Aim: The overall aim is to develop knowledge about learning to live with diabetes.   Methods: All four studies have been carried out within the caring science and using a life-world phenomenological approach. Study (I): data was collected through written narratives from seven patients with insulin treatment. Studies (II and III): data was collected through interviews with twelve patients with diabetes. Study (IV): Data was collected from four groups and two individual interviews with sixteen diabetes nurses. The method for the analysis can be described as a dialectic process, beginning with the whole, analyzing its parts, and then reconstructing the whole in order to understand the essence of the phenomenon.   Main Findings: The result showed that patients’ experiences of the most obvious meanings of the phenomenon of being stricken by diabetes (I) are the fight against becoming your illness, a wish that everything would be as usual and that the new situation should only be natural. Furthermore, after having been diagnosed with the illness, the results demonstrated two themes that were particularly important in learning to live with diabetes. These were your own responsibility for gaining knowledge in order to incorporate the illness into your life and to find a balance between fear and control (II).  As support for the learning (III), reflection over the learning and experiences has a crucial role for a new understanding of health processes. Insight into your own responsibility was a key factor for this reflection. To be able to give support (1V), the diabetes nurse must adopt a reflecting, self-critical attitude with an insight that the responsibility for learning lies with the patient and that the role for the diabetes nurse is to encourage and challenge the patient to self-reflection and taking responsibility on the basis of individual goals and pre-requisites. To give support in this way, the diabetes nurse must downplay the medical requirements for control and make more use of his/her medical competence to ask reflection-triggering questions based on a life-world perspective.   Conclusion: Based on the patient’s life-world, an understanding is created that supports learning, which thereby can reduce the influence of the illness on the patient's life.  This understanding makes it possible to incorporate the illness into the patient's life and create a balance between fear and control.

Bakgrund: Under det perioperativa vårdförloppet föreligger många riskfaktorer för patienten att utveckla oavsiktlig hypotermi. Detta kan leda till flertalet operativa och postoperativa komplikationer vilket kan skapa obehag och lidande för patienten, förlänga vårdtider och generera ökade kostnader för samhället. Den perioperativa specialistsjuksköterskans omvårdnadsansvar innefattar ett flertal värmebevarande omvårdnadsåtgärder för att förebygga och behandla hypotermi hos patienten. Syfte: Syftet med studien var att beskriva anestesi-, operations- och intensivvårdssjuksköterskors värmebevarande omvårdnadsåtgärder i det perioperativa vårdförloppet. Metod: En studie med deskriptiv analys utfördes. Data samlades in genom en strukturerad intervjuguide. Sammanlagt deltog 36 specialistsjuksköterskor i studien. Resultat: Specialistsjuksköterskornas värmebevarande omvårdnadsåtgärder bestod utav både passiva och aktiva åtgärder varav tre var utmärkande; att använda luftvärmetäcke, att ge varma infusions- och spolvätskor samt att undvika onödig exponering av patienten. Rutinmässig temperaturmätning av patienten saknades i det perioperativa vårdförloppet. Dokumentering av värmebevarande omvårdnadsåtgärder utfördes i hög grad inom det perioperativa specialistsjukskötersketeamet. Slutsats: Flertalet aktiva och passiva värmebevarande omvårdnadsåtgärder utfördes perioperativt trots avsaknad av skriftliga lokala arbetsrutiner och nationella riktlinjer. Förvärmning av patienten eller operationsbädden förekom däremot inte som aktiva förebyggande omvårdnadsåtgärder. Klinisk betydelse: Studien önskar lyfta fram ett viktigt omvårdnadsområde för specialistsjuksköterskor verksamma inom perioperativ vård. Studieresultatet skulle kunna ligga till grund för utbildningsinsatser och utformandet av lokala arbetsrutiner gällande värmebevarande omvårdnadsåtgärder. / Background: During perioperative care multiple risks exist for the patient to develop accidental hypothermia. This can cause increased morbidity, unnecessary patient suffering, prolonged recovery time and subsequently increased costs for the society. Perioperative nursing care involves several warmth preserving interventions to prevent inadvertent hypothermia. Objective: The aim of this study was to describe the perioperative specialist nurses warmth preserving nursing interventions in perioperative care. Method: A study with descriptive analyses has been performed. Data was collected through a structured interview guide. A total of 36 specialist nurses participated in the study. Result: The specialist nurses’ warmth preserving interventions consisted of both passive and active interventions where three were more distinctive; to use forced air warming blankets, to give warm intravenous and/or irrigation fluid and to avoid unnecessary exposure of the patient. Warmth preserving nursing interventions was well documented within the perioperative nursing team. Temperature monitoring was not routinely performed. Conclusion:. Several active and passive warmth preserving interventions were carried out, even though local and national guidelines regarding warmth preserving interentions were missing. Prewarming of patient or operating table was not implemented as active preventative measures. Clinical significance: This study wishes to aid in the ongoing work of improving perioperative care by giving focus to an important area within nursing. The study result will hopefully encourage to further education and to the development of local guidelines regarding warmth preserving interventions.

O objetivo da pesquisa foi desvelar práticas musicais dos professores na comunidade e na escola, focando as relações entre a música, a escola e a comunidade. A metodologia adotada foi o estudo de caso, tomando como aportes teóricos reflexões de Setton (2010), Forquin (1993), Bozon (2000) e Souza (2012). As práticas musicais dos professores incluem o ato da escuta musical, as preferências musicais, a prática do canto, as experiências com aulas de Música, a prática de tocar ou não um instrumento musical, a participação em atividades musicais, interações com as bandas e conjuntos em atividade na comunidade, a percepção e a inserção em relação aos diferentes espaços onde a música está presente nas comunidades, os profissionais que trabalham com música em sala de aula, o quanto são contextualizadas em sua prática docente em sala de aula as experiências musicais dos alunos e dos professores. Os resultados contribuem para as atuais discussões no Brasil relativas ao contexto da Lei Federal no 11.769, de 2008, a respeito de práticas musicais e pedagógicas de professores nãoespecialistas em Música. / The objective of this research was to unveil the musical practices of teachers in the community and at school discussing the relationship between music, school and community. The methodology adopted was the case study, taking as theoretical support reflections upon Setton (2010), Forquin (1994), Bozon (2000) and Souza (2012). The musical practices of teachers include the act of music listening, musical preferences, the practice of singing, experiments with music lessons, practice playing a musical instrument or not, participation in musical activities, interactions with bands and ensembles active in community, awareness and inclusion in relation to the different spaces where music is present in communities, professionals who work with music in the classroom, how that in their teaching practice in the classroom musical experiences of students and teachers are contextualized. The results contributes to current discussions in Brazil relating to the context of Federal Law. º to 11.769/08 regarding the musical and pedagogical practices of teachers non-specialist in music.

Hållbarhet är en stark trend i dagens samhälle vilket avspeglas i bolagens rapportering då hållbarhet ges ett allt större utrymme. Detta har lett till att den traditionella revisorn utför allt mer icke finansiell granskning och en ny roll i form av hållbarhetsspecialister har vuxit fram. Granskningen av hållbarhetsinformation är inte lika reglerad eller strukturerad som denfinansiella. Detta ställer granskaren inför nya utmaningar vilket kan skapa en ökad osäkerheti granskningsprocessen. Området är dock under utveckling vilket således gör det relevant att beskriva och förklara hur en granskare blir komfortabel i granskningen av hållbarhetsinformation. Syftet med denna studie är att beskriva och förklara hur en granskare uppnår känslan av komfort i granskningsprocessen av en hållbarhetsrapport. För att uppfylla studiens syfte och besvara forskningsfrågorna genomfördes en kvalitativ studie med åtta semistruktureradeintervjuer där respondenterna bestod av hållbarhetsspecialister och revisorer. Metodvalet gav utrymme för att skapa en djupare förståelse för granskningsprocessen vilket är centralt för att beskriva och förklara hur en granskare blir komfortabel. Studiens huvudsakliga slutsatser påvisar att det är individuellt hur en granskare uppnår känslan av komfort i sin granskning. Det handlar om i vilken grad de har kunnat avlägsna osäkerhet. Studien visar även att en granskare i grunden blir komfortabel utifrån den kunskapsamt erfarenhet denne besitter. Vidare påvisas det att i en del fall även är faktorer hos kunden och granskaren som påverkar om känslan uppnås. Slutligen konkluderas att hänsyn bör tas till granskarens individuella egenskaper och dess rådande granskningssituation. / In today’s society sustainability is trending, which is reflected in companies reporting as the part for sustainability increases. Resulting in an increase in non-financial auditing for accountants and the introduction of a new profession, in the form of sustainability specialists. Since the review of sustainability information is not as regulated or structured as the financial one, new challenges have appeared in the review process which creates uncertainties. However, the area is under development. Because of this, it is relevant to investigate how a reviewer becomes comfortable in reviewing sustainability information. The purpose of this study is to describe how a reviewer achieves the sense of comfort in the review process of a sustainability report. To fulfill the purpose of the study and answer the research questions, a qualitative study was conducted with eight semi-structured interviews with respondents consisting of auditors and sustainability specialists. The chosen method provided a deeper understanding of the review process, which is central in order to describe and explain how a reviewer becomes comfortable. The main conclusion of the study is that it is individually how a reviewer achieves the feeling of comfort in their reviewing and it is about the extent which they have been able to remove uncertainties. Another conclusion is that a reviewer gets comfortable based on their knowledge and experience. Furthermore, it is shown in some cases that whether the feeling of comfort is achieved is affected by the customer and the reviewer. Finally, it is concluded that the individual characteristics of the auditor should be considered as well as the current review situation.

Bakgrund: Oftalmologisk sjukvård står inför framtida förändringar av flera orsaker. Antalet patienter, som är i behov av ögonsjukvård ökar stadigt, både i takt med att befolkningen blir äldre, men även beroende av kunskaps- och teknikutveckling. I och med detta behövs fler specialistsjuksköterskor. Syfte: Att undersöka ögonsjuksköterskors uppfattning om den specialistutbildade ögonsjuksköterskans kompetens inom oftalmologisk omvårdnad. Metod: En intervjustudie med fokusgrupper och induktiv ansats genomfördes. Materialet analyserades med kvalitativ innehållsanalys och utmynnade i tre kategorier som svarade mot syftet; Från nybörjare till expert, Otydlig rollfördelning samt Specialistsjuksköterskors potential. Resultat: Ögonsjukvård uppfattades vara en komplex verksamhet som kräver hög kompetens. Sjuksköterskor som arbetade inom ögonsjukvården ansågs vara drivande både inom utveckling av den egna professionen och för att ytterligare stärka den personcentrerade vården. Specialistutbildade sjuksköterskor uppfattade dock att deras förvärvade kompetens och vilja till utveckling inte togs tillvara i den utsträckning som önskades. Det fanns även en entydig uppfattning att professionen omgärdades av en otydlighet, vilket bidrog till svårigheter att implementera specialistsjuksköterskors funktion och kompetens. Konklusion: Resultatet visar en entydig uppfattning att specialistutbildningen måste leda till mer avancerade eller ansvarsfulla arbetsuppgifter för att motivera till vidareutbildning. Studiens resultat kan vara av betydelse för att belysa kompetensen hos en specialistsjuksköterska inom oftalmologisk omvårdnad. / Background: The field of ophthalmic health care is due to undergo changes in the future for different reasons. The number of patients in need of ophthalmic care are increasing because of longer life expectancy along with a better understanding and technical development of ophthalmology. Thus, creating a demand for ophthalmic nurses. Purpose: To examine ophthalmic nurses perception of competence in ophthalmic care among specialist nurses. Method: This study was conducted as a focus group interview with an inductive approach. Quantitative content analysis was used and resulted in three main categories; From novice to expert, Lack of role clarity and Specialist nurses’ potential. Results: Results of the study find that ophthalmic care is described as complex, demands a high degree of competence and that ophthalmic nurses are ambitious and dedicated in improving their profession and the care of patients. Unfortunately, the competence and dedication from ophthalmic nurses have not received much attention. Conclusion: Results show with unequivocal importance that motivating nurses to complete specialist studies must be met accordingly either through more advanced duties or an increase of responsibility for said duties. The studies result can be of importance in shedding light on the competence of specialist nurses in ophthalmic care.

京都大学 / 0048 / 新制・課程博士 / 博士(人間健康科学) / 甲第22838号 / 人健博第80号 / 新制||人健||6(附属図書館) / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 若村 智子, 教授 任 和子, 教授 武藤 学 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM

Geriatric board-certified specialists (GCSs) address health care needs of the growing geriatric population. The study's purposes were to: examine career paths of GCSs, identify influencing factors, and explore implications for higher education. Twelve of 14 original 1992 GCSs participated. Data included document collection and interviews. Using a qualitative methodology, commonalities were sought among individuals and HyperRESEARCH software was used for data management. The participants were adventurous, valued education, and were enthusiastic about physical therapy (PT), geriatrics, and specialization. Their career path began with choosing PT as a career, professional education, and their first job. One GCS moved directly into geriatrics. Others went to different settings before geriatrics. As participants recognized they "fit" in geriatrics, they pursued postprofessional education to increase knowledge before choosing board certification. In choosing PT, volunteer experience and personal research were common influences. In choosing to work with elders, influences throughout life gradually built a social context supporting the decision. GCSs chose specialist certification to assist in professionalization of geriatric PT, because they were highly skilled, for career advancement, and for self professionalization. Specialist certification had few financial consequences. Participants gained friends and professional networks. They experienced improved patient care, increased educational opportunities, and/or increased professional service. GCSs' vision was for a better society and health care system. This vision included successful aging - that it is possible and would benefit society. To bring about global change, GCSs perceived they had to influence older individuals, legislators, PT students, peers, and other professionals. Implications for higher education are as follows. Professional schools should not base admission on expressed intentions to work with elders. Curricula and clinical experiences should be such that a nonageist generalist is produced. Higher education's role postprofessionally can be through continuing education, formal degrees, and geriatric residency programs. Gerontology programs also could meet educational needs. Higher education can play an important role in the professionalization of individuals and ultimately the profession itself.

Both audiologists and hearing instrument specialists (HIS) can assess hearing loss and fit hearing aids; consumers interested in purchasing hearing aids can choose the type of hearing professional they see. However, there are vast differences in required training and scope of practice for each professional and advanced test batteries, such as those associated with vestibular assessment and tinnitus management, may distinguish the two professional groups more thoroughly than standard hearing testing and hearing aid fitting. This study aimed to determine the knowledge and opinions the average individual possesses regarding differences between these two types of hearing professionals in order to identify areas in which audiologists can more effectively differentiate themselves from hearing instrument specialists. A one-time survey was administered at 3 locations to a total of 47 English-speaking participants over the age of 18. Locations included the 2018 Remote Area Medical event in Gray, TN; the Johnson City Senior Center, and the Bristol Public Library. The survey consisted of 8 demographic questions with 3 additional questions if the participant wore hearing aids, followed by 18 questions that covered “Diagnostics,” “Intervention,” and “Interpersonal Patient Interactions.” Responses were analyzed for trends in overall data as well as in sub-categories for gender, household income, education level, age, and hearing aid use. Overall, participants tended to believe audiologists were most likely to perform tasks in the “Diagnostic” category, while a majority of participants believed both professionals could perform tasks in the “Intervention” category. There was no clear trend within the “Interpersonal Patient Interactions” category. Most participants believed that either both professional groups, or only audiologists, could perform most tasks adequately, indicating subjects likely do understand differences between the two professionals. In analyzing results, two issues emerged. The first was that the majority of participants believed that they would not be likely to pay a reasonable price for hearing aids when visiting either professional. One reason may be that only a few hearing aid companies produce most of the world’s hearing aids, leaving little room for low-cost competition. The “bundled” method which most hearing healthcare providers use for selling hearing aids along with services might also exert an influence on the perception of hearing aid pricing and may not be clear to patients who try to understand the actual cost of devices and services. Another issue identified in this survey was access. A significant number of respondents believed it was difficult to make and attend appointments with either professional, signifying a possible deficit in this area in access to hearing healthcare. The barriers to access included income, availability of transportation, inconvenient provider hours, and lack of insurance coverage. The results suggested that audiologists and HISs face challenges when recommending personal hearing devices to support rehabilitative efforts. Additionally, the provision of services that utilize advanced diagnostic batteries, such as balance assessment and tinnitus services, may offer audiologists an opportunity to distinguish their practices from those managed by HISs.

Access to healthcare is needed and wanted by people of all ages and especially by those of the older population. The number of people in the 65 years of age and older population is rapidly growing with their needs expected to have a significant impact on the existing healthcare system and healthcare providers. The impact will be critical given the severe shortage of healthcare providers, especially of nurses and the rate of services being more often provided in non-hospital settings. The objectives of the study were to discover the plans of graduating nursing students as they choose their first place of employment, if they have future plans to pursue a nursing advance practice degree, and if they are very happy with their decision to become a nurse. Data for the study were obtained from a questionnaire presented to senior graduating nursing students. The findings were: (a) Most students prefer a hospital setting. (b) Younger students are three times as likely to seek out the hospital, and 1/3 of the students seek out the hospital setting because they were encouraged to become a nurse. (c) About 70% of the students want to work with their friends while 1/3 will seek the hospital worksite, as it is perceived as being the strongest resource in paying back loans. (d) Nearly 87% are considering the nursing advance practice role, and 52% have interest in the nurse practitioner role. The majority of students identified as very happy with their decision to become a nurse. This study provided insight for schools of nursing as they make curriculum decisions and to businesses as they learn of the preferences and plans of the new emerging nurses.

Bakgrund. Bilden av svensk ambulanssjukvård idag visar att vissa regioner ökat kraven på legitimerad kompetens i ambulanserna, samt att vissa också kräver specialistsjuksköterskeutbildning. I samband med den utvecklingen har även kraven på den medicinska nivån på omhändertagandet höjts. Sjuksköterskor i ambulans verkar ofta i miljöer som skiljer sig tydligt från sjukhusen. Detta kan medföra stressade situationer, påverka beslutsfattandet och det medicinska omhändertagandet. Kunskap inom luftvägshantering är en av de viktigaste kompetenserna för patientens fortsatta överlevnad. Att säkerställa fri luftväg kan vara en uppgift på tio sekunder till en livshotande faktor under hela uppdraget och därför viktig att bedöma och åtgärda. Syfte. Att beskriva specialistsjuksköterskors erfarenhet av prehospital luftvägshantering. Metod. En kvalitativ studiedesign med induktiv forskningsansats. Datainsamlingen genomfördes genom tio stycken semistrukturerade intervjuer med specialistsjuksköterskor som är verksamma i prehospital verksamhet i Mellersta Norrland. Dataanalysen genomfördes med en manifest kvalitativ innehållsanalys. Resultat. I analysen framkom två kategorier: Prehospitala erfarenheter för luftvägshantering och förutsättningar för trygghet i luftvägshantering prehospitalt samt åtta subkategorier. Dessa var erfarenhet har betydelse för luftvägshantering, erfarenhet av enkla luftvägshjälpmedel, erfarenhet av avancerade luftvägshjälpmedel, hantering av stress, vikten av kollegial kompetens vid luftvägshantering, utbildning och mängdträning skapar trygghet och bristande stöd vid upprätthållande av kompetens. Majoriteten ansåg att de enkla luftvägshjälpmedlen oftast skapar mest trygghet, men att erfarenhet och kollegors kompetens har stor betydelse för lyckat resultat samt ökad trygghet. Bristande stöd vid upprätthållande av luftvägskompetens visades och förslag för ökad trygghet och erfarenhet var att få öva luftvägshantering på anestesin. Slutsats. Erfarenhet ger ökad trygghet hos samtliga specialistsjuksköterskor oavsett typ av luftvägshjälpmedel. Dock visar resultatet att utbildning och upprätthållande av kompetens är av vikt för minskad stress.