Violence against women and children is a pervasive challenge across the globe. Research has shown that survivors of interpersonal violence, such as child maltreatment and intimate partner violence, may develop a complex form of post-traumatic stress disorder accompanied by, for example, difficulties in regulating emotions and relating to others. Additional mental health and social problems contribute to survivors' long-term impairment. Therefore, it is imperative that we understand the key elements and processes that facilitate trauma recovery. The majority of research places survivors as individuals at the core of understanding trauma and recovery, which makes it an intrapsychic problem focused on, for example, the individual's cognitive bias, maladaptive interpersonal behaviour, or emotion dysregulation which need repairing, rather than considering appropriately the role of context, external factors and social processes. Thus, trauma recovery may be more complicated. The current study explored key elements and processes of trauma recovery in female adult survivors with a focus on emotional and interpersonal skills, within the narratives of individuals constructing their own recovery within an interpersonal context. Fifteen female adult survivors were recruited from a statutory clinical service and a third-sector community project. Participants were interviewed individually, and data were analysed qualitatively using grounded theory. The study constructed a framework of four key components. Women survivors initially disengaged from feelings, other people and themselves (1), gradually made hidden experiences visible (2) and examined these (3), and eventually reconstructed their reality (4). Although not always a linear process, this framework revealed a transition from self-guided to supported self-management. Women survivors sought out relationships, were impacted by relationships, and these relationships changed the way survivors responded. Thus, female trauma survivors reconstructed abuse, trauma and identity through various supportive others. Similarly, female survivors reframed emotional and interpersonal difficulties and gradually managed these through relationships. Future research as well as theories, practices and policies need to consider the multifaceted and relational nature of interpersonal trauma recovery. Guidelines and practices, for instance, could include community-focused strategies that provide a larger network of support to survivors and, thus, would offer multiple opportunities to experience positive interactions. Equally, mandatory training of health care staff about interpersonal violence and subsequent trauma as well as training in relating positively to survivors would make a real difference.

A presente tese propõe-se a contribuir com os estudos sobre resistência e ação política das classes trabalhadoras no Brasil, a partir da análise de experiências de autoges­tão e recuperação de empresas por trabalhadores, fenômeno que surge no país no contexto de redemocratização e de forte crise econômica nas décadas de 1980 e 1990. Para isso, o trabalho investiga a história de luta dos trabalhadores daquela que foi considerada por estudiosos do tema a maior experiência de autogestão da América Latina, a Usina Catende, em Pernambuco. Situar os casos contemporâneos no rastro da história das experiências de autogestão dos trabalhadores, que ultrapassa as fronteiras nacionais e nos conduz às lutas associativistas do início da Revolução Industrial; apresentar um panorama atual das recuperações de empresas por trabalhadores no país, com a análise de dados coletados em estudo nacional realizado com pesquisadores de dez universidades brasileiras em 2012; e analisar a experiência dos trabalhadores de Catende no período em que lutaram para manter o seu trabalho, buscando criar novas relações sociais na produção do açúcar e em suas vidas são os objetivos dessa pesquisa, inspirada nos conceitos sobre história de Walter Benja min e em seu significado para os estudos sociológicos. / The purpose of this thesis is to contribute to the study of the working-class re­ sistance and political action in Brazil, through the analysis of experiences of work­ ers\' self-management and recovety of emerprises: a phenomenon which arises in the country in the context of re-democratization and a serious economic crisis in the 1980s and 1990s. To do this, the study investigates the history of a workers\' struggle considered by researchers to be the largest self-management experience in Latin America: the Catende sugar refinery in the Brazilian state of Pernambuco. The research was inspired by Walter Benjamin\'s concepts of history and its signif­ icance for sociological studies. Based on those, the objectives of this study are: to situate contemporary cases in the historical path of self-management experiences of workers, which transcends national borders and take us back to the associative struggles of the early Industrial Revolution; to present a current overview of the experiences of worker recovered enterprises in the country, with an analysis of the results of a national joint study conducted by researchers from ten Brazilian uni­ versities in 2012; and to analyze the experience of the Catende workers during the period in which they fought to keep their jobs, aiming to create new social rela­ tions in sugar production and in their lives.

O crescente desenvolvimento da Economia Solidária no Brasil, disparado pela Crise do Emprego dos anos 90, exigiu de muitos trabalhadores a dedicação a ações econômicas e políticas mais amplas. Por meio da interação com diversos atores e instituições, passaram a criar e a modificar processos, nos modos de gerir o trabalho, de comercializar produtos, de obter crédito, de praticar intercooperação, no ânimo resistente de gerar trabalho e renda e de organizar outra economia. Esta pesquisa propõe compreender uma dessas experiências, a Justa Trama, rede autogestionária que reúne cerca de seiscentos trabalhadores, de sete empreendimentos de todas as regiões do país. Abarca grande parte dos elos da cadeia produtiva têxtil, do plantio do algodão agroecológico à confecção final. A pesquisa objetivou identificar e descrever as principais relações entre trabalho e política no cotidiano desses trabalhadores. Como referencial metodológico, adotou a etnografia, e como ferramentas, a observação etnográfica combinada a entrevistas prolongadas. Um extenso trabalho de campo permitiu acompanhar atividades políticas da rede entre 2010 e 2012, em onze incursões. Como resultados, apresenta casos que ilustram como os trabalhadores conciliam demandas do trabalho e da política, e assim constroem e sustentam a rede no cotidiano; que alimentos e entraves encontram e que recursos têm desenvolvido para operar com eles. As entrevistas fundamentaram a exposição de narrativas sobre o processo histórico de organização da rede, outro importante resultado. Os principais apoios teóricos da pesquisa são as obras de Agnes Heller sobre cotidiano e história. Concluiu-se que os espaços políticos da rede não são os elos em separado, mas os encontros onde estão representados e ativos todos os elos. Ali os trabalhadores comungam de uma identidade coletiva e dedicam-se ao desenvolvimento do empreendimento que criaram. As práticas cotidianas da rede revelaram uma tensão dialética constante. Significa viver, enquanto trabalhadores, os efeitos das contradições do modo de produção capitalista mas também construir recursos para esquivar-se deles e, muitas vezes, agir politicamente no sentido de criar outro paradigma econômico, não sem dificuldades. A rede Justa Trama revelou-se dialeticamente como organização econômica, cujo fim é gerar renda, e como organização política, de resistência ao modo de produção capitalista, por meio de práticas apoiadas em valores humano-genéricos. Concluiu-se também que a política no cotidiano da autogestão da rede pode ser entendida como inerente ao trabalho. E o trabalho, por sua vez, pode ser tomado como objeto da atividade política do grupo de trabalhadores / The increasing development of Solidarity Economy in Brazil, triggered by the Employment Crisis of the 1990s, demanded from many workers dedication to more comprehensive economic actions and policies. Through interaction with various actors and institutions, they began to create and modify processes, in ways to manage the work, to trade products, to obtain credit, to practice intercooperation, in the tough-mind towards generating jobs and income and to organize \"other economy \". This research proposes the understanding one of these experiences, the Justa Trama, a self-managed network that brings together about six hundred workers of seven economic enterprises from all regions of the country. It encompasses most of the links in the textile production chain, from agroecological cotton plantation to the final making. The research aimed to identify and describe the main relationships between work and politics in the daily lives of these workers. Ethnography was adopted as a methodological framework while ethnographic observation combined with long-lasting interviews was used as tools. An extensive fieldwork enabled to monitor the political activities of the network in eleven surveys between 2010 and 2012. As a result, it presents cases that illustrate how workers reconcile the demands of work and politics, and thus builds and maintain the network in everyday life; and what inputs and barriers they face and what resources they have developed to deal with them. The interviews, in turn, justified the exhibition of the historical process of organizing the network, another important result. The works of Agnes Heller about daily life and history are the main theoretical framework of this research. It was concluded that the political spaces of the network are not separate links, but the join where all links are active and represented. There, workers share a collective identity and are dedicated to developing the enterprise they created. The everyday practices of the network revealed a constant dialectical tension. It means living, as workers, the effects of the contradictions of the capitalist mode of production but also, to build resources to evade them and often act politically to create another economic paradigm, not without difficulties. The Justa Trama network proved dialectically as an economic organization, whose purpose is to generate income, and as a political organization, resistance to the capitalist mode of production, by means of practices sustained in human-generic values. It was also concluded that politics in the daily self-management of the network can be regarded as inherent to the work. And the work, in turn, can be taken as an object of political activity of the group of workers

Within the 21st century, Type II diabetes has emerged as a public health crisis. African Americans and Hispanic Americans have the highest rates of Type II diabetes and obesity compared to European Americans. The purpose of this DNP project was to teach medical assistants (MA) to provide self-management of diabetes and obesity for the African American population in the local clinical setting. An educational tool kit for health providers was developed to guide the educational project. The chronic care model was used to guide the development of the educational toolkit. A pretest posttest design was incorporated into the educational program. The materials were found to be clear, accurate, and easy to read by the medical assistants. Four MAs, who worked at the clinical setting, participated in the educational program that taught them to use the toolkit developed for this project. To evaluate the effects of the educational program for the MAs, the results of the pre and posttests were scored and showed that MAs had significantly increased their knowledge of teaching diabetes and obesity self-management for African Americans (pretest mean score 80, posttest mean score 93). An implication of this scholarly project is that it will give clinicians the resources needed to create social change in health care by addressing education in diabetes and obesity. Positive social change may result as the African American patients who receive education from medical assistants at the clinical site improve their self-management skills to prevent diabetes and obesity or the complications of the disease.

Care Coordination Home Telehealth (CCHT) maintains a positive impact on the delivery of patient care in the primary care clinic at the Department of Veterans Administration Medical Center (VAMC). This quality improvement initiative targets patients with chronic conditions such as diabetes, hypertension, heart failure, and chronic obstructive pulmonary disease. These patient are frequently seen in the emergency room, and are often admitted to the hospital, where they saturate the outpatient clinics' waiting room with multiple walk-ins. CCHT has, to some extent, reduced walk-ins, emergency room visits, and hospitalization while minimizing the strain on access to care at the VAMC. Sustaining self-management skills of veterans with chronic conditions at the VAMC continues to impose challenges. In this project, retrospective data from 95 randomly selected charts reviewed during a 2-year period were used to compare hospitalizations, emergency room visits, and primary care visits. The findings of the study indicate veterans enrolled in Home Telehealth show positive social change. The social change is evidenced by change in behavior patterns, such as maintaining a healthy diet, performing daily physical activity, and compliance with medication administration. Enrolled veterans had better outcomes regarding hospitalization, emergency room visits, and primary care visits. The data highlighted the need for incorporating disease-specific protocols guiding care coordinators at first point of contact with the veteran patient. Following these protocols may enhance communication style that matches the patient's stage of behavioral change with interventions.

The overall aim of this thesis was to evaluate effects of a multi-component pain and stress self-management group intervention (PASS) and to explore plausible predictors associated with short-term and long-term treatment effects among patients with persistent tension-type neck pain in primary health care (PHC). Study I was a pilot study in order to explore feasibility of the study design and methods. It included 37 participants randomly assigned to the intervention (n=18) or treatment-as-usual (n=19). Study II-III was a pragmatic randomized controlled trial that compared effects of the PASS and individually administered physiotherapy (IAPT) on patients with persistent tension-type neck pain in PHC. Study II evaluated short-term effects over a 20-week follow-up. Study III evaluated long-term effects on maintenance over a follow-up period of 2 years. Studies included 156 participants randomly assigned to PASS (n=77) or IAPT (n=79). Study IV explored predictive factors for favorable outcome in disability regarding participants assigned to PASS. The results showed that PASS had better effects than IAPT regarding coping with pain, in terms of patients’ ability to control pain, self-efficacy regarding activities interfered with by pain, disability and catastrophizing, over the 20-week follow-up, and treatment effects were largely maintained over a 2-year follow-up. Post-treatment scores in disability, self-efficacy and pain intensity were associated with long-term outcome in pain-related disability 2 years post-treatment following PASS. Pre-treatment characteristics explained only a minor proportion of variance in disability, and were assumed weakly associated with treatment success and long-term outcome. Key components for enhancement of long-term efficacy in pain self-management coping efforts were adequately targeted by PASS. It is suggested important to strengthen self-efficacy beliefs in regard to pain coping, to reduce disability and enhance pain self-management in the treatment of persistent neck pain, and to induce long-term maintenance of treatment gains on disability following a pain self-management intervention.

Bakgrund: Det är av stor vikt att förstå patientens roll inom diabetesvården. Vårdgivarenmåste kunna hjälpa patienten med patientundervisning och livsstilsförändring. Patientensmotivation och egenvård går hand i hand och patienten spelar en viktig roll i hanterandetav hans eller hennes diabetes typ 2 sjukdom. Syfte: Att fördjupa kunskaper om olikafaktorer inom omvårdnaden av patienter med diabetes typ 2 som påverkar deras hälsa ochvälbefinnande Metod: Metoden i denna studie är en litteraturöversikt. En modell avFriberg (2006) användes för att granska de vetenskapliga artiklarna. Resultat: För att få ettoptimalt behandlingsresultat måste relationen mellan vårdgivare och patient vara byggd påen jämlik grund och ha en gemensam förståelse för behandlingsmålen. Patientundervisningär till hjälp för patienter och kan ses som ett värdefullt verktyg för patienten att få kunskapoch för att få motivation till att hantera sin diabetes sjukdom på bästa möjliga sätt.Patienten har en central roll inom diabetesvården och den inre motivationen till attförändra sin livsstil och att hantera sin egenvård finns hos patienten själv. Diskussion:Eftersom den inre motivationen kommer från patienten så är det där vårdgivaren måstelägga sitt fokus, att förstå hur patienten känner sig och sedan motivera patienten. Omvårdgivaren bygger upp en relation med patienten som skapar en positiv attityd och låterpatienten komma med egna idéer, då kan patienten bli motiverad utifrån sina egna villkor.Dessa patienter kan lättare genomföra livsstilsförändringar och lyckas bättre med sinegenvård. Detta innebär också att kostnaden för sjukvården och för samhället blir lägre. / Background: It’s important to understand the patients’ role in the diabetic care. The careprovider must be able to help the patient on issues like patient education and lifestylechange. The patients’ motivation and self management goes hand in hand and the patientplays an important part coping with his or hers diabetes type 2 disease.Purpose: To deepen our knowledge about the different factors in the caring of patients withdiabetes type 2 that affects their health and wellbeing. Method: The method in this study isa literature review. A model from Friberg (2006) was used to examine the scientific articles.Result: To get an optimal treatment result the relationship between the patient and the careprovider must be built on an equal ground and have a mutual understanding of the treatmentgoals. Patient education is helpful to patients and is seen as a helpful tool to get knowledgeabout diabetes and to get motivation to handle ones diabetes disease at the best waypossible. The patient are a central part in diabetic care and the inner motivation to changeones lifestyle and to handle ones self-management lies within the patient. Discussion: Sincethe inner motivation comes from the patient that’s what the care provider must lay the focuson, to understand how the patient feels and then get him or her motivated. If the careprovider does build a relation with the patient that creates a positive attitude and let’s thepatient come up with own ideas then the patient can be motivated on his or hers own terms,these patients are going to make lifestyle changes and do a lot better with their selfmanagement.This will also mean that the costs for the medical care system and the societyare going to be lower.

Background: Type 2 diabetes is a serious disease that is increasing globally. The focus of diabetes care has been to prevent diabetes related complications and thereby reduce mortality. An older population, the disease progression and decreased ability to perform self-management activities increases the risk for complications. Group education and patient-centred care are recommended to improve self-management through increased patient empowerment. Despite these recommendations, professionals have been reluctant to adopt these methods referring to lack of knowledge, time and tools to deliver patient-centred care in diabetes. Focusing on the patient’s illness integration process has in the literature been suggested to improve self-management and metabolic balance. Aim: The overall aim of the thesis was to describe the experiences of illness integration, self-management and support in type 2 diabetes and to evaluate the metabolic effects of a nurse-led patient-centred model for self-management support. Methods: The study setting was primary health care in Västerbotten County, Sweden. In total, 21 diabetes nurses (Study I) and 257 patients (Studies II-IV) participated in the four studies (Study II, n=44; Study III, n= 18; Study IV, n= 195). Data consisted of focus group interviews (Study I), individual semi-structured interviews (Studies II-III) and laboratory measurements (Study IV). Methods for analyses were qualitative content analysis (Studies I-III) and statistics (Study IV). Results: Study I revealed that diabetes nurses found the ideal diabetes care complex to achieve. Conflicting paradigms, power relations and departmentalisation of work were described. Study II describes a process whereby illness integration and self-management in type 2 diabetes develop simultaneously. When a turning-point occurs, people view self-management as both necessary and feasible. In study III, turning points in self-management are illuminated. Turning-point transitions include existential and emotional aspects that increase inner motivation and power for lifestyle change. Study IV evaluates the effects of a nurse-led intervention in which haemoglobin A1c (HbA1c) was significantly decreased at 12 months’ follow-up. Group intervention and individual intervention were both effective compared to traditional diabetes care. Conclusions: There is a potential for improvement of type 2 diabetes care. Increased patient-centredness is important to support patients towards illness integration and self-management. Focusing on the patients’ illness experiences, including the existential and emotional aspects of having and managing type 2 diabetes, in counselling can lead to improved self-management and glycaemic control. Patients’ experiences of illness are central to their inner motives for change, and patient-centred self-management support and patient education preferably emanate from this perspective. / Bakgrund: Typ 2 diabetes är en allvarlig sjukdom som ökar globalt. Fokus i diabetesvården har varit att förebygga diabetesrelaterade komplikationer och därmed minska dödligheten. En åldrande befolkning, progression av sjukdomen samt en begränsad förmåga att utföra egenvårdsaktiviteter ökar risken för komplikationer. Grupputbildning och patientcentrerad vård rekommenderas för att förbättra egenvården genom ökad empowerment. Trots dessa rekommendationer har läkare och sjuksköterskor rapporterats vara tveksamma till dessa metoder och hänvisat till bristande kunskap, tidsbrist och avsaknad av verktyg. Att fokusera på patienters sjukdomsintegrationsprocess har i litteraturen föreslagits förbättra såväl egenvård som metabol balans. Syfte: Avhandlingens övergripande syfte var att beskriva erfarenheter av sjukdomsintegration, sjukdomshantering och support vid typ 2 diabetes samt att utvärdera effekter av en sjuksköterskeledd patientcentrerad modell för egenvårdssupport. Metod: Studierna genomfördes inom primärvården i Västerbottens läns landsting. Totalt deltog 21 diabetessjuksköterskor (Studie I) och 257 patienter (Studie II-IV), i de fyra studierna (Studie II, n=44; Studie III, n= 18; Studie IV, n= 195). Data bestod av fokusgruppsintervjuer (Studie I), individuella halvstrukturerade intervjuer (Studie II-III) och laboratoriemätningar (Studie IV). Analysmetoderna var kvalitativ innehållsanalys (Studie I-III) och statistik (Studie IV). Resultat: Studie I visade att en ideal diabetesvård är svår att uppnå enligt diabetessjuksköterskorna. Paradigmkrockar, maktrelationer och splittrade arbetsuppgifter beskrevs. Studie II beskriver en modell där sjukdomsintegration och sjukdomshantering utvecklas samtidigt. När en ”turning point” nåddes såg patienterna sjukdomshanteringen som både nödvändig och möjlig att genomföra. I studie III belystes ”turning points” och som omfattar både existentiella och emotionella aspekter som kan öka inre motivation och egenkraft att utföra livsstilsförändringar. Studie IV utvärderade 12-månaderseffekterna av en sjuksköterskeledd intervention och HbA1c sänktes signifikant. Gruppintervention och individuell intervention visades vara effektiva metoder i jämförelse med traditionell diabetesvård. Slutsatser: Det finns en förbättringspotential inom diabetesvården och ökad patientcentrering är viktig för att stödja patienter att integrera sjukdom och egenvård i livet. Att i diabetesvården fokusera på patienters sjukdomsupplevelser inklusive de existentiella och emotionella aspekterna av att leva med och hantera en sjukdom kan innebära förbättrad sjukdomshantering och metabol balans. Patienters sjukdomsupplevelser är centrala för deras inre motiv till förändring och patientcentrerad egenvårdssupport och patientutbildning bör utgå från detta perspektiv.

The purpose of the current study was to investigate the effect of mindfulness and task-relevant attentional focus on running performance. WKU psychology undergraduate students were assigned to one of two conditions: task-relevant attentional focus experimental training and no training control. Participants in the experimental condition received training designed to optimize the use of attentional focus strategies in a running context. Trait level mindfulness was examined as a covariate. Participants were compared on two mile run times and the use of attentional focus strategies. Differences were expected to reveal the effectiveness of the training by showing faster running times in the experimental group, and higher use of task-relevant attentional focus strategies. Only higher use of task-relevant attentional focus strategies, specifically focus on bodily sensation was supported by the data. Explanations of the results as well as exploratory analyses are provided in addition to suggestions for future research.

Bakgrund: Allt fler människor drabbas av den kroniska sjukdomen diabetes typ 2. Att leva med sjukdomen upplevs olika, av vissa som en naturlig del av livet, av andra som något patologiskt. Delaktighet och egenvård har nära samband för att patienten ska kunna anpassa sig till den nya situationen. För att kunna stötta patienterna och motivera till god egenvård är det också viktigt för hälso- och sjukvården att ha kunskap om patienters upplevelser av egenvård. Syfte: Syftet var att utifrån ett patientperspektiv beskriva upplevelser av främjande respektive hindrande faktorer i egenvården hos patienter med diabetes typ 2. Metod: En litteraturstudie genomfördes baserad på tio kvalitativa artiklar insamlade från databaserna Cinahl och PubMed. Artiklarna analyserades genom att identifiera gemensamma nämnare i artiklarnas resultat och därefter skapades teman. Resultat: Tre huvudteman med tillhörande subteman identifierades. I huvudtemat Främjande och hindrande faktorer i mötet med andra beskrivs hur människor i patientens omgivning upplevs som främjande respektive hindrande för egenvården. Huvudtemat Främjande och hindrande faktorer i mötet med sig själv handlar om faktorer i relation till patienten själv och i det tredje huvudtemat, Främjande och hindrande faktorer i mötet med praktiska omständigheter, presenteras upplevelser av hur egenvården påverkas av praktiska faktorer. Diskussion: Resultatet visar sig gå i linje med tidigare forskning inom området. Centrala faktorer som visat sig påverka egenvården, såsom familj och vårdpersonal/vårdorganisation, diskuteras också utifrån hur de påverkar hälsan. I enlighet med andra studier visar resultatet även att vissa faktorer upplevs främjande/hindrande beroende på patienternas ursprung eller landet de bor i. / Background: The number of people living with diabetes type 2 increases. Perceptions of living with the disease differ; some sees it as a natural part of life whilst other sees it as pathological. Self-management and involvement in care are central for the patient’s opportunity adjusting to the new situation. Health care need knowledge about patients’ perceptions of self-management for being able to motivate them. Aim: The aim was to describe perceived facilitators and barriers to self-care by patients living with diabetes type 2. Method: A review was carried out, which included ten qualitative articles collected through the databases Cinahl and PubMed. The articles were analysed by identifying common denominators in the articles’ results. Themes were created. Results: Three head themes with associated subthemes were identified. Facilitators and barriers in the meeting with others focuses on how people in the patient’s environment are perceived as a facilitator and/or a barrier. Facilitators and barriers in the meeting with oneself, describes how the patient herself affects the self-management. In Facilitators and barriers in the meeting with practical circumstances, factors in relation to the patient’s practical environment are presented. Discussion: The result goes in line with previous research. Areas, which turned out to be central for the patients’ self-management, such as family and different aspects of health care, are also discussed in relation to health. Additionally, some perceived facilitators/barriers are in accordance to other studies shown to be more or less prominent depending on the patients’ origin or country they live in.