Background: Type 2 diabetes mellitus (T2DM) is a welfare disease increasing with such a high rate that it, in popular speech, is being called epidemic. To prevent the spread of this disease, future health care workers are in need of a deeper, science-based education. Purpose: The aim of this study is to research the knowledge about T2DM regarding risk factors, nutrition, activity and foot hygiene among public health students at Thammasat University in Bangkok, Thailand. Method: A cross-sectional study was made using a questionnaire. A convenience sampling of public health students were approached and 121 decided to participate. Results: The majority of the students knew that obesity and an unhealthy diet (containing a high amount of fat, sugar and fast food) was correlated with T2DM and associated with negative outcomes of the disease. The students were uncertain or had less knowledge that smoking is a risk factor (79%). The greater part of the participants (73%) thought that people with T2DM should let their feet air dry. 74% of the respondents underestimated the amount of time that was needed to exercise per week to achieve positive results and 63% of the students were dissatisfied with their education regarding T2DM. Conclusion: Although the students overall had good knowledge about T2DM, they also showed a lot of uncertainty and insufficient knowledge in several questions. This was especially distinguished in the questions regarding activity, foot hygiene and risk factors. / Bakgrund: Typ 2 diabetes mellitus (T2DM) är en välfärdssjukdom som ökar i så snabb takt att den i folkmun kallas för en epidemi. För att förhindra spridningen av sjukdomen behöver framtida vårdpersonal en djupare, evidensbaserad grundutbildning. Syfte: Syftet med denna studie var att undersöka kunskapen kring T2DM, med avseende på riskfaktorer, nutrition, aktivitet och fothygien bland studerande folkhälsovetare vid Thammasat University i Bangkok, Thailand. Metod: Ett bekvämlighetsurval på studerande folkhälsovetare gjordes, varav 121 av 136 studenter deltog. Enkäter användes i denna studie. Resultat: Majoriteten av eleverna visste att fetma och en ohälsosam kost (innehållande hög fetthalt, socker och snabbmat) var korrelerat med T2DM och associerat med negativa konsekvenser av sjukdomen. Majoriteten av studenterna visste inte att rökning var en riskfaktor (79%). Större delen av deltagarna (73%) tyckte att personer med T2DM skulle låta fötterna lufttorka. 74% av respondenterna underskattade mängden fysisk aktivitet som behövdes varje vecka för att uppnå positiva resultat och 63% av eleverna var missnöjda med sin utbildning avseende T2DM. Slutsats: Även om eleverna i allmänhet hade goda kunskaper om T2DM visade de också en hel del osäkerhet och otillräcklig kunskap i flera frågor. Detta särskilt i frågorna gällande aktivitet, fothygien och riskfaktorer.

Bakgrund: I dagens samhälle är det många individer som lider av hjärtsvikt och det är många patienter med hjärtsvikt som behöver vård. Patienter med hjärtsvikt upplever både fysiska och psykiska påfrestningar som påverkar deras välbefinnande.  För patienter med hjärtsvikt är egenvård viktig del för att möjliggöra att vardagen fungerar. Syfte: Att beskriva upplevelser av egenvård hos patienter med hjärtsvikt. Metod: litteraturöversikt med induktiv ansats. Databaserna CINHALL och MEDLINE användes och tretton kvalitativa artiklar inkluderades i litteraturöversikt. Resultat: Litteraturöversiktens resultat beskriver patienters upplevelse av egenvård. Bland annat framkommer att motivation är viktigt för att utöva egenvård. Patienter uppskattade stödet de fick från familj, vänner och vårdpersonal i samband med egenvård. Utifrån resultatet framkommer egenvårds- och insiktsbrist hos patienter med hjärtsvikt, vilket leder till dålig följsamhet till egenvård. Resultatet presenteras i följande tre huvudrubriker: motivation, stöd, kunskap. Slutsats: Patienter med hjärtsvikt har hinder och begränsningar i samband med egenvård. Patienterna har också bristande insikt kring hjärtsvikt och egenvård vilket medför nedsatt välbefinnande. Patienter med hjärtsvikt och bristande egenvård är i stort behov av stöd, vägledning och kunskap i syftet att öka patientens makt och självbestämmande över situationen. Sjuksköterskor bör utifrån litteraturöversiktens resultat ha kunskap om värdet att förstå patientens upplevelse av egenvård i samband med hjärtsvikt för att kunna anpassa vården tillsammans med patienter och utefter individens behov. / Background: In today's society, there are many people who suffer from heart failure and many people with heart failure who need care. Patients with heart failure experience both physical and mental stresses that also affect the quality of life. For patients with heart failure, self-care is an important part for enabling a functioning life. Aim: To describe experiences of self-care in people with heart failure. Method: Literature overview with inductive approach. Thirteen qualitative articles were included and downloaded through the CINHALL and MEDLINE databases. Result: The essay result describes patients' self-care experience and shows that motivation is a driving force in self-care practice. Patients appreciated the support they received from family, friends and care personnel in connection with self-care. Based on the results, self-awareness and lack of knowledge results in poor compliance with self-care. The results are presented in the following three main headings: motivation, knowledge and support. Conclusion: The essay showed that patients with heart failure have barriers and constraints associated with self-care. Another problem in patients was lack of knowledge about heart failure and self-care which results in reduced quality of life. Patients with heart failure and lack of self-care are in great need of support, guidance and knowledge in order to increase patient's power and self-determination over the situation. Nurses should understand the patient's perception of self-care in heart failure in order to be able to adapt care together with the patient and to the needs of the individual person.

Bakgrund: Hjärtsvikt är en av de vanligaste folksjukdomarna som drabbar båda könen, men främst äldre människor. Vid hjärtsvikt krävs optimal behandling och bra egenvård i form av patientutbildning för förbättrad livskvalitet. Egenvård kräver patientutbildning i syfte att stärka patientens förmåga att lindra effekten av sin hjärtsvikt. Syfte: Syftet är att beskriva vad som hindrar att genomföra egenvård och vad som påverkar livskvaliteten hos patienter med hjärtsvikt. Metod: Det här arbetet är en litteraturöversikt. Fjorton vetenskapliga artiklar med olika metoder hämtades i databaserna CINAHL, Pub och PsycINFO. Artiklarna lästes igenom och utmynnade i huvudkategorier och underkategorier. Resultat: Resultatet visar brist på egenvårdutbildning medför brist på kunskap, ekonomiska begränsningar och brist på förtroende. Ensamboende och brist på förtroende och multisjuklighet. Fysiska förändringar sker på grund av kliniska symtom och dessa komponenter utgör hinder för egenvård, vilket försämrar livskvalitet. Symtomen från hjärtsvikt har negativ inverkan på dagliga och sociala aktiviteter. Kognitiva förändringar i samband med hjärtsvikt leder till försämrad koncentrationsförmåga och dåligt minne. Diskussion: Minskad egenvård relaterade till fler besök till sjukhuset. Kliniska symtom på hjärtsvikt var det som mest påverkade patienternas livskvalitet och hindrade dem från att fortsätta leva som tidigare. Nedsatt fysisk förmåga försvårade för patienterna att kunna fortsätta jobba som tidigare, vara social eller bibehålla sina tidigare hobbyer. / Background: Heart failure is one of the most common diseases that affect both sexes, but mainly elderly people. In heart failure requires optimal treatment and good self-care in the form of patient education to improve quality of life. Self-care requires patient education in order to enhance the patient's ability to mitigate the effects of its failure. Aim: The purpose is to describe what prevents implement self-care and what affects the quality of life in patients with heart failure Method: This work is a literature review. Fourteen scientific papers with different methods was picked in the databases CINAHL, PsycINFO and Pub. The articles were read through and resulted in major categories and subcategories. Results: The results show a lack of self-care education means lack of knowledge, financial constraints and lack of confidence. Living alone and lack of trust and multimorbidity. Physical changes happen because of clinical symptoms and these components constitute barriers to self-care, which impairs the quality of life. Symptoms of heart failure have a negative impact on daily and social activities. Cognitive changes associated with heart failure leads to impaired concentration and poor memory. Discussion: Reduced self-care related to more visits to the hospital. Clinical symptoms of heart failure was the most affected patients' quality of life and prevented them from continuing to live as before. Reduced physical ability it difficult for patients to be able to continue working as before, be social or maintain their previous hobbies.

Bakgrund: För den individen som har diabetes typ två, som är en kronisk sjukdom medför sjukdomen planering och struktur för att få en vardag i välmående tecken att fungera. Det förutsätter att individen reglerar egenvården i form av följsamhet i behandlingsplan och upprättande av en hälsosam livsstil som har betydelse för individens upplevelse av livssituationen. Egenvård är ett förekommande begrepp inom diabetesvården som ställer både krav på individen men även anhöriga och sjuksköterskan i form av förståelse och att ge stöd vid behov. Syfte: Att beskriva individers upplevelser av att leva med diabetes typ två. Metod: Litteraturöversikt med 14 artiklar utifrån kvalitativ metod med induktiv design analyserades med hjälp av Fribergs femstegsmodell. Resultat: Att leva med diabetes typ två innefattade upplevelser av hanterbarhet och känslor av maktlöshet. Sjukdomen ställer krav på nya livsstilsvanor och förutsätter ett positivt sätt att tänka och prioritet av hälsan. Socialt stöd från omgivning som anhöriga, bekanta och sjuksköterska vid bristande egenvårdskapacitet var värdefullt för att kunna hantera sjukdomen och uppleva hälsa. Rädsla och oro fanns hos individer inför att hamna i utanförskap till omgivningen och för sjukdomsförsämring. Slutsats: Kontroll upplevdes genom kunskap och stöd från omgivning samt förståelse och när sjuksköterskan bekräftade personens livssituation. / Background: For the individual with diabetes type two, which is a chronic disease causes the need of planning and structure to experience health in daily life. It assumes that individuals regulate their own health care in terms of adherence to the treatment plan and the establishment of a healthy lifestyle that is important for the individual's experience of life situation. Self-care is a common concept in diabetes care that places both the demands on the individual but also the family and the nurse in the form of understanding and to provide support if necessary. Purpose: To describe individual's experiences of living with diabetes type two. Method: Literature review of 14 articles of qualitative method with inductive design and were analyzed with help of Friberg five-step model. Results: Living with diabetes type two included the experiences of control and feelings of powerlessness. The disease requires new lifestyle habits, and assumes a positive way of thinking and priority of health. Social support from the surroundings as relatives, acquaintances and nurse at the lack of self-care capacity was valuable to be able to manage the disease and experience health. Fear and anxiety were in individuals face of exclusion to the environment and disease progression.Conclusion: Control was perceived through knowledge and support of the environment and understanding and when the nurse confirmed the person's life situation.

Bakgrund: Hjärtsvikt är vanligt förekommande sjukdom i den svenska befolkningen och även en vanlig orsak till sjukhusinläggning. Egenvård är en viktig del i behandlingen. Bristande egenvård kan vara en bidragande orsak till försämring vid hjärtsvikt vilket både kan leda till onödigt lidande för patienten och leda till stora kostnader för sjukvården. Syfte: Syftet med litteraturstudien var att beskriva patienters erfarenheter av egenvård i samband med hjärtsvikt, samt beskriva de inkluderade artiklarnas datainsamlingsmetod. Metod: Deskriptiv litteraturstudie. Elva vetenskapliga artiklar inkluderades. Artiklarna söktes via databaserna Pub Med. Artiklar med kvalitativ och kvantitativ ansats inkluderades. Resultatet analyserades genom att bearbeta artiklarna två tabeller och markera med färg och sammanställdes. Resultat: Resultatet i studien visar på att patienter med hjärtsvikt ofta lider av någon form av psykisk ohälsa. Patienter med hjärtsvikt har ofta goda kunskaper i egenvård. Dock medverkar depression eller annan form av psykisk ohälsa till minskad följsamhet i egenvård på grund av sänkt initiativförmåga. Slutsats: Att sjukdomen hjärtsvikt är multidimensionell och påverkar psyket negativt leder till minskad förmåga i att utföra egenvård. Familjestöd, patientutbildning och snabb respons från sjukvård har visat sig ha goda effekter på egenvård. Likaså bidrar en stark familj och god ekonomi till bättre egenvård. / Background: Heart failure is a common disease in the Swedish population and also a common cause of hospitalization. The self-care is an important part of the treatment. Lack of self-care can be a contributing factor to the worsening of heart failure, which both can lead to unnecessary suffering for the patient and lead to large costs for health care Aim: The purpose of this study was to describe patients' experiences of self-care associated with heart failure and describe the articles included data collection method. Method: Descriptive literature. Eleven scientific articles were included. Articles were searched using PubMed. Articles with qualitative and quantitative approach included. The results were analyzed by processing the articles two tables and mark with paint and compiled Result: The results of the study show that patients with heart failure often suffer from some form of mental illness. Patients with heart failure often have good knowledge of self-care. However participates depression or other forms of mental illness to reduced adherence to self-care because of reduced initiative. Conclusion: Disease heart failure is multidimensional and affects the psyche negatively leading to reduced ability in performing self-care. Family support, patient education and quick response from health care have been shown to have positive effects on self-care. Also contributing a strong family and good economics to better self-care.

Bakgrund: Tanken med telefonrådgivningen var både att minska antalet besök hos läkarna men även öka tillgängligheten genom att slussa patienterna till rätt vårdnivå i början av sjukdomsprocessen. Sjuksköterskan i telefonrådgivningen ska göra adekvata och välgrundade omvårdnadsbedömningar utifrån den vårdsökandes individuella hälsoproblem. De ska även kunna bemöta och kommunicera på ett sätt som inger trygghet. Telefonrådgivning är en självständig och utmanande arbetsuppgift som kräver kompetens hos sjuksköterskan. Syfte: Att belysa sjuksköterskans upplevelser och erfarenheter av att arbeta med telefonrådgivning. Metod: Semi-strukturerade intervjuer genomfördes med åtta sjuksköterskor som arbetar med telefonrådgivning. Kvalitativ innehållsanalys användes för att granska och tolka materialet. Resultat: Genom bearbetning av analysen framkom fem kategorier vilka benämns; Att ge ett bra bemötande, Behov av återhämtning, Att möta utmaningar, Att vara professionell, Att utvecklas inom arbetet samt underkategorier. Slutsats: Denna studie har belyst komplexiteten i att arbeta med telefonrådgivning för människor med olika symtom i alla åldrar. Det är ett arbete som kräver gedigen erfarenhet, kompetens och självständighet. Studien har synliggjort en positiv upplevelse av arbetet och visar att det krävs tydliga strategier för att kunna utföra arbetet på ett patientsäkert sätt. / Background: The purpose of having telephone triage is to decrease the number of doctor appointments and to increase the availability by getting the patient to the right level of care from the start. The nurses working with telephone triage should make adequate and informed decisions based on the patient's health problem. They should also give the patient a sense of security. Telephone triage is an independent and challenging work task that requires the nurse to be competent.   Purpose: To illustrate how nurses experience working with telephone triage Method: Eight nurses working with telephone triage were interviewed using semi-structured questions. A qualitative analysis was performed to review and interpret the results.   Results: By performing the qualitative analysis five categories and some subcategories were found to be important. The five categories are; To give good service, The need of recovery, To be challenged, To be professional and To develop at work. Conclusion: This study has given light to the complexity of working with telephone triage to people with various symptoms in all ages. The job requires extensive experience, competence and the ability to work independently. The study has shown that the nurses have a positive experience of working with telephone triage and shows that it requires clear strategies for it to be performed without risking the patient safety.

Although it is well known that self-care reduces the frequency of hospital admissions and exacerbations and enhances quality of life (QOL) in heart failure (HF) patients, little is known about self-care in this population. Therefore, the study purpose was to examine relationships among selected individual characteristics (demographics, severity of illness, comorbidities, and social support), self-care strategies, and QOL using Reigel's Model of Self Care in Patients with Heart Failure as the guiding framework. In this descriptive correlational study, self-care was measured using the Self-Care of Heart Failure Index (SCHFI), which measures self-care maintenance (SC-Mt), self-care management (SC-Mn), and self-care self-confidence (SC-Sc). QOL was measured using a disease-specific instrument, the Minnesota Living with Heart Failure Questionnaire (LHFQ), and a generic instrument, the Short-Form Health Survey (SF-12) characterizing physical and mental-emotional functioning. Multiple regression analysis was used to identify predictors of QOL.Data were collected using Dillman's tailored design method for surveys. One hundred and sixty-five patients with HF were invited through a mailed letter and a survey packet to participate in this study. Five potential participants requested not to take part in the study, seven were reported as being deceased, and 23 letters were returned as undeliverable. After the initial mailing, we discontinued mailings to them. Thus, out of a possible sample of 130 subjects, 98 participants completed and returned questionnaires for a response rate of 75.38%.The sample (mean age = 56.33 years, SD = 13.65) included 56.1% males and 43.9% females and consisted of 48% Caucasians and 52% non-Caucasians. Approximately 55.1% were married and 60.2% had an annual income less than $30,000. The majority of the sample (72.5%) had at least a high school education. Half of the sample were somewhat functionally impaired (NYHA Class 11) and had an ejection fraction less than 30%. Ninety-three percent of the sample had been diagnosed with HF less than 10 years (mean = 5.05, SD = 3.34). Seventy percent of the sample had 0 to 4 comorbidities, and 17.7% reported that they only had HF and no other diagnoses. In addition, the sample reported mean score of social support at 71.72 (SD = 17.30) indicating good social support. On average, participants reported that they frequently performed self-care in order to maintain a healthy lifestyle: SC-Mt (mean = 69.59, SD = 15.56). They responded quickly and were likely to manage signs and symptoms that occurred: SC-Mn (mean = 61.69, SD = 19.91). Sixty-two percent reported that they recognized signs and symptoms of HF that occurred in the last month. They were very confident they could perform self-care: SC-Sc (mean = 66.11, SD = 17.02). The results showed that the participants' perceived their QOL as good (mean = 49.44, SD = 27.82). On average, participants perceived their physical functioning as fair (mean = 45.38, SD = 22.47), as was their mental-emotional functioning (mean = 53.32, SD = 22.36).Multiple regression analyses demonstrated that better disease-specific QOL was predicted by being less likely to use SC-Mn strategies (β = .325; p = 0.003), better SC-Sc (β = -.251; p = 0.012), better NYHA functional class (β = .246; p = 0.008), and less comorbidity (β = .236; p = 0.014) (R 2 = .334; F = 7.269, p = 0.000). Better generic QOL (physical functioning) was predicted by better NYHA functional class (β = -.309; p = 0.001), better SC-Mt (β = .205; p = 0.037), better SC-Se (β = .296; p = 0.003), and being less likely to try SC-Mn strategies (β = -.165; p = 0.000) (R 2 = .361; F = 9.602, p = 0.000). Better generic QOL (mental-emotional functioning) was predicted by better NYHA functional class (β = -.229; p = 0.024) and being male (β = -.204; p = .047) (R 2 = .277; F = 4.548, p = 0.000).Findings suggest that better QOL is associated with being male displaying better NYHA functional class, less co-morbidity, and better performance of self-care activities in order to maintain health (SC-Mt), being less likely to identify and respond quickly to signs and symptoms of HF (SC-Mn), having and confidence in performing of self-care strategies (SC-Se). The findings add to the scientific body of knowledge in self-care.

Vicarious traumatisation (VT) has been defined as an experience of change in several domains of personhood including worldview, identity, and beliefs related to major psychological needs. Self-care practice is widely considered essential in sustaining personal and professional well-being, and a lack of appropriate practice can enhance the risk of VT in trainee and newly qualified therapeutic practitioners. Both quantitative and qualitative research suggests that mindfulness practice can have a protective role in the risk of VT for trainees. This study examined the relationship between VT, self-care and mindfulness in a sample of 238 trainee therapists from the UK, Australia, Canada and Ireland. Structural equation modelling was used to test a mediation model with good fit with self-care as predictor variable, mindfulness as mediator, and VT as outcome variable. The hypothesis that when controlling for the effects of mindfulness on VT the effect of self-care on VT is no longer significant could not be confirmed as no mediational effect was present. The hypothesis that predicted a negative association between self-care practice and VT was confirmed with a significant total effect although the direct effect of self-care on VT was not significant. Findings are discussed in relation to previous research involving mindfulness in trainee cohorts. Links are made with neuroscience research to consider underlying mechanisms of mindfulness within the context of VT.

This thesis offers a rethinking of the role for education as critical workplace pedagogy in complex problems of health care. Taking the case of paediatric diabetes, the study explored how health-care professionals learn the work of supporting children, and their parents, to self-manage the condition. By reconceptualising work problems as sociomaterial learning struggles, this research contributes new understandings of informal professional learning in everyday health-care provision. Data were generated through fieldwork in an outpatient clinic. Particular challenges of supporting self-management in this case were the difficulties of balancing policy aspirations for empowerment with biomedical knowledge about risks to immediate and long-term health. Tracing the materialisation of learning as it unfolded in moments of health-care practice showed professionals handling multiple and contradictory flows of information. Particular challenges were posed by insulin-pump technologies, which have specific implications for professional roles and responsibilities, and introduce new risks. A key insight is that professionals were concerned primarily with the highly complicated perpetual discernment of safe parameters within which children and their parents might reasonably be allowed to contribute to self-management. Such discernment does not readily correspond to the notion of empowerment circulating in the policies and guidelines intended to enable professionals to accomplish this work. As a result, this thesis argues that the work of discernment is obscured. Learning strategies evolve, but could be supported and extended by explicit recognition of the important work of learning as it unfolds in everyday practices of supporting self-management in paediatric diabetes. Most importantly, workplace pedagogies could be developed in ways that attune to the profound challenges and uncertainties that are at stake in these practices.

Bakgrund: Cystisk fibros (CF) är inte längre en barnsjukdom eftersom 95% lever upp i vuxen ålder. Sjukdomen har stor påverkan på kroppens organ där lungorna och mag-och tarmkanalen är främst utsatta. Behandlingen är krävande och består till stor del av egenvård. Syfte: Syftet var att belysa personers erfarenheter av att leva med CF. Metod: Studien är utformad som allmän litteraturstudie med induktiv ansats. Sökningar genomfördes i tre databaser och genererade i elva artiklar. Resultat: Fyra kategorier skapades: Oro över att vara annorlunda, Symtomens påverkan på livet, Hopp och lidande samt Vårderfarenheter. Konklusion: Personer med CF upplever en bristande normalitet, önskan om ett normalt liv och en relation med döden. Att vara delaktig i vården är en förutsättning för personer med CF och bidrar till självständighet. Fortsatt forskning inom sjukdomen behövs för att lindra lidandet hos personer med CF. / Background: Cystic fibrosis (CF) is no longer a pediatric disease since 95% live up to adulthood. The disease has a great impact on the organs especially the lungs and the gastrointestinal tract. The treatment is very demanding and consists mainly of selfcare. Aim: The aim of this study was to illustrate persons´ experience of living with CF. Method: The study was constructed as a general literature study with an inductive approach. The searches were conducted in three different databases and resulted in eleven articles. Result: These eleven articles resulted in four categories: The worry of being different, The symptoms effect on life, Hope and suffering and Health care experience. Conclusion: People with CF experience a lack of normality, a wish for a normal life and they have a relationship with death. Being involved in the care is a prerequisite for people with CF and it contributes to independence. Continued research within the disease is necessary to relieve the suffering of people with CF.