Intensivvårdspatienter är ofta sederade och intuberade och kan därmed ej vara delaktiga i sin vård. Närstående har enligt svensk lag rätt att delta i planering och utförande av vården för patienter som inte kan tala för sig. Studier har undersökt och belyst närståendes behov vid vård av intensivvårdspatienter. Få studier har fokuserat på närståendes uppfattning om delaktighet i vården av intensivvårdspatienter. Syfte  Att undersöka hur närstående upplever sin delaktighet i beslutsfattande och omvårdnad av intensivvårdspatienter. Metod  En deskriptiv kvalitativ design med semistrukturerade intervjuer användes, med en fenomenografisk ansats. Nio närstående intervjuades. Resultat Fem kvalitativt skilda beskrivningskategorier framkom och ordnades hierarkiskt; Beslutsfattandets betydelse – medicinska beslut överlämnas, Delta i omvårdnad – både positivt och skrämmande, Positivt bemötande avdramatiserar, Viktigt att vara fysiskt nära och Tydlig information underlättar delaktighet. Beskrivningskategorin Tydlig information underlättar delaktighet placerades högst i hierarkin eftersom informanterna angav att informationen hade störst betydelse för upplevelsen av delaktighet i vården. Slutsats Kännedom om närståendes olika upplevelser av delaktighet, i synnerhet vikten av rak och tydlig information kan möjliggöra för personalen att bättre inkludera närstående och därigenom öka deras upplevelse av delaktighet i vården av intensivvårdspatienter. / Intensive care patients are often sedated and intubated and can not participate in their care. Swedish law states that when a patient can not participate in care, relatives should be invited to participate in his/her place. Many studies have been conducted focusing on relatives’ needs, but very few focus on their perception of participation in care of intensive care patients.  Aim This study was conducted to explore how relatives perceive their participation in care of intensive care patients, with regards to decision making and participating in physical care. Method A descriptive, qualitative design was used, with semi-structured interviews and with a phenomenographic approach. Nine relatives were interviewed. Results Five qualitatively differing categories of description appeared and were organized in a hierarchy; The importance of decision making – medical decisions are handed over, Participating in physical care – both positive and scary, A welcoming atmosphere helps ease the mood, Important to be physically near, Clear information helps the perceived participation. The category Clear information helps the perceived participation was placed the highest in the hierarchy because the informants described information as the most important for the perceived participation in care. Conclusion Knowledge about relatives’ different perceptions of participation in care, especially the importance of straight forward and direct information, may enable the nursing staff to better include relatives and increase their satisfaction and perceived participation in care of the intensive care patients.

Changes in the health-care system during the past decades have led to an increased transfer of health care to the home environment which also concerns patients treated with home enteral tube feeding (HETF). Research is scarce about how HETF care is functioning. Therefore, the overall aim with this thesis was to describe and explore HETF care and treatment from patients', relatives' and nurses' perspectives. Three qualitative and one quantitative study were used. The findings showed that the HETF treatment and care had a great impact on daily life for both patients and their relatives and implied many practical, emotional and social problems in their daily life, which they strived to manage. Side effects were common and the patients' reported low HRQL and general health. The amount and quality of received guidance and support from the health care, not least before discharge, turned out to have impact on the patients' and the relatives' daily life and how they could manage their situation. Lack of guidance and support meant insecurity, worries and distress. Cooperation in the care trajectory was found to be decisive for how well the care was running. Nurses' knowledge about tube feeding and discharge planning procedures, their commitment to the patients' care, as well as clarity regarding responsibility of HETF care were factors of crucial importance on how the cooperation worked, and the quality of the HETF care. This thesis shows the need of improvements regarding the care of HETF patients and their relatives.

<p>Syftet med denna studie var att belysa olika aspekter av nyutexaminerade allmänsjuksköterskors erfarenheter av att möta närstående i sorg. Studien hade en kvalitativ ansats och data insamlades genom sex stycken bandade intervjuer på tre medicinavdelningar vid ett medelstort sjukhus i mellersta Sverige. Datamaterialet analyserades enligt en manifest metod och ur analysen skapades två huvudteman – relationer och kunskap. Det största temat är relationer som byggs upp av tre underteman och beskriver sjuksköterskans förhållande till närstående, sig själv och övrig vårdpersonal. Temat kunskap innehåller två underteman och beskriver sjuksköterskans kunskapsutveckling och behov av kunskap.</p><p>Slutsatserna från studien är att nyexaminerade sjuksköterskor anser att möta närstående i sorg är en av deras svåraste uppgifter på grund svårigheterna i att tillgodose närståendes individuella behov. Det visade sig även att sjuksköterskorna ansåg att sjuksköterskeutbildningen inte förberett dem tillräckligt för detta. Att lära sig att möta närstående är något som sker i praktiken. Sjuksköterskorna ansåg att det viktigaste i mötet med närstående är att vara närvarande och visa att de är tillängliga snarare än att säga eller göra rätt saker.</p><p>Vidare forskning inom området skulle kunna fokusera på skillnader mellan erfarna och nyexaminerades erfarenheter. En vidare forskning skulle också kunna inbegripa patientens perspektiv.</p> / <p>The aim of this study was to shed light on different aspects of newly graduated nurses’ experiences from interacting with relatives to patients who were dead or dying. The study has a qualitative approach and data was collected from six tape recorded interviews conducted at three medicine wards in a medium sized hospital in the middle of Sweden. The data was analyzed by a manifest content method and two main themes – relationships and knowledge, were derived from it. The largest main theme is relationships, which also contains three sub themes describing the nurse’s relationship to relatives, self and other members of staff. The main theme knowledge contains two sub themes which describes the nurse’s need for and development in knowledge. The study concludes that interacting with grieving relatives is one of the most complicated tasks for the newly graduated nurse. The difficulties were grounded in satisfying the complex needs of the relatives. The nurses stated that the nursing education program didn’t sufficiently prepare them for this, it was something they learnt from real life experience.</p><p>The findings of this study could be beneficial for the nurse education program as well as hospitals to increase their awareness of the difficulties newly graduated nurses experiences when interacting with grieving relatives.</p><p>Further research could involve describing differences between experienced and newly graduated nurses and including the patient’s perspective.</p>

Human-induced land degradation and climate change can reduce agricultural productivity and increase susceptibility to food shortages at local and global scales. Planting perennial crop species, such as fruit and nut crops, may be an intervention strategy because of their beneficial contributions to sustainable agriculture and human nutrition. Many perennial temperate fruit and nut species are however, particularly vulnerable to frost events, drought, insufficient chill hours, and disease and insect outbreaks. Modifying these species to yield harvests under a wider range of biotic and abiotic conditions may increase the value and long-term viability of perennials in agroecosystems. This dissertation examines adaptation and ecogeography in temperate perennial fruit crops, using apple (Malus sensu lato) as an example for case studies. The resilience of feral domestic apple trees in abandoned farmstead orchards throughout the southwestern U.S. indicates plasticity in adapting to local environmental conditions. Dendrochronology reveals these trees tend to persist where they have access to supplemental water, either as shallow groundwater or irrigation. While domestic apples are cultivated under a range of growing conditions, wild relatives of agricultural crops may further expand the cultivable range of the species. Crop wild relatives are species closely related to agricultural species, including progenitors that may contribute beneficial traits to crops. Sampling the genetic variation in crop wild relatives may benefit from ecological genetics and GIS theory to reveal genetic structure. The Pacific crabapple is an example of a wild apple relative that may contain genetic variation useful in apple breeding. Species distribution modeling of the Pacific crabapple identifies a narrow climatic window of suitable habitat along the northern Pacific coast, and genetic fingerprinting reveals a highly admixed genetic structure with little evidence of natural or cultural selection. While the moist coastal Pacific Northwest is not necessarily characteristic of many apple-growing regions, the species may have useful adaptations transferable to domestic apples. Genetic resources offer a promising source of raw material for adapting crops to future agricultural environments; their characterization, conservation, and use may offer important contributions to adaptation and use of perennial crops in agro-ecosystems.

Despite extensive research into the impact of brain injury on individuals and their adult relatives, much less is know about the impact of parental brain injury on child relatives. The aim of the study was to identify if there was a relationship between changes in how children construed themselves and their parents following the brain injury and adjustment, and to identify if there was a relationship between structure of the child’s construct system and level of adjustment. There were four hypotheses to be tested. Hypothesis one predicted that larger changes in how young people construe themselves and significant others following parental brain injury compared to how they were construed prior to parental brain injury would be associated with poorer adjustment. Hypothesis two predicted that more structured ‘before acquired brain injury’ constructs in comparison to the structure of ‘after acquired brain injury’ constructs would be associated with poorer adjustment. Hypothesis three predicted that more superordinate ‘before acquired brain injury’ constructs in comparison to ‘after acquired brain injury’ constructs would be associated with poorer adjustment. Hypothesis four predicted that tighter construing would be associated with better adjustment following parental brain injury. There were 10 participants in the study aged 10-17 who had a parent with a brain injury. Each participant completed a repertory grid and the Personality Inventory for Youth, a measure of adjustment. It was found that larger distances between how children construed themselves or their parents currently compared to how they were construed pre-injury were related to poorer adjustment. There was also found to be a relationship between relative intensity of the post-brain injury construct system and some aspects of adjustment. There was no significant relationship between adjustment and relative superordinancy of post-injury constructs or adjustment and tightness of construing. Future research is indicated to verify the findings of this study, and to explore possible interventions for young people experiencing poor adjustment following parental brain injury.

Bakgrund: Den palliativa vården ska bygga på symtomlindring och livskvalité för den döende. Den ska också finnas som ett stöd till anhöriga som är en viktig pusselbit i den palliativa vården. Omvårdnadsteoretikern Joyce Travelbee har använts som grund i litteraturstudien vilket innebär att se människan utifrån en helhetssyn och veta att människan är en unik varelse. Syfte: Att utifrån aktuell forskning belysa anhörigas situation inom palliativ vård. Metod: En litteraturöversikt som baseras på 13 vetenskapliga artiklar med kvalitativ metod. Resultat: Resultatet visade på att de anhöriga var omgivna av många känslor som till exempel osäkerhet och medlidande. Det visade sig också att många anhöriga var i behov av att få prata med vårdpersonal kring döden. Deltagarna tyckte också det var viktigt med en personal som visade empati och att det var kontinuitet bland vilka i personalen som tog hand om patienten. Konklusion: För att kunna ge de anhöriga en bra upplevelse av vården vid livets slut bör de erbjudas samtal om döden. Vårdpersonalen bör vara kompetent och empatisk. Det är också viktigt för de anhöriga att det var samma personer från personalen som tog hand om deras anhörige då det skapar en känsla av trygghet. / Background: Palliative care should be based on symptom relief and quality of life for the dying. The care should also be available as a support to families, they are an important part of the palliative care. Nursing theorist Joyce Travelbee was the basis of this study. Travelbee use a holistic approach and says that a person is a unique being. Aim: Illuminate family members' situation in palliative care based on current research. Method: A literature review based on 13 scientific articles with qualitative method. Result: The result showed that the relatives experienced many different emotions, such as insecurity and compassion. It was also found that many families wished to communicate about death with professionals. Relatives wished that the proffesionals would be competent and empatic. It was also good with professionals that were periodic, it created a sense of security for the relatives. Conclusion: In order to give the families a good experience of care at end of life, they must be offered conversation about death. The nursing staff should be empathetic, continuous and competent.

Aim: The overall aim was to create knowledge about what it means to live with bipolar disorder from an existential perspective, both for individuals with the diagnosis and for their close relatives. Method: An existential perspective in this context entails that it is explored and described from a lifeworld perspective of individuals who in various ways experience that which is termed as bipolar disorder. The lifeworld phenomenological approach Reflective Lifeworld Research (RLR) was used in the four empirical studies. Meaning-oriented interviews and analysis were conducted following the leading methodological principles of the chosen scientific approach. A synthesis, based on lifeworld hermeneutic existential philosophy, then presents how it is possible to understand the perspective of individuals with bipolar disorder and their close relatives as a coherent whole. Findings and conclusions: A magnitude and complexity of experiencing, which means that life with bipolar disorder is characterized by extra dimensions, specific tension and contradictions, has been elucidated. Knowledge of the meaning of these aspects enables for the persons with the illness and for their close relatives to understand, to put words to, and to communicate how their life is and what they need, which in turn enhances their ability to influence their lives. It also increases the opportunities for professional caregivers to develop care, both in content and organization, so that it can meet the actual needs of those concerned in an adequate way. Living with bipolar disorder means so much more than the usual description with changes between episodes of depression and mania. The diagnosis “bipolar disorder” thus appears to be an inadequate label that only reflects the more obvious and visible dimensions of the illness, while those that characterize life in its entirety remain hidden. The thesis also shows that the importance of the common everyday life of persons with bipolar disorder and their close relatives should be highlighted as the most important factor in a liveable existence. A change in the view of mental health care is thus needed; a change that is characterized by consensus, collaboration and transparent communication between the person with the illness, their close relatives and mental health care. The common goal should be about meeting actual needs, and to strengthen a profound connectedness in order to make everyday life more liveable.

Bakgrund:   Allt fler människor vårdas i sina hem och det anses ofta vara en betydelsefull plats för både sjuka och anhöriga. När sjukdom drabbar en person spelar de anhöriga en viktig roll. De får ta ett stort ansvar gentemot den sjuke och för vården i hemmet. Det är trots detta fortfarande sjuksköterskans uppgift att främja patientens och familjens upplevelse av livskvalitet och välbefinnande. Allas behov behöver tillgodoses för att vården i hemmet ska vara adekvat. Syfte: Att beskriva anhörigas upplevelse av att vårda en sjuk familjemedlem i hemmet. Metod: Denna litteraturöversikt baserades på tio vetenskapliga artiklar. Dessa hämtades från databaserna CINAHL plus with Full text och PubMed. Familjefokuserad omvårdnad var den teoretiska referensram som kom att diskuteras utifrån litteraturöversiktens resultat. Den handlar om familjens betydelse för patientens upplevelse av hälsa och sjukdom. Även de vårdvetenskapliga konsensusbegreppen behandlades. Resultat: Det framkom fyra områden i resultatet. Det första var känslomässig påverkan på den informella vårdaren, vilket berörde de tankar och känslor som uppkom när någon tog sig an vårdarrollen. Det andra var social påverkan, som handlade om hur de anhörigas sociala liv påverkades när de tog sig an den informella vårdarrollen. Det tredje var förändringar, vilket berörde kontrasterna mellan hur livet var innan sjukdom drabbade familjen och hur livet blev efter sjukdomen inträdde. Det sista området var information och stöd som omfattade det som familjen ansåg sig behöva hjälp med.                                                                                          Diskussion: De två områdena känslomässig påverkan på den informella vårdaren och social påverkan diskuterades utifrån den familjefokuserade omvårdnaden och de vårdvetenskapliga konsensusbegreppen. / Background: Nowadays more people are being cared for in the home which is often considered an important place for both the patient and relatives. When illness hits one family member the relatives plays an essential role. They have to take responsibility for their sick family member and for the home nursing. Nevertheless, it is still the nurse´ task to ensure that the patient and the family experience quality of life and wellbeing. Aim: To describe the family experience of caring for a sick family member at home. Method: This literature review was based on ten scientific articles. These were taken from the databases CINAHL Plus with Full Text and PubMed. Family focused nursing was the theoretical framework that the literature review was proceeded from. Family focused nursing is about the family importance to the patient experience of health and illness. The consensus concepts of caring science were also discussed.   Results: Four themes appeared in the result. The first one was emotional impact on the informal caregiver. That theme includes thoughts and feelings that arise when someone takes on the caregiving role. The second one was social impact which is about the family members' social lives and how the informal caregiving role affects them. The third one was changes and that theme is about the contrast between what life was like before the illness struck their family and how life became after the disease entered. The final theme was information and support which included the areas where the family required more help. Discussions:  Emotional impact on the informal caregiver and social impacts were discussed on the basis of family focused nursing and the consensus concepts of caring science.

Bakgrund:Att vara anhöriga till en person med psykisk sjukdom medför ofta en egen försämrad psykisk hälsa samt kan vara både tidskrävande och kostsamt. Känslor av skuld och skam samt stigmatisering från omvärlden är vanligt förekommande. Anhöriga önskar delaktighet i vården men exkluderas ofta. Det finns nationella riktlinjer och lagar som betonar vikten av anhörigas delaktighet, trots detta upplevs anhöriga ofta påträngande. De finns lite kunskap om anhörigas kontakt med psykiatriska intensivvårdsavdelningar. Syfte:Syftet med denna studie var att beskriva sjuksköterskors erfarenheter av möten med anhöriga på psykiatriska intensivvårdsavdelningar Metod:Studien har en kvalitativ design med induktiv ansats. Sju sjuksköterskor på psykiatriska intensivvårdsavdelningar i Sverige intervjuades enligt semistrukturerade metod. Materialet analyserades med kvalitativ innehållsanalys. Resultat:Resultatet från intervjuerna utmynnade i fyra kategorier: Organisatoriska förutsättningar för att möta anhöriga, Olika syn på anhöriga, Utmaningar i mötet med anhöriga samt Att möta och kommunicera med anhöriga. Diskussion:Resultatet i studien diskuteras i relation till tidigare forskning och Andersheds teori om Delaktighet i Ljuset – Delaktighet i mörkret. I resultatet framkom aspekter som kan tänkas leda till både delaktighet i ljuset och i mörkret. / Background: Being a relative to someone with mental disorder often causes a decreased mental health and can be both time-consuming and costly. Feelings of guilt and shame and stigmatization from the surroundings are common. Relatives’ wishes to participate in care but often get excluded. National guidelines and laws emphasize the importance of relatives’ participation; despite this relatives' often get perceived as intrusive. Little is known about relatives contact with psychiatric intensive care units. Aim: The aim of this study was to describe nurses’ experiences from meeting relatives at psychiatric intensive care units. Method: This study has a qualitative design with an inductive approach. Seven nurses at psychiatric intensive care units in Sweden were interviewed with semistructured method. The material was analyzed using a qualitative content analysis. Results: The result from the interviews developed into four categories: Organizational requirements to meet relatives, Different views on relatives, Challenges in the meeting with relatives, and To meet and communicate with relatives. Discussions: The result is being discussed in relation to previous research and Andershed's theory of Involvement in the light – Involvement in the dark. In the result aspects emerged that can lead to both participation in the light and in the darkness.

Bakgrund: Etiska riktlinjer vid hjärtstopp rekommenderar att närstående ska få möjlighet att närvara vid hjärt- och lungräddning om de önskar och inte utgör ett hinder. Befintlig forskning visar att många närstående vill närvara och att närvaron gynnar både patient och närvarande närstående. Trots detta är sjuksköterskors upplevelser och åsikter kring ämnet fortfarande delade. Genom att sammanställa sjuksköterskors upplevelser i en övergripande litteraturöversikt kan sjuksköterskor utveckla sin professionella omsorg och därmed bidra till att stärka människors hälsoprocesser. Syfte: Att belysa sjuksköterskors upplevelser av att närstående närvarar vid hjärt- och lungräddning på sjukhus. Metod: En litteraturöversikt, baserad på 14 vetenskapliga artiklar med både kvalitativ och kvantitativ ansats. Resultatet har sammanställts genom en beskrivande syntes. Resultat: Resultatet presenteras i två huvudteman med tre underteman vardera. En källa till nya möjligheter belyser sjuksköterskors upplevelser av mellanmänsklig relation där nya perspektiv och erfarenheter för att göra skillnad råder. En källa till oro belyser sjuksköterskors upplevelser av oönskade minnen, försvårande omständigheter och en rädsla för påföljder. Konklusion: Sjuksköterskor upplever i linje med växande erfarenhet att oron dämpas och istället blev närståendes närvaro en källa till möjligheter. / Background: Ethical guidelines for cardiac arrest recommend that relatives should be given opportunity to be present during cardiopulmonary resuscitation, if they wish and aren’t a hindrance. Existing research shows that most relatives would attend and that their presence benefits both patient and relative. Despite this, nurse’s attitudes and opinions about present relatives during resuscitation remain fragmented. This places emphasis to merge this fragmented picture into an overall literature review containing nurse’s experiences of this practice. Based on this picture nurses could develop their professional care and help to strengthen people's health processes. Aim: To highlight nurse’s experiences of relatives being present during CPR in hospital. Method: A literature review, based on 14 scientific articles with both qualitative and quantitative approach. The result was compiled through a descriptive synthesis. Results: Is presented in two main themes with three subthemes each. A source of new opportunities illuminates nurse’s experiences of interpersonal relationship in which new perspectives and experiences of making a difference prevail. A source of concern illuminates nurse’s experiences of unwanted memories, aggravating factors and fear of sanctions. Conclusion: Nurses experience that when their experience grew, their concern dampened and it became a source of opportunities having relatives present.