed kunna vara till stöd i vården och som är anpassad utifrån personens individuella behov. Diskussion: Uppsatsen visar att vårdpersonalens bemötande och förhållningssätt gentemot närstående är viktigt samt att deras delaktighet i vården bör förbättras och som i sin tur kan förbättra hälsotillståndet hos patienten med psykossjukdom. Det finns ett stort behov av stöd och kommunikation med vårdpersonal. / Background: Being related to a person who suffers from a psychosis is a complicated, stressful and creates a painful situation. The related are expected to handle their everyday lives including family and work, and at the same time be able to function as support for the patient. Therefore the support shown by the medical staff for the relatives becomes an important issue. Aim: The aim is to describe how nursing staff can provide support to relatives who live close to a person with psychosis. Results: The results are presented in five identified categories where they describe the experience of relatives who live close to a person with psychosis. The descriptions show a variety of experiences of the care of patients with psychosis. This is important knowledge. To sum up, the ability of nursing staff to understand the different experiences of relatives becomes important in order to gain a broader understanding and thereby be able to offer health care adapted to the individual needs of the patient. Discussion: the discussion personal opinions are presented; there is a great need for good alliances, support and communication with the medical staff which implies that the relations between the parties in the nursing relation play a major role in psychosis care.

The overall aim of the thesis was to study post-resuscitation care of cardiac arrest (CA) patients with a focus on therapeutic hypothermia treatment, outcomes up to six months post-CA and relatives’ experiences during the hospital stay. In Paper I, the aim was to asses effectiveness of hypothermia treatment with cold, 4°C, intravenous crystalloid infusion combined with ice packs. In conclusion, the described cooling method was found to be useful for inducing and maintaining hypothermia, allowed good temperature control during rewarming and to be feasible in clinical practice. The aim in Paper II was to investigate biomarkers and the association of serum glial fibrillary acidic protein (GFAP) levels with outcome, and to compare GFAP with neuron-specific enolas (NSE) and S100B. The result showed increased GFAP levels in the poor outcome group, but did not show sufficient sensitivity to predict neurological outcome. Both NSE and S100B were shown to be better predictors. A combination of the investigated biomarkers did not increase the ability to predict neurological outcome. In Paper III, the aim was to investigate whether there were any changes in and correlations between anxiety, depression and health-related quality of life (HRQoL) over time, between hospital discharge and one and six months post-CA. There was improvement over time in HRQoL, but changes over time in anxiety and depression were not found. Physical problems seemed to affect HRQoL more than psychological problems. The results also indicate that the less anxiety and depression patients perceive, the better their HRQoL. In the fourth paper, the aim was to describe relatives’ experiences during the next of kin’s hospital stay after surviving a CA. The analysis resulted in three themes: The first period of chaos, Feeling secure in a difficult situation, and Living in a changed existence. In conclusion, the results of the thesis have helped to improve knowledge within the areas studied and reveal aspects that should be taken into account in the overall treatment of this group of patients. The thesis have also shown the importance of developing an overall view and establishing a chain of care from an individual’s CA until follow-up for both the patient and his/her relatives.

Background: In pace with the increasingly aging population will the number of older people in nursing homes and with care in home grow. This means that the nurse will face related to the older more frequently and more widely. Nurses has overall responsibility over both the care of the elderly as a responsibility of maintaining good relationships with related parties. Related parties are of great importance for the older individual, it is therefore relevant for the nurse to be able to interact in a respectful and sensitive manner to involve the relatives in care. Aim: The aim with this study was to highlight nurse's experiences of interaction with related parties to elderly in community health care. Method: A literature review based on nine qualitative articles was conducted. Friberg design was used with the inspiration of Lundman and Hällgren Graneheim regarding the analysis of Articles. Results: The study resulted in four themes. They included information about nurse's experiences of interaction with related parties. These themes describes the importance of communication in the interaction, the attitudes various expressions, cooperation with related parties and experiences with related parties' participation in care. Conclusion: An important conclusion is that the nurse should take advantage of related parties skills and resources in health care around the elderly. The nurses sometimes has difficulties interacting with related parties. Nurses probably need to see the difficulties from different perspectives and seek help of colleagues.

Aim: The overall purpose of this thesis was to increase the understanding of relatives’ changing life situation during the first six months of a person’s onset of stroke, with focus on learning. Furthermore, the purpose was to evaluate theprinted education materials (PEM) targeted at relatives at Swedish stroke units. Method: In paper I, 16 relatives were interviewed about the meaning of becoming a relative of a person affected by stroke. In paper II, 9 relatives were reinterviewed about what it meant to be a relative of a person affected by stroke. The interviews took place six months after the stroke survivors’ onset of stroke. Data from the two studies were analyzed by Lindseth and Norberg’s hermeneutic phenomenological method of analysis, inspired by Ricoeur. In paper III, 16 and 9 relatives were interviewed about what they wanted to know and understand during the first six months after the onset of the survivors’ strokes. Krippendorff’s method of qualitative content analysis was used to analyse data. In paper IV, 42 PEM:s from 21 Swedish stroke units were examined. Data were analysed by use of descriptive statistics and Krippendorff’s method of qualitative content analysis. Results: Becoming the relative of a person affected by stroke means to experience chaos but also to reach a turning point. The turning point is the start of a febrile activity that shows the relatives’ willingness to seek order in the chaotic situation (I). Being the relative of a person affected by stroke also means to be in a struggle for freedom. Relatives do not want to adapt to the stroke or its consequences. Instead, they prefer to choose their own way of life and to write their own history. Therefore, they strive to integrate the stroke and its consequences to their everyday lives (II). The information that the relatives wished to have was about the stroke survivor, the professionals and themselves. Moreover, the results showed that the relatives’ information quest was related to personal involvement, contextual factors, different knowledge needs and different ways to obtain information (III). The PEM:s, offered at Swedish stroke units, were adequate in terms of quality of suitability and readability. The content of the printed education materials offered to relatives varies with the stroke units. Conclusion: To become a relative of a person affected by stroke means to end up in chaos, but also to reach a turning point (I). At this turning point the person is prepared to adjust arrange his/her life to the new conditions. Therefore, nurses need to learn to identify these turning points and include support for relatives in their changing life situation. Being a relative during the first six months of a survivor’s onset of stroke means to fight for freedom (II) without abandoning the stroke survivor. In this process, it is important that the relatives learn to balance freedom with responsibility and life and care for the survivor with relations to other relatives. Relatives are capable as they are active, committed and social persons (I, II, III). This is why alternative pedagogic methods and approached need to be developed and tested. Nurses need training in using such alternative methods. The content of the printed education materials offered to relatives at Swedish stroke units varies with the unit. As a result, it would be useful to establish a national electronic centre.

<p>När en familjemedlem drabbas av demens förändras hela livssituationen för den anhörige. För att sjuksköterskan ska kunna stödja de anhöriga krävs det kunskap och ökad förståelse om de anhörigas vårdarroll i hemmet. Syftet med studien var att beskriva anhörigas upplevelser av att vårda en familjemedlem i hemmet som insjuknat i demens. Sex självbiografier analyserades för att ta del av anhörigas egna upplevelser av att vårda en demenssjuk familjemedlem. Till grund för analys av data låg Burnards (1991) innehållsanalys och Graneheims & Lundmans (2004) kvalitativa innehållsanalys. Resultatet utgörs av tre huvudkategorier och 10 kategorier. Huvudkategorierna var: Lidande, desperation och isolering. Det mest utmärkande hos anhörigvårdarna är den känslomässiga upplevelsen som beskrivs som mer betungande än vad det fysiska vårdandet gör. Det som även kännetecknar anhörigas upplevelser är att de blir mer och mer isolerade allt eftersom sjukdomen fortskrider.</p> / <p>Being the relative of a person with dementia is a life changing experience. The relatives often find themselves in a complex situation, which requires that the nurse, can identify needs among the relatives. It‘s also important that the nurse has a broad knowledge about the role of the relative as a caregiver, to be able to give support to them in this situation. The purpose of this study was to describe the relative’s experiences of taking care of a familymember with dementia in the home. Six autobiographies were studied to emerge in the experiences of the family caregivers. Burnards (1991) content analysis and Graneheims & Lundmans (2004) qualitative content analysis was used to analyze the data and the result reveals 3 main categories and 10 categories. The main categories were: Suffering, desperation and isolation. The situation of the caregiving relatives involves experiences of mental distress as well as having to cope with several difficulties. Their new role as a family caregiver is characterized by feelings of isolation which increases as the sickness proceeds.</p>

Anhöriga hamnar ofta i bakgrunden av närståendes sjukdomar. Syftet med studien var att undersöka hur anhöriga upplever emotionellt stöd, skuld samt hantering av att leva nära någon som överlevt en potentiellt livshotande fysisk sjukdom. Den hermeneutiskt upplagda studien baserades på semistrukturerade intervjuer. Åtta kvinnliga deltagare med differentierad sysselsättning och ålder kunde återfinnas genom snöbollsurval samt sociala medier. Analysen utfördes genom en meningskoncentrering, där fyra teman kunde återfinnas: de fanns där för mig, självanklagelser för känslor och tankar, lärdomar om det sårbara livet, samt att sysselsätta sig eller fly undan. Studien visade att det emotionella stödet upplevdes som konstant, skuld yttrades i form av tankar och känslor, deltagarna rapporterade nya lärdomar samt hanteringsprocessen var övergripande lik hos deltagarna. Studien kan ligga till grund för fördjupning inom området att vara anhörig. Dels för att främja förståelse men också för att låta anhöriga kliva ur skuggan och göra sin röst hörd.

abstract: Since the Convention on Biological Diversity was established in 1992, more importance has been given to the conservation of genetic resources in the international community. In 2001, the International Treaty on Plant Genetic Resources for Food and Agriculture (PGRFA) focused on conserving plant genetic resources, including crop wild relatives (CWR). Some of these genetic resources hold desirable traits--such as transfer of plant disease resistance, improvement of nutritional content, or increased resistance to climate change--that can improve commercial crops. For many years, ex situex situ conservation was the prevalent form of protecting plant genetic resources. However, after PGRFA was published in 1998, in situ techniques have increasingly been applied to conserve wild relatives and enhance domesticated crops.In situ techniques are preferred when possible, since they allow for continued evolution of traits through natural selection, and viability of seed stock through continuous germination and regeneration. In my research, I identified regions in Bolivia and rated them according to their potential for successful programs of iin situ conservation of wild crop relatives. In particular, I analyzed areas according to the following criteria: a) The prevalence of CWRs. b) The impacts of climate change, land use change, population growth, and economic development on the continued viability of CWRs in an area. c) The socio-political and economic conditions that might impede or facilitate successful conservation programs and outcomes. This work focuses on three genera of particular importance in Bolivia: Peanut (Arachis spp.), Potato (Solanum spp.) and Quinoa (Chenopodium spp.). I analyzed the above factors for each municipality in Bolivia (the smallest scale for which appropriate data were available). The results indicate which municipalities are most likely to successfully engage in CWR conservation projects. Finally, I present guidelines for the creation of conservation projects that pinpoint some of the potential risks and difficulties with in situ conservation programs in Bolivia and more generally. / Dissertation/Thesis / M.S. Biology 2011